“The healthcare sector is both a significant contributor to the global planetary health crisis and uniquely burdened by it,” says Practice Greenhealth’s “Why Sustainability” page.
The organization is seeking to transform healthcare worldwide so that it reduces the industry’s environmental footprint, with the goal of proactively improving the health, safety, and happiness of individuals and communities worldwide.
With healthcare representing 18% of the U.S. economy and 10% of the global economy, the industry has enormous buying power to transform the status quo.
It’s easy to find headlines about the detrimental effects of healthcare—in carbon footprint, single-use plastics, and more. But in a recent BBC article, How do you fix healthcare's medical waste problem? the author posits the question, “What if health care providers didn’t have to choose between sustainability and patient safety?”
Enter Health Care Without Harm (HCWH) and Practice Greenhealth. HCWH was formed more than 20 years ago in response to the serious problem of medical waste incineration and the potent pollutants that were making people sick. The organization called upon healthcare to act in line with its Hippocratic oath of “first, do no harm.” Since its founding, HCWH has grown into a broad-based international coalition of hundreds of organizations and thousands of hospitals and health partners in more than 50 countries. Working closely with Health Care Without Harm, Practice Greenhealth is the leading membership and networking organization for sustainable healthcare, delivering environmental solutions to more than 1,100 U.S. hospitals and health systems.
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To further these efforts, Practice Greenhealth released its sustainable procurement guide in July with the goal of practical and cost-effective sustainable supply chain transformation. (See Resources sidebar.)
Looking to align with health systems’ sustainability goals? Healthcare Packaging talked with Practice Greenhealth’s Beth Eckl, director of environmental purchasing and lead on the sustainable procurement guide, and Scott Rich, director of membership growth and marketing, who offered information for pharma and medical device manufacturers.
1. What are hospitals looking for from life science manufacturers?
Recycling may still be tough in many fast-paced operating rooms due to time constraints. But beyond that, Eckl notes that members continue to struggle with recycling certain packaging. “That is one of the biggest hurdles because they ultimately want to reduce the hospital waste and there are several waste streams, such as solid waste, regulated, and hazardous waste. Hospitals are looking for packaging that would help them reduce their waste and reduce disposal costs. Recyclable or reusable is ideal.”
The organization highlights the issue of chemicals of concern in packaging, and making sure that the packaging isn't going to leach chemicals that would potentially cause harm to patients or workers in the buildings. “Reducing greenhouse gas emissions is also important,” says Eckl.
2. What claims can be made on packaging?
A recyclable package is as good as the stream it goes into. There must be access to a given recycling stream. “The Federal Trade Commission Green Guides came out in 1992 and they define what claims can be made. Manufacturers can use the recycling claim if the package can be collected, separated, and recovered by a system that is available to the majority of customers, which they mean as 60%,” Eckl says.
3. How can manufacturers collaborate with health systems?
Healthcare manufacturers (both big and small) know that changing a package configuration is not an easy task with factors such as validation, the use of legacy machinery, and more. Collaboration is needed between manufacturers and their customers for realistic requests and meaningful change.
Medical device and pharma manufacturers (often referred to as vendors) can now join Practice Greenhealth, where they were unofficial partners in the past. Rich explains, “We've been working over the last year and a half to develop a product for what I call our “non-hospital” and “non-provider” partners to be able to join, because we heard from our supply chain partners that they wanted to help support our mission to transform health care. They also wanted to collaborate and see what our resources were so they can help support that work in the hospitals.”
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4. What resources are available in the reusable transport space?
Practice Greenhealth helps systems navigate the field of reusable transport packaging. In one example, they collaborated with StopWaste and the Reusable Packaging Association (RPA) to create case studies and content at usereusables.org. The stories are organized by reusable type and industry, and the site features cost comparison calculators for containers, pallets, and wraps.
5. Packaging pulls a lot of focus in headlines, but what about sustainable transportation?
The organization is expanding its resources on sustainable transportation to reduce climate impact. “We've set transportation supply chain goals and performance metrics for our members to consider. One example is for hospitals to increase the percentage of EPA SmartWay partners among their top 10 distributors (by annual expenditure) to 80% or greater and/or achieve an idle-free campus,” says Eckl. “That way, their transportation and suppliers’ transportation efficiencies can be increased and greenhouse gas emissions can be reduced.” The EPA makes this program readily available for suppliers and vendors.
