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Credit: Eric Millette

When it comes the environment, healthcare facilities often struggle to get a clean bill of health. According to the U.S. Department of Energy, hospitals account for 836 trillion Btu of energy per year, an amount that, according to the Energy Information Administration, accounts for 4 percent of the total energy consumed in the United States. Practice Greenhealth also estimates that hospitals generate 6,600 tons of waste per day, 80 percent to 85 percent of which is nonhazardous solid waste such as paper, cardboard, food waste, metal, glass, and plastics.

Recognizing that hospitals have a responsibility to minimize their environmental impact, six large-scale healthcare systems and organizations recently founded the Healthier Hospitals Initiative (HHI). Among the charter members is Kaiser Permanente, one of the largest not-for-profit health plans in the country that serves more than 8.6 million members. Eco-Structure recently spoke with Kathy Gerwig, vice president for workplace safety and officer of environmental stewardship for Kaiser Permanente, about how healthcare providers, both individually and collectively through initiatives like the HHI, are looking to improve their environmental footprint.

Can you tell us a bit about Kaiser Permanente’s philosophy regarding the environmental performance of its facilities?

Our efforts stem from an understanding that people need a healthy environment in order for them to be healthy. Our mission is to make our members and their communities healthier, and buildings play an enormous part in that. Buildings that are highly efficient, that are sited well, and [that] are accessible by mass transit, walking, and biking are directly connected to the health of the communities in which they operate, and that’s a fundamental point in our discussions of green buildings or any other sustainability initiatives.

We have four sustainability initiatives that all tie into green buildings in some way. They are climate and energy; safe chemicals; sustainable food; and waste reduction.

Let’s talk about your climate and energy initiatives. Has Kaiser Permanente set specific targets?

Our overall goal is to reduce our carbon footprint through two parallel means: increasing energy efficiency and reducing fossil fuel use. To address energy efficiency we’re instituting design features such as installing cooler roofs and white roofs, examining how a facility is positioned on its site, evaluating the type of window overhangs we’re using, and looking at the vegetation we have on site and how it provides shade. Then, we have a sophisticated system of building standards and templates so that if you’re building or renovating a facility and are putting in windows, we already know which windows are the most energy efficient and we have contracts in place that a team can access during construction. These standards apply to all new buildings and any existing buildings undergoing renovation.

Our goal this year is to reduce greenhouse gas emissions per gross square foot by at least 4 percent from a 2008 baseline.

In attempting to use less fossil fuel, we’re moving toward renewable energy. We’ve begun work on an extremely large solar power installation that will provide 15MW of solar over the next year. Overall, the installation will generate about 10 percent of the energy used in about 15 facilities.

[On a larger scale,] we have the goal of having 25 percent of our energy come from on-site renewable resources by 2020.

How are you addressing waste reduction?

We’ve been tracking waste reduction for about a decade and overall we estimate that total work volumes are down about 30 percent less than they would have been. Last year we adopted a program-wide waste reduction policy that mandates that each facility set a target, track its waste, and report on its performance once a year so we can be transparent about it within the organization and with our communities. This year we’re getting the system set up so we can get common metrics from each facility. It’s actually quite difficult to compare one facility to another because each uses different vendors and each recycling system is different. We’re working on getting enough data to create a baseline for everyone.

What was the impetus behind Kaiser Permanente’s involvement in the Healthier Hospitals Initiative?

We’re a big system that has a lot of experience with green building and safer chemicals and products, and the HHI provides a forum to share our knowledge. We also have a lot to learn and would love to find out how other systems have approached their work and achieved certain things. The overall impetus [for participating in the HHI] was the thought that if we’re going to change the environmental performance of the entire healthcare sector, getting some of these large systems together to share information, change practices, and improve our approaches can help move the entire marketplace. An important feature of the HHI is that we’re also partnering with three nongovernmental organizations: Health Care Without Harm, Practice Greenhealth, and the Center for Health Design. They bring an additional expertise and community of voices to the work.

How do you see the HHI operating going forward?

The first thing we’re working on is setting metrics around each of our key agenda items. Once we formalize the metrics, we’ll be tracking performance and reporting back to other HHI members. We also want to invite any hospital system or any individual hospital to pledge to work toward the agenda so that we can expand communication with other systems and work more deeply within the healthcare sector. (For specific agenda items related to building performance, see “A Prescription for Healthier Facilities and Operations,” left.)

How do you see the initiative impacting healthcare facility design and construction directly in the next 10 years?

In terms of the actual bricks and mortar, there are specific areas the HHI speaks to. We would like everyone to use the Green Guide for Healthcare for construction. We’d like them to use materials that are environmentally preferable and use the Healthy Building Network’s Pharos Project as a tool when selecting building materials. There are recommendations based on evidence-based design, a core focus of the Center for Health Design. There are recommendations to promote clean and renewable energy and on-site installations. We also want to address transportation and site issues.

One thing we haven’t talked about but I’d like to mention is the larger issue of how you deliver care and how that contributes to environmental stewardship. As an example, Kaiser Permanente has done a lot to encourage members to e-mail their doctors and connect with their providers in ways that don’t require a physical trip. Last year, patients sent 8.6 million e-mails to doctors, reducing the need for car trips to those doctors’ offices. When you think about delivery of care in the future, the greenest hospital is the one you don’t build or the one you don’t need because you’re able to offer care in ways that are not generating the environmental footprint of a traditional facility. Obviously we will still need facilities, but I think 21st century technology is going to rapidly change how we think about care delivery.


In May, HHI released the Healthier Hospitals Agenda, which outlines specific strategies participating HHI organizations should take into consideration in designing, building, and operating their hospitals. Click here to see the outline.