Greening the Medical Center
UCSFMC's Second Sustainability Report
Fiscal Years 2013 and 2014
Sustainability and Health Care
UCSF is a campus entirely dedicated to health and biomedical sciences. We recognize that healthcare’s ethical responsibility is “first, do no harm.” We also take seriously our responsibility to identify and implement sustainability measures at the medical center. Our sustainability efforts save money, minimize waste, reduce emissions, and increase efficiency, as well as embed a culture of sustainability, reducing UCSF’s impact on the environment and community.
This is our second Sustainability Report covering the period from July 2012 – June 2014, which corresponds to FY13 and FY14.
Over the past two years, the medical center has continued to earn recognition for our efforts, earning awards from Practice Green Health, Becker’s Hospital Review, University HealthSystem Consortium, and Healthier Hospital Initiative.
Some highlights and savings from UCSF Medical Center (UCSFMC) sustainability initiatives are summarized below, followed by a complete report with details:
- Completed the Sustainability Action Plan (SAP) 2.0, determining goals, strategies, and tactics for the coming years through 2020.
- Constructed the new UCSF Medical Center at Mission Bay, which is expected to receive LEED Gold standard. Highlights of the new facility include reduced toxic exposures to building materials and furnishings; an energy-efficient design resulting in 50% less power usage than the average US hospital; a 750 kW photovoltaic system; 4.3 acres of green space, and water conservation measures that will save four million gallons of potable water per year.
- Increased sustainable food purchases from 12.6% to 26.7% over the past four years.
- Saved over $3.5 million per year through reprocessing medical devices, reducing medical waste, greening efforts in operating rooms, purchasing reusable pillows, and energy-saving upgrades.
- Composted 90% of UCSFMC’s food waste, which is almost 7% of our total solid waste.
- Diverted 41% of all solid waste from landfill In FY13-14.
- Created a specific section on the UCSF Sustainability Website called Greening the Medical Center.
- Awarded the 2013 Bronze Telly Award in the employee communications category for the UCSF-produced LivingGreen at UCSF engagement video. Filmed at the medical center, the video has over 3,000 hits on YouTube.
- Replaced an inefficient stream-operated chiller with an electric chiller at the Moffitt/Long Hospitals at the Parnassus campus, reducing the medical center’s utility bill by about $1.3 million a year.
- Ran the Race to Certification campaign encouraging offices, labs, and units to be LivingGreen certified. To date, 16 offices, labs, and units at the medical center have participated in the program.
- Completed the remodel of Ambulatory Care Clinic (ACC4), which is expected to receive at least LEED Sliver. This is the first use of energy-saving chilled beam HVAC technology in a medical center remodel project.
- Earned the 2013 Practice Greenhealth Partner for Change Award with Distinction. Pictured left are: Louise Hallberg,(nursing) Gary Cohen (Healthcare Without Harm President), Dan Henroid (Director,Nutrition and Food Services)
- Earned the 2014 Practice Greenhealth Emerald Award, the second highest award level, as well as received two Environmental Excellence awards in the new categories of Climate and Green Building.
- Named one of the 50 Greenest Hospitals by Becker’s Hospital Review.
- Earned the University HealthSystem Consortium’s Sustainability Award for its commitment to sustainable healthcare operations increasing awareness of and communicating about the sustainability program to staff and internal stakeholders and throughout the community.
- Received the Stryker’s Sustainability Solutions gold level Healthy Hospital Award for maintaining the top percentile amongst national hospitals. The medical center won the award for waste reduction efforts and sustainable healthcare practices in 2013.
- Donated 26,000 pounds of medical equipment and supplies to international hospitals/clinics in 70 countries.
- Replaced conventional toxic cleaners with certified Green Seal cleaning products.
Want more detail? Read on for the full report.
UCSF MEDICAL CENTER SUSTAINABILITY REPORT (FY13 and FY14) FULL REPORT
Our goal for FY15 is to implement the top two SAP 2.0 tactics in each of the workgroups in the areas of climate neutrality, zero waste, water conservation, sustainable food, green building, green procurement, toxics reduction, sustainable operations, and culture shift.
UCSF is the nation’s leading university exclusively focused on health, dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes three top-tier hospitals, UCSF Medical Center (which includes Moffitt/Long Hospitals and Mt. Zion), and UCSF Benioff Children’s Hospital San Francisco collectively known as the UCSFMC.
We take seriously our responsibility to identify and implement sustainability measures at the medical center. In 2012, UCSFMC joined the Healthier Hospital Initiative (HHI) and committed to five of the six planks: Engaged Leadership, Healthier Food, Safer Chemicals, Smarter Purchasing, and Less Waste. This initiative was founded by 11 of the largest, most influential U.S. health systems, comprising over 490 hospitals with more than $20 billion in purchasing power. It has served as a guide to help UCSFMC reduce energy and waste, purchase safer and less toxic materials, and serve healthier foods.
This is our second Sustainability Report covering July 2012 – June 2014 (FY13 and FY14). It summarizes our key accomplishments for FY13 and FY14. Similar to our first report, it is organized around Practice GreenHealth’s (PGH) award categories. Please see our slide show (link to new PDF) where we share images of our sustainability activities.
Why Health Care Providers Should Care about Sustainability
In May 2014, UCSF hosted a Sustainability Summit. Jeffrey Thompson, MD, CEO of Gundersen Health System, was one of the speakers. In his comments he offered the following points for why health care providers should care about sustainability:
- Big Footprint: According to the Department of Energy, hospitals are 2.5 times more energy intensive than other commercial buildings.
- Link to Disease: Pollutants from the burning of fossil fuels and waste disposal are linked to cancer, liver disease, kidney disease, reproductive issues, and cardiovascular deaths and stroke. The health care profession is responsible for contributing to disease through our wasteful consumption.
- Improved Bottom Line: Energy costs will eventually escalate, making it more difficult to provide affordable care. Reducing waste results in an improved bottom line.
