Advisor Live® Healthier Hospitals Initiative - sustainability and the role of supply chain November 28, 2012

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Speakers

Kellie McNelis Director,

environmental purchasing,

Premier healthcare alliance

Janet Brown Director, content

and outreach, Healthier

Hospitals Initiative

David McCombs VP, supply chain

operations, Bon Secours

Health System

www.HealthierHospitals.org

Introducing Healthier Hospitals Initiative

November 2012

Janet Brown Director, Facility Engagement Practice Greenhealth Director, Content & Outreach Healthier Hospitals Initiative jbrown@practicegreenhealth.org

Poll Question Number One

Have you heard of the Healthier Hospitals Initiative? Yes No I’m not sure

seEMA I WANT OTHER ENGAGEMENT LISTED HERE MAYBE A SCREEN SHOT FOR BLOGS FORUMS NEWS ETC….

HHI — Presentation Title Goes Here 6

Poll Question Number 2

Is your facility enrolled in the Healthier Hospitals Initiative? Yes No I’m not sure

Strength in Numbers •480 hospitals •Represent over 90,000 beds •700,000 employees •$20 billion spent in purchasing materials & supplies •9% of total hospital sector

9

Engage

•Webinars •Sharing Calls •Forums •Case Studies

•Spark Newsletter •Blogs •And more!

How to Enroll

12

•www.healthierhospitals.org and click on “Get Involved – Enroll Now •Christopher Bodkin a-603-491-6106, or cbodkin@healthierhospitals.org, help@healthierhospitals.org •9:00am-5:00pm EST Monday- Friday

Introductions & Welcome!

Seema Wadhwa Project Director swadhwa@healthierhospitals.org (703) 405-8758 Janet Brown Director of Content and Outreach jbrown@healthierhospitals.org (866) 598-2110

www.healthierhospitals.org

www.HealthierHospitals.org

Bon Secours Health System HHI Participation Summary

November 2012

David J. McCombs Vice President, ERP/Supply Chain Bon Secours Health System, Inc. David_McCombs@BSHSI.org

Presentation objectives

• Why Bon Secours is participating in HHI • Review BSHSI efforts in three key HHI

Challenges: • Less Waste – first and “easiest” • Leaner Energy – long term effort • Engaged Leadership – accountability

• Lessons Learned

16

Bon Secours Health System

Joint Venture Owned

NY

PA

MD

VA

SC

FL

KY

A $2.9 billion not-for-profit Catholic health system, Bon Secours owns, manages, or joint ventures: 19 Acute Care Hospitals 1 Psychiatric Hospital 5 Nursing Care Facilities 4 Assisted Living Facilities 7 Retirement Communities/

Senior Housing 15 Home Care/Hospice

Providers Bon Secours’ more than 21,000 caregivers help people in 10 communities in 7 states

Bon Secours Health System Mission Statement The Mission of Bon Secours Health System is to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a System of caregivers, we commit ourselves to help bring people and communities to health and wholeness as part of the healing ministry of Jesus Christ and the Catholic Church.

In early 2008 the Bon Secours Health System’s decision to develop Ecological Stewardship as a system-wide initiative reflected a deepening of its mission, vision and values:

… to bring good help to those who are poor and dying …. and to help bring people and communities to health and wholeness as part of the healing ministry of Jesus through the sustainable use of natural resources and reduction in the use of toxic chemicals and materials.

BSHSI sustainability commitment

Health Hospital Initiative – Why participate?

• HHI Challenges provides new framework, benchmark targets and collaborative support group for enhancing Sustainability efforts

• Cost Reduction imperative – HHI focus areas good match for business model changes needed to reduce operating expense that will be required to thrive in health reform future

• Community Benefit – helps achieve the “triple Aim” of providing benefits to patients, upstream prevention of disease and reduced health care costs

HHI Challenge: Less Waste

Baseline: Report a waste baseline for: Solid waste, regulated medical waste, recycling and hazardous waste. Continue tracking for a three-year minimum. Level 1: Commit to one of: Regulated medical waste reduction, recycling or construction and demolition diversion goals. Level 2: Commit to two of: Regulated medical waste reduction, recycling or construction and demolition diversion goals. Level 3: Commit to three of: Regulated medical waste reduction, recycling or construction and demolition diversion goals. Measures and Targets: RMW: Reduce RMW to either less than 10% of total waste or less than 3 lbs. per adjusted patient day Recycling: Achieve a 15% recycling rate compared to total waste Construction/Demolition Diversion: Implement a construction and demolition debris recycling program for major renovations and new construction to achieve at least 80% recycle and diversion rate

