Transcript H2E http://www.h2e-online.org Providing Practical Solutions to Today’s Environmental Challenges Today’s Objectives  Health care’s footprint  H2E’s Data Tool  The vision for it’s roll-out  What next?

H2E
http://www.h2e-online.org
Providing Practical Solutions
to Today’s Environmental
Challenges
Today’s Objectives
 Health care’s footprint
 H2E’s Data Tool
 The vision for it’s roll-out
 What next?
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You want me to do what???
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Health Care’s Footprint
 Healthcare is 16% GDP - 20% by
2015
 Hospital workforce: 4.1 million
 24/7 operations
 $6.5 billion on energy each year*
 Water – facilities are often largest
water users in the community
 Over 2 million tons of waste per
year - increase in disposables,
packaging, chemicals, toxics
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Evidence of Inefficiency
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Understand your waste!
GREEN MEMORIAL HOSPITAL
Total Waste Disposal Costs=$245,000
BROWN MEDICAL CENTER
Total Waste Disposal Costs= $596,000
1%
38%
0%
33%
That’s a difference of
$351,000 every year!
51%
66%
1%
10%
Solid Waste: ~ 1200 tons = $72,000
Solid Waste: ~ 1550 tons = $93,000
RMW: ~ 225 tons = $135,000
RMW: ~ 775 tons = $465,000
Hazardous Chemical Waste: ~19 tons =
$38,000
Recycling: Assumes breakeven costs.
Avoided landfill cost of $54,000!
Hazardous Chemical Waste: ~19 tons =
$38,000
Recycling: No recycling Program
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Benchmarking…
Waste Stream
Municipal solid waste
(MSW)
BIOHAZARD
Regulated medical waste
(RMW)
Hazardous chemical
waste
Recycling (average for
all recyclables")
Other Stuff: Universal Waste
Construction and Demolition
Donated Supplies
Bulky Waste
Grease ….
Avg. Disposal Cost
per ton
Avg. Disposal
Cost per pound
Percent of
total Waste
$40-$120
$0.02-0.06
45%
$450-$1,000
$0.24-0.40
6-12%
$1,000 or more
$0.50-$10
<1%
breakeven
Up to 50%
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Normalization Options

Direct patient care activity related factors: (this should be average per month)

Number of Licensed Beds:
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Number of Staffed Beds:
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reflects the maximum number of beds the hospital is staffed to manage. may not
reflect the true level of activity.
Average Inpatient Days per month (or Daily Census/mo):

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industry standard - “permitted” size of a facility
often much larger than the number of operating beds.
consistent from year to year - standard way to describe a facility.
changes daily but the average reflects the level of activity
Adjusted Patient Days
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
account inpatient and outpatient activity, unlike the values above that only
measures inpatient activity. APD is calculated as follows:
APD= (Total Patient Days) * (Total Inpatient + Outpatient Revenues)
Inpatient Revenue

Patient Day


period of service defined in whole days between the census-taking hours on 2
successive calendar days, including inpatient census and out-patient surgical
days.
Outpatient visits

useful for facilities that have a lot of clinics or only have clinics. Interestingly,
university hospitals tended to have by far the greatest outpatient activity -- over a
million outpatient visits a year.
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Other factors:
 Number of FTE’s
 measures staff size in full time equivalents.
 Square footage –
 includes facility space where waste generated is
included in the total waste weights and cost.
 primarily used to describe the size of the facility
and normalize energy and water data in building
metrics.
 It has not typically been used to normalize
waste data
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The Tool
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Success Story