The business case of sustainability has become stronger. UCSFMC is seeing more than $3.5 million in savings per year and additional efforts have been under way for a number of years across the campus and medical center. Savings from UCSFMC’s sustainability programs over the past two years include:
- $903,336 saved in FY13 by using reprocessed medical devices;
- $240,000/year saved through the purchase of reusable pillows;
- $250,000/year saved by reusing sharps containers;
- $1.3 million/year in estimated energy savings from replacing one of two absorption chillers and upgrading the chilled water piping and pumping systems at the Moffitt-Long hospitals; and
- $250,000/year saved by converting from off-site to onsite sterilization of medical waste.
Organization of Report
This report includes a summary of the key achievements over the past two years for the following issues:
- Sustainability Leadership
- Solid Waste
- Chemicals/Toxics Reduction
- Medical Waste and Greening the OR
- Medical Center Procurement
- Sustainable Food
- Green Building
- Water Use
- Culture of Sustainability
Leadership and Infrastructure
The framework of the Chancellor Advisory Committee on Sustainability (CACS) includes representation from both the medical center and the campus staff and faculty. Co-chairs from the medical center serve on each of the nine work groups who develop our Sustainability Action Plan to achieve campus-wide goals and specific goals for the medical center and campus. The second Sustainability Action Plan (SAP2.0) was completed in 2014, detailing the top priorities for FY15. Most of these goals are driven by UC Policy on Sustainable Practices, developed by the University of California Office of the President (UCOP) staff and representatives from all ten UC campuses, the American College and University Presidents’ Climate Commitment (ACUPCC), and other goals, which resonate with our mission.
At the first Health and Sustainability Summit in May 2014, Mark Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals, stressed in his welcome address, “Once you develop a culture and a mindset for it, it can become infectious and we’re doing that at UCSF,” said “As a public university, we have an obligation to stand up and take a position that this is the right thing to do. It’s the right thing to do for the environment, it’s a right thing to do as an example to our community, and it’s the right thing to do for the patients we serve.”
A new Sustainability Leadership Work group was created in FY13, with the goal to enter and maintain membership in the Top 25 Environmental Excellence Award, the highest recognition awarded by Practice Greenhealth(PGH).
Notable accomplishments in the sustainability leadership category over the past two years include:
- Office Certification Program Promoted by Leadership: Mark Laret was part of the Sustainability poster series to promote the LivingGreen office certification program. At the medical center, 16 offices, labs, and the newly created unit/clinic certification were awarded or participated in the program.
- 2013 PGH Partner for Change Award with Distinction: Received 2013 PGH Partner for Change Award with Distinction by significantly increasing our solid waste diversion with 90% composting in the cafeteria and patient food areas in addition to reprocessing of single use medical devices, surgery department recycling outreach and education, collection of unusable medical supplies for donation, energy efficiency projects, farmer’s markets, and more. PGH is the nation’s leading health care community that empowers its members to increase their efficiencies and environmental stewardship while improving patient safety and care.
- 2014 PGH Emerald Award: Received PGH’s 2014 Emerald Award, the second highest award level, The Greenhealth Emerald Awards recognize the cream of the crop with more advanced programs that cross many different categories. UCSFMC also received two PGH Circles of Excellence awards, a new recognition program in the categories of climate and green building. The medical center was recognized in the Climate category for measuring and reporting greenhouse gas emissions and in the Green Building category for the construction of the LEED-Gold level Medical Center at Mission Bay.
- Named one of the Greenest Hospitals: In 2013, Becker’s Hospital Review named UCSFMC as one of the 50 Greenest Hospitals in America. These 50 hospitals represent 9% of all registered hospitals in the US.
- Honored by University HealthSystem Consortium: At the University HealthSystem Consortium (UHC) conference in Atlanta, GA in 2013, the medical center was awarded the UHC Sustainability Award for its commitment to sustainable healthcare operations in academia. The award honors a UHC member’s commitment to sustainability as measured by the following criteria: a demonstrated, continuous commitment to a sustainability strategy; a quantifiable means of measuring and reporting progress toward and achievement of sustainability goals; and a demonstrated commitment to increasing awareness of and communicating about the sustainability program to staff and internal stakeholders and throughout the community.
- Recognized for Waste Reduction Efforts: In early 2014, UCSFMC received the Stryker’s Sustainability Solutions gold level Healthy Hospital Award for their achievement in maintaining the top percentile amongst national hospitals. The medical center won the award for its waste reduction efforts and sustainable healthcare practices in 2013. By purchasing remanufactured supplies, the Moffitt Long Hospitals and Mt. Zion Hospital saved an estimated $813,904 in FY13 and $822,074 in FY14 and diverted nearly 14,000 pounds of waste annually from the landfill. This success qualified UCSFMC for the Healthy Hospital Award.
Other achievements included:
- Incorporated sustainability goals into employees’ performance evaluations.
- Collaborated with Physicians for Social Responsibility on the Sustainable Meat Summit and Sustainable Food projects
- Collaborated with Academic Senate Committee on Sustainability and The Chancellor’s Advisory Committee on Sustainability to host the Health and Sustainability Summit where 60 faculty and leadership attended to determine a path for UCSF leadership in Health and Sustainability.
- UCSF featured in “Hospitals Go Green on Cleaning Supplies” in the San Francisco Chronicle and in the Guardian Sustainable Business.
- Climate Change and Health presented at Medical Grand Rounds on January, 24, 2013 by Tom Newman, MD, professor in Pediatrics and Epidemiology and former Chancellor’s Advisory Committee on Sustainability chair.
- Academic Senate Sustainability Task Force became an official Academic Senate Committee on Sustainability to begin in FY15.
Achieve recognition by PGH as one of the Top 25 Environmental Excellence Award.