Less Waste – Opportunity to improve the operating model

Historical Business Model: • Multiple Waste Streams

managed through many departments

• Limited goals other than maintaining costs of each separate waste stream

• Data limited to various vendor “manifests” and invoices

• Limited engagement of staff to change behaviors in support of greening efforts

• Lack of understanding of impact of waste practices

New Business Model: • Limited comprehensive

waste vendor(s) – manages all waste contracts

• Database of all waste stream weights & measures

• Development of recycling, RMW reduction and waste reduction targets for each waste stream

• Oversight by Supply Chain and Green Team

Bon Secours Waste Operating Model change

• Supply Chain charged with developing new business model in conjunction with Operating Department Leadership ( EVS, Plant Ops, Nursing) and Green Team

• Baselines assessment performed of all major waste streams (Municipal Waste, Regulated Medical Waste, CDD, Recycling)

• Proposal developed for comprehensive waste management model All waste contracts managed by vendor through LOA Central invoicing of all waste streams; one BSHSI invoice Central database of costs and weights by facility 24/7 Service Call center for all waste vendor performance Incentives for cost reduction and waste reduction efforts

• Contract awarded and all waste agreements under central administration • Major waste strategy: Convert unnecessary RMW to MSW; increase MSW

recycling for all eligible categories; target special recycling opportunities – construction, scrubs, blue wrap, etc.

BSHSI Waste Stream scorecard

Facility Waste Stream Total Weight (LBS)

Waste Stream

Total Weight (LBS)

Waste Stream

Total Weight (LBS)

Waste Stream

Total Weight (LBS)

Facility Total Weight (LBS)

% of Total Waste RMW FY 2012

% of Total Waste Recycled FY 2012

Memorial Regional Medical Center MSW 1,734,880 RMW 180,157 CDD 413,254 RCY 558,623 2,886,914 6.2% 33.66% St. Mary's Hospital MSW 2,465,456 RMW 326,722 CDD 548,511 RCY 1,296,059 4,636,749 7.0% 39.78% Richmond Community Hospital MSW 314,080 RMW 11,311 CDD 62,751 RCY 130,257 518,399 2.2% 37.23% St Francis Medical Center MSW 1,141,620 RMW 84,537 CDD 141,591 RCY 394,907 1,762,655 4.8% 30.44% BSHSI Richmond Totals MSW 5,656,036 RMW 602,727 CDD 1,166,107 RCY 2,379,847 9,804,717 6.1% 36.17% St. Francis Downtown MSW 1,730,671 RMW 146,340 CDD 334,535 RCY 1,035,651 3,247,197 4.5% 42.20% St. Francis Eastside MSW 660,380 RMW 47,564 CDD 70,257 RCY 119,256 897,457 5.3% 21.12% BSHSI St. Francis Health MSW 2,391,051 RMW 193,903 CDD 404,792 RCY 1,154,908 4,144,654 4.7% 37.63% Our Lady of Bellefonte MSW 1,071,230 RMW 79,465 CDD 228,900 RCY 299,440 1,679,035 4.7% 31.47% Maryview Hospital MSW 1,269,258 RMW 115,888 CDD 519,800 RCY 538,040 2,442,986 4.7% 43.30% Mary Immaculate MSW 886,860 RMW 90,426 CDD 238,900 RCY 294,472 1,510,658 6.0% 35.31% Depaul Medical Center MSW 962,540 RMW 78,940 CDD 163,396 RCY 343,284 1,548,160 5.1% 32.73% BSHSI Hampton Roads MSW 3,118,658 RMW 285,254 CDD 922,096 RCY 1,175,796 5,501,804 5.2% 38.13% BS Virginia 8,774,694 RMW 887,981 CDD 2,088,203 RCY 3,555,643 15,306,521 5.8% 36.87% Good Samaritan Hospital MSW 1,490,220 RMW 203,102 CDD 199,310 RCY 393,229 2,285,861 8.9% 25.92% St Anthony's MSW 318,739 RMW 34,789 CDD 196,760 RCY 129,255 679,543 5.1% 47.98% Bon Secours Community MSW 529,250 RMW 32,483 CDD 169,330 RCY 181,742 912,805 3.6% 38.46% BSHSI Charity Health MSW 2,338,209 RMW 270,374 CDD 565,400 RCY 704,226 3,878,209 7.0% 32.74% Bon Secours Baltimore MSW 801,548 RMW 77,177 CDD 110,459 RCY 225,376 1,214,559 6.4% 27.65% BS New York MSW 1,000,329 RMW 3,370 CDD 20,400 RCY 192,400 1,216,499 0.3% 17.49% BS St. Petersburg MSW 395,739 RMW 1,477 CDD 25,600 RCY 116,647 539,463 0.3% 26.37% Senior Services MSW 1,396,068 RMW 4,847 CDD 46,000 RCY 309,047 1,755,962 0.3% 20.22% Grand Totals MSW 16,772,800 RMW 1,513,747 CDD 3,443,753 RCY 6,248,640 27,978,940 5.4% 34.64%

