BY: JEAN LIVINGSTON, PhD
Dr. Livingston is director, organizational effectiveness, Consorta Catholic
Resource Partners, Rolling Meadows, IL.
Group Purchasing Practices Can Help Hospitals Protect the Environment
How large is your organization's ecological "footprint"? If it is part of
the large and diverse U.S. health care enterprise that currently represents
about 12 percent of the gross national product, chances are that its footprint
makes a weighty contribution to the unprecedented changes occurring in the global
environment.
Two of the more significant changes are mercury contamination and synthetic
industrial chemical contamination of the world's ecosystems. Such contamination
threatens the reproductive processes (ovarian follicles, egg yolk, amniotic
fluid, and breast milk) of both human and nonhuman inhabitants of the Earth.
U.S. Health care consumes, uses, and disposes of large quantities of diverse
natural resources, pharmaceuticals, chemicals, and manufactured goods. By putting
some basic environmental practices in place, U.S. hospitals could significantly
reduce the impact of their ecological footprints. Hospitals can demonstrate
environmental responsibility in three broad ways:
- Eliminating toxic products
- Reducing waste
- Choosing environmentally sound disposal technologies
Environmental impact is one area where group purchasing organizations (GPOs)
are well-positioned to help health care organizations incorporate strategies
for positive change.
Environmental Issues in Health Care
Advances in medical care have resulted in substantial decreases in morbidity
and mortality in the United States. Ironically, however, many hospitals add
to environmental pollution—and thus morbidity and mortality—as they dispose
of highly toxic substances. These disposals actually contribute to public health
problems.
Medical waste is believed to be a major source of dioxin contamination, for
example. Dioxin is a byproduct of the disposal of synthetic chlorinated organic
compounds. It is released into the environment through the incineration of chlorinated
plastic products. The use of chlorinated plastic products—primarily polyvinyl
chloride (PVC)—has grown rapidly in U.S. Health care, especially for single
use or short-term use applications. It accounts for most of the organically
bound chlorine in medical waste. Virtually all of the chlorinated organic compounds
that have been studied exhibit at least one serious toxic effect, such as endocrine
dysfunction, developmental impairment, birth defects, reproductive dysfunction
and infertility, immunosuppression, and cancer. According to the U.S. Environmental
Protection Agency (EPA), more than 90 percent of human exposure to dioxins results
from eating meat and dairy products from animals that have ingested plants on
which dioxin deposits from the atmosphere have settled and from fish that ingest
dioxin deposited into bodies of water.
Scientists have identified a number of specific changes in Americans' health
status—including increasingly common antibiotic resistance; a sharply increasing
incidence of chronic diseases such as asthma, hypertension, heart disease, and
diabetes; a higher incidence of developmental disabilities in children; an increasing
age-adjusted incidence of certain types of cancer; higher percentiles of birth
defects and congenital heart disease; and declining sperm counts—some of which
suggest a link to dioxin deposits in the nation's air and water.
The factors that determine dioxin formation during incineration are not yet
fully understood. Scientists do know, however, that the best way to reduce the
formation and release of dioxin is to avoid the use of chlorine and its compounds
in manufacturing in the first place. The next best way is to reduce the incineration
by hospitals of chlorinated plastic products.
Relationships among health care providers, their environments, the technology
they use, and other components of the health care enterprise (e.g., medical
device manufacturers, pharmaceutical firms, insurance companies, government
regulatory agencies, and public utilities) are complex and often difficult to
navigate. For example, the medical manufacturing industry uses and disposes
of an array of toxic substances, such as mercury, cadmium, solvents, dioxin
precursors, cleansing agents, and pharmaceuticals. Patient care facilities produce
wastewater that contains toxic industrial and pharmaceutical compounds, many
of which do not break down in sewage treatment plants and get disposed of in
landfills, on farmland (where it may be applied as sewage sludge), or in rivers
and streams. According to the EPA, medical waste incinerators are the second
leading quantified source of environmental dioxin emissions and are responsible
for about 10 percent of the mercury emitted into the environment. Although not
all of these environmental threats are unique to health care, scientists, public
health experts, and physicians are beginning to document links between ecological
changes and environmental contamination and malignancies, birth defects, reproductive
problems, impaired behavior, and immune system dysfunction.
In addition to protecting the ecology, health care organizations need to protect
their own patients and employees from potentially harmful substances. These
substances include mercury, a toxin that can cause neurological damage; diethylhexylphthalate
(DEHP), a softener for PVC plastics that is a suspected human carcinogen, reproductive
toxicant and possible hormone disrupter; and other substances such as latex,
which triggers serious allergies in up to 16 percent of health care professionals.
