BY: ROGER W. HITE, PhD
Dr. Hite is chief operating officer, Dominican Hospital, Santa
Cruz, CA. Dominican Hospital is part of Catholic Healthcare West, San Francisco.
A Catholic System in California Has Made Environmental Protection Part
of Its Mission
In the Spring 1970 issue of the Forensic Quarterly, the journal
of the National Federation of State High School Associations, the lead article
began as follows:
The decade of the 1970's may well bear witness to the dawning of the age
of ecology—the age in which man realizes that he is a part of nature, not
apart from nature. The previously obscure term "ecology" is apt to become
as commonplace as "motherhood" and "apple pie" in the political rhetoric of
our nation's leaders and in the polemics of political activists. . . . The
question is not whether the environment is deteriorating, although some disagree
over the magnitude of the loss, but rather, what can be done to check the
current destruction, to repair past damage, and to establish some balance
in the environmental ecosystem? . . . The problem of environmental quality
is particularly consequential to today's high school students because they
will be—or fail to be—the heirs of nature's ecological legacy—a livable environment.1
The research that went into the preparation of that essay (and a handbook
of resources I helped edit after soliciting information from more than three
dozen U.S. senators), made a lasting impression on the author—that is, me. Now,
almost 35 years later, a certain blend of nostalgia, awe, and pride fuels my
appreciation of what my employer of the past 30 years, Catholic Healthcare West
(CHW), has done to ensure that the ecological awareness of the late 1960s and
early 1970s continues to flourish in the system's mission, philosophy, and actions.
CHW Core Values
CHW, whose corporate offices are in San Francisco, is a system of 40 hospitals
in California, Nevada, and Arizona. Sponsored by eight congregations of women
religious, it is the third largest not-for-profit religious hospital system
in the nation.
Central to CHW's mission is a focus on providing high-quality health care
services to all, especially those who are poor and underserved, and partnering
with others to promote the overall health of the community. When we CHW people
say "community," we mean community in the widest sense possible: the whole Earth
community, not just those within the walls of our hospital members.
CHW's ecological initiative is two-pronged:
- The strategic dimension directs the system's facilities to improve their
business practices so that CHW hospitals can minimize any negative impact
on the environment.
- The spiritual dimension cultivates an awareness of the interconnection
of all things.
CHW's leaders understand that what lies "outside" any organism—person, plant,
animal, or institution—is very much connected to what lies "inside" it. If one
part is compromised, all are compromised. If the planet happens to be unhealthy,
individuals and communities will be unhealthy as well. In CHW's organizational
culture, spirituality and ecology are accordingly closely aligned.
CHW's mission is reflected in a set of core values and a systemwide strategic
map that provides broad strategic direction for each member hospital. Each facility
is directed to consider how it can create and deploy operational budgets that
allow the facility to not only meet the health care needs of the local community
but also to determine how the facility can maintain ecological sensitivity and
fulfill the institution's responsibility to be a good corporate citizen. The
five core values that shape the activities of all member hospitals are:
- Justice Advocate change of social structures that undermine human
dignity, demonstrating a special concern for those who are poor.
- Collaboration Work together with people who support a common vision
to achieve goals.
- Dignity Respect the inherent value and worth of each person as a
member of the human family.
- Excellence Share a commitment to quality in work through teamwork
and innovation.
- Stewardship Accept accountability for the management of human, financial,
and ecological resources.
CHW's vision is to be linked with other nationally recognized health care
leaders in sustaining a customer-focused, value-driven, process-managed, results-oriented
health care organization focused on clinical outcomes, health promotion, care
management, and spiritual care. The vision is to be not just "best in
the world" but "best for the world"—the world of patients and their families.
Being best for the world includes viewing the planet itself as a primary healer
and source of health for the human being.
CHW strives to establish and sustain a position as a consistently solid financial
performer so that sufficient capital can be reinvested in facility, staff, and
equipment. But, whereas financial solidity is necessarily an enabler of our
future, it is not in itself sufficient to ensure the success of the system's
mission and ministry. CHW also has a primary focus on measures that reflect
how well it is meeting the needs of its patients and staff. CHW strives to meet
these needs in ways that are environmentally friendly.