BSHSI Waste Stream scorecard

Facility Waste Stream Total Weight (LBS)

Waste Stream

Total Weight (LBS)

Waste Stream

Total Weight (LBS)

Waste Stream

Total Weight (LBS)

Facility Total Weight (LBS)

% of Total Waste RMW FY 2012

% of Total Waste Recycled FY 2012

Memorial Regional Medical Center MSW 1,734,880 RMW 180,157 CDD 413,254 RCY 558,623 2,886,914 6.2% 33.66% St. Mary's Hospital MSW 2,465,456 RMW 326,722 CDD 548,511 RCY 1,296,059 4,636,749 7.0% 39.78% Richmond Community Hospital MSW 314,080 RMW 11,311 CDD 62,751 RCY 130,257 518,399 2.2% 37.23% St Francis Medical Center MSW 1,141,620 RMW 84,537 CDD 141,591 RCY 394,907 1,762,655 4.8% 30.44% BSHSI Richmond Totals MSW 5,656,036 RMW 602,727 CDD 1,166,107 RCY 2,379,847 9,804,717 6.1% 36.17% St. Francis Downtown MSW 1,730,671 RMW 146,340 CDD 334,535 RCY 1,035,651 3,247,197 4.5% 42.20% St. Francis Eastside MSW 660,380 RMW 47,564 CDD 70,257 RCY 119,256 897,457 5.3% 21.12% BSHSI St. Francis Health MSW 2,391,051 RMW 193,903 CDD 404,792 RCY 1,154,908 4,144,654 4.7% 37.63% Our Lady of Bellefonte MSW 1,071,230 RMW 79,465 CDD 228,900 RCY 299,440 1,679,035 4.7% 31.47% Maryview Hospital MSW 1,269,258 RMW 115,888 CDD 519,800 RCY 538,040 2,442,986 4.7% 43.30% Mary Immaculate MSW 886,860 RMW 90,426 CDD 238,900 RCY 294,472 1,510,658 6.0% 35.31% Depaul Medical Center MSW 962,540 RMW 78,940 CDD 163,396 RCY 343,284 1,548,160 5.1% 32.73% BSHSI Hampton Roads MSW 3,118,658 RMW 285,254 CDD 922,096 RCY 1,175,796 5,501,804 5.2% 38.13% BS Virginia 8,774,694 RMW 887,981 CDD 2,088,203 RCY 3,555,643 15,306,521 5.8% 36.87% Good Samaritan Hospital MSW 1,490,220 RMW 203,102 CDD 199,310 RCY 393,229 2,285,861 8.9% 25.92% St Anthony's MSW 318,739 RMW 34,789 CDD 196,760 RCY 129,255 679,543 5.1% 47.98% Bon Secours Community MSW 529,250 RMW 32,483 CDD 169,330 RCY 181,742 912,805 3.6% 38.46% BSHSI Charity Health MSW 2,338,209 RMW 270,374 CDD 565,400 RCY 704,226 3,878,209 7.0% 32.74% Bon Secours Baltimore MSW 801,548 RMW 77,177 CDD 110,459 RCY 225,376 1,214,559 6.4% 27.65% BS New York MSW 1,000,329 RMW 3,370 CDD 20,400 RCY 192,400 1,216,499 0.3% 17.49% BS St. Petersburg MSW 395,739 RMW 1,477 CDD 25,600 RCY 116,647 539,463 0.3% 26.37% Senior Services MSW 1,396,068 RMW 4,847 CDD 46,000 RCY 309,047 1,755,962 0.3% 20.22% Grand Totals MSW 16,772,800 RMW 1,513,747 CDD 3,443,753 RCY 6,248,640 27,978,940 5.4% 34.64%

Grand Totals MSW

BSHSI Waste results

•Recycling increased 90%, 5.01 M pounds to 9.7 M pounds •RMW decreased 69%; 4.9 M pounds to 1.5M pounds •Annual Waste expense decreased over 20%; $500K •4,800 tons of waste diverted from community landfills

HHI Challenge: Leaner Energy

Baseline: Track Energy Use and Greenhouse Gas Emissions through ENERGY STAR@ Portfolio Manager Level 1: Reduce Energy Use by three percent from baseline Level 2: Reduce Energy Use by five percent from baseline Level 3: Reduce Energy Use by ten percent from baseline Measures and Targets: (Energy Star) Energy Consumption: Weather Normalized Energy Utilization Index (kBtu/SF/Yr) Greenhouse gas: Greenhouse Gas Emissions (MtCO@e/yr) Cost: Energy Cost per Sg. Ft. annualized