Solutions Begin with Purchasing
Purchasing is an effective area in which a hospital can begin improving its
environmental impact. That's because the procurement of nearly every product
and service that a hospital will need is centralized in local, corporate, or
group purchasing functions. It is less costly to correct a problem if action
is taken close to its source. Experience shows that addressing environmental
impact at its source, rather than paying for pollution abatement later
on, results in lower overall costs.
Group Purchasing Strategies
Consorta Catholic Resource Partners, a group purchasing and resource management
company sponsored by 13 Catholic health care systems, is one GPO that promotes
and supports environmentally responsible purchasing practices. Consorta's shareholders
realize that environmental compliance, pollution prevention, mercury reduction,
and solid waste reduction make both good business and environmental sense. Environmental
programs and services provided by Consorta include educational and networking
forums for specific interest groups (such as pharmacy, materials management,
laboratory, building services, and surgical services) and strategic initiatives
to identify, evaluate, and implement best-demonstrated environmental practices.
Consorta, like its 13 shareholder organizations, is guided by the Ethical
and Religious Directives for Catholic Health Care Services, always mindful
that "the Catholic health care ministry seeks to contribute to the common good.
The common good is realized when economic, political, and social conditions
ensure protection for the fundamental rights of all individuals" (Part 1, Introduction,
pp. 8-9). Besides contributing to the common good, environmentally responsible
purchasing can help hospitals:
- Significantly improve their impact on the overall quality of the environment
- Reduce costs due to overhead, waste disposal, liability, or occupational
health problems
- Provide a healthier environment for patients and employees through reduced
exposure to cleaners, solvents, paints, and other hazardous materials
- Leverage positive publicity and promotion potential
GPOs are accountable to their members for acquiring the equipment and supplies
they need to deliver high-quality, safe health care. This requires them to work
closely with manufacturers to identify and (if necessary) develop products and
services that minimize damage to the environment. GPOs can pool member hospitals'
experiences with products and provide cogent feedback to manufacturers. They
can hold manufacturers responsible for meeting product performance expectations,
including potential effects on the environment and on patients' health and safety.
GPOs can implement an environmentally responsible purchasing strategy through
several means.
Identifying Potential Dangers By working closely with suppliers, GPOs
can identify both products with potentially dangerous content, on one hand,
and environmentally preferable products and good waste minimization practices,
on the other. For Consorta, this process begins the first time a "request-for"
proposal is sent to a supplier; the GPO's standard request-for proposal asks
suppliers to clearly identify any products containing potentially harmful substances.
Consorta is currently developing a comprehensive survey that will actively
identify environmentally responsible suppliers who are involved in recycling
and are compliant with ISO 14000/14001 (industry quality assurance standards).
Another area of concern is "single use devices" (disposable plastic items such
as catheters and trocars) and their potential reuse. It might seem rational
to think that reusing disposable devices would cut waste by reducing both the
consumption of nonrenewable resources and solid waste. But, in fact, the only
reduction in solid waste is the delay in adding the original product to the
waste stream. Repackaging and reprocessing may add an even larger ecological
burden. Consorta is sorting through these complex issues by product category,
both looking for some quick fixes while developing a long-range plan.
Conducting Environmental Education Consorta provides users with information
on environmentally preferable products, making it easy for them to use those
products. To support members' efforts to convert to environmentally preferred
products, Consorta provides educational programs at member conferences, posts
information on a secure website that deals specifically with products and their
related environmental issues, and uses a classification and identification system
in its proprietary on-line product catalog. In this catalog, a "green tree"
icon identifies environmentally preferred products.
Providing Information on State-of-the-Art Disposal Practices Consorta
supports its members' product evaluation/value analysis teams and encourages
team missions that include preventing pollution, recycling, evaluating the need
for toxic ingredients, considering products' energy efficiencies, working with
vendors to develop/redesign alternative products, and providing members with
educational information about how such work promotes a healthier environment
for patients, workers, and the community.
Monitoring the Development of Environmentally Preferable Products Consorta
has found, in its continuing dialogue with manufacturers, that some have sophisticated
approaches to making their products safer for the environment. Such manufacturers
are committed to developing products and packaging that are free of PVC, DEHP,
latex, and mercury and have safer needle devices and safer cleaning products.
Besides conducting aggressive research and development, some suppliers monitor
a product's impact on the environment throughout its life cycle, beginning with
production and ending with disposal.
Some manufacturers have begun research in a new field called "materials science."
The scientists involved are trying to learn—and mimic—how nature manufactures
its materials under life-friendly conditions: in water, at room temperature,
and without harsh chemicals or high pressures. Such scientists, working on the
fringes of their organizations, have become frustrated with the current "heat,
beat, and treat" manufacturing process that results in dwindling oil reserves,
toxic emissions, and high failure rates—because of breaking, cracking, and stretching—of
many materials. Consorta aims to encourage this materials revolution by working
directly with manufacturers in identifying opportunities to develop biomimetic
products with superior environmental performance.
