Hospitals Leading a Sustainable Charge: Q&A With Gary Cohen, Founder of the Healthier Hospitals Initiative
However, their reputations have started to change significantly in the past several years thanks to new sustainability measures. For example, Gundersen Lutheran Health System in La Crosse, Wis., plans to be completely energy independent by 2014. Baptist Health South Florida in Coral Gables has undergone a "comprehensive green" strategic overhaul.
Hospitals and health systems have started to become leaders in the greening of the economy and the sustainability of the environment, mostly because they have had to become leaders, says Gary Cohen. Mr. Cohen is the founder and president of Health Care Without Harm, an international campaign for environmentally responsible healthcare, and in April, he started another project: the Healthier Hospitals Initiative.
He and others — including non-profits HCWH, Practice Greenhealth and the Center for Health Design — launched HHI this past April so hospitals and health systems could finally have legitimate benchmarks and means in order "to do no harm" across the entire sustainability spectrum. Some of the largest health systems in the country have already signed on with HHI — Dignity Health in San Francisco, Hospital Corporation of America in Nashville, Tenn., Kaiser Permanente in Oakland, Calif., Partners HealthCare in Boston, Tenet Healthcare in Dallas and many others.
Here, Mr. Cohen talks about why HHI has become such an integral part of the hospital sector's business plan, how hospitals can improve their environmental responsibility and why healthcare needs to be sustainable from an ecological point of view.
Question: HHI broke onto the healthcare scene earlier this year, and you wrote about your organization in the Huffington Post, essentially explaining how it's a nationwide campaign for hospitals and health systems to improve their environmental health and sustainability. What actually gives the organization its teeth, and can you describe the objectives a bit further in detail? What spurred you to do this?
Gary Cohen: What spurred us was that Health Care Without Harm, along with Practice Greenhealth, had been working in sustainability for the past 16 years. We've been bringing different programs to the forefront — less waste, safer chemicals, environmentally preferable purchasing, sustainable building design, healthier food, energy efficiency and engaged leadership. As we introduced them, there was adoption of each program by 200 hospitals, 400 hospitals or 1,000 hospitals — so it's very uneven. We found, generally, that hospitals weren't outlining a comprehensive vision of what sustainability may mean in healthcare delivery. They also weren't measuring sustainability metrics in a consistent manner.
The point of HHI is threefold: First, develop a comprehensive agenda around sustainability that can be embraced by major hospital systems and then the rest of the hospital sector. Second, develop measureable objectives in which hospitals could be working together to meet, and they would agree on how to measure those objectives. Third, offer the opportunity to travel down the sustainability road for every hospital in America free of charge. We want to move the whole sector to embed sustainability as a core business practice and eventually enroll 2,000 hospitals, which is one-third of the marketplace.
We actually built our model after the 100,000 Lives Campaign from the Institute of Healthcare Improvement. Essentially, that campaign said we are killing patients through errors and poor quality, and if we implement six interventions, there will be less hospital-acquired infections, less medical errors and less harm to patients. We thought that was a fantastic model because it really brought patient and quality into the center of operations. We see HHI as the next phase of that quality journey by integrating environmental health into healthcare's core business strategy.
Q: Don Berwick, MD, former CMS administrator, is the figurehead of the Triple Aim — improved healthcare outcomes, better quality and lower costs. It seems as though the Triple Aim and HHI have some overlap. How does the HHI fit within the Triple Aim, especially within the costs portion?
GC: What we've realized is that a number of innovations in healthcare sustainability save hospitals lots of money. When they reduce their waste, they save a lot of money. When they reduce energy intensity and bring more efficiency into their design and operation, they save a lot of money. Instead of throwing away all their medical devices, hospitals could send them to be re-sterilized then buy them back, and they save a fortune. What we've found is that sustainability measures can save hospitals at a time when they are completely strapped for cash and are trying to reduce waste in the system.
Because of the [Patient Protection and] Affordable Care Act and broader push toward population health, this has created a really powerful opportunity for sustainability. It's not just about what you're doing inside your hospital but also how you're providing leadership to reduce chronic disease in your population.
One of the important transformations in healthcare is the realization that we can't have an entire system focused on treating chronic diseases at the same time that reimbursement rates are going down. We will bankrupt the system. If obesity rates go up to half of the population by 2030, and hospitals won't get reimbursed for all treatment, the system cannot sustain itself. We have to address the environmental and social conditions that contribute to the epidemic of chronic disease in our society.
It's a great moment of awakening for healthcare. If you are a hospital and are concerned with obesity and changing the food environment of your facility, for example, you could also sponsor farmer's markets and utilize purchasing orders to support local and sustainable agriculture. Healthcare can be a major anchor in the community for supporting a healthier local and regional economy. Additionally, reducing healthcare's reliance on coal to fuel hospitals and clinics also has collateral health co-benefits, as it could lead to reduced asthma rates and other climate-related health impacts.
Q: How were you able to get such large hospitals and health systems on board?
GC: We've been working for quite a long time with several systems. Kaiser Permanente and Catholic Healthcare West [now Dignity Health] — those relationships span 16 years with HCWH and Practice Greenhealth. When they were getting their own sustainability coordinators, we were just getting started as an organization. We've collaborated for quite a long time with Partners HealthCare in Boston and Advocate Health Care in Chicago and MedStar Health in Baltimore. Once we had a critical mass of six sponsoring systems, then we were able to attract a lot of other systems, including some of the big for-profit systems. Once you see a lot of the biggest health systems under one tent, you want to be under that tent, too.
Q: How does HHI plan on recruiting more hospitals to become part of the initiative? If I'm a hospital or health system executive out there, what are some of the other advantages to this?
GC: We started with about 500 hospitals that were the sponsors. We're up to about 700 hospitals. We've reached out and gotten support from the Michigan Health & Hospital Association and have pending support from the California Hospital Association, both of which represent significant numbers of hospitals. Those types of organizations can be disseminators and recruiters. We're also using outreach partners such as the Catholic Health Association of the United States, children's hospitals, and some of the group purchasing organizations like Novation and Premier, which have networks of more than 1,400 hospitals each. The Obama administration sponsored us at a White House event in July.
There's something for everyone here: improved patient and public health, cost savings, improved operational performance and environmental improvement. Another dimension is that there's a lot of focus on purchasing and driving the marketplace to an accelerated adoption of safer and environmentally preferable products.
One of the objectives in the purchasing component is the more hospitals you have, the faster the marketplace is going to adapt to meet this demand. For example, there's a broad agreement we should move away from PVC plastics and the chemicals that leach out of those plastics. DEHP [a plasticizer used in the making of PVC] doesn't bond to the plastic, so when you infuse a patient, it leaches out of the IV bag or tubing into the patient. The U.S. National Toxicology Program has said it's a reproductive toxin. Treating patients, especially vulnerable patients, with this reproductive toxin makes no sense whatsoever. There are alternatives on the market, so this is about moving the market away from this product toward safer plastics in IV systems. My prediction is that over the next several years, there will be a broad move away from PVC plastics in medical devices. And by having this large purchasing power, you'll see that transformation happen.
Q: Overall, where do you see hospitals and health systems fitting in these types of efforts to combat climate change and move toward a greener economy?
GC: I think we need healthcare to model the kind of transition from an economy addicted to fossil fuels and toxic chemicals to one focused on more sustainability of life on the planet. Healthcare is in a unique position to lead the effort toward a sustainable economy precisely because of its mission "to do no harm." Healthcare also represents up to 18 percent of our total economy, so this is a way of repositioning healthcare to see itself in the broader ecology of the communities they serve and to be a force for healing.
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