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BSHSI Energy Management Operations Model – Two Parallel Efforts

ENERGY CONSERVATION ENERGY SUPPLIER COST MANAGMENT ENERGY MANAGEMENT

OUTCOMES

BSHSI Utility Invoice, Energy

usage and facility Data base

BSBSI Energy Conservation Measures =

smaller footprint

BSHSI Energy Services Contracts

= Price Savings

ENERGY STAR PORTFOLIO MANAGER

• Monthly Monitoring

•Benchmark Comparison

ENERGY FACILITY AUDITS

•Level 1 Walk Through Analysis

•Level 2 Energy Survey & Analysis

•Level 3 Detailed Analysis of Capital Intensive modifications

•Level 4 Retro-commissioning

ENERGY INVOICE AUDITS

•Verify billing accuracy

•Optimize rate structure

ENERGY PROCUREMENT SERVICES

•Assess facility energy supply contract obligations, supply requirements, and market opportunities

•Competitively source facility energy supply requirements

PRIORITIES OPPORTUNITIES

DEVELOPMENT AND IMPLEMENTATION OF ENERGY CONSERVATION MEASURES

• Low cost/no cost

• High ROI Projects

FUNDING

Bon Secours 2011 and 2012 Energy Action Plan – Key Elements

Goal 1: Create a Sustainable Energy Management Culture Goal 2: Develop Tools to Implement, Measure and Track ECM’s and Energy Savings Goal 3: Change business model for energy supplier contracting Goal 4: Identify, prioritize and implement Energy Conservation Measures Goal 3: Decrease Energy Consumption 3% Energy Audits performed in six prioritized facilities ( based on ES score) to identify and prioritize potential capital improvement and other projects, a set of 24 standardized No Cost/Low Cost Energy Conservations Measures implemented across all facilities

Energy Scorecard

No. Facility (Energy Star Category) City State

Baseline Energy Star

Rating1

Current Energy Star

Rating

FY 11 Baseline Weather Normalized

Source EUI1

(kBtu/SF/YR)

Weather Normalized Source EUI

(kBtu/SF/YR)

Percent Change from

Baseline

Weather Normalized Source

EUI (kBtu/SF/YR)

Percent Change from Baseline

Baseline Greenhouse

Gas Emissions1

(MtC02e/yr)

Greenhouse Gas Emissions

(MtC02e/yr)

Percent Change from Baseline

09/10 - 08/11 08/11 - 07/12 C = B/A-1 08/10 - 07/11 E = B/D-1

GENERAL MEDICAL & SURGICAL

3 Bon Secours Hospital Baltimore MD 32 32 518.5 526.3 1.5% 518.9 1.4% 7,289 7,251 -0.5%

6 Good Samaritan Hospital Suffern NY 16 18 622.1 619.3 -0.5% 620.6 -0.2% 9,229 9,132 -1.1%

10 St. Anthony Community Hospital Warwick NY 70 66 517.6 535.6 3.5% 551.7 -2.9% 1,690 1,729 2.3%

5 Bon Secours Community Hospital Port Jevis NY 89 88 372.0 384 3.2% 372.8 3.0% 2,540 2,529 -0.4% Total Charity 539.0 543.1 543.1 0.0%

15 Maryview Medical Center Portsmouth VA 70 72 446.8 436.2 -2.4% 446.6 -2.3% 11,860 11,645 -1.8%

14 Mary Immaculate Hospital Newport News VA 72 72 426.9 419 -1.9% 426.9 -1.9% 6,613 6,574 -0.6%

13 Depaul Medical Center Norfolk VA 27 32 503.7 491.9 -2.3% 508.2 -3.2% 12,883 12,411 -3.7%

Total Hampton Roads 463.3 452.9 464.9 -2.6%

2 Our Lady of Bellefonte Hospital Ashland KY 50 57 635.0 602.1 -5.2% 635.9 -5.3% 8,613 8,338 -3.2%

17 Memorial Regional Medical Center2 Mechanicsville VA 54 31 455.8 507.3 11.3% 456.1 11.2% 10,975 12,293 12.0%

21 St. Mary's Hospital Richmond VA 21 26 561.9 544.7 -3.1% 560 -2.7% 24,547 23,613 -3.8%

18 Richmond Community Hospital Richmond VA 71 79 638.4 624.8 -2.1% 677.7 -7.8% 2,380 2,224 -6.6%

19 St. Francis Medical Center Midlothian VA 13 22 596.0 541.8 -9.1% 595 -8.9% 10,229 9,399 -8.1%

Total Richmond 543.6 537.6 544.2 -1.2%

12 St. Francis Hospital - Eastside Greenville SC 85 84 409.2 414.1 1.2% 413.9 0.0% 4,099 4,076 -0.6%

11 St. Francis Hospital - Downtown Greenville SC 44 45 522.3 517.3 -1.0% 522.8 -1.1% 11,138 10,975 -1.5%

Total South Carolina 486.6 484.7 488.4 -0.8%

Bon Secours Low Cost/No Cost ECMs identified

Rank No Cost ECM Compliance Requirements

Verification Documentation

1

Develop a program on Healthstream that every employee has to review yearly educating them on behavior awareness, simple information that inspires and motivates.

