By Stephen Walsh
WasteManagement no longer means just trash hauling. There is a new breed ofprofessionals in healthcare helping hospitals manage their waste. Names forthese companies include Environmental Service Providers, Red Bag Consultants,and Waste Management Professionals. The medical waste haulers' old pitch of,"we will give you a better price per pound on your medical waste" isfalling on deaf ears as many hospitals recognize the need for lower cost, notjust lower price. Department heads are demanding a raft of value-added servicesto help them control costs and maintain compliance.
The New York Presbyterian Hospital's (NYPH) Weill Cornell Campus outsourcedits waste management program in August 1999. The outside contractor that came inprovided everything they needed--system planning, the necessary in-servicing,and professional support materials like posters, pens, and Post-it notes. Thegive-away items are effective, and since a hospital's budget usually does notallow for such items, having an outside company supply them is useful. Over thefirst year, the NYPH reduced 65% of their medical waste, and in December 2000earned the EPA's Environmental Performance Track Award as recognition for theirwork in reduction of mercury, ozone-depleting chemicals, regulated medical waste(RMW), and solid waste.
For many hospitals, going with an outside company is difficult because theremay be the impression that perhaps they could be doing this work on their own.In the end, a hospital's and waste management company's ability to focusexclusively on their core activities gets results. As a part of the offering,some outside contractors will provide specialized technology to the hospitals.For instance, Walsh Integrated Environmental Systems, Inc. developed the WasteTracker System that uses handheld computers to take a picture ofthe red bag waste in the department and then e-mail it to that department head.There is no arguing with a photo. However, the core of the solution is oldfashioned training and in-servicing. Using an outside contractor means thatin-servicing will be getting done on schedule.
In 1981, The Medical Waste Tracking Act was passed, effectively creating thered bag waste industry as we know it today. Since that time, the volume ofmedical waste has grown and legislation has changed. Of the $1 billion spentannually on the disposal of medical waste, about 33% of that is actuallynecessary. "It is common knowledge in this industry that perhaps as much as67% of all medical waste is actually general trash. We have put legislation inplace to protect the environment and the general public, but many hospitalsoverreact," says Diane Buxbaum, Environmental Scientist, US EPA, Region 2.This overreaction is certainly unintentional, and given hospitals' desire to cutcosts, it is something that is being corrected.
Given the growing complexity of legal, health, and operational issues,hospitals are increasingly relying on outside professionals to help them get andstay organized. "Since we introduced the Memorandum of Understanding withthe American Hospital Association in July 1999, we have seen a significantincrease in hospitals requesting assistance in developing and implementingintegrated recycling and waste reduction plans," says Buxbaum."Outside professionals are providing important services in helpinghospitals meet their goals."
Hospitals with their own incinerators are also looking to outsource themanagement of their waste as they see increasing costs and compliance issues onthe horizon. The old attitude of "throw it in the incinerator, it is easyand practically free" doesn't cut it today. With incinerator complianceupgrades in the $100,000 to $500,000 range and a Supreme Court decision toenforce the letter of the law, many hospitals are looking to reduce their redbag waste and eventually shut down their own incinerators.
As the field is increasingly complex, and the risk and cost of non-complianceincreases, outsourced management contracts are becoming a more attractiveoption. Like many professions today, keeping abreast of the industry requires anunderstanding of regulations, costs, people issues, and the latest availabletechnology. The values that Healthcare Waste Management Professionals can bringto the table are focus, expertise, and cutting-edge technology.
Many directors of Environmental Services (ES) or Housekeeping know more abouthospital waste management than an outsider ever will. Unfortunately, staffing invirtually every hospital is being cut on an ongoing basis and these directorsare expected to do more with less. Because the management of waste isessentially a people management issue, it is time consuming and repetitive.One's ability to succeed depends on the time and focus that can be put on thewaste management issues and an outsider can provide that ability to focus.
Optimal waste management is, at best, a moving target. A waste managementpartner will display a detailed knowledge of applicable regulations andguidelines, such as EPA, JCAHO, and OSHA. More than that, they must be up todate, and able to apply them in everyday use.
