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Healthcare Sustainability Managers

9/24/2010 - Nearly a year into her new job at the 750-bed University of Maryland Medical Center in Baltimore, Md., Denise Choiniere — a registered nurse — is busy ordering new recycling bins for areas under renovation and keeping up the hospital’s regular Tuesday farmer’s market, which serves both hospital employees and city residents.
“It really depends on the day as to what I’m up to,” says Choiniere, whose duties include overseeing the hospital’s waste contract, managing the farmer’s market, investigating the use of greener and safer disinfectants, collaborating on energy audits, and detailing policies on everything from waste separation to waste management.
Choiniere is more than just a nurse. She is also the hospital’s new sustainability manager — in the job for less than a year. Hospitals with sustainability managers are a growing trend as medical facilities around the country go green.
It helps, also, that Choiniere has a natural affinity for sustainability.
“My boss sees my role as a consultant to these different departments and an educator who helps them understand sustainability and incorporate sustainability into their operations,” she says.
Up until last year she was a bedside nurse who had initiated a battery-recycling program in the Cardiac Care Unit about five years ago. The battery program took off and Choiniere was put in charge of other sustainability projects while working fulltime as an RN. When UMMC created a green team a few years ago, administrators’ found Choiniere to be an ideal candidate to lead the it.
“The hospital realized that in order to really make this work, someone had to be designated to do it as opposed to having people with full-time jobs doing it on the side,” she says. “So they made a commitment and created a position.”
If she had to name a challenge, Choiniere says it would be justifying the financials —though she has had success with finding sustainable products that cost the same, if not less than, than products already in use at the hospital.
“When we look at cost, we often look just at the bottom line,” she says. “I guess my biggest challenge would be to look beyond that bottom line and incorporate a different way of thinking about the lifecycle of our products and how to build that into a value analysis.”
The result is that since starting a year ago Choiniere has cut the hospital’s regulated medical waste by a third — and boosted recycling by a third — all while implementing several green projects, including an interdisciplinary pharmaceutical program conducted in conjunction with the hospital’s safety and hazardous waste teams.
While Choiniere is still new in her position, hospital’s having sustainability coordinator’s on-staff has been a growing trend in recent years as facility managers realize the cost savings they could see by going green.
Janet Brown, director of sustainable operations for Practice Greenhealth, a nonprofit green advocacy organization based in Reston, Va., says the numbers don’t lie. Practice Greenhealth works with more than 1,100 hospitals and businesses nationwide that have committed to green practices.
In 2009, 45 percent of Practice Greenhealth’s top 60 green institutions had someone on staff directly responsible for sustainability operations at the facility, Brown says. Of those 60 institutions, 33 percent had a designated sustainability officer. This year, she says, the number has climbed to 54 percent. Brown added that 75 percent of facilities that have been inducted into the organization’s Environmental Leadership Circle — Practice Greenhealth’s highest level of sustainability performance — have designated sustainability managers on board.
Additionally, a recent survey conducted by the International Facility Management Association’s Health Care Council found that three out of four industry professionals support appointing hospital sustainability managers. The study, which was released in July following seminar put on by IFMA and the Corporate Realty Design and Management Institute, revealed that 73 percent of respondents believed hiring a sustainability manager to be of primary importance when reorganizing a healthcare system around better sustainability practices.
“What we know from this data is that it is no coincidence that if you have somebody in charge of this work you’re going to have more to show in terms of sustainability efforts,” Brown says. “Sustainability has the potential to impact every single decision, from how you build, to what you buy, to what you invest in, and how you train your workers.”
Around the country, similar programs have been springing up at hospitals and medical centers, says Janet Brown. For example, some of the hospitals within the Providence Health & Services network are recycling as much as 50 percent of their waste while implementing compost programs and purchasing items like zero-waste barbecues for staff use.
At the Seattle Children’s Hospital, managers track employees that carpool, ride their bikes to work or take public transportation, she says.
“They have a program that employees can sign on to let administrators know everyday how they got to work,” Brown says. “Any day the employees don’t drive to work in their own car, they get paid $3.25 that day. This online program also measures the environmental impact these employees make and the impact of all the hospital’s workers.”
Seattle Children’s goal is to get down to 30 percent of employees driving to work, says Brown. To date, the hospital says the measures have prevented the need to build a $20 million parking garage.
 “In most cases, sustainability coordinators are working for a large enough system that they can justify the position,” she says. “Smaller facilities may have more difficulty in justifying the position but it does not take long to identify the cost-saving opportunities realized in having a full-time sustainability employee. Some facilities start with an intern, administrative resident or consultant while they build their own business case for creating a new position.

UMMC staff and Baltimore residents purchase produce at the UMMC farmer’s market.
Historically, Brown says, the sustainability coordinator has grown out of an onsite grassroots effort, with one person or a team taking on the work. More and more, she says, the effort and the position are evolving top-down, with leadership taking the first step.
“I call it getting out of the basement and into the boardroom,” Brown says. “It really is exciting that sustainability is becoming a part of these institutions’ strategic plan, mission language, and sustainability reporting — and I see it continuing in that direction.”
An early adopter of the sustainability movement was Boulder Community Hospital in Boulder, Colo., which hired Kai Abelkis as its first sustainability coordinator back in 1999. In the eleven years that he has been on the job, Abelkis says that he has found no two days to be the same.
 “There are different aspects to my position that encompass long-term, short-term and immediate projects,” says Abelkis of his “average” workday at non-profit medical facility, based in Boulder, Colo.
“A lot of it has to do with waste reduction,” he says. “For example, we’re shutting down an area for re-construction and I’ve been asked what to do with the construction waste and materials. Just today I got a call that we’re getting brand new beds in, and the hospital needs to get rid of 20 beds — quickly.”
It’s Abelkis’ efforts that have led to BCH opening the first LEED certified medical center in the country in 2003 — Boulder Community Foothills Hospital — and cost savings or cost avoidances amounting to $650,000 per year throughout the entire system. On top of that, waste output has fallen 42 percent at BCH since Abelkis joined the institution in 1999 —not bad for one of the country’s first, if not the first, medical center sustainability coordinators, a position that is quickly catching on nationwide.
According to Brown, sustainability coordinators typically come in two types: There are those that focus more on research and on making evidence-based policy decisions and changes, and there are those who evolved from within, usually through a grass-roots efforts, and have a more personal approach to the job.
“We see both types as critical,” Brown says. “We need research and evidence to make the right choices, but the ‘roll up the sleeves’ approach, with frequent staff interaction and the coordination of activities throughout various departments, can be found in an energetic individual with excellent communication, management and motivational skills.”
Because of the relatively small size of the BCH system —2,400 employees and two inpatient hospitals with 265 beds between them — Abelkis says that a vital part of his job has been building personal relations with his staff.
“When you have larger systems, like the Cleveland Clinic, it might be a bit different because obviously one person doesn’t have the ability to do all that work,” says Abelkis. “But here, I work very interpersonally with a lot of folks on the decision making.
“What I’ve found is that policies are wonderful for a lot of folks, and I think it’s important to have those policies,” Abelkis says. “But at the end of the day, my responsibility is to have those kinds of relationships in which individuals know to come to me or they feel empowered themselves to make decisions regarding sustainability issues, like putting in an LED light instead of a regular bulb.” 

By Nicholas Gosling

This article was originally published by Emlen Media, via HC&O News, and can be found here.