Each employee is to take the energy conservation training module annually.

Healthstream Documentation

2

Implement a standard policy for departments to:

· Close out of clinical and non-clinical areas after hours to turn out unoccupied area lighting.

Each hospital system is to prepare a comprehensive standard policy and procedures for closing out clinical and non-clinical areas after hours and to reduce lighting levels in occupied areas after hours.

Submit the standard policy and procedures.

· Reduce lighting on patient floors and other occupied areas after hours.

Each hospital to develop a method to verify and document compliance.

Submit proof of compliance.

3 Security is to turn off lights in unoccupied locations during security rounds after hours.

Add turning off light to security rounds procedures.

Submit proof of training and compliance twice annually.

Add turning off lights to security training program. Develop method to verify and document compliance.

4 Turn lights out in offices and conference rooms if away longer than 15 minutes. Include in Healthstream training module. Healthstream records

5 Have staff turn off monitors, computers, peripheral devices and local printers at the end of the day.

Include in Healthstream training module. Submit policies

Have IT and facilities departments collaborate, prepare and implement standard power savings settings and policies for all computers to include turning non-critical computers off at night.

Submit verification of compliance.

6 Close loading dock or delivery doors after deliveries to eliminate the loss of heat/air seasonally.

Develop medium range plan to add automatic closures, timers or other automatic means to close loading dock doors when not in use.

Submit medium range plan.

Submit annual progress report on implementation.

7 Turn off, reduce flow or change set points at air handling units that serve non-patient or unused areas after hours

Identify air handling units that have potential for changing settings or turning off during unoccupied hours without affecting patient care or operations.

Submit implementation progress for identified AHUs.

Turn off or change settings for identified AHUs.

8 Turn off TVs in lobbies, waiting rooms, patient rooms and other areas when unoccupied.

Include in Healthstream training module. Include in Healthstream training module.

Add turning off TVs to security rounds procedures.

Submit proof of security training and compliance.

Add turning off TVs to security training program.

Develop method to verify and document compliance.

9 Reset HVAC hot water supply temperature according to season or outside air temperature.

Implement (automatically through control system if possible) hot water supply temperature reset.

Submit reset schedules that have been implemented.

10 Optimize chiller plant operation, either manually or automatically, to improve the efficiency and operation of the chiller plant.

Develop and implement a chiller optimization plan and procedures to improve the efficiency of the central chiller plant.

Submit chiller plant optimization plan.

11 Make using color a manual option for color copiers. Submit details on how compliance has been achieved.

All facilities are to include preventative maintenance procedures in their

Id tif PM d th t di tl l t t

Submit a list of PM procedures that

Rank No Cost ECM Compliance Requirements Verification Documentation

13 Limit thermostat set points in areas in accordance with facility energy policy.

Develop energy policy for facility operations that describe all hospital areas and the range of allowable temperature settings.

Submit energy policy

Limit the adjustment range of all thermostats, either through the DDC control system or by means of blank covers, locks or thermostat guards to comply with the policy.

Submit medium range plan for compliance

Submit annual progress report

14 Ensure that all printers and copiers are in energy saver mode where available.

Submit vendor documentation of compliance.

15 Change filters on a planned routine basis. Implement a routine filter replacement program.

Submit filter replacement program

16 Reset static pressure setpoint in air handling unit units based on load for systems with DDC controls.

Implement duct static pressure reset control in air handling units.

Submit a list of air handling units and indicate which have DDC controls and which have implemented sp reset control.

17 Reset supply air temperature setpoint in air handling unit units based on load for systems with DDC controls.

Implement supply air temperature reset control in air handling units.

Submit a list of air handling units and indicate which have DDC controls and which have implemented supply air temperature reset control.

18

Reset differential pressure set point on chilled and hot water pumps based on system demand for systems with DDC control and pumps with VFDs.

Implement differential pressure reset for chilled and hot water pumps.

Submit a list of pumps and indicate which have DDC controls and which have implemented differential pressure reset control.