UCSF is working hard to reduce our carbon emissions based upon five major sources: electricity, natural gas, fleet vehicles, commute, and air travel. Our goals are to achieve 1990 levels by 2020 and carbon neutrality by 2025. Last year, UC President Janet Napolitano set a goal for UC to become the first research university to achieve carbon neutrality, with a target date of 2025. If UCSF succeeds, it will be the first healthcare research university in the world to become carbon neutral.
UCSF’s total square footage has doubled since 2000 and with the opening of the Mission Bay Hospitals in 2015, an additional 1 million square feet will be added. This increase in square footage makes achieving this emissions goal more challenging. The UCSF Strategic Energy Plan (SEP), the Greenhouse Gas Reduction Strategy, along with strategies being developed at the UC system-wide level, will assist UCSF to meet this challenge. The figure below shows GHG emissions for the campus and medical center and the impact of Tier 1 and Tier 2 reduction strategies.
(note: Table does not include emissions from leased spaces)
- Reduced Energy Bill by more than $1M: The medical center replaced its inefficient steam-powered chiller with an electric chiller. The $7.5 million chiller project is the first big-scale energy savings project at a UC medical center. The project is expected to reduce the medical center’s utility bill by about $1.3 million a year. The upgrade saves almost 410,000 kilowatt (kW) hours and more than 666,000 therms of energy each year, savings equivalent to avoiding nearly 3,628 metric tons of CO2e per year.
- Upgraded HVAC at the Clinical Labs at China Basin: As UCSF works toward its goal of reducing carbon emissions to 1990 levels by 2020, many of the strategies to reduce energy use, especially heating/cooling mechanical retrofits, happen behind the scenes, invisible to staff and visitors. This is true of one of UCSF’s efficiency upgrade project at the UCSFMC Clinical Labs, which will save energy, reduce carbon emissions, and in the long run, save UCSF over $100,000/year. The upgrade saves 10 metric tons of CO2e per year.
- Greenhouse Gas Emissions (GHG) Inventory Completed: UCSF completed a GHG inventory, had it verified by a third party, and reported it to The Climate Registry and the American College and University Presidents’ Climate Commitment (ACUPCC). UCSFMC’s portion of UCSF’s Scope 1 and 2 emissions for CY12 and CY13 were 32,080 and 31,747 metric tons of CO2e, respectively, indicating a 1% reduction. This work was recognized by the PGH Circles of Excellence award in the Climate category.
- Lighting Retrofits: UCSFMC completed several lighting retrofits, including replacing lights at the Moffitt/Long 4th floor OR with energy efficient LED lights, reducing heat load in OR suites. The Moffitt/Long lighting retrofit installed more energy efficient fixtures with electronic ballasts. Medical Center at Mission Bay Energy Efficient: At the new Medical Center at Mission Bay, an energy-efficient design resulted in 50% less power usage than the average US hospital.
Other achievements include:
- Installed infrastructure and obtained funding for 750 kW solar photovoltaic (PV) system on rooftop of the Medical Center at Mission Bay
- At the Mt. Zion campus, an air-cooled chiller was refurbished and reduced the load on the central gas powered chillers at the Cancer Treatment Center.
- Promoted SunShares, a discount program that helps UCSF employees, and friends and family, purchase solar panels for their home. Collectively, 12 UCSF employees had PV installed on their homes generating a total of 69 kW of energy per year.
- Implemented a program that offered a special discount for UCSF employees on the all-electric Nissan Leaf. Over 14 employees have taken advantage of the program.
- Developed Sustainability Action Plan 2.0 for 2014-2020 and identified top tactics through the work of nine workgroups.
- Purchased Energy Star equipment including desktop computers, laptop computers, and servers, drives and monitors.
- Implemented LED lighting in 42 of 44 surgical operating rooms, which reduced heat load in the surgical suites, eliminated shadowing, and increased staff comfort.
- Consolidated supply deliveries at Oyster Point warehouse to reduce traffic and emissions at the Parnassu campus.
- Retrofitted Moffitt/Long Hospitals with an energy efficient Air Supply Fan.
- Retrofitted with LED lighting at the MC Design & Construction (D&C) Offices located at Laurel Heights campus and increased focus on switching off lights when not needed – saves approximately 10% of electrical consumption.
Metric tons of C02e equivalent
Implement top tactics in SAP 2.0, including implementation of energy efficiency projects as part of the Strategic Energy Partnership with Pacific Gas & Electric (PG&E). Small projects include installation of lighting controls (occupancy sensors) in storage closets and changing rooms and cool roofs.
Solid Waste - Reduce, Reuse, Recycle
According to the Healthier Hospitals Initiative (HHI), hospitals generate an average of 30.9 pounds of waste per staffed bed per day, comprised of plastics, paper, food, needles, packaging, and electronics. Solid waste reduction has been the main focus of UCSF, PGH and UCOP goals from the beginning of their programs. UCSFMC continues to identify ways to further reduce all our waste streams. Our goal is to achieve zero waste by 2020 meaning 100 percent of waste that can be recycled and composted are diverted from landfill.
Highlights of Accomplishments
- Composting and Recycling: UCSFMC diverts 41 percent of its waste through its recycling and composting programs, such as patient room recycling, composting of exam room paper and paper towels in bathrooms, and composting 90 percent of all patient and retail food waste. Implemented rigid plastics recycling education in the OR and patient rooms. San Francisco’s excellent waste infrastructure is a major factor to the success of these programs.
- Donating Medical Supplies: Hospitals generate millions of tons of waste each year, discarding annually over $200 million worth of perfectly usable medical equipment and costing millions in disposal fees. Remedy at UCSF, a student-run organization that “recycles” castoff medical supplies into global aid, was honored with a 2013 Team Sustainability Award for donating 26,000 pounds of medical supplies to 70 countries, reducing unnecessary medical waste and providing much-needed supplies to under-served areas. Donated supplies included clinical supplies that were expired or opened and furniture (mattresses).