From: Pam Starlin [mailto:[email protected]]
Sent: Thursday, October 26, 2006 11:00 AM
To: Susan Zabo
Subject: Success Story
Just wanted to share my first big victory which I have the Waste
Management tool to thank. I met with Stericyle this morning and showed
them what my costs had snuck up to over the years for back-up services.
Bags and boxes which were once free were suddenly being charged for and
the cost per pound had nearly doubled over the past 6 years or so. All of this
was due to the fact that since we are not a regular customer, we are not on
contract pricing. I offered to sign a 3 year back up service agreement it they
would improve their pricing structure. Right off the bat, they agreed to
eliminate the charges for the bags and boxes and he will bring back an
agreement with better pricing. Don't know what the bottom line will look like,
but I expect to be able to report substantial savings. It was wonderful to be
able to pull up the spreadsheet and have all the history and figures
right on the desktop. The rep was pretty impressed and it sent a clear
message to him that I am keeping tabs on this now.
Have a good day Susan!
Pamela S. Starlin
Manager, Environmental Services & Patient Transport
Fairfield Medical Center
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Wheaton Franciscan Healthcare
 Early Pilot – 12 hospitals
 Did not have a process to
track and trend our waste streams
 Numerous waste streams to
manage and collect data
 Value of Stewardship
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Metro Hospital – Grand Rapids MI
 Saved $40,000 first year
 “Asked our data your questions
 It gave us a loud and clear response
 We acted and won’t stop asking and
listening”
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Questions to ask of your
Solid Waste Program
 Where does your waste go? Have you
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had a recent waste stream analysis?
What types of solid do you generate?
Assessing your fees. Do you
understand them?
Container sizes?
Hauling frequency?
Opportunities for Improvement?
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Questions to ask of your Regulated
Medical Waste (RMW)


BIOHAZARD

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

One of the largest opportunities to save money
GOAL: Hospitals should be at about 6-12% and or a
RMW generation rate or 1 pound per adjusted patient
day…
Does your clinical staff understand what qualifies as
RMW?
How is your waste treated? Waste treatment and
COST is critical to any successful program
Hauler negotiations. How are you charged? Per
pound? Per tub?
What is your pick up frequency?
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Recyclables
 Are you recycling?
 What are you recycling?
 How are you recycling?
 With a comprehensive paper and
cardboard recycling program, you can
hit a minimum 20% recycling rate
 GOAL: Hospitals should at least hit a
overall 25% rate although the stretch
goal should be 50%
 Opportunities to reduce costs, even
generate revenue
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 Use net benefit…
Hazardous Waste
 Do you generate hazardous waste? What
type?
 If yes, do you know where and how it is
disposed of? Is it recycled?
 Electronic scrap is the most rapidly growing
recycling problem in the world

E-scrap is not only a crisis of quantity, but of a
toxic content due to toxins such as lead and
mercury.
 Solvent recovery – xylene, formalin, alcohol
 Biggest volume of HW in an acute care hospital
with a lab.
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Why Wheaton participated?
 System goal to become mercury free and
reduce RMW by 50%
 Needed to understand problem to then set
goals, short and long term
 Lack of system wide recycling
 Identify opportunities for improvement
 Identify cost savings and efficiencies
 System compliance, vendor compliance and
contracts
 Celebrate successes
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Benchmarking
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Wheaton findings
 Solid waste % was above benchmark
 Inconsistent lbs per load of solid waste
 Not utilizing a pressure gauge on the
compactor, inconsistent lbs per pull
 Lack of data on hazardous and recyclable
hazardous waste
 Lack of formal recycling program for plastic
and aluminum and mixed office paper
 Inconsistent revenue for recycled cardboard
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(continued)
 Cardboard recycling is sub contracted and
they did not receive any revenue
 Receive 50% of mixed paper revenue,
although this has not been verified
 Shred all paper
 Lack of a commingled program
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Wheaton Franciscan Healthcare Action
Plan for 2006
 Consolidate vendors
 Negotiate new contracts
 Hold vendors accountable
 Choose benchmarks
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Wheaton Franciscan Healthcare Action
Plan Update and Accomplishments
 RMW and Recycling contracts are in
negotiations


