Fears over cost of hospital sustainability measures 'misplaced'

US report urges hospitals to implement cost-cutting measures 'without delay' as significant savings are realised

The NHS has been charged with reducing carbon emissions by 34% by 2020

Fears that energy-saving solutions in hospitals will cost more to deploy than the amount of cash they save have been allayed following the publication of a new report which calls for public funds to be used to improve healthcare sustainability.

The US report entitled Can Sustainable Hospitals Help Bend The Health Care Cost Curve? looks at the impact of interventions such as improved waste management, energy use reduction and better operating theatre procurement practices to gauge the possible savings both financial and in carbon emissions.

And it shows that, if adopted nationally, the healthcare sector in the US alone could save in excess of $5.4billion in just five years, and £15billion over a decade.

It has been assumed by some that interventions aimed at sustainability would cost hospitals more to undertake than any savings that would accrue to them. Based on the data analysed in this study, we find this concern to be misplaced

Commissioned by the Healthier Hospitals Initiative (HHI) and Health Care Without Harm, the research looked at the efforts of nine hospitals across the US. And the results have led to calls for all hospitals, both in the US and further afield, to adopt similar programmes and, where capital investment is not available, it calls on governments to provide grants or loans from public funds.

The report states: “Hospitals, in particular, are among the most energy-intensive facilities. Reducing such pollution and greenhouse gas emissions would reduce the incidence of human disease, thereby saving money for the healthcare system and society as a whole.

“It has been assumed by some that interventions aimed at sustainability would cost hospitals more to undertake than any savings that would accrue to them. Based on the data analysed in this study, we find this concern to be misplaced, even for cases in which capital costs are spent to achieve energy savings.

Given the small costs and the positive return on investment within a short timeframe for the sustain¬ability activities studied - as well as their broader environmental and public health benefits - we recommend these innovations for all hospitals

“Many interventions studied did not involve any additional identifiable costs and realised immediate savings. Given the small costs and the positive return on investment within a short timeframe for the sustainability activities studied - as well as their broader environmental and public health benefits -we recommend these innovations for all hospitals.”

The research shows that the most wasteful and costly practices in a hospital building are heating or cooling unoccupied spaces, failing to maintain equipment, and neglecting to check for air and water leaks. Operating rooms, in particular, have a large environmental impact and were found to be the cause of many wasteful practices including the use of disposable rather than reusable products and through the use of pre-made ‘packs’ for specific surgical procedures.

“Given the costly effects of environmental dam¬age, efficient, sustainable hospital buildings and opera¬tions have a logical place in conversations about care quality, efficiency, and costs,” the report states.

The report highlights the potential for savings, particularly in hospital operating theatres

To explore the possibilities for savings through energy use reduction, data was collected from five study hospitals with between 300-900 beds. Interventions included lighting upgrades and the introduction of high-efficiency electric motors, fume hoods, steam insulating jackets, occupancy sensors for public areas, zone air handler scheduling, annual steam trap audits, changes to steam trap design, boiler replacement and the fitting of solar film to windows.

Given the costly effects of environmental dam¬age, efficient, sustainable hospital buildings and operations have a logical place in conversations about care quality, efficiency, and costs

The report states: “For any given hospital, the effectiveness of the interventions depends on the state of the facility, the skill of facilities managers to continuously verify that the building’s systems are working properly, the availability of rebate and support programmes from utilities and government agencies, and the mix of fuel and energy prices.”

However, the research found that the average reduction in energy use across the study hospitals was 27.2 kBtu per square foot by year five - or 9.8% of the baseline. Reductions ranged from 3.1% to 24.2% between the hospitals and five-year gross cost savings as a result of the interventions was $2.12 per square foot. After deducting the cost of introducing the measures, the saving was $1.40 per square foot of floor space. Over five years this is equivalent to a cumulative net saving of 72 cents per square foot.

Looking at waste management, the researchers studied four hospitals with between 75-500 beds. Interventions included improving recycling rates for plastics, metal, glass, paper, electronics, ink cartridges, X-rays, batteries and cooking oil, among other materials; composting food waste from kitchens and cafeterias; growing food in an on-site garden; using an on-site autoclave for regulated medical waste; reprocessing surgical devices; separating pharmaceuticals; and re-using office supplies.

Our study results indicate that concerns are misplaced about the likelihood for hospitals’ costs associated with sustainability interventions to outstrip any savings accrued

The cost of interventions was deemed minimal, other than staff time organising the changes, after which the saving per adjusted patient day was around 40 cents.

“On the basis of these figures, we estimated that if hospitals nationwide adopted the study hospitals’ waste management interventions, the five-year net cost savings would exceed $700m,” says the report.

Interventions within operating theatres were found to have a major impact on spending. In particular a review of seven hospitals explored the savings generated by re-using single-use devices where possible. As part of a pilot, a service collected single-use devices from the theatres, inspected them to determine which could be re-used, then cleaned and sterilised them and sold them back at a reduced price. The five-year estimated saving was $12 per procedure, not including the savings from cutting back on waste disposal.

Another area where operating theatre savings can be made is through intervention packs. These pre-packaged supplies are specially formulated for specific surgical procedures. However, research has shown that often items included in the packs are not used and are thrown away after the procedure. By asking suppliers to leave unwanted instruments out of the packs, the average net saving was found to be $4.33 per procedure in the reformation and $22.66 after five years.

The report states that top-down commitment to improvements was necessary to enjoy the highest possible savings. It adds: “Our study results indicate that concerns are misplaced about the likelihood for hospitals’ costs associated with sustainability interventions to outstrip any savings accrued. Our study shows that intervention costs, including capital costs, are relatively small and investments yield positive returns within a short timeframe.

“We also found that an organisational culture of commitment to sustainability, set by the board and top leadership, was as important a factor in cost savings as the setting or the specific activities undertaken.

Based on this initial study, agencies and organisations that regulate and advise healthcare systems would do well to increase their educational efforts in regard to sustainability interventions for both their institutional and societal cost-saving consequences

“Given the small interventional costs and the positive return on investment for the interventions studied -as well as their broader environmental and public health benefits - we contend that all hospitals should implement these innovations. Hospital executive leadership should designate green teams to evaluate the implementation of these and other interventions within their organisations.”

And the report states that healthcare systems around the world can benefit from a similar approach, adding: “Based on this initial study, agencies and organisations that regulate and advise healthcare systems would do well to increase their educational efforts in regard to sustainability interventions for both their institutional and societal cost-saving consequences. This study additionally demonstrates the need for increased standardisation of data collection and further evaluation of the costs and benefits of sustainability interventions in healthcare.

“Although no single sustainability intervention will bend the steadily rising healthcare cost curve, the national adoption of the proven environ¬mental innovations described in this study would help. They are needed without delay.”

The findings have been welcomed by the NHS Sustainable Development Unit.

To read the full report, click here.

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