- Switching from Disposable Patient Pillows: The medical center has switched from disposable patient pillows to vinyl-covered reusable ones that are cleaned and disinfected after each patient is discharged from the hospital. Each pillow is expected to last about six months rather than be thrown out after each patient’s hospital stay. In the past, the medical center purchased about 160,000 disposable pillows a year, resulting in 296,000 pounds of waste. The change to reusable pillows is expected to save the medical center an additional $240,000 a year from the reuse of 158,000 pillows instead of disposable pillows.
- Decrease in Solid Waste: As shown in the chart below, the amount of solid waste generated in 2014 went down, in part due to switching to reusable totes. The implementation of reusable totes instead of disposable cardboard boxes significantly reduced the amount of cardboard recycled.
Other accomplishments include:
- Established Hara Energy and Environment software to track emissions, energy, waste and water
- In-patient room recycling in all adult patient rooms Moffitt/Long and Mt. Zion
- Using reusable totes for medical supply delivery through Professional Hospital Supply reduced a significant cardboard waste previously recycled
- Implemented paper reduction programs to reduce network printers, double side copying, and patient record systems
- Implemented new programs that reduce paper use including electronic medical records in outpatient areas, electronic surgery scheduling, and electronic patient care management reports
- Established contract with responsible, e-steward certified electronics waste recycler and document destruction
Percent diversion of solid waste from landfill
- Achieve a 2 percent waste reduction at the Moffitt/Long hospitals through the implementation of a Medshare formal collection program
- Implement top tactics in SAP 2.0, including creating a Department-specific waste tracking efficiency and improving waste-sorting education for staff.
Regulated Medical Waste and Greening the Operating Room
Reduction of medical waste and greening operating rooms are two strategies to reduce our environmental impact by focusing on staff training for proper sorting of infectious and non-infectious materials and waste.
UCSF has medical center and research activities that generate hazardous and medical waste in the process of providing health, diagnostic, and investigative benefits. A conscious effort is made by our Environmental Health and Safety staff to reduce hazards through safety training, practices, and reduction of hazardous materials where feasible. Leadership by the Nursing Environment of Care committee, the Cardiac Catheterization Lab, Hospitality and OR staff were critical to the success of these reprocessing programs.
- Use of Reprocessed Single Use Devices: In 2012, the UCSF Reprocessing Team was awarded the 2012 Sustainability Award for identifying single-use devices (SUDs) used in the operating room (OR) that can be collected, reprocessed by a third-party vendor, and potentially purchased for reuse. This entailed working with OR staff, sterile processing staff, and third-party reprocessors, to ensure eligible devices are appropriately collected, reprocessed and repurchased at a discount. Education, training, and information opportunities were provided for surgeons and staff. Efforts spanned the Parnassus and Mt Zion campuses and the Orthopedic Institute. UCSF reduces waste and saves money through its reprocessing program. Through partnerships with Hygia, Masimo, and Stryker, single-use devices collected in the Surgery Department, Electrophysiology lab, and patient rooms for reprocessing saved UCSFMC $903,336 in FY13 and $931,466 in FY14.
- On-Site Sterilization: UCSFMC’s on-site autoclaves sterilize clinical and laboratory infectious waste so it can be disposed of at a landfill, rather than be sent to an expensive medical waste treatment and disposal facility. The on-site steam sterilization system has reduced our disposal costs by $250,000 per year.
- Reusable Sharps Containers: UCSF has contracted with Stericycle®, a medical waste and sharps disposal company, to collect, disinfect and reuse plastic containers for “sharps”—hypodermic needles and other sharp tools such as scalpels—as well as certain glass vials. This change diverts more than 100,000 pounds of plastic waste from landfills and saves about $250,000 a year. In the past, when the containers were full, the whole container was sterilized and landfilled. Now, each container is used hundreds of times.
Other achievements include:
- Collected, baled and sold sterile blue wrap is as a commodity. In FY14, UCSF recycled 935 pounds of blue wrap.
- Purchased reusable linens including back table covers, surgical drapes, and surgical jackets.
- Reprocessed and repurchased single-use medical devices include trocars, harmonic scalpels, arthroscopic shavers, burrs, US and EP catheters, suture passers, sequential compression devices,
- tourniquets, pulse oximeters, and BP cuffs.
- Periodic update of OR kits to eliminate items that are not used
- Recycled over 2,500 pounds of toner cartridges in FY14
- Used reusable hard cases for surgical instruments where storage space is available
- Staff education and collection of rigid plastics for recycling before surgery begins in the OR suites.
- Medical Waste Tonnage Each year
- Savings through the use of reprocessed single-use devices
Implement top tactics in SAP 2.0, including point of collection waste signage and APEX double-sided printing.
Reduction of chemicals and toxics is addressed through UCSF’s Toxics Reduction Workgroup where we recognize the need to reduce the environmental impact of chemicals and employee exposures. This category is a PGH priority, but it has not yet been associated with a target goal by UC Office of the President (UCOP). However, because UCSF recognizes environmental health as a key component of our mission, the SSC chose to focus on this area.
Flame retardants are also part of the concern of the UCSF Toxics Reduction Workgroup. The updated UCSF Sustainability Action Plan 2.0 identifies strategies with specific interest for toxics reduction in the following areas: environmentally preferred purchasing, cleaning agents, medical devices, pharmaceuticals, laboratories, building materials, furniture, textiles, electronics, combustion/transportation, water contamination, and communication programs for patients/staff.
Highlights of Accomplishments
- New UCSF Medical Center at Mission Bay: The new UCSF Medical Center at Mission Bay was designed to include fully sprinklered fire suppression system and is not required to comply with Technical Bulletin (TB)-133. It complies with TB-117.
- Reducing Exposure to Toxins: The medical center is using Green Seal or EcoLogo-certificated cleaners for hard surfaces, windows and glass, and floors. DEHP and PVC was reduced in parenteral infusion devices in the NICU where possible and in construction/renovation projects.
