People, Planet, Profit

The Triple Bottom Line

The simultaneous pursuit of economic prosperity, environmental quality and social equity are the underlying goals of environmental stewardship. This is also described as “People, Planet and Profit.” This term was coined in the 1990s by John Elkington as an accounting framework for businesses that considers social and environmental impacts as well as financial performance. The Triple Bottom Line requires a balance of financial, environmental and social benefit for a project or program to be sustainable.

Ascension’s Quadruple calls us to improve health outcomes, enhance the patient and provider experience, and make healthcare delivery more affordable.

The Triple Bottom Line combined with the Quadruple Aim creates the framework for the Environmental Stewardship Program hosted by Medxcel and deployed across Ascension.

We have a moral imperative to care for the earth. Sustainability incorporates Catholic Social Teaching elements of concern for the environment:

• Concern for the environment calls us to respect human life and dignity.
• As the world becomes increasingly interdependent, we have a call to promote the common good and the virtue of solidarity.
• In caring for the environment, we have a special responsibility to the poor and vulnerable, who are the most affected and least heard.¹

Managing Climate Change

Climate-Smart Healthcare

Source: Climate Effects on Health; CDC

Climate change is increasingly a focus of discussion in healthcare, given that healthcare accounts for about 10 percent of U.S. greenhouse gas emissions. Furthermore, natural disasters such as hurricanes, ice storms, floods, tornadoes, extreme heat and deep snow occur in the regions where Ascension facilities are located. Hospitals are anchor institutions that must be resilient and remain functional, especially after a severe weather event.

Reports from the United Nations² and the Centers for Disease Control³ describe how climate change directly and indirectly affects patients’ well-being. Increases in extreme weather events, poor air quality and transmittable illnesses threaten human health. Extreme events can also disrupt the delivery of health services, potentially leading to further impacts on human health.

Several recent developments demonstrate Medxcel and Ascension’s commitment to develop climate-smart healthcare.

• Ascension pledged to support collaboration for One-STL regional greenhouse gas reduction targets in St. Louis as part of a regional partnership to strengthen the economy, improve public health and advance climate action.
• Ascension endorsed the Health Care Climate Challenge to commit to climate change mitigation, resilience and leadership solutions and to set a greenhouse gas emissions reduction goal.
• Ascension signed the “We Are Still In” declaration as part of the healthcare sector in support of the Paris Climate Agreement – We, the undersigned... are joining forces to declare that we will continue to support the 2015 Paris Agreement to combat climate change, adapt to its effects, and intensify the actions and investments needed for a sustainable low carbon future.

“Climate change is a global health emergency that disproportionately impacts the poor and vulnerable. As a healthcare leader, Ascension became a founding member of the Health Care Climate Council of 18 health systems in 2014 to address the health impacts of climate change and to help our facilities become anchors for resilient communities. This is in line with our Quadruple Aim as well as Ascension’s Mission to improve the health of individuals and communities.”

Seven elements of a climate-friendly hospital

Source: Healthy Hospitals – Healthy Planet – Healthy People; World Health Organization, Health Care Without Harm

Waste Management in Healthcare:

Current State

Source: RecycleResponsibly.org

Recycling is top of mind for operations managers and individual consumers in recent months. In July of 2017, China stopped accepting most post-consumer plastics and paper, including that exported from the United States. Fortunately, healthcare plastics are extremely suitable for recycling due to their high quality, stemming from strict production regulations. In addition, paper and plastics used in clinical areas are clean and typically sterilized.

Now that recyclables can’t be sent to China for processing, companies and governments are turning inward and looking to invest in local recycling infrastructure, such as improved Materials Recovery Facilities (MRFs) and factories to make pellets from recycled plastics that then can be manufactured into consumer products. Growing recycling capabilities in the U.S. will create new jobs, keep waste out of landfills, and expand our long-term recycling sustainability.

The key factor for healthcare facilities will be to separate high-value materials such as cardboard and metals, and to keep all waste streams dry and free from contamination. This will require close coordination among clinical staff, environmental services, facility managers, infection control, safety officers and implementation managers at each facility to monitor all waste streams safely and in compliance with codes and regulations.

Single-stream recycling poses challenges when plastic bags and non-recyclables such as Styrofoam and items contaminated with food are mixed into the co-mingled waste stream, causing unacceptable contamination. This results in the entire load being sent to the landfill. Materials Recovery Facilities cannot earn a profit if they spend too much labor separating materials for recycling.

“The China ban just may be the disruption that the U.S. recycling industry needs for radical improvement. Although painful in the short term, I truly believe that this disruption provides opportunities for new and better business and will be better for everyone and the environment in the long term.”

Ascension is one of eight health system members that make up the HPRC Healthcare Facilities Advisory Board, helping members understand recycling barriers that exist within healthcare facilities, identifying needs and opportunities for action, and developing and testing solutions for healthcare plastics design, packaging and recycling.

FY19 Goal

Pulse Oximeter Medical Device Reprocessing

The Environmental Stewardship Program is collaborating with Medxcel, The Resource Group, Environmental Services, Environment of Care committees and Green Teams at each hospital, focused on a single FY19 goal to increase medical device reprocessing of Pulse Oximeters by 15 percent over FY18 collections. The goal supports the Stewardship Shared Capability for Ascension’s Advanced Strategic Direction.

In previous years, the Environmental Stewardship Steering Committee created a menu of goals; each ministry selected two goals for implementation. For FY19, one goal has been developed to optimize the value delivered by the Green Team and Environment of Care Committee alignment across all markets. Establishing a single goal aligns with One Ascension, as it unifies us across ministries to deliver our shared Mission, goals and objectives.

Single-use device reprocessing provides opportunities to minimize waste in landfills. Reprocessing saves financial resources that can be redirected towards patient care, helping to further our Mission to sustain and improve the health of individuals and communities. If the goal is achieved, the supplier partner will plant 755 trees for all of Ascension, $4.1 million dollars in savings will be delivered through Pulse Oximeter buyback, and 29.8 tons of waste will be diverted from landfills.