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Waste MappingLean Techniques Applied in Healthcare

October 3, 2013

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Speakers• Millie Calistri-Yeh, PhD

– Senior Staff Engineer, Becton Dickinson– Leader, Technical Working Group, Healthcare Plastics

Recycling Council• Timothy Eng, PE, CIE

– Project Manager, Kaiser Permanente

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What is HPRC?

HPRC is a private, technical coalition of industry peers across healthcare, recycling and waste management industries seeking to improve recyclability of plastic products within healthcare.

HPRC Members

Mission

To inspire and enable the healthcare community to implement sustainable, cost-effective recycling solutions for plastic products and materials used in the delivery of healthcare.

Value Chain Approach

HPRC is unique in its focus on identification of plastics recycling barriers and solution development along the entire value chain.

HPRC is seeking to affect plastics recycling from healthcare product design and manufacturing through product use, disposal and recycle.

© 2013 HPRC

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37 Hospitals 568 Medical Office Buildings 336 Administrative locations Over 56 million square feet of real estate 9 million members 173,300 technical, administrative, and

clerical employees and caregivers 16,658 physicians representing all

specialties

14 Medical Centers 198 Medical Offices 3.5 million members 70,000 technical and clerical

employees and caregivers 5,700 SCPMG physicians Los Angeles County's largest

private employer

Southern California

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Outline• Introduction

– Waste Issues & their Costs in Healthcare– Lean Principles

• Kaiser Permanente Story– Understanding Baseline & Metrics Development– Value Stream Mapping as a Tool to Ideate, Propose, Communicate,

and Drive Change

• Waste Exercise• Conclusions• Questions

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INTRODUCTIONWASTE & LEAN

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Here’s the Situation…

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Waste Issues• Healthcare facilities in the United States generate 6,6001 –

14,2002-3 tons of waste per day, most of which is being disposed of in landfills or by incineration.

• It is estimated that between 20 and 25 percent can be attributed to plastic packaging and plastic products.4

• In addition, 85 percent of the hospital waste generated is non-hazardous, meaning free from patient contact and contamination.5

1. 6,600 tons - American Plastics Council, Hospital Plastics Characterization and Recycling Feasibility Study (1999).2. 30.9 pounds waste/bed/day – Practice Greenhealth Benchmark Report (2013).3. 924,333 staffed beds in US hospitals. American Hospital Association Fast Facts (http://www.aha.org/research/rc/stat-studies/fast-facts.shtml 2013). 4. Lee, B., M. Ellenbecker, and R. Moure-Eraso. “Analyses of the Recycling Potential of Medical Plastic Wastes.” Waste Management (2002): 461-4705. Grogan, Terry. “Solid Waste Reduction in US Hospitals.” Hospital Engineering & Facilities Management (2003): 88‐91.

© 2012-2013 HPRC

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Waste CharacterizationWaste study conducted by the City of Los Angeles:

Services: Medical / Health•Other Organic – 37.8%•Paper – 27.8%*•Plastic – 24.3%•Metal – 9.4%

*Paper recycling through Goodwill

CleanMed 2013_Less Waste using LEAN principles_April 25, 2013 © 2013 Partners Sustainable Initiatives

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Waste Characterization

Paper, 25.8%

Plastics, 14.0%

Metals, 5.5%

Glass, 2.2%

Organic Materials, 20.6%

Construction and Demolition, 13.9%

Household Hazardous Waste, 3.2%

Electronics, 3.3%

Other Materials, 11.3%

Other Miscellaneous, 1.9%

Commonwealth of Massachusetts

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Cost of Waste• Average healthcare provider spent ~$98 million on supply

chain functions.1

• Estimated $10 billion/year in disposal costs for US health care industry.2

Average Costs of Waste Streams for PGH Award Winners:3

1 Nachtmann, H; and Pohl, E. State of Healthcare Logistics: Cost and Quality Improvement Opportunities, Center for Innovation in Healthcare Logistics, University of Arkansas (2009).2 American Hospital Association. “Sustainability Roadmap for Hospitals – Waste” (downloaded 3/4/2013).3 Practice Greenhealth Benchmark Report, 2013 (21)

