1. Julie Moyle, MSN, RN Outreach Specialist Healthier Hospitals Initiative Introducing the Healthier Hospitals Initiative Katie Holmes, RN Senior Vice President, Operations and Membership Washington State Hospital Association

2. Goals and Objectives Understand why Sustainability is important to Health Care. Understand HHI and how to use it at your hospital/health system. Review the details of each challenge and examples of how hospitals successfully implemented each challenge. Understand the resources of HHI and how to enroll in this free initiative.

3. How does Sustainability fit into Health Care? First, Do No Harm Climate Change is a public health issue Centers for Medicare and Medicaid Services (CMS) Triple Aim - Better Care, Better Health, and Lower Costs Affordable Care Act provisions – population health outcomes Patient HealthCommunity HealthEmployee Health

4. Health Care Sector – Some of the Facts – $8.3 billion on energy each year Produces over 30 lbs. of waste per bed/per day 20-30% of a hospital’s waste stream from the OR alone Nurses & EVS staff have highest work related asthma

5. Sustainability: More than a Blue Bin by the Copier SUSTAINABILITY Quality Safety and Risk Management Patient Experience Employee Engagement and Wellness Community Relations and Benefit Environmental Impact and Climate Preparedness Cost Savings Mission, Ethics, Hippocratic Oath

6. Your hospital Green Team

7. Healthier Hospitals Initiative Goal is to enroll 2000 hospitals FREE for all enrollees Modeled after IHI 100,000 Lives Campaign Acceleration strategy at the intersection of sustainability, patient and worker safety Using proven strategies to drive success Milestone Report a POWERFUL evidence-based story to tell

8. HHI Enrolled Hospitals 1118 enrolled hospitals as of 9/17/14 34 Washington hospitals/health systems already enrolled in HHI Statewide representation Urban & rural hospitals

9. HHI Overview

10. Engaged Leadership The furthest reaching sustainability programming has leadership support, demonstrated by environmental charters, reporting structure and goal setting that recognizes the importance of continuous environmental quality improvement for the long term.

11. Baseline: Sign an Executive Commitment statement Level 1 – 3 activities Level 2 – 6 activities Level 3 – 10 activities Engaged Leadership Strategic Priority: Create a strategic sustainability plan Create a Mission statement/Guiding principle/charter Operational Focus: Create sustainability responsibilities within the organization Create an environmental steering committee with regular meetings Systematic Communication: Communicate progress on sustainability initiatives to the board Report progress regularly on sustainability initiatives to leadership team Stakeholder Engagement: Participate in programs to support employee and community engagement Educate all employees, including entering employees, about sustainability

12. Healthier Food Use your purchasing power to model healthy food procurement and consumption by serving healthier food to your patients and staff. WA Results: University of Washington Medical Center Overlake Hospital & Medical Center

13. Healthier Food Baseline: Sign HCWH Healthy Food Pledge Level 1 – Commit to one Level 2 – Commit to two Level 3 – Commit to all three Balanced Menus Challenge Decrease amount of meat purchased by 20 percent within three years from baseline. (meat = beef, pork, poultry and lunch meat; measure = lbs.) Healthy Beverages Increase the percentage of healthy beverage purchases by 20 percent of total beverage purchases annually OR achieve healthy beverage purchases of 80 percent of total beverage purchases Local and/or Sustainable Foods Increase the percentage of local an/or sustainable food purchases by 20 percent annually OR achieve local and/or sustainable food purchases of 15 percent of total food dollar purchases

14. Leaner Energy HHI hospitals are conserving energy and reduce emissions to benefit patients, staff and local communities. WA Results: Kittitas Valley Community Hospital Providence Health and Services

15. Leaner Energy Regulated Medical Waste Reduction Reduce regulated medical waste to less than 10 percent of total waste or less than three pounds per adjusted patient day Recycling Achieve a 15 percent recycling rate Construction and Demolition Diversion Achieve an 80 percent recycle and diversion rate for major renovations and new construction Baseline: Participate in ENERGY STAR Portfolio Manager to track energy use and GHG emissions Level 1 – 3% reduction Level 2 – 5% reduction Level 3 – 10% reduction (or >75 ES) Level 1 Reduce greenhouse gases by decreasing weather-adjusted energy intensity from metered energy use by three percent from baseline. Level 2 Reduce greenhouse gases by decreasing weather-adjusted energy intensity from metered energy use by five percent from baseline. Level 3 Reduce greenhouse gases by decreasing weather-adjusted energy intensity from metered energy use by ten percent from baseline OR if facility is already an ENERGY STAR rated facility (> 75), maintain ES status.

