Carilion is on a journey to reduce waste and make the health care system more sustainable
Like others of her generation, Sara Wohlford, R.N., M.P.H., grew up internalizing the “reduce, reuse, recycle” mantras guiding people to be more environmentally responsible. That’s why, when she started working as a nurse in the Emergency Department at Carilion Roanoke Memorial Hospital in the early 2000s, certain practices didn’t feel right. Pounds of unused supplies were thrown away daily.
Lights were left on around the clock, and the hospital didn’t have the recycling programs she would have expected. Wohlford soon realized that she wanted to make it her life’s work to bring more environmentally friendly practices to Carilion Clinic. Yet it was hard to know where to start. At the time, only the largest health systems seemed to have the resources to address the issue, so there were few models to follow, and she wasn’t aware of degree programs that might train her for such a career.
Like others at Carilion and in the health care field more broadly, if Wohlford wanted to leave less of a footprint, she would, ironically, have to blaze a trail. Over the next decade and a half, Wohlford and her colleagues would do just that, forging a sustainability program that would, in a relatively short time, decrease medical supply and food waste by tens of thousands of pounds per year, and drastically reduce water and energy usage. It’s a journey that’s put Carilion on the cutting edge of a growing movement in health care.
An Exceptional Challenge
Carilion isn’t alone in struggling with this sustainability crisis. According to Practice Greenhealth, an organization that advises the health care community on sustainability, hospitals are second only to food service among commercial energy users, producing roughly 8 percent of the country’s greenhouse gas emissions. Hospitals also generate more than 4.67 million tons of waste every year and use 7 percent of the country’s commercial water supply. While some of these inefficiencies are an expected byproduct of volume—nearly 38,000 inpatients and an estimated 113,000 visitors pass through Roanoke Memorial’s doors each year—others can be traced to inescapable challenges peculiar to the health care industry.
Many of these revolve around patient safety. “We have many regulations we must match or exceed when we’re taking care of patients, because their well-being is our top priority,” Wohlford explains. “For example, any new recycling container has to be approved by life safety experts to make sure it meets fire code standards. It also has to be run by infection control because certain materials, like corrugated cardboard, can collect bacteria or dust mites—things that we absolutely cannot have here. So, when we introduce new programs, everything is a bit more complicated.” Nevertheless, to Wohlford and a growing number of health care professionals, sustainability is an effort worth investing in, especially considering the impact of environmental factors on community health. It was that connection that led Wohlford to enroll in a master’s program in public health at Virginia Tech. Concurrently, she started to work with Virginia Tech faculty and Carilion leaders to draft a business plan for sustainability, relying on advocacy organizations such as Practice Greenhealth and Health Care Without Harm for guidance in what were relatively uncharted waters. As she did, it became clear to all involved that running and advocating for any of the proposed programs would be a full-time job. Working with her boss, Vice President of Emergency Services and Care Management Paul Davenport, R.N., M.B.A., and other Carilion leaders, Wohlford drafted the sustainability manager position, a role she would formally move into in 2015.
Coming out of the gate, Wohlford and her advisors prioritized projects that were achievable and financially sound. They started recycling programs that emphasized reuse and donation, for instance. Five years later, Carilion boasts a single-stream recycling initiative that has cut the waste destined for landfills by 97,000 pounds per year. Carilion has also donated more than 53 tons of excess medical supplies to support medical education and international missions. Another early success involved a retrofit of light bulbs at Roanoke Memorial. The project, which was completed last year, saw more than 30,000 bulbs replaced by LEDs, an effort that has cut the energy used for lighting in half. Meanwhile, several other programs made their way to various stages of the project pipeline as teams across the health system worked with the sustainability team to build strategies and business cases for implementation.
The consistent thread through all of these efforts has been the commitment of employees to see them through. The success of the programs has relied not just on the sustainability team, but on the oversight of an Environmental Stewardship Council composed of executives and other leaders who offer guidance on the feasibility of individual programs, as well as the commitment of department heads willing to partner on sustainability. Perhaps most important are the thousands of nurses and clinicians who do much of the legwork, ensuring that the reforms are put into action systemwide.
For this, Carilion relies heavily on sustainability champions—roughly a hundred volunteers from departments throughout the system who help educate colleagues and oversee the execution of new initiatives. “I can put down recycling containers all day long,” Wohlford says, “but if the thousands of employees we have don’t know what belongs in each one, it’s all for naught.” Sustainability champions not only relay objectives and logistics; they also receive updates to share with their teams about how much waste they’ve reduced and when sustainability milestones are hit. Meg Scheaffel, R.N., M.B.A., vice president and chief nursing officer at Carilion, believes the feedback they provide to and from the sustainability office helps nurses and other health care workers appreciate the upside of their efforts.