Rank Low Cost ECM Compliance Requirements Verification Documentation

1 Change out T12 lamps to T8 lamps or better as they burn out. Develop replacement plan

Submit plan and annual report showing percentage replacement

2 Put all exterior lighting on astronomical timed control and/or photocells. Develop implementation plan

Submit plan and annual report showing percentage compliance

3 Ensure that all doors and windows have appropriate weather seals.

Develop implementation plan and cost estimates

Submit plan and annual report showing percentage compliance

4 Ensure all facilities do annual balancing of chilled water systems

Develop plan to address balancing of chilled water systems (filter replacement, etc)

Submit preventative maintanence plan

5 Add occupancy sensors in multi-occupant spaces. Prepare a medium range plan to install occupancy sensors in multi-occupant spaces

Submit an annual report detailing percentage compliance.

6

Limit the adjustment range of all thermostats, either through the DDC control system or by means of blank covers, locks or thermostat guards to comply with the policy.

Submit an annual report detailing percentage compliance.

Energy Audit High ROI ECMs Projects Identified Energy Audit Summary Category Description

HVAC & Energy Consuming Systems Retro-Commission Main Hospital & associated buildings to ensure proper and Efficient operations

Heating & Cooling Points & Schedule Reduce operating schedule and alter heating and cooling set points during unoccupied periods of time for % of the hospital.

After-hour Lighting Reduce after hours lighting use by 20% through staff training and the use of simple lighting control devices (motion detectors, timed switches, etc.).

T-8 Lighting Replace all existing T-12 fluorescent lighting with energy efficient T-8 lighting.

Air Handling Units Install/Program a discharge air temperature reset on all air handling units serving areas with substantial exterior wall surfaces. (20%)

Air Handling Units Enable the economizer sequence on all AHU’s to utilize Outside air for cooling and shut off the chiller.

Air Exchange Rates - OR Reduce Operating Room air exchange rates from 20 ACH to 8 ACH during periods of non-surgical use

Chilled Water Control Replace all 3-way chilled water control valves with 2-way valves.

Air Handling Unit Fans Replace supply fans on AHU Exit Signs/Lighting Change out all exit signs bulbs to L.E.D. type. A/C Units Replace all “window shaker” A/C units with VRF system. Inlet Guide Vanes Replace inlet guide vanes with variable frequency drive

Atrium Rooftop Unit Add rooftop unit to atrium to positively pressurize the lobby area.

Fountains after-hours Turn off fountains and water features after hours.

Energy Reduction Results – FY 12

•BSHSI Facilities achieved a 2.5% Site EUI reduction and a 1.0% Weather Normalized EUI reduction •Six facility Energy audits completed; 14 high ROI projects ID’ed •Low Cost/No Cost ECM completion of 95% across all facilities •Greenhouse Gas Emissions decreased 1.6%

HHI Challenge: Engaged Leadership Baseline: Sign and submit an executive commitment statement Level 1: Implement three of the leadership activities from the reference list Level 2: Implement six of the leadership activities from the reference list Level 3: Implement ten of the leadership activities from the reference list Strategic Priority • Create a strategic sustainability plan • Created and Environmental Mission statement • Formulate a sustainability program budget • Appoint a sustainability executive owner • Build in sustainability measures as an

organizational priority • Create a sustainability reporting structure

Systematic Communications • Communicate progress on sustainability

initiatives to the board • Report progress regularly on sustainability

initiatives to leadership team • Communicate sustainability progress from the

leadership team to the organization routinely • Create and distribute an annual report • Provide a feedback mechanism for intitiatives

Operational Focus • Create sustainability responsibilities • Create an environmental steering committee • Conduct a baseline assessment • Define measurable sustainability objectives • Identify leader for sustainability efforts • Identify the clinical champion • Demonstrate progress on at least 2 HHI

Challenges

Stakeholder Engagement • Participate in programs to support

employee and community engagement • Educate all employees about sustainability,

including new employees • Share sustainability practices • Engage leaders to serve as spokespeople • Include sustainability in community benefit

reports

33

Vision Statement By 2012, Bon Secours Health System (BSHSI) will be distinguished for ecological stewardship in the communities we serve through a cultural transformation that fulfills our responsibility to God’s creation and each other in the generations to come. Guiding Principles The mission, values and operating principles of Bon Secours Health System shape this initiative to enable a consistent ethic of functioning. The program focus will be on assessment and reduction of the system’s “carbon footprint” through efficient recycling and waste stream management, reduction of use of toxic chemicals, reduction of energy use, and movement toward the use of sustainable products and resources, and to develop within the Bon Secours Health System a culture of sustainability and awareness of the far reaching impact of decisions and actions. The connection between the health of individuals, community and environment will underlie decisions and program planning. Three Year Action Plan A three-year “road map” for the development of the Ecology Model and basis for transforming the Organization to meet the expanded mission. Three Basic Elements of the Plan: Goal 1: Design and Implement Program Goal 2: Establish an Organizational Model Goal 3: Provide Support Tools and Resources Organization and Accountability Structure A System-level BSHSI Green Team, accountable to the CEO/Executive Council; Local System Green Teams accountable to the Local system CEO; Board and Executive-level Objectives and Measurement program

