Presentation given at Rollins School of Public Health, Emory University, live from Kaiser Permanente Center for Total Health, Washington, DC

1. Ted Eytan, MD MS MPH
Physician Director, The Kaiser Permanente Center for Total Health • The Permanente Federation, LLC • @tedeytan
April 30, 2013
© 2013 The Permanente Federation, LLC
#GreenHC • Environmental Stewardship
Emory University | Rollins School of Public Health

2. Hi. I’m Ted.
@tedeytan

3. We’re here from the future.
kp.org/centerfortotalhealth | @kptotalhealth

4. To heal, you have to not harm
NHS England
KP
0.8675'MtCO2e 5.04'MtCO2e'
(energy'only)
9'million'members
178,000'employees
37'hospitals
611'medical'office'buildings'
607'other'faciliGes
52'million'people
MtCO2e : Metric Tonne (ton) Carbon Dioxide Equivalent, 2010 Reporting Year
Source: http://www.theclimateregistry.org/ ; http://www.sdu.nhs.uk/sd_and_the_nhs/

5. Medical Care only happens here?

6. doctor | 19th century

7. !24/7 access worldwide
!9,000,000 members can
–email their doctor
–check lab test results
–order prescription refills
–manage appointments
patient | 21st century

8. discovery

9. Health doesn’t happen here

10. It happens here

11. It happens here
Photo: M.V. Jantzen - http://www.flickr.com/photos/mvjantzen/8464490630/

12. It happens here
La Mesa Medical Offices, California Photograph: Ted Eytan, MD, http://www.flickr.com/photos/taedc/8382776635/

13. “Dream Grounds for a Dream Hospital”
Why.
Source: http://kasierpermanentehistory.org ; Joe Bialowitz, MS, HEM, Senior Environmental Stewardship Consultant, Kaiser Permanente

14. “Showcases of modern, green hospital design”
Why.
Source: http://xnet.kp.org/centralvalley/pages/green_features/green_features.html ; http://xnet.kp.org/newscenter/pressreleases/scal/
2012/011712sandiegosolar.html

15. How - Better food

16. How - Better food

17. How - Better food
Source: http://www.nytimes.com/2010/09/22/dining/22doctors.html

18. How - Better food
! 190 tons of fruits and
vegetables served to
patients sustainably
produced (50% of total)
! Milk, yogurt free of rBGH
! Cage-free shelled eggs
! Partnership with UCSF,
John Muir, others for
Regional Produce
Sourcing Project
Source: http://www.nytimes.com/2010/09/22/dining/22doctors.html

19. How - Better food
! 190 tons of fruits and
vegetables served to
patients sustainably
produced (50% of total)
! Milk, yogurt free of rBGH
! Cage-free shelled eggs
! Partnership with UCSF,
John Muir, others for
Regional Produce
Sourcing Project
Source: http://www.nytimes.com/2010/09/22/dining/22doctors.html

20. How - Safer Chemicals
!Steam instead of chemical sterlization of
endoscopes
!PVC-free carpet
!PVC-free and DEHP-free IV bags and tubing
!PVC-free and DEHP-free PCA sets
!Green Seal-certified cleaning products
Source: http://xnet.kp.org/newscenter/pressreleases/nat/2012/011912ecofriendlyIVbags.html

21. Source: http://xnet.kp.org/newscenter/pressreleases/nat/2012/011912ecofriendlyIVbags.html
How - Safer Chemicals
! IV tubing / bags: 100 tons of medical products
! PVC : Cancer, through dioxin generation
! DEHP : Neuroendocrine abnormalities
! Safer product saves $5 million / year

22. How - Better care models: Blood pressure control
60%
73%
85%
2005 2006 2007 2008
KP member
US 90th %
Source: Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients.
Health Affairs. 2010;29(7):1370-1375. Available at: http://content.healthaffairs.org/cgi/content/abstract/29/7/1370 [Accessed July 7, 2010].

