Sometimes, the road to sustainability starts with a question.
Nurse Ildi White wondered why the cafeterias at Providence St. Patrick Hospital in Missoula, Montana, used metal spoons but the hospital used plastic spoons on its floors, such as when nurses gave patients medication with a container of applesauce.
"My very first question was, can we get metal spoons on the floor? I know we have them and can wash them," White said. "Initially, the first answer was no, and that was almost the end of my interaction and involvement."
She sat on the question for a couple months and asked again. An environmental council based in her hospital looked into the issue and realized that not only would it be environmentally beneficial to provide metal spoons, but also financially beneficial, even if the hospital lost up to half of the spoons it bought.
Since making that switch about 10 years ago, up to 70,000 fewer plastic spoons have gone to the landfill every year, said Sarah Johnson, the clinical program manager registered nurse for environmental stewardship across the Providence Montana region. In this role, she leads initiatives that improve patient outcomes while actively reducing health care's environmental footprint.
Said White, who is also a clinical environmental stewardship liaison for the hospital: "I didn't realize I had the ability to have my voice heard, and to be able to make impactful changes in the organization. Now that I do, I have used it often and frequently encourage others to do the same."
Repeated recognition
Encouraging employees to have a voice and make suggestions has propelled the system's sustainability efforts and has led to national recognition for Providence St. Patrick, part of Providence St. Joseph Health. This year, Practice Greenhealth recognized the hospital with a Top 25 Environmental Excellence Award. The facility has been an honoree four years in a row. Providence Swedish Medical Center campuses in Cherry Hill, Edmonds, First Hill and Issaquah in Washington were also recognized this year with the award. Providence St. Patrick differentiated itself from the other Providence hospitals by also earning four Circles of Excellence awards in the categories of climate, energy, greening the operating room, and waste.
The Top 25 Environmental Excellence Awards is Practice Greenhealth's highest honor for hospitals. The organization said "the hospitals are leading the industry in all-around sustainability performance, demonstrating comprehensive programs and are illustrating how sustainability is entrenched in their organizational culture."
As a system, Providence remains committed to work toward being carbon negative by 2030.
A love of the outdoors
Johnson and White say it's relatively easy for their colleagues to buy into sustainability efforts. Many come to hospital work after working in fields that kept them mostly outdoors, such as in forestry or on ski patrols. White has been a nurse for about 10 years, now in medical oncology. Before that, she spent about 15 years in outdoor work, mostly as a park ranger in the West, including at Yellowstone, Yosemite and Glacier national parks.
Johnson, who has a background in organic farming, works part-time at the hospital and with her husband runs a small farm that follows organic standards.
Johnson said her colleagues "come into health care, and they see the same things that we're seeing, and they're concerned about it."
In 2018, Johnson, White and Beth Schenk founded Providence Montana's Green 4 Good Shared Governance Council, which has implemented dozens of improvements at the Missoula hospital, at Providence St. Joseph Medical Center in Polson, Montana, and at Montana clinics.
Schenk started recycling efforts at Providence St. Patrick in the early 1990s. She is now executive director of environmental stewardship at Providence and helps implement change systemwide.
Action across the board
Providence Montana's environmental stewardship efforts are vast and varied. Among them are:
- Sending a monthly Green 4 Good newsletter to employees, from which articles get pulled into a main newsletter for the Montana region and a larger environmental stewardship letter. Monthly news is posted in the Providence St. Patrick cafeteria and online.
- Engaging employees by giving away organic seeds on Earth Day, hosting a cleanup of the Clark Fork River with more than 25 caregivers and their families, organizing highway cleanups, selling bike helmets in partnership with Missoula in Motion, and hosting a tour of trees near Providence St. Patrick with Trees for Missoula and Climate Smart Missoula.
- Continuing advocacy and education by informing new nurses and support staff about environmental stewardship during orientation, co-hosting the screening of two documentaries about microplastics and plastic use, and providing speakers at colleges and with the Alliance for Nurses for Healthy Environments about sustainability efforts.
- Figuring out ways to avoid putting waste into landfills, to collaborate with food and nutrition services to increase reusable dishware and source local foods, and to work with community groups, such as Stay Cool Missoula, to improve the climate.
White said that through her work at the hospital, she realized she could make a greater impact on the environment as opposed to advocating on her own by writing emails or recycling at home. "I can influence my co-workers. I can influence other departments. We can spread education. We can make policy change here in the hospital and really change how we function as a system and change our impact," she said.
Grassroots efforts
Nurses at Providence St. Patrick can come up with their own sustainability efforts for their units, such as using washable gowns instead of disposable ones, revising policy to reduce the number of times bed linen is changed if it's not medically necessary, and providing bins for donations of wipes, tape and other supplies to go to medical organizations or animal rescue groups. These are all examples of efforts supported by collaboration, research and the creation of guidelines or policies, Johnson said.
"I think my favorite thing is that there's been so many grassroots efforts," Johnson said. "People are doing projects around the hospital, and we don't always hear about it until after it's implemented."
Both White and Johnson credit Providence leadership for being supportive, and they encourage other hospitals and systems to seek advice and mentorship on sustainability. Providence offers a downloadable Green Team Toolkit with advice on minimizing waste, on planning, and on reducing nitrous oxide emissions.
They encourage clinicians and caregivers to speak out and take action at their hospitals and care sites.
"I think you're bound to hear no along the way when you're asking questions," White said. "And I think that's where we've found some successes. You know, don't take the first no. Don't be afraid to ask questions and keep asking questions."