The profitable hospital system with sustainability in its DNA
We have all heard the aphorism "health is wealth." Gundersen Health Systems, a nonprofit hospital network operating in 19countiesacross three Midwest states, is proving this.
2008年，Gundersen-headquartered in La Crosse, Wisconsin, where it is its county’slargest employer-began the path to achieve carbon neutrality. By October 2014, it became the first U.S. health system toattain energy independenceby producing more energy than it consumed, at least some of the time.
"Since then, we’ve had hundreds of days where we produced more energy than we used, but we’re still working on getting to 100 percent all the time," said pediatrician Dr. Jeffrey Thompson, executive advisor and CEO emeritus at Gundersen Health Systems and a White HouseChampion of Change。
By prioritizing sustainable operations, the惠誉A + -Ratedorganization contributed to the surrounding community’s fiscal health, was named one of the top 50 hospitals in the country and was recognized by the United States government for the operational prescription it used to get there: namely its预见program, which aims for leadership (and monetary returns) through the four pillars of energy conservation, waste management, recycling and sustainable design — all while reducing the cost of care.
The philosophy behind Envision, which commenced in 2008, is driven by the idea that it's possible to make a positive environmental impact while reducing costs for patients. In fact, sustainability explicitly was written into the core principles of Gundersen’s strategic plan.
Energy independence was Gundersen’s primary objective. First, the healthcare case: Pollutants from the burning offossil fuels cause (PDF)human birth defects, damage the nervous system and internal organs, lead tocardiovascular deaths和卒中和尖刺癌症风险。能源部发现医院经常2.5 times more energy intensivethan other commercial buildings, which Gundersen believed was "inconsistent with our mission."
Second, it made fiscal sense. The health system found that its energy costs were rising by about $350,000 annually. A 2008 energy audit discovered dozens of energy-saving opportunities-and acted on them. Retrofitting light fixtures reclaimed $265,000 per year. Replacing exhaust fans, which had been running 24/7, reduced Gundersen’s electricity consumption by more than 71,000 kilowatt-hours (kWh) a year, saving $4,300 more.
Wiring cooling systems to respond to outside temperature and humidity reduced electricity consumption by about 1.1 million kW hours; upgrading old water chillers to energy-efficient models saved an additional $70,000 per year. Scheduling HVAC system hours reduced utility energy use by 35 percent in some locations. And simply instituting automatic computer shut-off routines in the evenings shaved up to $165,000 annually.
Measure by measure, Gundersen's energy expense consistently has stayed below 2008 costs, despite the system's move to add 26 percent more facility space since that time and a 25 percent electricity price increase over that timeframe.
“2008年和2009年，我们花了200万美元的保护措施，”汤普森说。“我们投资60％的回报。没有其他投资，您可以使这表明这一年过年的回报。”
生物量和生物学
By 2014, Gundersen became the first health system in the United States to completely offset its fossil fuels use as it began sourcing locally produced, "organic" energy. The Envision program diversified its energy mix to hedge against inflation, find local sources power for specific projects and contribute to the community’s economy in the process.
"Solar was not a strong financial option in Wisconsin," said Thompson. "We came up with a mix of landfill gas, biomass, dairy digesters and wind turbines."
A biomass boiler turns wood from the local lumber industry into steam energy, the health system’s major source of power. A 300-ton geothermal heat pump, supported by hundreds of wells dug beneath parking lots, leverage Earth’s natural temperature for year-round heating and cooling. Dairy and manure digesters churn farm waste into 20 million kW hours of renewable power while preventing runoff-enriched algae blooms in waterways.
此外，Gundersen与两个风电场合作，每个风电场都会发电足够的电力，以电力为1,200家。医院系统支付了电力，抵消了其能源成本，而销售给房屋和企业的电力。它与La Crosse County废物部门合作，生产垃圾填埋场垃圾的天然气。太阳能电池板点停车坡道和太阳能热水器为儿童保育办公室和肾透析中心供电。
"As a marker of how far we’ve come, we’ve been able to drop our greenhouse gas, particulate and mercury emissions from coal plants by over 95 percent in eight years and make money," said Thompson. "Many industries and governments are aiming to get 30 percent down by 2030 or 2050." Gundersen estimates that it prevented about nine asthma attacks in 2015 due to fossil fuel emissions reduction.
Gundersen Health System’s energy expense has stayed below 2008 costs, despite adding 26 percent more facility space and a 25 percent electricity price increase in the same period.
一盎司的预防转移了一磅治疗，而gundersen45 percent recycling and reuse rate将740吨家具，食品和X射线薄膜留出垃圾填埋场。这没什么可打喷嚏的，因为医疗废物处理差不多five timesthat of traditional waste, according to industry data.