Key Structural Elements of BSHSI Environmental Stewardship Model

34

BSHSI Environmental Stewardship Organization Bon Secours Health Ministries

Board of Trustees

BSHSI CEO

BSHSI Executive CouncilLocal System CEOs, VP Sponsorship

BSHSI Green TeamSr. Rosemary Moynihan, Director, Ecology and Global Health Ministry

Local System Green Team Leaders (10)VP ERP / Supply Chain Operations

VP Strategic Performance

BS New YorkGreen Team

BS Richmond Green Team

OLBHGreen Team

St. FrancisHealth System Green Team

BS Hampton Roads

Green Team

BS St. PetersburgGreen TEam

BS Charity Green Team

Health System Office

Green Team

BS Baltimore Green Team

St. FrancisRoper

Green Team

BSHSI Energy Management

Council

BSHSI Food Council

InformationSystems Future

Board & Executive

System-wide

Local System; Facility

35

Key Elements of BSHSI Environmental Stewardship Leadership Engagement model

BSHSI Green Team

Vision Statement

Guiding Principles

Ecological Stewardship Plan Action Plan (3 year)

Ecological Stewardship Annual Objectives

Ecological Stewardship Baseline Assessments, Targets and Measures

IRIS Ecology Initiative Repository

BSHSI Board & Executive Management Team

BSHSI Strategic Quality Plan (3 years)

BSHSI Annual Objectives

BSHSI Board Dashboard Report

BSHSI Incentive Plans

BSHSI Local System Management & Green

Teams

Annual Objectives

Local System Board Dashboard Reports

Local System Green Team Reports: •PGH Eco Checklist t

•PGH Awards Applications

•Recycling Improvement Plans

•HWS Waste Management Summary & Detailed Reports

•Energy Star Portfolio Manager SEP reports

Annual Performance Reviews

System-wide Board & Executive Local System

36

Objectives Included in Annual Short Term Incentive Goals for Directors and Above

Objective: Achieve Energy and Waste Reduction Targets

Threshold Target Maximum 1. Submit application by

February 1, 2010 to PGH for Partner Recognition Awards

2. Join Energy Star 3. Achieve 20% Recycling

as a Percent of Total Waste

1. Develop and Implement at least 3 Approved Energy Reduction Practices with document Energy reduction and Net cost savings; or

2. Achieve 25% Recycling as a Percent of Total Waste

1. Implement Regulated Medical Waste reduction plan

2. Achieve 8% RMW as Percent of Total Waste

3. Achieve PGH Partner for Recognition Award

Threshold Target Maximum 1. Reduce energy

consumption (Weather adjusted EUI) 3% over

prior year 2. Implement 80% of BSHSI

no cost/low cost Energy Conservation Measures

1. Reduce energy consumption (Weather adjusted EUI) 4% over prior year

2. Implement 90% of BSHSI no cost/low cost Energy Conservation Measures

1. Reduce energy consumption (Weather adjusted EUI) 5% over prior year

2. Implement 100% of BSHSI no cost/low cost Energy Conservation Measures

FY 2010-11 Incentive Goals

37

Progress to Goals Tracked Monthly in BSHSI Board Dashboard Report (System-wide, Local System and for each Facility)

Board Summary DashboardBon Secours Health System, Inc.

For The Two Months Ending October 31, 2012Variance Shading Index

Type >= <= >= <=Increase is Favorable 0.0% 0.0% -2.8% -2.9%Decrease is Favorable 2.9% 2.8% 0.0% 0.0%

Indicator Description Timing Prior Yr YTD Current Yr MTD Current Yr YTD Target % Var to Tgt % Var to PY Type

17 Energy Conservation M2L 492 N/A 487 481 1.2% -1.0% Decrease is Favorable

18 Recycling as a Percentage of Total Waste ML 34.60% 32.75% 32.75% 34.60% -5.3% -5.3% Increase is Favorable

19 RMW as a Percentage of Total Waste ML 5.40% 6.20% 6.20% 5.40% 14.8% 14.8% Decrease is Favorable

Express our Catholic IdentityModel and Advocate Social Justice

FavorableFavorable

Favorable

Favorable

Favorable

Sustainability Metrics Model supports alignment and focus at all levels – Individual, Facility, Local System, Board