Waste Stream Solid Waste Cost per Ton

Recycled Cost per Ton

RMW Cost per Ton

Hazardous Waste Cost per Pound

Average, 2011 $126 $90 $1015 $3.1

Average, 2012 $105 $113 for hospitals reporting costs

$109 for hospitals reporting savings

$905 $3.2

© 2012-2013 HPRC

CleanMed 2013_Less Waste using LEAN principles_April 25, 2013 © 2013 Partners Sustainable Initiatives

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Complexity of Waste

OR

ER

Med Surg

IsolationPharmacyLab

Research

Engineering

Administration

Dietary

MSW RMW C&D Recycle Sharps Trace Chemo

Path HIPAA Universal Compost E-waste Rx Haz

WASTE

Partners System (and HHI) Waste Goals Reduce RMW to less than 10% Achieve a 15% recycling rate compared to total waste

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Lean Essentials

Creating a Lean Culture, David Mann, CRC Press, 2010Lean Healthcare: Get Your Facility in Shape, Sarah Cottington & Shawna Forst, HCPro, 2010

1. Cross Functional: expedite decision

making

2. Focused amount of time – reach

consensus & avoid future rework

3. Co-develop the plan – ideas come

from team

4. Clear metrics & goals – shared by

team

5. Anticipate and recognize problems

6. Interactive process of continuous improvement –

Plan, Do, Check, Adjust

7. Changes are Embraced

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Actual Operations

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Integrated Waste Management Hierarchy

http://www.epa.gov/osw/homeland/hierarchy.htm

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Waste Characterization Studyfor Zero Waste PlanningConducted by E. Tseng and Associates for City of Los Angeles 2009

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Three-Year Project• Contractor establishes initial “Reference Baseline”

– Develop basic correlative environmental metrics– Conduct on-site “Functional Assessments”– Develop a tracking/monitoring database

• KP/Contractor conducts joint assessment of progress and update metrics (training)

• KP conducts assessment / metrics under supervision of contractor

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Goals / Objectives of Solid Waste Baseline Study

1. Compliance with the Kaiser Permanente National Waste Minimization (NWM) policy of make a significant effort to reduce the amount of waste that is generated by implementing waste reduction and recycling programs.

2. Promote the overall Kaiser Permanente environmental sustainability strategy which also promotes individual and community health, environmental stewardship, cost savings and legal compliance by reducing the amount of waste generated in Kaiser Permanente buildings and establishing waste minimization as part of it operational thinking.

3. Create a standardized comparative quantitative basis with legally and technically defensible environmental metrics which can be used to be compare against other medical centers, cites, and other organizations/entities.

4. Create an institutionalized Kaiser Permanente infrastructure with trained personnel which can quantitatively monitor, evaluate, track the progress of the implemented waste reduction and recycling programs and the disposal at each medical center with legally and technically defensible environmental metrics.

5. Create an award-winning Kaiser Permanente solid waste reduction and recycling program which will be a UCLA “Best Management Practices” (BMP) reference teaching model at and peer match model for the medical services industry.

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Waste Mapping Team

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Conduct Detailed On-site “Functional Assessment”

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Identify Existing Programs

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Identify Opportunities for Reducing Disposal and Increasing Recycling

Shrink Wrap / Cardboard Recycling

Pallet and Metal Recovery/Recycling

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Opportunities for Improvement, Communication, and/or Education

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Learning to See

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Joining efforts at the Los Angeles Medical Center

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Loading Dock / Materials Management

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Emergency Department

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Oncology

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Regional Waste Profile 2012

Highlights•Panorama City at Zero Landfill at year-end•Increases in recyclable tonnage

Solid Waste Medical Waste Hazardous Waste

Cost by Category

201020112012

2010 2011 2012

Waste Disposal Costs

14% 12% Increase

Solid Waste (lbs) Recyclables (lbs) Medical Waste(lbs)

Hazardous Waste(lbs)

Waste Totals

201020112012

-6%, 15%

0, 14%-34%,

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Waste Map / Exercise

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Conclusions

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• Waste is a Big Deal!• Effective management of waste streams is Essential

• Hospital• Product & packaging design & reduction

• Space optimized for inventory & waste & disposal• Reduce cost for hospital • Ease of waste stream optimization

• Opportunities for Suppliers to make impact!

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Questions?

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Environmental Purchasing Program (EPP)

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EPP Disclosure Questions

http://xnet.kp.org/compliance/supplier/ep/policies.html

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Additional Questions?

• Contact Information:–Millie Calistri-Yeh,

millie_calistriyeh@bd.com–Tim Eng, timothy.c.eng@kp.org