“我们每年节省大约一百万美元的重用”单用“设备，就像仔细拆卸和消毒麻醉面具随后重用，节省了50％的成本，”汤普森说。转移医疗废物可以挽救生命-卫生系统停止循环危险药物废物，如药物，化疗剂和抗生素。相反，Gundersen安装了患者，访客和员工使用的药物，并在一年内收集了超过4,150磅的药物废物（超过设施本身产生）。
All told, sustainability improvements save Gundersen $3 million annually, according to the health system's data. These savings fill the bottom line and filter into holistic health programs such as feeding patients locally raised, antibiotic- and hormone-free meals; offering community health seminars; and holding ongoing energy kaizens (Japanese for "check-ups"). Envision has become the healthcare system’s signature, differentiating it as innovative as it is effective.
"There are still people who aren’t terribly onboard with the project, despite the notoriety and success we’ve had-they still think this is a hobby and not a responsibility," said Thompson. "What we did every step of the way was try to show the board that this was consistent with our mission. [...] That theme, coupled with hard data, is what helped us convince them that this is a good path to go down."
治疗的策略
当我们发言时，汤普森正在前往波士顿哈佛经济学学院的路上，他被邀请谈论非营利组织如何通过小说投资改善社区福祉。Gundersen将匹配资金与La Crosse的联合开发集团迅速改善艰苦的社区。更重要的是，该组织还曾使用其总公司现金和投资基金的20％，以便将一家高新技术服务公司保存在城市约有55,000人。
该组织的领导层也涟漪，以至于其直接社区的更广泛的影响ospitals account for 8 percent ofelectricity consumption，而医疗保健行业整体促成了美国温室气体排放的8％。
Gundersen is a member ofPractice Greenhealth是一个非营利组织，促进医疗组织的环境管理和最佳实践。努力在1998年在美国医院协会和美国环境保护局同意推进卫生设施污染预防。
“医院需要在危险的天气方面是有弹性的;他们需要通过举例来引导并成为清洁能源的早期采用者，他们需要成为气候变化是公共卫生危机的信息的领导者，”加里科恩说：“加里科恩说：”加里科恩说，练习GreenHealth总裁兼联合创始人，2015年麦克阿瑟基金会。
它的国际手臂，没有伤害的医疗保健（它融入了实践GreenHealth，Cohen也是总统于2008年），发现医疗行业由于其焚烧含有聚氯乙烯的IV袋的实践，是联合国最大的二恶英发射器状态。没有伤害的医疗保健鼓励医院在高压灭菌器中灭菌，而是将市场转变为更安全的塑料。
Hospitals need to be resilient in the face of dangerous weather; they need to lead by example and become early adopters of clean energy.
"Dioxin is linked to cancer, birth defects, brain damage and learning disabilities," said Cohen. "When we started, there were over 4,500 medical waste incinerators in the U.S. 10 years later, there were only 73 left in the country."
Practice Greenhealth also helped turn the health industry away from mercury thermometers, which leaked the brain-damaging liquid when broken or thrown away.
促进持续的合作ability practices, Practice Greenhealth launched the Greenhealth Exchange (GX) in 2016, apurchasing cooperativecomprising Gundersen and three other founding health systems. GX works with healthcare suppliers and group purchasing organizations that allow hospitals to buy sustainable products.
压力似乎在工作：根据实践绿色健康的2017 benchmark report, the number of participating facilities with a written climate mitigation plan has about doubled. The number of facilities that generate or purchase renewable energy increased by 81 percent. Leading hospitals have a 30 percent recycling rate-double the EPA standard. And nearly 80 percent have purchasing programs that avoid chemicals of concern.
练习GreenHealth列表中的麻醉气体捕获是接下来的。根据Cohen，根据Cohen，据二氧化碳的温室药剂造成的气体是额外的气体。该集团还在共同投资太阳能，风和其他清洁能源技术。
“气候周围的叙述正在发生变化，”他说。“传染病正在蔓延，因为蚊子正在前往其他气候。登革热沿着美国东南部出现出来的夏天，极端热量的夏天更多意味着由于热量压力，更多的人在急诊室中蜿蜒缠绕。”
希波克拉特狗与医疗保健从业者结合治愈整个疾病，而不是症状。因为社区健康由健康的人组成，因此医疗保健不存在于对环境问题的泡沫免疫。
"Healthcare is 18 percent of the U.S. economy, only second to the military," said Cohen. "They have to heal the communities they’re accountable to."
Former NRG CEO David Cranewrote医疗保健提供者需要盟友创造更可持续的行业。行业正在响应。其他医院系统优先考虑社区健康，包括Kaiser永久性，尊严健康，Buffalo Niagara Medical Campusand Hackensack University Medical Center-或Beckers医院审查的任何组织"50 Greenest Hospitals in America"list.
For network administrators who don’t know where to start, Thompson draws from experience: "When we set the goal in 2008, we didn’t know how we were going to get it done. But we had guiding principles, we had a set of values and a tremendous number of people who worked hard across the organization and the community to make this happen."