23. How - Better care models: Blood pressure control
60%
73%
85%
2005 2006 2007 2008
+ email
US 90th %
Significant? How
about p<0.0001
Source: Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients.
Health Affairs. 2010;29(7):1370-1375. Available at: http://content.healthaffairs.org/cgi/content/abstract/29/7/1370 [Accessed July 7, 2010].

24. 2,500,000 members
5,000,000 members
20032005 2007 2009
2012 (4Q)
4.2 million members connected, via kp.org
Source: Kaiser Permanente Web Analytics, updated 12/18/2012

25. Environmentally responsible, too
Health Affairs, May 2011: “Kaiser
Permanente Study Finds Use of
Electronic Health Records
Reduces Carbon Emissions,
Waste and Water Consumption”
PotenGal'CO2'emissions'reducGons'as'
much'as'1.7'million'tons'across'the'enGre'
U.S.'populaGon'
Source: Turley M, Porter C, Garrido T, et al. Use of electronic health records can improve the health care industry’s environmental
footprint. Health affairs (Project Hope). 2011;30(5):938-46. Available at: http://content.healthaffairs.org/cgi/content/abstract/30/5/938
[Accessed January 3, 2012].

26. “Kaiser (Permanente) is so far past faxing
orders that they’re into sustainable apples”
-Jess Jacobs, April, 2013, TEDMED
http://http://jessjacobs.me/my-intravenous-lecture/
For whom

27. seeing that there is a long list of crazy
administrative headaches shows how very
broken the communication process is for
every single step of getting healthcare.
http://http://jessjacobs.me/my-intravenous-lecture/
@jess_jacobs
For whom

28. next year’s medical
challenge: waste
http://http://jessjacobs.me/my-
intravenous-lecture/
@jess_jacobs
For whom

29. Catalyzed by…
!“Only one health insurer,
Kaiser Permanente, has a
strong climate position.”
Source: Insurer Climate Risk Disclosure Survey: 2012 Findings and Recommendations - Ceres -
https://www.ceres.org/resources/reports/naic-report/view

30. Catalyzed by…
Source: Insurer Climate Risk Disclosure Survey: 2012 Findings and Recommendations - Ceres -
https://www.ceres.org/resources/reports/naic-report/view
! “If greenhouse gas
emissions continue to
increase, climate change will
cause health effects that will
directly impact Kaiser
Permanente’s ability to fulfill
our promise of quality,
affordable care.”

31. Catalyzed by…
Vision'for'Environmental'Stewardship'&'
Guideline'for'Climate'Change
Source: Kaiser Permanente Environmental Stewardship, Strategies, Principles, and Guidelines;
http://blog.epa.gov/blog/2009/10/15/healthy-health-care-leader-kaiser-permanente/ Ted Eytan, MD
! “If greenhouse gas
emissions continue to
increase, climate change will
cause health effects that will
directly impact Kaiser
Permanente’s ability to fulfill
our promise of quality,
affordable care.”

32. Catalyzed by…
Vision'for'Environmental'Stewardship'&'
Guideline'for'Climate'Change
Source: Kaiser Permanente Environmental Stewardship, Strategies, Principles, and Guidelines;
http://blog.epa.gov/blog/2009/10/15/healthy-health-care-leader-kaiser-permanente/ Ted Eytan, MD
! “If greenhouse gas
emissions continue to
increase, climate change will
cause health effects that will
directly impact Kaiser
Permanente’s ability to fulfill
our promise of quality,
affordable care.”