Neptune System
Bio Systems (3 pilots)
 Consolidated to one RMW vendor
 Vendors are being held accountable by
Corporate Materials and on-site
management
 Utilizing the H2E guidelines as the
benchmark
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WFHC-All Saints Solid Waste outcomes
YTD 2006 vs. 2005
 Reduced solid waste from 67% of the
waste stream to 55% (YTD June
2006)
 Moved from a set pull to a requested
pull
 Then requested Waste Link System
 Re-calibrated compactors
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WFHC-All Saints Solid Waste outcomes
YTD 2006 vs. 2005
Waste management Category
T ons
Baseline* C urrent
Percent of T otal W aste
Baseline
C urrent
Solid W aste
942.74
440.26 0.671390725
55%
Recyclable, Solid
376.33
293.80 0.268010768
37%
84.18
57.09 0.059950433
7%
0.91
7.69 0.000648074
1%
Regulated Medical W aste
Hazardous W aste
Recycled Hazardous W aste
T otal
1404.16
798.84
1
100%
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WFHC-All Saints Solid Waste outcomes
YTD 2006 vs. 2005
Waste management Category
T ons
Baseline* C urrent
Percent of T otal W aste
Baseline
C urrent
Solid W aste
942.74
440.26 0.671390725
55%
Recyclable, Solid
376.33
293.80 0.268010768
37%
84.18
57.09 0.059950433
7%
0.91
7.69 0.000648074
1%
Regulated Medical W aste
Hazardous W aste
Recycled Hazardous W aste
T otal
1404.16
798.84
1
100%
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WFHC-All Saints Solid Waste outcomes
YTD 2006 vs. 2005
Waste management Category
T ons
Baseline* C urrent
Percent of T otal W aste
Baseline
C urrent
Solid W aste
942.74
440.26 0.671390725
55%
Recyclable, Solid
376.33
293.80 0.268010768
37%
84.18
57.09 0.059950433
7%
0.91
7.69 0.000648074
1%
Regulated Medical W aste
Hazardous W aste
Recycled Hazardous W aste
T otal
1404.16
798.84
1
100%
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Recyclable Solid Waste outcomes YTD
2006 vs. 2005
 Increased Recyclable solid waste from
27% of our waste stream to 37% (YTD
2006)
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Recyclable Solid Waste outcomes YTD
2006 vs. 2005
Re-construction
of the facility to better
accommodate recycling program
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Recyclable Solid Waste outcomes YTD
2006 vs. 2005
 Enhanced commingled program in Aug
2006
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WFHC-All Saints Recyclable Hazardous
Waste outcomes YTD 2006 vs. 2005
 Increased Recyclable Hazardous Waste
from .91 tons to 7.69 tons
 Increased storage space
 New E-Scrap contractor
 Captured all of the lbs
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TOOLS for Change – e.g.,RMW
generation…
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What goes in a red bag anyway?*
YES! RED BAG

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Blood, Products of Blood
Anything caked, soaked or
dripping in blood
Tissues from surgery and
autopsy
Cultures and stocks of
infectious agents and
discarded vaccines.
Suction canisters with any
fluid. Hemovac and pleurovac
drainage.
Operating room waste
saturated with body fluids as
defined by OSHA.
Waste from patients isolated
with HIGHLY communicable
diseases. (These are CDC Class
IV definitions including Ebola,
Lassa Fever, Marburg and Small
Pox. NOT such conditions as
AIDS< Hepatitis or TB.)

