Sustainability Practices in Hospitals

CATEGORIES

EXAMPLES OF PRACTICE

STRATEGIC MANAGEMENT AND LEADERSHIP

1. Establishment of a strategic plan.

2. Development of ‘green’ policies and plans.

3. Executive support.

4. Use of indicators and measurement systems to assess costs and performance.

5. Involvement of clinical and non-clinical staff in decision-making.

SUPPLIER MANAGEMENT

1. Supply base rationalisation.

2. Sharing information with suppliers related to material flow management (forecasts, planned consumption, inventory, costs, promotions, and performance).

3. Inclusion of environmental, economic, and social dimensions in supplier arrangements.

4. Selection of ISO 14000-certified suppliers.

5. Work with suppliers to innovate and improve availability of sustainable products.

6. Assessment of suppliers´ sustainability and ethical practices.

7. Knowledge sharing and transfer (improvements, special handling requirements, good practices, technical issues, management solutions, and new product planning and development).

8. Payment control (enhanced control of payments to suppliers focused on preventing delays).

PURCHASING MANAGEMENT

1. Supply standardisation.

2. Use of purchasing groups.

3. Alliances between hospitals for the purchase of common items (aggregating purchasing volumes) to attain lower prices and avoid monopolies.

4. Use of life-cycle analysis to assess the environmental impacts of procured items.

5. Considering the environmental and human rights impact of procured products.

6. Purchasing of reusable, rather than disposable, products.

7. Eliminating, minimising and substituting chemicals for safer alternatives.

8. Coordination between hospitals to increase buying power for economic, environmental, and ethical purposes.

WAREHOUSING AND INVENTORY MANAGEMENT

1. Determination of quantity to order and reorder points based on information systems.

2. Development of collaborative arrangements with trading partners to manage inventory of functional products (non-critical medical supplies) with high and stable demand (vendor-managed inventory, CPFR, outsourcing).

3. Use of hybrid stockless systems (high-volume products are delivered directly to points of care and low-volume products are delivered to the central store).

4. Stores consolidation and deployment of a centralised replenishment system for nursing units.

5. Deployment of a two-bin system.

TRANSPORTATION AND DISTRIBUTION MANAGEMENT

1. Consolidation of inter-site transport system.

2. Consolidation of external transport.

3. Promotion of active travel.

4. Promotion of public transport use.

5. Promotion of shared-occupancy vehicle use.

6. Use of alternative fuels and technologies.

7. Development of services to minimise travel (e.g., telehealth, home healthcare, and videoconferencing).

INFORMATION AND TECHNOLOGY MANAGEMENT

1. Use of information systems and technologies in interactions between hospital departments.

2. Internal joint initiatives regarding product availability improvement and logistics cost reduction.

3. Deployment of e-commerce systems.

4. Use of track-and-trace systems (e.g., barcodes, RFI).

5. Collaboration among supply partners using pharmacy information systems.

6. Automated central stores.

7. Use of automated guided vehicle systems for the transportation of pharmaceuticals, meals, linen, waste, patient files, tests results, lab tests, blood samples, and non-stock purchases.

8. Use of supplier relationship management system for the interaction between hospitals and their suppliers.

ENERGY MANAGEMENT

1. Implementing initiatives for savings (e.g., conducting periodic audits, installing variable-speed drive fans for operating theatres, automatic lighting timers and sensors, updating lighting to LED).

2. Use of alternative technologies (e.g., cogeneration: combined heat and power).

3. Shifting to cleaner fuels.

4. Applying Lean Six Sigma approach to optimise a hospital linen distribution system.

5. Implementing social marketing interventions (turning off machines, lights out when unnecessary, closing doors when possible).

WATER MANAGEMENT

1. Implementing initiatives for savings (auditing usage, controlling leaks, installing flow restrictors and dual-flush toilets, use of drought-resistant plants, reclaiming water from services such as dialysis and sterilisation, harvesting rainwater).

2. Switching from film-based radiology to digital imaging.

FOOD MANAGEMENT

1. Serving locally grown and organic food.

2. Integrating the nutritional care pathway, nutritional standards, and regional menu framework.

3. Purchasing sustainable products (rBGH-free, cage-free eggs, meat produced without hormones or antibiotics, certified organic and fair-trade coffee).

4. Identifying and working with small, local vendors to achieve healthy food goals.

5. Limiting meat consumption.

6. Applying tariffs to reduce prices for more sustainable choices (e.g., vegetarian meals) and maintaining higher prices for less-sustainable options (e.g., high-fat dishes).

7. Recycling (fat, oil, grease, cardboard, paper, batteries, plastic, aluminium, newspaper, and tin cans).

8. Composting.

HOSPITAL DESIGN

1. Flow-through design (design for product, information, and people flow).

2. Integrated nursing workstations.

3. Building and adapting facilities considering sustainability criteria (using safer materials, local and regional materials, locating hospitals near public transportation routes, planting trees on site, incorporating design components such as day lighting, natural ventilation, and green roofs).

4. Application of sustainability healthcare-building assessment tools (e.g., BREEAM, LEED, and CASBEE).

WASTE MANAGEMENT

1. Addressing over-treatment and implementing methods like social prescribing.

2. Development of processes that use less material and improved technology.

3. Proper segregation.

4. Recycling.

5. Use of alternatives to incineration.

6. Setting of criteria and procedures regarding reverse logistics.

7. Take-back programmes of pharmaceuticals for patients and communities.

8. Applying Lean Six Sigma.

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STAFF AND COMMUNITY BEHAVIOUR

1. Hire/train well-qualified professionals.

2. Encouraging critical thinking to understand, adopt, and promote sustainability initiatives.

3. Education of staff and community on sustainability.

4. Joint initiatives with the community for disease prevention and environmental health.

5. Collaboration with stakeholders to address environmental problems and develop plans to improve sustainability.

OTHER
PRACTICES

1. Quality management practices (quality policy, employee training, product/service design, supplier quality management, process management/operating procedures, quality data and reporting, employee relations).

2. Patient flow logistics (cross-functional or cross-organisational teams, information technology support, format standardisation for information sharing, meetings focused on both medical and inter-organisational integration issues, and application of lean and agile approaches).