CHW's "Strategic Map"
To carry out its mission, CHW's corporate leaders engage more than 300 leaders
throughout the system to create and maintain an annually updated, broad-brush
vision of the role the system wishes to play in providing health care services
to facility-specific communities. Several points on this "strategic map"
highlight the system's commitment to meet not only the needs of its patients
and its staff but also the needs of planet Earth:
- Public Policy and Advocacy Implement an integrated, systemwide public
policy and advocacy strategy that results in expanded access to health care,
a more favorable regulatory environment for providers, improved program reimbursement
for providers, and better stewardship of Earth's resources.
- Shareholder Advocacy Ensure deployment of a shareholder advocacy
plan that addresses issues of corporate social and environmental accountability
at portfolio companies is reviewed and approved by the CHW Investment Committee.
- Annual CERES Report Ensure that the annual CHW Environmental/CERES
Report (based on principles developed in 1996 by the Coalition for Environmentally
Responsible Economies, or CERES) shows a 100 percent achievement of systemwide
waste reduction and resource conservation goals.
Public Commitment and Accountability
During fiscal year 2003 CHW marked its seventh year of formal commitment
to environmental conservation and protection. The system's board of directors—recognizing
that providing compassionate, high quality, affordable health care in a way
that enhances patient and employee safety and minimally affects the environment
is central to CHW's mission—endorsed the CERES principles. CERES is a not-for-profit
organization composed of leading social investors, environmental groups, and
public entities that promote environmentally responsible economic activity for
a just, healthy, and sustainable future throughout the world. (For more information
about CERES, call 617-247-0700 or access www.ceres.org/.)
To join CERES, an organization must promise to abide by 10 non-negotiable
principles that are sometimes described as "the house rules of the planet."
The principles are:
- Protect the biosphere
- Use natural resources wisely
- Minimize risk to employees and community
- Restore environmental damage
- Elicit commitment from top management
- Reduce waste
- Conserve energy
- Provide safe products and services
- Inform the public
- Audit and report
In keeping with the 10th principle, CHW is required each year to conduct an
environmental audit and then report to the public:
- How much water and energy the system is using
- How much solid and medical waste the system is generating
- How much waste the system is recycling
- How well the system is improving its waste disposal/recycling
CHW has developed a tool that each of its facilities uses to report data on
the solid and medical waste generated in each quarter. This data enables CHW
to set systemwide and facility-specific goals for waste reduction and encourages
the sharing of best practices throughout the system.
In support of the goals of Hospitals for a Healthy Environment (see Laura
Brannen, "Managing
Medical Waste"), CHW has developed and implemented a systemwide environmental
mercury-elimination policy stating that CHW hospitals will not use products
or processes that contain mercury, unless no alternatives are available.
Mandate for Facilities
Each CHW facility is mandated to have an environmental action committee.
The members, who are selected from different departments, meet regularly to
set and monitor goals and to use their expertise and creativity to help their
hospital focus on its specific ecology initiatives.
Each CHW facility has an "ecocontact"—a person who, serving as the liaison
between the facility and the system's corporate offices, is responsible for
finding ways to use the system's resources wisely, save money, and improve the
environment. "Ecocontacts" report how the facility is disposing of waste and
constructing or retrofitting buildings.
Among what CHW calls its "Mission Integration Standards" is one
on ecology, which says: "CHW exercises responsible stewardship of the environment
and partners with others to advance ecological initiatives." The standard
emphasizes the necessity of developing environmental policies, gathering data,
and educating staff at both the system and local levels. Through its corporate
offices, the system coordinates a wide range of activities that are deployed
at each hospital. In fiscal 2003, these activities aimed at reducing the use
of, reusing, or recycling various resources and at conserving them through the
redesign of established processes.
Efforts to Reduce the Use of Resources Among these initiatives were:
- Water Saver Program The United Nations declared 2003 the "International
Year of Freshwater," calling on each person to help safeguard the most precious
source of life on our planet. CHW is implementing what it calls its "Water
Saver/Plus" program to reduce water consumption and waste stream production.