16. Less Waste This challenge offers win-win strategies that produce annual cost savings and contribute to improved community benefit. WA Results: Evergreen Health Naval Hospital Bremerton Virginia Mason Medical Center

17. Less Waste Regulated Medical Waste Reduction Reduce regulated medical waste to less than 10 percent of total waste or less than three pounds per adjusted patient day Recycling Achieve a 15 percent recycling rate Construction and Demolition Diversion Achieve an 80 percent recycle and diversion rate for major renovations and new construction Baseline: Collect baseline data on recycling, RMW, hazardous waste and solid waste Level 1 – Commit to one Level 2 – Commit to two Level 3 – Commit to all three

18. Safer Chemicals Scientific research shows that exposure to hazardous chemicals found in the environment, our homes and workplaces increases the risk of various diseases in the general population. “DEHP-Free IV bags are in line with Dignity Health’s commitment to improving the health and safety of patients, staff and the community.” Sister Mary Ellen Leciejewski, Dignity Health Ecology Coordinator

19. Safer Chemicals Baseline: Virtual elimination of mercury Level 1 – Commit to one Level 2 – Commit to two Level 3 – Commit to all three Green Cleaning Purchase 90 percent Green Seal or EcoLogo certified cleaning products in these four categories: carpet, window, all purpose, and bathroom. DEHP/PVC Reduction Eliminate DEHP/PVC from at least one product line. Healthy Interiors Ensure that 25 percent of the annual volume of freestanding furniture and medical furnishings purchases based on cost eliminate the intentional use of halogenated flame retardants, formaldehyde and PVC

20. Smarter Purchasing By selecting products with reduced environmental impact, hospitals can positively affect their environment and reduce their costs. Fairview Health System – Operating Room Kit Reformulation

21. Smarter Purchasing Surgical Kit Review Review at least 30 custom Surgical O.R. kits or 90% of O.R. kit types, whichever is greater in efforts to eliminate unneeded materials Reprocess Single-Use Medical Devices Increase procurement of reprocessed FDA-eligible SUDs by 50% (based on dollar expenditure) Electronic Products Environmental Assessment Tool (EPEAT) Specify and report expenditures on EPEAT registered devices Baseline: Pledge to support GPOs using environmental criteria for purchasing products Level 1 – Commit to one Level 2 – Commit to two Level 3 – Commit to all three

22. Washington Hospitals Enrolled in HHI by Challenge (n=34)

23. 34 WA Hospitals Enrolled in HHI All 6 HHI Challenges: Seattle Children’s Hospital Virginia Mason Medical Center Harborview Medical Center 2 or more HHI Challenges: Whidbey General Hospital Madigan Army Medical Center Providence St. Mary Medical Center Franciscan Health System: (Engaged Leadership & Leaner Energy) St. Clare Hospital St. Francis Hospital St. Joseph Medical Center St. Elizabeth Hospital St. Anthony Hospital PeaceHealth Farmer’s market at Virginia Mason

24. 34 WA Hospitals Enrolled in HHI Leaner Energy Challenge: Ascension Health: Lourdes MC Providence Health System: Colby Campus Holy Family Hospital Mt. Carmel Hospital Sacred Heart Medical Center Saint Joseph’s Hospital Little Company of Mary Hospital Providence Pacific Pavilion Holy Cross Medical Center Seward Medical Center Centralia Hospital St. Peter Hospital Healthier Food Challenge: Seattle Cancer Care Alliance UW Medical Center Overlake Medical Center Evergreen Healthcare Group Health PeaceHealth Farm direct purchasing at the University of Washington Medical Center

25. KC CHNA Workgroup Action In 2013, the King County Community Health Needs Assessment Workgroup asked: KC hospitals to sign the Healthy Food in Health Care Pledge in 2013 (complete) KC hospitals to take HHI’s Healthy Beverage Challenge in 2014 (in progress) for a King County Hospitals Healthier Community

26. HHI Resources How-To Guides Webinars & Sharing Calls Mentor Program Discussion Forums Case Studies Spark Newsletter Marketing and Publicity Toolkit

27. Strength in Numbers The 2013 HHI Milestone Report summarizes the initiative’s first year of progress, with over 1,000 hospitals committed to HHI and more than 630 contributing to the data pool. Here are some of the incredible accomplishments: 27 $42 million spent on healthy beverages $45 million in savings resulting from single-use medical device reprocessing $24 million spent on local/sustainable food options $62 million spent on DEHP/PVC free medical products

28. Join us in building a healthier future

29. Next Steps Provide support for your team and commit today to joining HHI. Connect with Julie Moyle, jmoyle@healthierhospitals.org, 720-273-4776jmoyle@healthierhospitals.org Need hospital address, main contact person, and at least one challenge committed to of the six challenges