- Safer Cleaning Products: The Healthier Hospitals Initiative (HHI) is a nationwide group of more than 600 medical facilities that have pledged to make their operations more environmentally friendly. As highlighted in the San Francisco Chronicle, UCSFMC was recognized by HHI for adopting the use of greener and safer chemicals at the medical center. For example, now for daily cleaning, UCSFMC uses non-alcohol, non-bleach wipes with chemicals that are generally considered gentler. According to Carl Solomon Sr., director of Hospitality Services at UCSF Medical Center and UCSF Benioff Children’s Hospital, bleach is only used to scrub out hard-to-kill bacteria in rooms where patients have checked out or in isolation rooms where patients have infectious diseases. “Not only does the staff like it, but the patients and the nurses like it too,” Solomon said of the new wipes. “It’s much safer.”
- Using Green Seal: UCSFMC has switched to nontoxic products approved by Green Seal, a third-party certification of sustainable products, to clean glass, carpets, upholstery, bathrooms and floors. In addition, the floors of the patient-care areas at the Parnassus campus are slowly being converted from vinyl, which periodically must be stripped and waxed or refinished to maintain its shine, to rubber, which only needs to be scrubbed with plain soap and water then buffed with a cleaning pad.
- Micro-Fiber Mops: To clean all the floors, custodians now use microfiber mops that require less water and chemicals and last twice as long as string mops. They use cleaning solutions that avoid volatile organic compounds, which create pollution when they are released into the air. Solomon said the flooring in patient areas at the new Medical Center at Mission Bay, which is under construction, will be mostly rubber.
- Minimize Stripping and Waxing: Design guidelines have been adopted so that newly installed flooring do not requiring stripping and waxing which cause unnecessary exposure to harsh chemicals.
- PVC-Free Flooring and Low VOC Paints: Specifications now require PVC-free flooring, PVC-free wall coverings and low VOC paints, finishes and furniture.
- Mercury Free: All MC facilities have been free of mercury since 2005.
Percent of nontoxic products purchased.
Implement top tactics in SAP 2.0, including development of a green parenting guide and flame retardant in design guidelines.
Medical Center Procurement
Environmentally Preferable Purchasing at UCSFMC recognizes that greener purchasing will result in less waste, less toxic chemicals brought into the organization, and support a market for even greener products. The medical center Waste/Procurement Work Group’s goal is to define a realistic waste reduction goal through waste diversion and procurement.
- Developed the Sustainability Action Plan 2.0 (2014-2020) and prioritized top tactics.
- Purchased EPEAT (Electronic Products Environmental Assessment Tool) and Energy Star certified electronic equipment through RFP specifications.
- Landscape and pest control contracts are pesticide-free as standard practice.
- 30 percent PCW paper is provided to all buyers as a default and purchase of 50% to 100% PCW is encouraged. The new E-procurement system, Procurement Materials Management and third party
- Global Healthcare Exchange (GHX) has reduced paper use by 90% with electronic or e-fax documents.
- Conversion to reusable totes for medical supplies through Professional Hospital Supplies significantly reduced cardboard waste (uses 23-26,000 totes/month).
- 26.7 percent of food purchases are sustainable products (see Sustainable Food section for details).
- Purchased reusable pillows (see Medical Waste section for details).
- Compostable wares for cafeteria and catering where reusable linens and dishware are only other option.
- Eliminated polystyrene purchasing in dishware.
- Saved $903,336 in FY13 and $931,466 in FY14 through purchases of reprocessed medical devices.
- Percentage of sustainable product spend of total purchases
- Measure percentage of paper purchased with PCW recycled content
- Implement top tactics in SAP 2.0, including point of collection waste signage and APEX double-sided printing.
- Develop procurement guidelines for major, strategic and critical purchasing decisions.
The adage you are what you eat, seems even more important when you are eating at a hospital cafe or sick in the hospital. UCSFMC has a commitment to moving the needle on sustainable food and has already exceeded its goal of procuring 20 percent of its food from sustainable sources by the year 2020. At UCSF, sustainable food must meet at least one of several standards: USDA certified organic, grown within 200 miles of San Francisco, domestic or fair trade certified or certified humane raised and handled, cage-free, grass-fed or pasture raised. Sustainably produced food supports a healthy environment by: conserving and protecting natural resources, reducing UCSF’s carbon footprint, providing fair wages for workers, promoting the humane treatment of animals and using less pesticides. To fund the cost premium of sustainable food, the medical center has captured cost savings by reducing traditional meat use and by implementing just in time purchases, which reduces waste.
According to the UCSF Sustainable Foodservice Annual Report (PDF), in addition to feeding 1,500 patients a day, the Department of Nutrition and Food Services at UCSFMC is responsible for several retail food outlets and a very busy and successful catering department, with combined annual sales of over $9.5 million.
- Surpassed UC Sustainable Food Goal: Despite the increasing costs of foods meeting UC criteria for sustainability, UCSFMC has continued its strong commitment to sourcing foods that are locally grown, organic, GMO-free, and cultivated in humane and sustainable ways. UCSFMC is proud to have surpassed the UC sustainability goal of 20% sustainable food purchases in FY13. We have not only maintained the progress made last fiscal year, but continue to grow our sustainable food spend, reaching an outstanding 26.7% sustainable food purchases in FY14. UCSFMC’s total “food spend” for FY14 was $5.89M, with over $1.5M of this going toward sustainable purchases.