6. What is the first step for manufacturers?
The first thing vendors can do to make procurement easier in terms of waste reduction is to collaborate with their downstream partners. “One thing we hear a lot from our supply chain and procurement folks is about opening the channels of communication with the vendors to really see what their needs are,” says Rich. “If the vendors don't know our hospitals are making waste reduction and packaging upgrades a priority, then they don't necessarily know they need to change. Having open dialogue so they can share goals and targets together is key because they're partners in this health care ecosystem.”
In the hierarchy of waste reduction—reduce, reuse, recycle—there could be more focus on minimizing packaging to eliminate unnecessary materials, reusing packaging, or using reusable totes rigid sterilization containers whenever possible. “A lot of hospitals are moving away from wrapping their medical devices in disposable blue wrap toward rigid sterilization containers that can be reused. That wrap is taken off the supplies before it's even entered an operating room,” says Eckl. She added that it’s also important that recyclable packaging is clearly labeled as such for busy healthcare personnel.
In terms of communicating efforts to the buyers, Eckl mentions Kaiser Permanente’s 2017 Environmental Preferable Purchasing standard, which is publicly available. “When we launched our sustainable procurement guide, we also released a standardized environmental criteria that is aligned with Kaiser Permanente's EPP standards. It suggests criteria for waste reduction with several questions around packaging. I would encourage vendors to be aware of the document and the criteria that health care is looking for.”
Check out the Resources Section below for relevant links.
7. How has the reception been among health systems?
Reception for the new procurement guide has been positive. As Eckl notes, “The health systems—especially during this current COVID-19 crisis—are very, very attuned to supply and costs because both of those are being impacted right now.” Health systems are working with their suppliers and communities in order to build resiliency so that they are better ready to face future disruptions to the supply chain.
The Practice Greenhealth network works with nearly one-third of U.S. hospitals. “Everybody that joins Practice Greenhealth is on a different sustainability journey. Some are at the very beginning trying to get their feet wet and they come to us because they don't know what they don't know yet. Then there are others that are a little bit more advanced in their journey,” says Rich. No matter where they are in the journey, health systems are finding that sustainable procurement is a key action area for financial sustainability and for the benefit of patients, workers, the community, and the planet.
8. How do you recognize achievement in the field?
Practice Greenhealth has an awards program for hospitals and health systems. They recently identified the top 25 Environmental Excellence Award winners. Topic areas include climate, waste reduction, leadership, water conservation, and more.
For example, the St. Cloud VA Healthcare System in Minnesota was honored for switching to reusable sterilization containers, reducing waste by 7,350 pounds in the first three months while maintaining high standards for staff and patient safety.
9. Are there financial incentives for making sustainable upgrades?
Eckl notes that sourcing options from sustainable suppliers continues to grow. “I think it started with the investment community’s focus on higher ratings. There are dozens of companies that rate supplier sustainability, and that is becoming an interest for some health care organizations because it's very difficult to know all the answers around what a vendor is doing. There are dozens of questions that could be asked, so health systems look at these ratings.”
Given two products that are nearly identical, it is possible that one manufacturer’s more sustainable processes—such as reducing fossil fuel use or conserving water at their plant—could help them stand out to procurement directors.
10. How do you handle concerns over of greenwashing?
Marketing claims can be confusing or misleading for a buyer. “We encourage health care purchasers to be cautious about these claims and to ask vendors to provide scientific evidence because claims, such as ‘biodegradable’ can be very confusing,” says Eckl. “In fact, two states have forbidden marketing claims using any degradable terms.”
She cites the study by William Rathje, a professor of anthropology, that found that very little degrades in a traditional landfill. To degrade, materials need water and sunlight. Materials buried in a landfill do not receive water and sunlight. “Additionally, when you put an item in a plastic liner and then throw it in the trash, it probably is even less likely to degrade in a landfill.” The term doesn't necessarily mean anything without context to describe the degradation conditions.
11. Is sustainability always more costly?
For health systems, choosing more sustainable pathways can lead to savings in some cases, in addition to reducing environmental harm. Practice Greenhealth members average about $1 million a year in savings.
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Eckl notes that broad claims do not apply, “Every product and service is going to be different,” she says. “But we have found through numerous reports, awards, and applications from our members—especially in the operating room—there are tremendous savings by choosing more sustainable products and reusable products.”
“An important thing to note: we encourage members to look at the total cost of ownership. Product purchasing decisions can be based on the purchase price or they can be based on costs, not only to buy, but also to use and to dispose. You can sometimes identify significant savings just by looking beyond the purchase price and that's what makes an impact,” says Eckl.
The Business Case
If a package upgrade decreases the total cost of ownership to health systems, it may be a justified upgrade to a device or pharma manufacturer.