Usually Environmental Services (ES) or Housekeeping are responsible forspearheading the waste management initiatives. Managing waste requires theeffective management of the people who produce the waste, not just those whohandle it. Managing these people is centered around training and follow up. Insome cases, the ES staff may not have the comfort level or expertise needed totrain clinical staff, including nurses and doctors. Expertise, presentationskills, and an ability to communicate are what you would expect from an outsidewaste management supplier.
In-servicing must be regular and scheduled to be successful. An outsidershould provide this service as a part of their program. Having a contractordeliver the in-service sessions also calms the potentially contentiousrelationship between the clinical staff and Environmental Services. For example,one issue that is often seen is the need for changes in the scheduling orfrequency of waste pickups in certain departments. As a middle man, the outsidecontractor may negotiate between parties to reach a workable solution.
An agreement with an outside service should provide a hospital withguaranteed savings. An experienced company in this industry will have theability to analyze waste costs and predict exact savings. These savings shouldinclude all additional costs and services, such as the cost of using a landfillfor clean waste that will be diverted from the red bags, the costs of providingmonthly in-servicing within the hospital, the cost of regular tracking of eachdepartments performance, any reporting costs, etc.
An outside contractor will hopefully have experience setting up and livingwith recycling programs as well. Recycling provides real opportunities, but mustbe dealt with carefully. For example, a paper recycling program may seem simpleenough, but many people don't realize that most recycled paper is sorted by aperson wearing work gloves who removes trash and segregates paper into variousgrades as it passes by on a sorting line. These people pickup and handle much ofthe material that comes out of the hospital and are exposed to any medical wasteor sharps that might be in the recycling stream. A single instance of bloodywaste or a sharps in the recycling can shut down an entire program if therecycler refuses to accept any more material from that hospital. Determiningwhich departments should participate and which should be excluded is a criticalbut politically sensitive component of a recycling plan. A system that recyclesfive tons a week of paper for five years is much better than one that tries todo 10 tons a week, but is shut down after six months.
In the summer of 2000, Marge Montgomery of VHA Southwest was evaluatingopportunities for her member hospitals who needed help with their wastemanagement. "Our hospitals expect a lot more from us than simply reducedproduct costs. We partner with companies who provide products and services tosolve real problems when the answer may not be so obvious. In this case, wewanted to reduce overall waste management costs, ensure compliance, and improvethe safety of the programs," says Montgomery. She determined that simplynegotiating a better cost per pound for medical waste destruction was not goingto be enough. "We spoke to hospitals about low price, and realized that itdid not equate to low cost. In other words, we saw the need to reduce the poundsof medical waste, and consequently the overall cost but we wanted these savingssustained over the long term, not for just a few months."
VHA Southwest compiled a list of required features for any given solution;detailed planning, on site in-service training, professional support materials,ongoing departmental auditing, and ideally, an integrated tracking and reportingstructure. "Healthcare tends to be a report-heavy environment and we feltthat efficient reporting would be a critical success factor for our clients. Inaddition, any solution would have to be available to all our members (in Texasand New Mexico) and ranging in size from 30 to 1000 beds. We selected a wastetracker program that met our requirements: clinical, environmental, andreporting with flexible financing."
As the management of healthcare waste becomes more complicated, and the timeand resources the traditional manager can devote to it are reduced, we will tosee more hospitals follow the trend toward contracted waste management services.
Where hospitals have been contracting for laundry, environmental services,engineering, or food services, they are beginning to sign waste managementpartnerships too. The reasons for contracted medical waste management are:
Stephen Walsh is the founder and president of Walsh IntegratedEnvironmental Systems Inc. in Montreal, Quebec, Canada. Since 1992, WalshEnvironmental has helped over 300 hospitals reduce their waste costs and improvecompliance. The Walsh Waste Tracker is a turnkey waste management system thatis available to hospitals on a shared savings basis. The company also offers aWeb page-based performance comparison tool to assist hospitals in calculatingmedical waste production. For more information, the company's e-mail address is:firstname.lastname@example.org.For a complete list of references click here