“From an engagement perspective,” she says, “it helps nurses relate the sustainability programs to our overall mission of providing quality care.” Part of that care is stewardship, Scheaffel adds. Clinicians and nurses have a responsibility to use resources wisely. In addition to recycling, the sustainability champions have encouraged nurses to be more mindful of supplies taken into patients’ rooms. When rooms aren’t overstocked, fewer supplies have to be discarded and fewer new items need to be stocked. Carilion also reduced supply waste by working with infectious disease experts to develop policies on restocking and donating unused items. It was determined that in many cases, if items hadn’t been opened and weren’t visibly soiled, they could be reused.
“Supply return has been huge,” Scheaffel says, noting that it’s saved $61,000 in less than a year. “And it’s something nurses can relate to, understand, and control. There’s a lot of momentum out there to support our environment and keep things out of the landfill.”
Food waste has been another key target for sustainability, and it’s another area in which teamwork made progress possible. Pat Bird, senior director of dining and nutrition services, joined Carilion just as the sustainability office was formally getting off the ground. It was fortuitous timing, as Bird’s department was looking to cut costs, and food waste pointed to possible inefficiencies. The timing was good on another front: Bird’s area had just partnered with the sustainability department to take on Adeola Adeoye, an efficiency and sustainability fellow with the time and drive to focus on the problem. Adeoye spent her first few months at Carilion researching what other health care systems were doing about food waste.
“Then we really needed to look at our patient menu, to understand what our patients actually wanted to eat,” Bird says. It was no small task given the variable duration of hospital stays, the nutritional needs of patients, and the logistics of serving patients, visitors, and employees.
For weeks, Adeoye monitored patient eating habits, measuring and tracking food that returned from patient areas. One pattern of waste that she uncovered was the volume of milk cartons and salads that came back untouched. Both items were served with meals as a matter of course, yet as much as 20 percent went to waste. Based on this and other observations, Bird’s team experimented with the menu, and milk and salad became optional items that patients could order. The team then further refined their menu using the feedback and data that Adeoye collected. Since adopting the new menu systemwide, Carilion has reduced food waste by tens of thousands of pounds and saved tens of thousands of dollars per year. A similar approach has resulted in savings on the public-facing, cafeteria side of Carilion’s food services as well. Additionally, Dining and Nutrition Services has started to convert from plastic and Styrofoam to more eco-friendly tableware.
“We’ve converted more than 40 percent of our Styrofoam products,” Bird says. “The added expense of the new products has slowed our progress, and yet I think eventually they’ll be entirely eco-friendly.” Bird is also excited about Carilion Cuisine, a new frozen-meal program that will benefit patients off-hours, in the Emergency Department, and in various clinics. The line—which will offer its own food jackets with nutritional information and cooking instructions—will provide more flexibility in feeding patients that should result in less waste.
Carilion’s laundry services has also found ways to cut waste, drastically reducing water usage and supply costs over the past four years. In addition to tuning up equipment and tightening pipes to prevent leaks, the department has invested in a new tunnel washer and three new pony washers. The machines, which were installed in April 2019, have helped reduce water usage by roughly 35,000 gallons a day. And that’s not because the machines are washing less. In fact, while many hospitals opt for disposable bed pads, gowns, and other linens for the sake of convenience, Roanoke Memorial has committed to reusing every product that can be reasonably laundered. This is even true for operating room linen. “I have five kids. We used disposable diapers, so I understand it.
"It’s a lot more convenient than laundering diapers,” says Jim Buchbinder, head of laundry services. “In a hospital setting, it’s easier just to throw away all the mess that’s created—just put it into a plastic bag and send it to a landfill. It’s harder to wash it, but it’s definitely something we have the technology to do, and it benefits the environment and the hospital for us to do it.” Carilion’s efforts have seen linen expenditures drop by $275,000 year over year, which has helped offset the investment in new machines. But the potential savings aren’t the main reason Buchbinder feels strongly about the initiatives. “Many hospitals have opted for convenience maybe even despite the cost, but Carilion is committed not to do that,” he says. “I’m proud that I work for an organization that stands for that.”
Looking to the Future
As the climate discussion has taken on more urgency, Wohlford has seen it reflected at work. “More and more, physicians and nurses are coming to the sustainability team and asking, ‘where do we sit with this?’ I want to figure out how we can help with climate solutions through the lens of health, because the links are real,” she says, citing the connection between air quality and health and the dangers that come with weather emergencies, just to name a few.
With that in mind, Wohlford’s team organized Carilion’s first Climate and Health Conference in October. The event brought clinicians, nurses, and other health care professionals from across Virginia to discuss what health providers can do to educate the public, as well as patients and each other, about the impact of climate on health. It’s part of an ongoing conversation that will continue to unfold in the coming years. That discussion is sure to add to the growing list of initiatives Carilion is considering. Yet the fact that the journey is incomplete shouldn’t detract from the progress already achieved. “If you look back on where we were four years ago and where we are now, we’ve made tremendous strides on sustainability,” Bird says. “We’re not totally there yet, but we are on the cusp of greatness. We’re almost there.”
By Veronica Meade Kelly