33. Healthier Hospitals #youcandoittoo
!healthierhospitals.org
!@hhiorg
The Healthier Hospitals Initiative (HHI) is a national campaign to
lead change in the health care sector. Twelve influential U.S. health
systems have joined with Health Care Without Harm (HCWH), Practice
Greenhealth and the Center for Health Design (CHD) to provide a free
way for hospitals to incorporate environmentally friendly practices
into daily operations. By sharing win-win strategies, and collective
sustainability experience, hospitals see results quickly in improved
health of patients, staff and their communities, reduced environmental
impact, and considerable financial savings.
LEANER
ENERGY
HEALTHIER
FOOD
LESS
WASTE
ENGAGED
LEADERSHIP
SAFER
CHEMICALS
SMARTER
PURCHASING
Leading Communities to a Healthier Future

34. KAISER PERMANENTEREDUCING, RE-USING & RECYCLING TO ELIMINATE WASTE
Hospitals in the U.S. annually generate more than 5.9 million tons of waste,much of which comes from scarce natural resources and ends up in our nation’s
landfills where wastes emit greenhouse gases and other pollutants. In addition
to standard waste products—paper, cardboard, bottles and cans—health care
has unique waste streams such as electronic equipment, infectious waste,radiological waste and other hazardous waste, such as solvents, that must be
properly managed and treated in order to protect both the environment and
public health. Cutting waste within the health care setting reduces operating
costs while lowering exposure risks for health care workers and often creating
good jobs for people in the local recycling industry.
Kaiser Permanente has set an ambitious waste reduction target to re-use,
recycle or compost at least 40% of our waste materials by the end of 2015(excluding construction and demolition debris, where we often achieve muchhigher rates of recycling on a typical project).
Examples of Kaiser Permanente’s rigorous waste reduction initiatives include:
Recycling or composting non-medical wasteSafely re-using medical devices
Purchasing products high in recycled content and recyclabilityBuilding efficiency into our care delivery system
Recycling and Composting Non-Medical WasteKaiser Permanente makes a priority of involving our staff and physicians inefforts to reduce the use of plastic bags, single-use water bottles, and officepaper. Our organization is rolling out efforts to compost food as well as papertowel waste in several of our facilities and office buildings.
In Southern California, Kaiser Permanente and Goodwill Industries havejoined forces to collect and recycle many of the waste materials generatedby Kaiser Permanente. Each year, the two organizations also host a series of
region-wide community waste and donation campaigns to recycle, reduce and
re-use thousands of pounds of electronics, clothing and other items.
Many Kaiser Permanente hospitals have developed innovative programsto recycle blue wrap, the material used to preserve the sterility of medical
instruments. The material feels like soft paper, but is actually made fromheavy-duty polypropylene plastic that can take years to disintegrate inlandfills. Blue wrap can be recycled into wash buckets, lawn furniture,flowerpots, squirt bottles, plastic lumber for picnic tables and thousands of
other commonly used products.
KAISER PERMANENTE
PROMOTING SUSTAINABLE FARMING AND FOOD CHOICES
Locally grown, sustainably farmed and produced food choices are good for the
environment and for people’s health. Kaiser Permanente offers sustainable food
choices on patient menus and in cafeterias and vending machines at many of
our hospitals and medical centers. We support the development of local and
sustainable food systems as a public health tool.
At Kaiser Permanente, we recognize that sustainable food promotes good
health by reducing the prevalence of synthetic pesticides and chemicals in
the food stream and the environment and by fostering the availability and
consumption of locally grown, fresh food choices. We advance sustainable
farming and food choices through these efforts:
Increasing sourcing of locally grown, sustainably farmed and produced food in
Kaiser Permanente hospitals, cafeterias and vending machines
Sponsoring farmers’ markets as a means to promote access to fresh, local produce
and support investments in local economies
Increasing awareness about toxins in the food chain
Collaborating with other major health care systems and non-governmental
organizations to accelerate improvements in sustainable food procurement
throughout the health care sector
Sourcing Locally Grown, Sustainable Food
As part of their mission of healing, health care providers have a responsibility to
their patients, employees, visitors and the communities they serve to offer food
options in their patient meals, cafeterias and vending machines that support