One Step in a Long Journey
Catholic health care systems share an explicit common mission: to contribute
to the common good, which entails working for economic, political, and social
conditions that ensure protection for the fundamental rights of all individuals.
Issues that relate to human health are inherently linked to the health of the
environment. Hence environmental issues are inescapably human health issues.
Consorta has launched a number of initiatives to assist its shareholders in
selecting products that maximize environmental benefit and minimize adverse
effects, consistent with price and performance considerations. However, the
GPO recognizes that this commitment is only the first step in a long journey.
Leaders throughout Catholic health care should urge purchasing decision makers,
suppliers, and manufacturers to invest in the research, design, production,
and use of environmentally safer products.
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CONSORTA'S ENVIRONMENTAL GOALS
Consorta's shareholders have charged the organization's Environmentally Preferred
Purchasing Program with several goals:
- Proactively identifying potentially dangerous products Consorta
will sort out environmental issues as they arise; identify and find alternatives
to dangerous products; and assess the quality and functionality of those products.
- Contracting for environmentally preferred products when it is possible
and sensible. For example, Consorta's recent review of suppliers of IV
administration sets included considerations of PVC content. Consorta ultimately
awarded the contract to a supplier that produces administration sets that
are free of PVC and DEHP. In this way, Consorta members have an assured source
of these environmentally preferred products.
- Providing disposal and waste management information when alternative
products are not available. únfortunately, there are not always viable
alternatives for essential supplies that pose a risk to the environment upon
disposal. In such cases, Consorta provides information on disposal methods
that have been proven to help protect the environment.
- Integrating life cycle analysis. Consorta is building the process
of life cycle analysis, which estimates a product's environmental impact,
into its contracting strategy. This process looks at raw material acquisition,
manufacture, recycled content or over-packaging, energy and water efficiency
ratings, distribution consideration, toxicity, use and disposal.
- Providing in-depth information, education, and resources to Consorta
members. Consorta's members' website includes examples of successful programs,
such as mercury-free hospital initiatives; executive briefings on environmental
concerns; and links to comprehensive information on topics such as phasing
out products that contain merýury and PVC without compromising quality. Education
is essential to good environmental stewardship, and Consorta is developing
a complete program for the continuing education of its members on new and
emerging environmental concerns. Educational programs are presented to an
audience of over 600 members during Consorta's Annual Resource Management
Conference.
- Participating in cooperatives and forging partnerships. Consorta
is a committed member of "H2E [Hospitals for a Healthy Environment] Champions
for Change," a partnership of the American Hospital Association; the EPA;
the American Nurses Association; and Health Care Without Harm (HCWH), a collaborative
of more than 300 organizations working together to eliminate pollution from
health care practices. The partnership sponsors workgroups and cooperative
projects that provide members and affiliated health care facilities with ongoing
promotional, technical and educational information.
—Jean Livingston, PhD
CHI ENDORSES ENVIRONMENTAL STEWARDSHIP
Catholic Health Initiatives (CHI), Denver, one of Consorta's 12 shareholder
organizations, sees partnerships with suppliers and purchasers as essential
to its stewardship of the environment. "We've worked with Consorta to make sure
that suppliers put provisions into their contracts that specify how they will
pursue environmentally responsible practices," said Colleen Scanlon, RN, JD,
CHI's senior vice president of advocacy.
Scanlon also helped Consorta develop language on environmental responsibility
for its Corporate Accountability Principles and Guidelines. CHI's own standards
of conduct include a commitment to environmentally responsible health care.
"It is part of our mission to create healthy communities in the 68 urban and
rural communities we serve," said Scanlon. "Our core value of reverence includes
reverence for the environment, so working with a group purchasing organization
that helps us live out that commitment is extremely important."
CHI believes that collaboration with other health care systems and industry
groups is an extremely effective way to make health care a better friend to
the environment. The system is affiliated with Health Care Without Harm and
its campaign for environmentally responsible health care. CHI cosponsored such
conferences as Setting Health Care's Environmental Agenda, in October 2000,
and CleanMed, in May 2001 and October 2002.
CHI continues to investigate the best ways to advance its commitment to care
of the environment. "We are presently conducting environmental impact assessments
at each of our facilities to collect key benchmark data that will enable us
to plan appropriate strategies for environmental responsibility," said Scanlon.
"This information can assist us in the development of focused initiatives, such
as making all of our facilities mercury free.
"Education also continues to be a tremendous need, not only within our organization
but throughout the health care industry," Scanlon continued. "As we work with
Consorta, we find that while health care organizations and suppliers are not
against using or producing products that are environmentally friendly, they
are at times concerned about costs, efficacy, and logistics. Education can do
a lot to allay these concerns. The more we all continue to work together to
better understand how to be environmentally responsible, the more likely we
are to be successful in fulfilling this commitment."
—Jean Livingston, PhD
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.