Posted by JD on May 20th, 2016 in Uncategorized | No comments »
As promised, I have more to say about the issues facing the soon-to-be UCOP Associate Director of Sustainability (ADS) in their quest to “green the Medical Centers”. Since the posting of Part I, I’ve learned that our Facilities Planning and Development Director, Joel Swift, will be on the interview panel, vetting ADS candidates. Very cool. Joel sits at that intersection of innovative and practical, and will be a good addition to the panel.
In my initial post, I talked about the fight for dollars in the healthcare environment, oversight agencies, student support (or lack thereof), Champions, and Zero Waste. Let’s see what else we in healthcare, and, by association, the soon-to-be ADS (s-t-b ADS? Nah.), have to deal with. Note: those who’ve read my older blogs know that I dangle participles at will, and I figure that I’m too old to change now.
Let’s consider sustainable purchasing. I’ve always found this interesting, as the UC Sustainable Practices Policy seems to treat sustainable purchasing as more like something done at UCOP, like within Strategic Sourcing, rather than amongst the campuses and med centers. Regardless, this is a tough nut to crack, on a number of levels. Following are a couple of examples.
First off, a few years ago the UCDMC Linen Efficiency Workgroup conspired to replace most of the single-use surgical linens with reusable items. We worked with perioperative folks and the vendor to see how good service could be provided at a reasonable cost. I had to laugh when talking with surgery veterans, who noted that they had reusable linens up to 10 or 12 years ago, when the Med Center was convinced to move to disposables. So we thought that we had it all sewn up, with the reusable vendor matching the price and product quality of the disposable vendor. Very cool! But not to be, for the disposable vendor, Kimberly-Clark, provided a $250K annual incentive payment through our group purchasing body, Novation. Putting the incentive loss on top of the reusable pricing killed the project. I find it interesting that Novation paints itself as very green, but its member vendors pull anti-sustainability stunts such as this one.
Second example: sustainable purchasing embraces returnable/reusable packaging, a great waste diversion component. And lots of pharmaceuticals, being heat sensitive, are shipped in Styrofoam containers. Well, hey, let’s return those to the vendors! Not so fast. The US Food and Drug Administration prohibits the reuse of such containers. Drat!
Multiply those two examples by a lot, and you’ll see that cost-containment can really knock the wind out of environmentally-preferable purchasing efforts. As sustainable purchasing efforts scale up, the pursuit of them in healthcare should become more commonplace, but, for now, it’s difficult.
I do want to highlight a recent “win” in the sustainable purchasing arena. Following UCLA’s lead, UCDMC is finally rolling out reusable isolation gowns to replace disposable gowns. I say finally because we first started looking at this several years ago when my Grad Student Researcher, Joanne, was still here. When her term ended, Troy Taylor, a manager in Materiel Mgmt, kept the ball rolling, pushing here and there to get the program trialed. Troy recently told me that full program roll-out was almost complete. Sometimes we have victories, and much credit goes to Troy for persevering for this one.
How about alternative transportation? Many campuses report significant reductions in SOV (single occupant vehicle) use via Alt Trans programs. Just go over to the Davis campus at 9 AM to get completely swarmed by bicyclists; it’s amazing. But to get this going in a hospital environment takes a lot of doing. Consider all of the doctors, nurses and staff involved in direct patient care. It’s 24/7/365, and people are always changing shifts around. Note also that most acute care nurses work 3-12s. That doesn’t help carpools and vanpools. Some units won’t let a staff member tweak their schedule by 30 minutes to accommodate a ridesharing opportunity. Our Alt Trans coordinator, Sarah Janus, is an outreach all-star, working her keister off to get people into her programs. It’s a lot of work, and she earns every new participant.
Sometimes it’s just a location issue that sideswipes the alt trans effort. We have really good transportation within the 140 acre medical center, but it gets flaky once you leave the facility. Only one bus line serves the (main) west side of the campus, and it’s hourly. And it’s a shuttle ride or a ½ mile walk to light rail. So if you can’t ride share, it’s tough to use alt trans. Much different in San Francisco, where alt trans is almost a residency requirement.
The California drought and water conservation has been in the news a lot over the past several years. UC has a Water Working Group that, while campus-centric, tries to include the medical centers. Once again, healthcare looks at water use differently. Infection prevention and sanitation are huge in the hospital. Due to infection prevention concerns, aerators can’t be used on faucets, making low-flow a challenge. However, many of our floor cleaning processes are water-free or use minimal water, so efforts are being made. Lots of water is used when surgery staff scrubs in, and we can’t readily change that. However, the larger issue, shared with campuses, is cost. Unless you do retrofits that are associated with a rebate, cost recovery takes many years due to the low cost of water, and funding projects with long ROI terms is not a priority.
We also work at minimizing irrigation use. Some med centers have little in the way of turf areas; I think we have about 20 acres or so. We can’t just stop watering the turf, as there is dust generation from dead turf, and that can create an infection prevention problem. We can take the turf up, but then it has to be replaced with something, and that costs money. We could have a better irrigation control system, but the cost is prohibitive. And even tracking/measuring water use is difficult, as many locations are on a loop, with buildings not being individually metered. Reducing water use is difficult, in some ways due to healthcare issues, and in others due to the challenges facing all UC locations.
I’ll wrap this up with some perspectives on green building and energy efficiency in healthcare. Current UC policy exempts acute care facilities from the requirement for LEED certification. However, both UCSFMC and UCSDMC have recently certified new hospital buildings, albeit under older, less stringent LEED certification systems. LEED for Healthcare v4 is going to be a bear. At this writing, there are only two Healthcare v4 hospital projects underway nationwide, one in New York, and one in Maryland. I would imagine that, as with everything else associated with v4, everybody is scrambling to register under v3 before it times out this Halloween. There are 12 hospitals in California either in progress or certified under New Construction; of these, three are v3 and the remainder LEED 2.2 (a relatively low bar).
Certifying acute care facilities in California is particularly onerous due to one State agency: OSHPD, mentioned in Part I. We have four LEED projects underway, and all are doing well in Energy and Atmosphere due to 2013 Title 24 requirements. This wouldn’t be the case with a hospital, as OSHPD isn’t held to Title 24. LEDs are foreign to them, as are occupancy controls. One wouldn’t even bother with Savings by Design, as the floor for SBD is 10% better than Title 24. And that’s just one credit element. Water Efficiency would be similarly elusive. For many systems, finding a balance between LEED credits and OSHPD buy-in will be nerve-wracking. I would certainly suggest that before UCOP sustainability policy requires LEED certification for acute care projects that the counsel of the five med center campus architects be obtained, as OSHPD realities definitely are an impediment to LEED success.
Hmmm. I said I’d be wrapping it up, but I’ve not addressed Climate Protection Practices. I’ll keep it brief. Regarding the UC Carbon Neutrality Initiative to be carbon-neutral by 2025 and its application to medical centers: you’ve got to be kidding.
So, Ms/Mr ADS, there you have it. And that’s just a “scratching the surface” intro. There’s more, lots more, starting with the lack of a central focus on healthcare sustainability. But I digress.
May The Force be with you.