organization and achieve those objectives. As far as increasing participation, we have used utility incentives, rebates, training, contests and demand response programs to help reduce energy consumption and expenses and to help advance recycling in our facilities. We see more regulations and fines to be more an influence in recycling and waste consumption. As far as sustain- able purchasing, organizational guidelines, criteria, goals and tracking and reporting can be valuable.” Mayo Clinic’s Mairose emphasizes the softer approach, too.

“Education is the only way to move the

ball forward on the buyer side of the supply chain,” he said. “Regulations and penalties will only serve to increase expense in a sector of the industry that is still nascent at best with undefined expectations and widely varying definitions of sustainable products.”

Don’t underestimate the sales pitch, urged Intermountain’s Bergstrom, with the ham- mer being something of a last resort. “I believe that part of the solution is to prepare a compelling case for the initia- tive, make a solid connection to the health benefits of the initiative, and make sustain- ability a part of performance reviews,” he said. “Carbon fees and regulation certainly will get the attention of our businesses and may be the only way to elevate the needed action.”

Duke’s Crawford favors incentives over penalties as the preferred mo- tivator.

“Regulations, fees and fines are not necessarily the driving force to increase interest in this space,” she asserted. “Without enforcement, which in this envi- ronment would be unlikely due to more pressing demands, they don’t work. Incentives would be a positive, not negative reward, which may draw more interest to perform at a higher level of sustainable involvement.” Greenhealth Exchange’s Starr concurs. “Measured goals would be one

by senior leadership, they carry the most weight and get the most attention. There- fore, success is more likely with leadership involvement and endorsement.” Dignity Health’s Leciejewski, however, articulates two examples about the effective- ness of regulations in practice in California. “When polystyrene foam was banned from our county, it’s usage in our hospital declined quickly; polystyrene is nearly impossible to break down and hazardous to the environment and marine life,” she said. “California has defined two groups of food generators that will [have] to comply with the requirements of SB1353 (50 per- cent reduction in Landfill Organic Waste by 2020; 75 percent reduction in Landfill Organic Waste by 2025; 20 percent edible Food recovery goal by 2025) by January 1,2024. There will be two driving forces: To decrease production and to recycle leftover food. This regulation will definitely help in our program development.”

What douses the flame? The biggest obstacle in a healthcare organi- zation’s ability to purchase and implement the use of more sustainable products reveals some familiar bad news but in a good way, the GX-HPN survey showed.

Yes, respondents pointed to price as the

No. 1 obstacle but at only 38 percent that excuse represented a plurality and not ma- jority as in past years, which indicates prog- ress, according to GX’s Starr (see Slide 3).

ability features or attributes they should be watching,” she said. “Sustainability is often viewed as doing things that improve the impact on the environment and not as some- thing that impacts patient care. Chemicals of concern should be of particular concern for clinicians because of the health problems they are suspected of causing.” Close on the heels of clinical buy-in is organizational priorities at 18 percent, ac- cording to the survey.

Dignity Health’s Stoner taps into that vein.

“Wide ranging executive support can be dif- ficult among the many competing priorities our leaders face,” he said. “When system- wide initiatives are developed, the burden of decision-making is reduced, and we can overcome some of the hurdles that might otherwise be too high for an individual facility to surpass on their own. Reliable, readily available data has become increas- ingly important to track and communicate, not only to understand if we are able to meet stated objectives, but to encourage ongoing dialogue, promotion of success stories and continued advancement efforts.” Duke’s Crawford identifies a confluence of issues from the individual to the collective and corporate.

SLIDE 3 — What do you believe is the biggest obstacle in

your organization’s ability to purchase and implement the use of more sustainable products?

“It is a challenge to establish a baseline and project scope in these particular areas, as well as long-term project oversight,” she indicated. “There is often a lack of system- wide communications around these efforts, meaning they are often occurring but there is no larger group to present to who would track and dissemi- nate this data. There is also a ven- dor component, and behavioral changes need to include vendor input as they are stakeholders as well.”

of the best ways to see progress improve,” Starr indicated. “Peter Drucker’s ‘If you can’t measure it, you can’t improve it’ is quoted over and over because it is proven correct so often. Goals not only com- municate organizational priorities, but also focus efforts. Whether it’s water conserva- tion, elimination of chemicals of concern, or increasing the use of local/regional foods, an established goal has everyone focused on common categories/work. When those goals are set and communicated with/

More noteworthy is the No. 2 hurdle

at 20 percent: Clinical buy-in on the use of sustainable products. Because value analysis professionals tend to spearhead sustainability efforts and clinicians tend to dominate the value analysis segment this figure raises eyebrows.

Starr attributes the curious statistic to awareness and knowledge.

“In many cases, it may be that clinicians aren’t knowledgeable about what sustain-


Financials take precedence, according to Intermountain’s Bergstrom, followed by areas targeted. “Funding is always an issue as you compete for limited or reduced dollars,” he said. “The formulas and modeling that we continue to use needs to be re-evaluated to include differ- ent factors such as risk, cost of environmental impact on health issues, longer-term ROI, etc.

“Tackling issues like water quality and reduction are difficult because the cost of water is so inexpensive,” Bergstrom contin- ued. “It is also difficult because people have to see the problem, such as algae bloom, or have a direct cause and effect, such as lead in the water/brain development issues or poor air quality/cardio-respiratory episodes.”

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