BY: JULIE MINDA, RN, MS
Ms. Minda is a communications specialist, Catholic Health Association St.
Louis.
To Be Effective, Ecology Programs Need the Support and Involvement of Management
and Staff
The Catholic health care ministry is called to protect the well-being of community
members; in accordance with this mission, it must ensure that it is not harming
people's health—directly or indirectly—by degrading the environment.
As research reveals the many ways that environmental health affects
human health, Catholic facilities are recognizing that they must attend
not only to the medical needs of their patients; they must also examine their
own impact on the environment to ensure that they are not having a negative
effect on their communities.
"Within hospitals, we have been slow to realize that ecology is part of our
mission," said Sr. Janet Corcoran, OSF, vice president, mission services, Marian
Medical Center, Santa Maria, CA. "We are now seeing that we are called to be
stewards of God's creation, to honor and respect the sacredness of creation."
Sr. Janet explained that in the past, most hospitals were not very engaged in
environmentalism. "Now we're starting to look at ourselves," she said.
Once a facility has examined its environmental impact and determined that
it is harming the health of its communities through pollution, its administrators
must dedicate themselves to making real and significant changes in the way they
operate, according to those who are now leading ecology initiatives in Catholic
health care facilities.
Pierre Gonyon, hazardous substance specialist, safety department, Saint Joseph
Mercy Health System, Ann Arbor, MI, said his facility uses a six-step process
to develop its mercury-reduction initiative and other environmental programs.
Through them, the facility:
- Builds support for its ecological initiatives among managers and staff
- Evaluates the organization's operations, identifying environmental problem
areas
- Develops solutions for each problem
- Writes policies to support the needed changes
- Communicates with staff about the new initiatives
- Implements the solutions
As Gonyon moves through the facility conducting this process, he assembles
an ad hoc environmental team for each affected department. In this way, he ensures
that staff members who will be involved in or touched by the initiative are
represented on the team.
Building Support
To secure facility-wide support for new environmental programs, ecology
teams must build relationships with staff members of the departments likely
to be affected. It is especially important to get "buy-in" from the
facility's administrative team, medical staff leaders, safety committee, and
the supply chain management department, Gonyon said. During this phase of planning,
the ecology team also should identify clinicians who are especially supportive
of environmental initiatives. These individuals can serve as "champions"
of the program.
"It is essential to get support early on," Gonyon said. Agreeing, Sr. Janet
emphasized that the support of the organization's leadership team is key to
ensuring the success of environmental programs. "Our president, Charles Cova,
is encouraging and supportive of our environmental initiatives," she said. "That's
where it all starts."
Evaluating Operations
Once the environmental initiative has received the backing of key departments,
the organization must begin a comprehensive assessment of the facility's operations
in order to identify areas of concern.
It is best to begin this phase with a plan outlining which departments will
be evaluated and how the assessment will take place. Some facilities use surveys,
others use check-off lists, and still others hold face-to-face meetings and
area inspections to determine what products the department is using and how
these materials are processed after use. The assessment should be a collaborative
process.
Gonyon made collaboration a priority in spearheading a mercury-reduction effort
at Saint Joseph Mercy. Because mercury has been shown to be harmful to humans,
animals, and other life forms, many health care providers are eliminating the
element from their facilities or at least reducing its use. From the outset,
Gonyon's team engaged staff members of the affected departments in planning
for the mercury-reduction initiative. Patient care units, the laboratory, the
pharmacy, and maintenance were some of the Saint Joseph Mercy departments involved.
Departments on the main hospital campus, as well as those at satellite facilities,
leased spaces, and other off-site locations, were included in the discussions.
During the assessment phase, Gonyon and the ad hoc team evaluated various
pieces of medical equipment, such as thermometers, sphygmomanometers, and gastrointestinal
tubes; devices such as thermostats, fluorescent lights, and barometers; and
chemicals—ranging from lab test reagents to housekeeping cleansers to vaccines—to
identify mercury sources.
Developing Solutions
Once a facility's environmental team has conducted a thorough assessment
of the organization's handling of materials and has identified opportunities
for improvement, it must work with each department involved to develop new approaches.
During this phase, the team should look at the entire life cycle of the products
used at the facility—from creation to use, and from use to disposal—to determine
whether those products are environmentally friendly. The team can meet with
vendors, set up product evaluations, conduct Internet research, and use other
methods to identify alternatives to harmful products. Once safe alternatives
are identified and implemented, the purchasing department must block any further
purchase of the hazardous product.