The system will attach 300 devices to wet film processors to reduce the consumption
of water needed to develop high-quality x-rays. Once fully implemented, this
program is expected to save 140,000,000 gallons of water (about 90 percent
of the total water currently used for x-ray production) a year and reduce
wastewater production; savings of $800,000 a year are expected.
- Mopless System Many CHW facilities are switching to a "mopless"
system of cleaning floors. The mopless system, an alternative to traditional
cotton mops, is a micro-fiber pad that lifts up to seven times its weight
in dirt and moisture, is lint free, and uses only one-twentieth of the cleaning
solution required by traditional mops. Since the pads never enter the solution
tank, the cleaning solution remains fresh, thereby eliminating the threat
of cross-contamination.
Efforts to Reuse Resources Rather than disposing of used items immediately,
CHW has launched the following campaign:
- "Single Use" to Multiple Use CHW contracted with a company that
specializes in reprocessing "single use" items to allow for multiple uses.
Items range from surgical instruments to scrub uniforms. CHW expects to reach
its initial goal, a 30 percent exchange of all eligible devices systemwide,
with associated annual savings of at least $2 million.
CHW has also contracted with a firm to purchase reusable pulse oximeters (noninvasive
devices used to measure the level of oxygen in the blood of the arteries and
heart rate). The shift to reusable devices will, over a five-year period, reduce
by one million the number of disposable probes entering landfills. Savings are
projected to top $7 million. As a result of its achievements at CHW, the company
secured a contract with a group purchasing organization and is now offering
an environmentally preferable product to one third of the nation's hospitals.
CHW's purchasing specialists deserve credit for changing the marketplace philosophy
for sensor oximetry from disposable to reusable.
Efforts to Recycle Resources As CHW reuses some items, it recycles
others, including the following:
- "Blue Wrap" Fifteen CHW facilities now recycle both the blue plastic
wrap used to protect surgical instruments and other soft plastic wraps, such
as bags for intravenous apparatuses. The recycled plastic is processed and
then used as siding for houses. Blue wrap represents at least 20 percent of
all the waste created in the surgical arena. Last year, Dominican Hospital,
Santa Cruz, CA, diverted 16,000 pounds of blue wrap from its solid waste disposal.
St. Mary's Medical Center, San Francisco, collected and bailed 2,500 pounds
of sterile wrap in 100 days. California's Department of Health Services endorses
the project; a video filmed at St. Mary's is shown at other facilities around
the state as an example of how blue wrap recycling can work.
Efforts to Redesign Resources CHW now includes environmental values
in its construction plans, as the following demonstrates:
- Sustainable Building CHW's leaders are beginning to understand the
connections between human health, and environmental quality, awakening to
the irony that health care facilities may be exposing patients to a host of
harmful substances through the building materials used. CHW's real estate
team has developed what it calls a "Sustainable Design Mission Statement,"
complete with guidelines that ensure sustainable siting, design, construction,
management, and disposal practices in construction projects throughout the
system. In September, CHW's board of directors reviewed and approved a sustainable-building
policy.
Aboard Spaceship Earth
The United States has come a long way since 1970, when a Cleveland businessman
rebuked a newspaper reporter for suggesting that his company was causing industrial
pollution. "It's not our waste that's making the lake smell," the
businessman said. "It's all the dead fish."2
Today responsible businesses, such as CHW's 40 facilities, take very seriously
the need to be solid corporate citizens. Perhaps the admonition given in the
criteria for the Malcolm Baldrige Award for Performance best summarizes the
challenge for health care providers:
A health care organization's leaders should stress responsibilities to the
public, ethical behavior, and the need to foster improved community health.
Leaders should be role models for your organization in focusing on ethics
and the protection of public health, safety, and the environment. Protection
of health, safety, and the environment includes any impact of your organization's
operations. Also, organizations should emphasize resource conservation and
waste reduction at the source. Planning should anticipate adverse impacts
that may arise in a facility's management, as well as in the use or disposal
of radiation, chemicals, and biohazards. Effective planning should prevent
problems, provide for forthright responses if problems occur, and make available
information and support needed to maintain public awareness, safety, and confidence.
