1. Leading the Path to Sustainability in Healthcare

2.  Describe the forces that drove the adoption of sustainable practices at Christiana Care.  Outline the process of organizing a sustainability program.  Discuss the role of Purchasing, Contracting, Materials and Logistics in the implementation of sustainable practices.  Explain the business value of a successful sustainability program.  Describe how to measure and report on progress. Objectives

3. About Christiana Care Health System  One of the largest healthcare providers in the Mid-Atlantic Region.  Serves all of Delaware and seven counties bordering the states in Pennsylvania, New Jersey and Maryland.  More than 1,100 licensed hospital beds in two hospitals.  Over 10,000 employees.  Largest private employer in Delaware, 10 th largest in Philadelphia region.

4. Christiana Care Environmental Stewardship 2005

5. Forming the Green Team  Employee initiated.  Senior leadership champion.  Senior leadership support.  Combination of department leaders and employees who have a passion for the environment.

6. Where do we start?

7. Initial Goals FY 2005  Waste reduction project – recycling, reduce medical waste.  Organize and expand current sustainable practices.

8. Annual Goal Development Process  Subcommittee develops recommendations for goals and presents to Environmental Stewardship Committee.  Committee assigns responsible individuals for each goal.

9. Committee Membership  Environmental Services  External Affairs  Facilities Engineering  Food and Nutrition Services  Infection Control  Information Technology  Nursing  Occupational Safety  Pathology and Laboratory Medicine  Patient Escort Services  Pharmacy  Purchasing  Radiology

10. Committee Goals (cont.)

11. Major Sustainability Initiatives  Wind Power Purchase Agreement  Reduce Regulated Medical Waste  Recycling  Energy and Water Reduction  Pharmaceutical Waste Program

12. Wind Power Purchase Agreement Christiana Care began Purchasing 15% of the output of the Locust Ridge II wind power facility in central Pennsylvania in January 2010.

13. Wind Power Purchase Agreement (Cont.)  Nine (9) year agreement with Iberdrola Renewables Locust Ridge II Wind Farm in Pennsylvania.  Christiana Care pays a fixed cost per kwh with no escalation over the term of the contract.  Provides 40% of the electricity needs of Christiana Care facilities – approximately 40 million kWh per year.

14. Wind Power Purchase Agreement (Cont.)  Locust Ridge is a wholly owned subsidiary of Iberdrola Renewable Energies USA (Iberdrola).  Iberdrola is a subsidiary of Iberdrola S.A., the largest wind power company in the world.

15. Wind Power Purchase Agreement (Cont.) LSE Agreement  Iberdrola is not authorized nor are they interested in selling electricity directly to end users in the PJM region.  Christiana Care has contracted with Sempra Energy to serve as the Load Serving Entity (LSE).

16. Wind Power Purchase Agreement (Cont.) Benefits  Wind energy is clean and renewable, a natural fit with health service providers.  Stabilizes a large portion of Christiana Care electricity costs.  Long-term natural price hedge that is not dependent on the cost of fossil fuel  We are helping to drive the development of a clean, renewable energy source.

17. Wind Power Purchase Agreement (Cont.) Initial Investment Required – None Cost Savings – Currently cost neutral.

18. Reduce Regulated Medical Waste Vendor Contract  Reusable Sharps Containers Consultant Services  Reusable storage containers for red bag waste  Training

21. Reduce Regulated Medical Waste (Cont.) Initial Investment Required - $0 54% reduction in Medical Waste Cost Savings - $230,000 per year

22. Reduce Regulated Medical Waste (Cont.)

23. Recycling Program  Paper  Cardboard  Plastic Bottles  Glass Bottles  Cans  Fluorescent Lamps  Solvents (Xylene and Ethanol)  Motor/Lubricating Oil  Cooking Oil/Grease  Rechargeable Batteries  Electronics

24. Recycling Program (cont.)

25. Recycling Program (Cont.) Initial Investment Required $60,000 Recycling Cost Savings  Commingled Recycling/Cardboard - $33,000/yr  Solvents (Xylene and Alcohol) - $27,000/yr

26. Recycling Program (Cont.)

27. Energy and Water Conservation Consultant Services  Building energy assessment.  Water and energy conservation assessment and project development.

28. Energy and Water Conservation (Cont.) Recent Energy Reduction Initiatives  Replacement of original chillers and cooling towers.  Occupancy sensors for lighting.  Night/weekend setback controls.  Window replacement project at Wilmington Hospital.

29. Energy and Water Conservation (Cont.) Business Plan for Major Water and Energy Reduction Project  Replacement of toilets, retrofits of urinals, laminar flow restrictors on faucets.  Sterilizer condensate tempering systems.  Replacement of water cooled compressors on refrigeration systems.  LED lighting  Induction lighting systems.

30. Energy and Water Conservation (Cont.) Water and Energy Conservation Business Plan  Cost – $2 Million  Simple payback – 3.6 years  Will result in a reduction in water use of 20 million gallons/year.

31. Pharmaceutical Waste Program  Developed PARE program (Pharmaceutical Waste Reduction Effort).  Developed by subcommittee of the Environmental Stewardship Committee.  Cooperative effort among Occupational Safety, Pharmacy, Nursing, Environmental Services and others.

32. Pharmaceutical Waste Program (Cont.) Addresses the following:  EPA regulated substances.  Pharmaceuticals which we have determined should be treated as a regulated substance.  Expired pharmaceuticals that cannot be returned to the pharmacy for credit.

33. Pharmaceutical Waste Program (Cont.) Profile lists maintained at container.

34. Measuring Progress

35. Measuring Progress (Cont.)

36. Community Involvement Community Medication Take-back Events Action Taken – Hosted two medicine cabinet cleanout events for the community in cooperation with the Delaware Nurses Association Investment Required – Less than $1,000 per event

37. Community Involvement (Cont.)  Delaware Valley Green Building Council  City of Wilmington Energy Leaders Roundtable  One of the first businesses in the City of Wilmington to sign the Climate Change Pledge.

38. Employee Involvement Environmental Champions  50 volunteers representing nursing units and departments  Quarterly lunch meetings  The ambassadors for the Environmental Stewardship program

39. Employee Involvement (Cont.) Earth Day Activities  Local nurseries donated trees for the Christiana Hospital Campus which were planted by employees.  The Environmental Stewardship committee and Environmental Champions also planted a 3000 square foot employee vegetable garden.  Cafeterias served special “earth friendly” menus.

40. Employee Involvement (Cont.) Earth Day

41. Recognition  Practice Greenhealth Awards – 2010 - Partners for Change with Distinction award.  Delaware Valley Green Building Council Business Leadership Award. - 2010  EPA Region III Trailblazer award 2009.

42. Communications  Employee newsletter articles – Focus  Press release and media interviews on wind power purchase agreement.  Local newspaper article on green initiatives in hospitals.

43. Communications (Cont.) Marketing

44. Communications (Cont.) Annual Report

45. Current/Future Initiatives  Achieve a recycling rate greater than 25%.  Purchase safer and more sustainable products when economically feasible.  Initiate a composting program.  Pursue LEED certification for one or more buildings.  Promote environmental health literacy internally and through community programs.

46. Questions?