- Hosted a Sustainable Meat Summit: At an unprecedented gathering in 2013, 80 participants gathered at the UCSF on October 7-8, 2013 Sustainable Meat Summit, including sixth generation cattlemen, chicken farmers, and physicians, to explore how to benefit from small and medium livestock producers who offer alternatives to intensive farming practices that boost production through antibiotic use. At the Summit, each sector involved in meat production was able to meet and converse with the others in the business. Estancia Beef attended the meeting and connected with UCSF, explaining that it was able to provide the necessary beef products consistently, in the volumes needed. While the cows come from Uruguay, which has carbon footprint implications, according to Estancia, grass fed, pasture-raised beef means a smaller carbon footprint, no concentration of waste in a small area (a hallmark of all feedlot operations), and no contamination (waste, antibiotics and/or growth hormones) from run-off into the local water system. As described by Health Care Without Harm, “Estancia Beef’s cattle are grass-fed, raised without antibiotics and hormones, certified by Animal Welfare Approved, and affordable. However, the company’s products were not available for hospitals to purchase through the major food distributors that they rely on, like US Foods and Sysco.”
- Leading the Way to Promote Antibiotic-Free Meat: UCSF is leading the way to promote the use of sustainable meat in health care. In addition to a multidisciplinary Sustainable Meat Summit focused on antibiotic-free purchasing, UCSF approved an Academic Senate resolution to phase out meat raised with non-therapeutic antibiotics. The medical center recently announced that it will now serve only antibiotic-free chicken on its patient and retail menus. UCSF reached out to hospitals statewide through Health Care Without Harm’s network, leveraging the combined purchasing power of multiple health facilities. With perseverance and collaboration, US Foods now offers Estancia products. UCSF’s work paved the way for other US Foods’ customers. The medical center now also offers a $4.50 grass-fed, antibiotic-free hamburger. In order to offer more sustainable meats, UCSFMC trimmed conventional meat purchases with offerings such as “Meatless Mondays” and other strategies for reducing waste. A new program recently put in place, offering hotel-style room service to patients, provides patients more control over food choices. The medical center expects this “on-demand” system will reduce waste and incur cost savings.
- Increased in Sustainable Meat Purchases: The medical center has significantly increased its pounds purchased of meat products that are hormone free or do not use non-therapeutic antibiotics from 1.9% to 26% over 5 years. In October of 2013, UCSFMC introduced Harvestland cage free, hormone free, antibiotic free chicken breasts. In February 2014, all bulk ground beef, beef patties and beef stew meat was converted to Estancia grass fed and finished, hormone free, antibiotic free and pasture raised beef.
- Composting Food Waste: The medical center now composts 90 percent of its food waste from cafeterias, staff lounges and patient rooms.
- On-Demand Meal Service: To be patient centric and reduce waste, we offer an on-demand meal service program for the UCSF Benioff Children’s Hospital (since April 2010) and on our bone marrow transplant unit (since January 2012). In May of 2014 we expanded this program to all inpatient units at the Parnassus location. The result will be reductions in food waste as food is only provided upon request of the patient except in special circumstances. NFS served an average of 1,200 patient meals daily prior to implementing on-demand meal service house-wide. We now provide an average of 1,000 customized trays daily to our patients. A majority of these meals are delivered to patients in the Moffitt and Long hospitals, which include the UCSF Benioff Children’s Hospital.
- Organic Baby Food: The medical center serves to organic baby food for pediatric patients. The following organic baby foods are now in use: organic apples, apple sauce, bananas, carrots, carrots/corn, chicken/brown rice, peas, sweet potatoes, pears and turkey/squash. This switch came as result of both the priorities of the Sustainable Food Working Group and external pressures from parents.
- Local and Organic Fruit and Vegetables: All whole fruits served at the Moffitt Cafe are now local, organic or both. If you buy an apple or banana in the cafe, it will be organic and/or local, where possible. Portions of the salad bar are also organic. The spring greens and spinach on the salad bar are local and organic over 95% of the time.
- Cage-Free Eggs: Despite rising costs, the medical center and cafe continue to use cage-free eggs from Wilcox Family Farms. The eggs are sustainably farmed from chickens with outdoor access, vegetarian feed, no GMOs or antibiotics and Food Alliance and American Humane Society Approved. The medical center also continues its use of American Humane Society-approved cage-free liquid and hard boiled eggs. This remains one of the top food expenses for the department and as the price of eggs has increased over 10%.
Other achievements include:
- The medical center and cafe continue to use whole wheat breads and wheat rolls from Alvarado Street Bakery, which provides local and organic bread. In addition, all brown rice is organic and local, from Lundberg in the Sacramento Valley.
- All yogurt in the cafe and medical center is local and organic from Wallaby in Sonoma. All Wallaby organic products are made using organic milk from cows raised on local, pasture-based farms. UCSFMC continues to purchase almost exclusively all fluid milk, sour cream and cottage cheese from northern and central California cows that have not been treated with rBST.
- UCSFMC was able to source 46 percent of its produce locally from Bay Cities Produce in FY14. Overall 36.9% of produce purchases for FY14 were local and/or sustainable from all vendors.
- Moffitt Café and MC Express launched an expanded Smart Snacks program in March of 2014 to offer a larger variety of snack products that meet Smart Choice and sustainability criteria
- Beginning in May of 2014 PFS and Moffitt Café made the switch from individually packaged, single serve conventional cereals to Nature’s Path organic bulk cereals.
- In May 2013, both PFS and retail services switched from serving tilapia fish to Pollock fish, which is Marine Stewardship Council certified. We also purchase wild-caught Alaska chum salmon, a Monterey Bay Aquarium Seafood Watch “Best Choice” for sustainable seafood.
- The NFS Sustainability Workgroup continues to meet bi-weekly. This has been a very successful coalition of the key members of the department and a great deal of progress has resulted from this active group.
- The Guardian Sustainable Business featured a story highlighting UCSFMC’s sustainable food program.
- In FY13, UCSFMC came up with a creative method by which to identify and track sustainable purchases using their food production system.
Percentage of annual food purchased that is sustainable (required by UCOP policy guidelines)
The NFS Sustainability Workgroup is looking at food waste reduction; introducing local and/or organic single serve items such as popcorn, nuts/dried fruit, hot/cold cereal cups, and kale chips; and switching to hormone free antibiotic free meat/poultry/seafood for the entire department.