Bon Secours Health System September 2009 Waste Stream Summary Report

Lawson Code Facility

Waste Stream Total Weight (LBS)

Waste Stream

Total Weight (LBS)

Waste Stream

Total Weight (LBS)

Waste Stream

Total Weight (LBS)

Facility Total Weight (LBS)

1400 Maryview Hospital MSW 126,538.00 RMW 26,338.00 CDD 20,567.50 RCY 18,018.40 191,461.90 1500 Mary Immaculate MSW 90,880.00 RMW 11,295.00 CDD 9,345.00 RCY 10,340.00 121,860.00 1600 Depaul Medical Center MSW 92,060.00 RMW 19,622.00 CDD 11,214.00 RCY 10,056.00 132,952.00

Total Hampton Roads MSW 309,478.00 RMW 19,622.00 CDD 19,622.00 RCY 19,622.00 446,273.90

Bon Secours Health System March 2010 YTD Waste Stream Summary Report

1400 Maryview Hospital MSW 886,026 RMW 175698 CDD 144622 RCY 221975.28 1432252.281500 Mary Immaculate MSW 514,746 RMW 69398 CDD 66616 RCY 119146.45 773396.451600 Depaul Medical Center MSW 596,460 RMW 126930 CDD 78898.5 RCY 355717.08 1160177.58

Board Dashboard by Facility

Individual Performance Evaluation

Facility and Green Team Recognition

66% Recycling Increase !!

Final Bon Secours Comments – Lessons Learned

• For Challenge areas to be successful there must be a change in the operating and business model to provide clear authority, measurement and accountability for accomplishment of objectives

• The greatest success is achieved when staff members see/feel a direct connection of the change required for an initiative to their patients benefit and their personal lives

• Vendors of services that are impacted by green initiatives must be willing to partner in new ways in terms of taking risk for accomplishment “green” results and providing data

• Community Benefit is the key driver; recognized leadership in Environmental Initiatives reinforces reinforces the Hospital’s status as a key community asset

GreenHealthy® Premier’s Environmental Leadership Program

41 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.

Healthier Hospitals Initiative – Challenges

www.healthierhospitals.org

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Premier - supporting partner of HHI

Publicly accessible resources, tools, case studies and educational programs on sustainable products and healthcare practices on Safety Institute website for • Members • Suppliers • Healthcare organizations

PGH Champion for Change award for ten consecutive years

Premier’s GreenHealthy® program

A to Z topics Cleaners - Green Computers and Electronics Construction – Safer design DEHP, PVC Donations, equipment Energy efficiency, renewable EPP-green products-suppliers Corner- Case Studies Mercury Pollution Prevention Pharmaceutical Waste Reuse of Single-Use Devices

Premier Safety Institute ® Website

www.premierinc.com/safety

43 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.

• EPP integrated into every sourcing process

• Use of standardized environmental questions for medical products

• Use EPEAT (electronic products environmental assessment tool) in sourcing process

• Green leaf icon Identifies “green-EPP” suppliers-products in member catalog & on Safety Institute website

Premier’s GreenHealthy program supports HHI challenges

Smarter Purchasing

44 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.

Premier’s GreenHealthy program supports HHI challenges

On-demand leadership programs from governance meeting CEO-leadership program assessment scorecard White paper on energy efficiency GreenCorner website > 100 case studies on healthier food, energy efficiency, waste, safer chemicals Healthier food contracts: eg, chicken raised without antibiotics or arsenic compounds

Case studies healthy food

CEO Scorecard

Energy efficiency white paper

45 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.

Premier’s corporate-wide, employee-led Yes to Green program recent accomplishments

Premier corporate headquarters:

• Gold LEED CI and LEED CS

Recycled > 175 tons of waste

Recycled >12 tons of electronics

All recycled paper

All duplex (double-sided) printing

90% employee participation in

“Yes to Green” pledge

4

46 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.

46

90 % of Premier employees took the “Yes to Green Pledge”

Thank you Healthier Hospital Initiative www.healthierhospitals.org Safety Institute www.premierinc.com/safety Premier GreenHealthy program www.premierinc.com/greenhealthy GreenCorner – case studies www.premierinc.com/greencorner Energy efficiency white paper www.premierinc.com/energy EPP contracts/products/suppliers www.premierinc.com/saferproducts Yes to Green Employee Pledge www.premierinc.com/greenhealthy

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Please submit your questions now

49 PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.

Kellie McNelis Director,

environmental purchasing,

Premier healthcare alliance

Janet Brown Director, content

and outreach, Healthier

Hospitals Initiative

David McCombs VP, supply chain

operations, Bon Secours

Health System

Questions and answers