"Now there is so much information available on environmentally friendly
products," said Gonyon. "There are many alternatives, many very good
products." He noted that the Hospitals
for a Healthy Environment website provides an extensive amount of information
on alternatives to health care products containing mercury and other hazardous
substances. "Chances are good that less hazardous products will cost less
and also save the organization money on disposal costs," Gonyon said. "Environmentally
friendly solutions are often cost-effective," concurred Sr. Janet. "They
save money."
In addition to helping identify products to be "switched out," the environmental
team also can assist departments with reducing waste through recycling, reuse,
and other methods. A cost-benefit analysis should be conducted as solutions
are evaluated. Savings related to reduced waste should be figured into these
calculations. When Saint Joseph Mercy's departments assessed product alternatives
during the mercury-reduction initiative, for instance, they did not look at
the "sticker price" of items alone. They also calculated the cost of recycling
or disposing of products, training staff to use materials, and recalibrating
or repairing equipment.
Creating Policies for Change
After identifying alternatives to environmentally unsafe practices and products,
the ecology team must develop a transition plan for implementing the needed
changes. New policies and procedures must be documented in a written policy
that is supported by the facility's leadership team.
When Saint Joseph Mercy launched its mercury-reduction initiative, for example,
Gonyon and his ad hoc team wrote procedures for controlling staff exposure to
the substance, for avoiding spills, and for handling the contaminated waste
during the transition. The team also put in place a policy to ensure that materials
management staff would avoid purchasing products containing mercury. In addition,
the team developed protocols to ensure that, if and when Saint Joseph Mercy
buildings are demolished, mercury in them will be contained. For instance, demolition
contractors will be required to identify mercury-containing items, such as thermostats
and plumbing traps, and ensure that they are collected and properly disposed
of before demolition occurs.
Gonyon and the team also created a phase-out plan for replacing products containing
mercury with mercury-free alternatives.
Communicating with Staff Members
Informing staff members throughout the facility of new environmental programs
is essential to ensuring compliance, Gonyon said. Management teams, safety committees,
physicians, and other staff members must have a clear understanding of how their
departments will be involved in implementing environmental plans. "You
don't want to just show up and take their old devices without letting them know
in advance," Gonyon explained. "Change is disruptive. You need to
communicate why the change is important."
Training sessions, open meetings, and newsletter updates are a few of the
ways environmental team members can keep staff members informed of the status
of implementation. Periodic updates are necessary even after an environmental
program is well underway.
Ongoing training and communication not only keep ecology initiatives on track,
they also can bring about broader cultural change in a facility. "Through education,
we're trying to move people to be more respectful of the Earth," said Sr. Janet.
Implementing Plans
As plans to reduce or eliminate hazards are implemented, the environmental
team should maintain contact with the materials management and safety teams
and with the other involved departments to ensure that product phaseouts and
replacements happen smoothly, new procedures are effective, and patient care
is not disrupted. Solutions can be tweaked if concerns are raised. When Saint
Joseph Mercy implemented its mercury-reduction plan, Gonyon worked closely with
affected departments, helping them recycle old materials and train staff to
use new products.
If environmental teams secure the support and resources they need, they will
develop a culture of environmental awareness that permeates their facilities.
At organizations with this type of culture, environmental responsibility is
a priority; it is tracked and measured, and every department is held accountable
for addressing it.
"As health care providers, we need to be concerned about environmental health,"
said Sr. Janet. "We can't sit back. We must keep challenging ourselves to do
better."
Environmental Responsibility and Catholic Health Ministry
Catholic health care facilities are using a variety of approaches to reduce
their negative impact on the environment. Among these efforts are:
- Reducing or eliminating mercury and setting up "roadblocks" to the ordering
of mercury and other hazardous materials by their purchasing departments
- Recycling batteries, toner cartridges, aluminum cans, paper, cardboard,
florescent light tubes, and other products
- Discontinuing waste incineration
- Ensuring that construction and demolition projects are handled in an ecologically
sound manner. For instance, some facilities are using a demolition "checklist"
to ensure that mercury-containing devices and other hazards are disposed of
properly
- Arranging buy-back and reuse programs with vendors to reduce the amount
of discarded product
- Implementing a utility-management initiative in which water and electricity
use is maximized
- "Adopting" local parks and roadways for clean-up and beautification
- Composting "green waste"
- Observing Earth Day in April, hoping thereby to involve employees and community
members in environmentalism