Capital projects at the medical center use green building concepts focusing on energy water conservation, waste reduction, and use of recycled content materials consistent with Leadership in Energy and Environmental Design (LEED) principles. UCSF is working hard to ensure that all new construction (NC), renovations/commercial interiors (CI), and existing building operations & maintenance (EBOM) meet the Leadership in Energy and Environmental Design (LEED) guidelines for green buildings. The UC system-wide Policy on Sustainable Practices requires that all new construction and renovation projects greater than $5M meet the LEED-Silver criteria at a minimum. Until recently, the medical center was exempt from this requirement. UCSF currently has 23 projects that have received or are in process of LEED Certification for all or part of their space. At the medical center, three projects are going through the certification process. The new UCSF Medical Center at Mission Bay, the Hematology clinic in the Ambulatory Care Center (ACC4), and a new clinic on ACC5 are seeking LEED-Silver or -Gold.
- Constructed the new UCSF Medical Center at Mission Bay, which is expected to receive LEED Gold standard. Highlights of the new hospitals include an energy-efficient design resulting in 50 percent less power usage than the average US hospital; a 750 kW photovoltaic system; 4.3 acres of green space, and water conservation measures that will save four million gallons of potable water per year. Learn more about sustainability at the new medical center here.
- Completed the remodel of Ambulatory Care Center 4th floor Hematology Clinic (ACC4), which is expected to receive at least LEED Sliver. This is the first use of energy-saving chilled beam HVAC technology in a medical center remodel project.
- The Medical Center has a LEED CI project at the ACC 5th floor in design phase during FY14.
- Developed sustainability checklist templates based on LEED-CI and LEED-HC tailored to the medical center Parnassus projects.
- Ensured construction waste documentation is provided and tracked for all capital projects greater than $5M.
- Capital Programs to integrated sustainability measures into Division 1 specifications as a standard.
- All new projects to integrate sustainability criteria into project specific specifications.
- Real estate regularly seeks partnerships with building owners to incorporate sustainability criteria.
- Retrofit of water fixtures with low flow alternatives where possible.
- Developed Best Practices application for California Higher Education Sustainability Conference submittal
- Increased collaboration with UCSF Capital Programs to enhance sustainability in Medical Center projects
Total Gross Square Footage of LEED certified space by level over time.
Implement top green building and sustainable operations tactics in SAP 2.0, including development of building operator training and creation of energy use signage. Other goals include completion of LEED Certification for ACC4 hematology renovation in Ambulatory Care Center, complete LEED certification for Medical Center at Mission Bay and begin construction of ACC5 clinic in 2015.
California’s driest year on record makes conserving water even more important than ever. University of California President Janet Napolitano recently announced a goal of reducing per capita water use by 20 percent throughout the UC system by the year 2020. Napolitano said the university must step up and contribute to the preservation of the state’s most precious resource. Water conservation is a key component of UCSF’s sustainability priorities. UCSFMC has implemented several activities to reduce water usage, including retrofits, installing appropriate faucet aerators as part of the LivingGreen Office certifications, and using stickers to remind staff to report water leaks.
- Overall water use at the medical center was reduced by 7%, from 137,448 hundred cubic feet (CCF) in FY13 to 127,327 CCF in FY14 (see chart).
- Estimated savings from retrofits and new equipment includes 7.74M gallons/year due to chiller replacement, 1.05M gallons/year from medical air upgrade project, and 136,000 gallons/year from autoclave retrofits. Completed in FY12.
- At Mt. Zion, there were efforts to use an air-cooled chiller for H building (Cancer Treatment Center) instead of continuing to rely on the central gas powered chillers, which are cooled by water-based cooling towers.
- Promoted the reporting of water leaks to facilities management through sticker distribution.
- Drought tolerant plants were planted at the new Medical Center at Mission Bay in landscape areas.
- At the new Medical Center at Mission Bay, water efficiency measures and the irrigation plan will save more than two million gallons of potable water per year. The Medical Center at Mission Bay will host one of very few extensive water conservation systems located on a large, urban hospital site. Efficient domestic water fixtures and water-saving appliances have been installed in all buildings.
Water use in CCF (hundred cubic feet)
Transportation is a significant source of GHG emissions and UCSF has a robust program that supports the medical center and campus faculty, students, and staff to use public transit and inter-campus shuttles as much as possible. In FY14, for the first time, data was reported for the medical center specifically, so information for this most recent year is reported below.
- UCSF Transportation Services was awarded a Gold & ‘Best of’ rating for Best Workplaces for Commuters in 2013. These awards, which we also received in 2010 (Gold & ‘Best of’) and 2011 (Gold), provide national recognition and an elite designation to UCSF for offering outstanding commuter benefits and alternatives. This honor recognizes UCSF for taking exemplary steps to offer transportation alternatives for our staff, faculty and students, reducing commuter-related greenhouse gas emissions, traffic congestion and parking congestion. To qualify as a Best Workplace for Commuters, UCSF met a “Standard of Excellence” initially set by the U.S. Environmental Protection Agency (EPA).
- Transportation survey reported data specifically for medical center for first time in FY14 showing slightly higher single occupancy vehicles, higher carpool/vanpool, and lower public transit than the campus. This was consistent with shiftwork inherent in hospitals.
- The FY14 survey included a question on how UCSF’s green efforts have influenced faculty, staff, and students to change their behavior. The results shows that 69 percent of medical center respondents say they are recycling and composting more (the top activity); 50 percent of medical center respondents are eating more sustainable food, and 16 percent of medical center respondents are telecommuting. Only 35 percent of medical center respondents say they have reduced the use of toxic chemicals, pointing out an area for improvement
- Doubled bike parking at the Parnassus Millberry Union Garage by utilizing state of the art bike racks and expanding space by 20 percent.
- GPS on all campus shuttles to provide real time notice via smart phone app to increase shuttle ridership.