. . . Public health service and supporting the general health of the community
are important citizenship responsibilities of health care organizations.3
Adlai E. Stevenson, a onetime U.S. ambassador to the United Nations, established
the metaphor for the challenge that faces all business as they strive to fulfill
their corporate citizenship responsibilities to protect the environment. He
wrote: "We travel together, passengers on a little space ship, dependent on
its vulnerable supplies of air and soil, preserved from annihilation only by
the care, the work, and the love we give our fragile craft."4
NOTES
- Roger W. Hite, "Environmental Quality: The Federal Role
in Air, Water, and Chemical Pollution Abatement," Forensic Quarterly,
vol. 44, no. 1, 1970, pp. 8-38.
- Abraham A. Ribicoff, "The Opinion of Senator Ribicoff,"
Forensic Quarterly, vol. 44, no. 2, 1970, p. 125.
- Baldrige National Quality Program, Health Care Criteria
for Performance Excellence, available at www.quality.nist.gov/HealthCare_Criteria.htm.
- Quoted in Ribicoff.
Dominican Has Been an Environmental Leader
Dominican Hospital, Santa Cruz, CA, formed its Ecology Task Force in the late
1980s. Recycling and reduction programs for heavy-strength paper, cardboard,
and other items have been part of the corporate culture since that time. The
hospital's focus on ecology sharpened in 1995, when Sr. Mary Ellen Leciejewski,
OP, was appointed coordinator of the hospital's Ecology Program.
In 1997 Dominican Hospital became a member of Healthcare Without Harm, an
international campaign dedicated to improving the environmental performance
of the health care industry without compromising safety or care. The hospital's
purchasing policy includes buying mercury- and PVC (polyvinyl chloride plastics)-free
products whenever possible. In 2001 Dominican Hospital joined Hospitals for
a Healthy Environment (H2E).
Today, Dominican Hospital's 1,400 employees are involved in recycling paper,
cans, plastics, fluorescent tubes, batteries, and blue sterile wraps. Each year,
the facility recycles tons of plastic, paper, and cardboard, and sends medical
equipment to emerging countries. However, as Sr. Leciejewski has noted, recycling
and reusing is just one aspect of environmental consciousness. The other two
"rs"—reducing and (especially) redesigning—are also important in maintaining
a healthy planet.
For more than 11 years, the hospital has operated a store, called DominAgain,
that offers reusable hospital goods to the community at no cost. These items
include scrub brushes, blue sterile wraps, white cards for calligraphy, plastic
containers, saline solution bottles, dishes, and pails with lids.
In 1996 Dominican Hospital launched a "red-bag" waste reduction
program; the program separates regular trash from medical waste, which is more
costly to transport and process.
Since 1997, the hospital has every year won a WRAP (Waste Reduction Awards
Program) award recognizing its efforts in reducing waste and protecting the
environment.* In 2002 Dominican Hospital was one of 10 state organizations to
receive the "WRAP of the Year Award." The facility was also the recipient of
the H2E Partners for Change Award in 2002 and 2003.
"The honor is a testament to the ecological awareness, support, and hard work
of our sisters, administrators, and employees," says Sr. Mary Ellen. "That is
key in the development and progress of our ecological initiative and our mission
to improve the health of the community we serve."
*WRAP is sponsored by the California Integrated Waste Management Board.
Mercury: A Dangerous Metal
Here are some little-known facts about mercury pollution.
- A single gram of mercury can contaminate a 20-acre lake so badly as to
require the issuing of fish advisories. (One gram of mercury weighs the same
as one M&M).
- Forty states have now issued mercury advisories concerning their rivers,
lakes, and streams.
- Every year, thermometers containing about 17 tons of mercury are dumped
in U.S. landfills.
- One hundred fluorescent lamps combined contain no more than four grams
of mercury.
—From "Making Medicine Mercury-Free: A Resource Guide for Mercury-Free
Medicine," published by Health Care Without
Harm.