Sharps, including syringes and
unused sharps.
NO! Put in Clear Bag

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IV Bags, tubing, foley bags
Non bloody gloves
Packaging,
Urine-soaked waste, feces,
vomit
 Blood-tainted waste
(Note distinction between
blood-soaked and bloodtainted. A little bit of blood
on an item can go in the
regular waste stream.)
Questions? Call Waste Manager
* Check your local regulations
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Waste Segregation – Implementation
Present Plan
Survey Facility
Develop Materials
Purchase equipment,
supplies.
Issue Memo
Container placement
Properly Labeled, Signage
Proper placement
Training (never ends.)
Monitoring and reporting
CQI!
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Suction Canisters
40% of Operating Room
Waste is from suction
Canisters!
Potential for occupational
Exposure in transport.
http://mntap.umn.edu/health/91-Canister.htm
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Business Model for the Launch
Subscription Pricing
Annual Pricing per facility:
up to beds =
50
350
350+
Support Options
Price Description
included Included
$500
$1,000
$2,000
25%
65%
10%
services included
DCT listserv, getting started teleconference
$5,000 On site consulting
phone support @20 hours per year, initital benchmarking
(4 hours)
phone support @8 hours per year, initital benchmarking
(4 hours)
(2 days on site, + expenses) + 12 hours of phone
support
$1,000 Benchmarking
ongoing benchmarking/goal setting report, EOY
benchmarking
$2,200 1st Year Support Plan
$1,200 2nd Year Support Plan
Health System Packages (>= #hospitals)
10
5%
25
10%
50
20%
100
30%
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Models – Shared Savings vs Fee for
Product/Service

Fee for Product and Service - A combined strategy of program sales
combined with assessment consulting

Shared savings model – Three year - 50-30-20%

Calculated using total annual waste costs

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Benefits:



No money upfront
Risk free
Disadvantages:

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Contract negotiations and tracking are more difficult
Accounting challenges – inconsistent with the mission of the tool
Improvements in operations may not be reflected in total waste budget ( “I haven’t had
time to implement the operational changes but it’s valuable knowing what I need to
do”)
Tool should drive a culture change – facility should “own” the potential savings
and invest it back into the program


RMW reductions, HIPAA, recycling increases, etc
Contracting savings
Will consider changes in operations and impacts on big costs
Risk of unintended lowering of motivation
Contract negotiations
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Facility will sign off on statement of intent and purpose – fully understanding the goals
Tool must be used for one year
Facility must have a dedicated staff person to launch tool
If facility doesn’t hold up their end of the bargain, a $1,000 fee per user is charged
Use of the tool must be discontinued
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Next Steps  New Features
 Additional modules
 Benchmarking
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Benchmarking
 Input data points to describe level of activity

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Square Footage
# beds
Adjusted Patient Days
FTEs
# emergency room visits
Facility type
**$$$ basic costs, waste disposal fees, KWH energy
costs, per gallon water costs, etc.
 Output
 For each target area, “acceptable” range
 Identifies opportunities for improvement

Costs savings and environmental performance
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Energy
 Hospitals use more than twice as much
energy per square foot as office buildings.
 ~ 50 billion kilowatt hours of electricity
 $3 billion each year on electricity costs.
 If hospitals improved their energy efficiency
by an average of 30%, the annual electricity
bill savings would be nearly $1 billion

and 11 million fewer tons of carbon dioxide
would be emitted--equivalent to taking 2 million
cars off the road.
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Water
Comparison of Pre- and Post-Conservation Water and Sewer Costs Based
on Utility Bills (Southwest Florida Regional Medical Center)
6,000
$60,000
2001 kgals
2002 kgals
2003 kgals
5,000
$50,000
2001 $
2002 $
2003 $
$40,000
3,000
$30,000
2,000
$20,000
1,000
$10,000
0
$/month
kgals/month
4,000
$0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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Next Steps
 Launch Tool in 2007 with systems and
state groups
 Gather benchmarking data
 How can we work together?
 HELP US FIND A NAME:
 H2E
Waste Data Compactor
 H2E WOW Strategies – (working on
waste)
 H2E Sustainable Strategies for
Environmental Programs
 H2E Environmental Excellence
Strategies
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Save the Date!
May 14 and 15, 2007, Minneapolis, MN
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Safe Disposal of
Pharmaceuticals - Workshop
Tuesday, May 15th – Minn. MN
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