- Preferred parking and available charging stations for electric vehicle users.
The Culture of Sustainability
UCSF recognizes that our efforts must be accompanied by a strong culture shift by faculty, students and staff to effectively engage and transform our workplace to be more efficient and less wasteful. The medical center is working to embed engagement, outreach, and education through all facets of operations to meet our sustainability goals. The goal of the Culture Shift working group is to encourage the UCSF community to act more sustainably.
- Developed and launched a poster campaign to support energy, water, and waste reduction activities.
- Developed and launched a poster campaign showing UCSF leadership supporting sustainability including the CEO and Chancellor.
- Unique monthly visitors to the LivingGreen at UCSF website increased from a low of 2,357 to a high of 7,101 over the past two years. A total of 79,360 unique visitors came to the site in the past two fiscal years.
- Over 3,000 hits on UCSF-produced LivingGreen at UCSF engagement video on YouTube, filmed at the medical center and was shown at the Practice Greenhealth 2013 annual Clean Med Conference and the 2013 California Higher Education Sustainability Conference to over 2000 people. The video won 2013 Bronze Telly Award in the employee communications category.
- Developed a medical center focused website presence through a landing page and additional webpages, including both Medical Center Sustainability Reports on the website.
- 1,200 attendees, 65 vendors at LivingGreen Fair/Bike to Work Day in FY14. 800 cycling participants received lunch and snacks along their route on Bike to Work Day to Parnassus on May 8, 2014.
- In June 2013, four sustainability award winners were recognized, with one award going to a medical center employee, Deborah Don, in the staff category. She personally runs Mark’s List, a furniture repair/re-use program, and maintains an efficient storage area in the Ambulatory Care Center. She literally saves the medical center tens of thousands of dollars in avoided costs.
- To date, 16 offices, labs and a new category in 2013 of patient care units and clinics have participated in the LivingGreen office certification program.
- Development of the Sustainability Action Plan 2.0 and identified priorities from 2014 to 2020.
- Launched a sustainable living app in partnership with Chinook Book. To date, UCSF has created over 210 accounts, redeeming 50 coupons (includes the campus and medical center).
- New employee orientation includes LivingGreen wallet card with link to Sustainability website and resources.
- Increased year on year communications included webpages, e-learning modules on the UC Learning Management Center, newsletters, and poster campaigns/signage.
- Conducted public education on proper medication disposal to outpatient clinics and medical center.
- Co-hosted grand rounds and two presentations including either film and/or panel discussions on Flame Retardants, Sustainable Agriculture, and
- Climate Change to MC and campus staff and students.
- Created a healing garden for patients and staff in the new Medical Center at Mission Bay.
- Included sustainability statement in Children’s Hospital Guide.
- Included sustainability questions in the annual commute survey.
- Held Recycled Art Show at Living Green Fair May 2013 and 2014.
- Staff Presented at California Higher Education Sustainability Conference.
- Reported progress to the HHI Healthier Hospitals Initiative portal.
- Shuttle bus placard with sustainability messages.
- Number of participants in the LivingGreen certifications for office, labs, events, and caterers.
- Number of unique visitors to the website year on year.
Implement top tactics in SAP 2.0, including to encourage telecommuting and promote mindful consumption at events.
The accomplishments of the past two years could not have been possible without support from the following leaders and their staff:
- Mark Laret, Chief Executive Officer
- David Odato, Chief Administrative Officer
- Sheila Antrum, Chief Nursing Officer and staff
- Kevin Pattison, Executive Director, Procurement
- Tim Mahaney, Executive Director Facilities and Support Services and staff
- Dan Henroid, Director, Food and Nutrition Services and staff
- Carl Solomon, Director, Hospitality and staff
- Sandy Weinholz, Director, Operating Room and staff
- Marijane White, and the Operations Improvement Department
- Medical Center representatives on the Chancellor’s Advisory Committee on Sustainability
- The Sustainability Steering Committee co-chairs and workgroup members
FY12 and FY13 Sustainability Leadership Work Groups
This report is brought to you by UCSFMC’s sustainability leadership work groups:
CACS co-chair, David Odato, Associate Vice Chancellor, Human Resources and Medical Center Chief Administrative Officer
Sustainable Food Work Group
CACS Member: Dan Henroid, Director, Nutrition and Food Services
Co-chair: Jen Dowd, Retail Services Manager
Waste/Procurement Work Group
CACS Member: Kevin Pattison, Director, Materiel Services Administration
CACS Member: Michael Skehan, Executive Director, Clinical Services
Co-chair: Jose Watson, Assistant Director, Hospitality Services and Louise Hallberg, Clinical Nurse IV
Toxics Reduction Work Group
CACS member: Tracey Woodruff, Associate Professor, OB-GYN, Program on Reproductive Health and the Environment
Co-chair: Alison Cleaver, and Julie Sutton
Climate Change Work Group
CACS Member: Bob Eaton, Director, Environmental Health and Safety
CACS Member: Tim Mahaney, Director, Medical Center Facilities and Support Services
Co-chair: Travis Clark, EHS (interim for Dick Chan, Medical Center Facilities Management)
Sustainable Operations Work Group
CACS member: Angela Hawkins, Associate Vice Chancellor, Campus Life Services
Co-chairs: Diori Johnson, Medical Center Leaseholds
Water Conservation Work Group
CACS member: Tim Mahaney, Director, MC Facilities and Support Services
Co-chair: Bruce Mace, Director, Building Maintenance
Green Building Work Group
CACS Member: Colin Boyle, Assistant Director, Global Health Sciences
Co-chair: Deepak Dandekar, Medical Center Design and Construction
Culture Shift Work Group
CACS Member: Ellen Weber, Professor, Clinical Medicine, Academic Senate
Co-chair; Frances Flannery, Marketing Manager
Gail Lee, Sustainability Manager, Medical Center and Campus
Sustainability Writer: Deborah Fleischer, Green Impact.