overall health. At Kaiser Permanente, we recognize that the way food is produced,
processed, packaged, distributed and consumed in the United States has significant
impacts on human health and the environment. We are working to shift the food
system in a more sustainable direction by increasing our sourcing of locally grown
and sustainably produced food options.
Kaiser Permanente devotes approximately 16 percent of our overall food
spending to sustainable food across the organization, nearly two times as much
sustainable food as most other hospital systems of our size. By the end of year
2015, that number is expected to grow to 20 percent.
Kaiser Permanente has developed specific sustainability criteria within each
food category which align with the Green Guide for Healthcare Food Service
Credits, a benchmarking tool for sustainable food in health care. Some
examples include: food produced within 250 miles of the Kaiser Permanente
facility; produced without pesticides, antibiotics or added hormones; and
certified as sustainably produced by a third-party eco-label. Food products
must meet at least one of these criteria to be considered sustainable, though
preference is given to products that meet multiple criteria for sustainability.
KAISER PERMANENTEFINDING SAFER ALTERNATIVES TO HARMFUL CHEMICALS
Exposure to toxic chemicals in everyday life has increasingly become a health
concern. More than 80,000 chemicals are used in commerce today, and onlya small fraction has been tested for effects on human health. There is growing
evidence that environmental exposures to some chemicals contribute to cancer,
asthma, reproductive disorders and other heath impacts.
Kaiser Permanente is committed to researching and sourcing saferalternatives to products used in health care settings such as cleaners, solvents,
disinfectants, plastics used in medical devices and building materials, flameretardants and formaldehyde.
The organization promotes safer alternatives to harmful chemicals in four ways:
Sourcing products with safer ingredients
Adding to the body of knowledge through research into health effects ofchemical exposures
Informing public policy and decision-making pertaining to safer chemical useCollaborating with other major health care systems and non-governmental
organizations to accelerate improvements in safer chemical use throughout the
health care sector
Sourcing Safer Products
In 2006, Kaiser Permanente created an Environmental Purchasing Policy insupport of its social mission to improve the health of its members and thecommunities it serves. The policy requires that the principles of environmentally
preferred purchasing be applied to all major purchasing decisions.
To further embed these principles in its decision-making process, Kaiser
Permanente developed the Sustainability Scorecard in 2010 as a way to rate
medical supplies on how eco-friendly and non-toxic they are. The scorecard
is the first of its kind for health care and enables Kaiser Permanente tobetter choose products that reduce environmental and human healthimpacts while also encouraging our suppliers to increase their offerings of
eco-friendly supplies.
With coordination by Practice Greenhealth, Kaiser Permanente made theSustainability Scorecard available to the health care industry’s largest grouppurchasing organizations (GPOs) representing an estimated $135 billion in
annual purchasing volume. This significant leveraging power is helping toadvance an economy where the production and use of chemicals are notharmful for humans or the environment.
KAISER PERMANENTE
RESPONDING TO CLIMATE CHANGE
Greenhouse gas emissions are a known contributor to climate change and the
rise of pollution and disease. At Kaiser Permanente, we realize that we have a
responsibility to try to limit our greenhouse gas emissions, even while growing
our health care services.
With nearly 78 million square feet of real estate across nine states, Kaiser
Permanente is aware that our environmental footprint is substantial. That’s why
we have set an aggressive goal to reduce our greenhouse gas emissions by 30
percent by the year 2020 (compared to 2008). By lessening our reliance on fossil
fuels and reducing our overall energy consumption, we are working to minimize
our impact on the climate. The fact that this also reduces operating costs is
good news for our members.
Kaiser Permanente follows a two-pronged approach to reducing greenhouse
gas emissions:
Maximize energy efficiency through green building solutions in new and existing facilities
Increasing use of on-site and off-site clean and renewable energy solutions
Maximizing Energy Efficiency Through Greenbuilding Solutions
Recognizing the link between the health of the environment and human health,
we have sought to make our health care facilities among the “greenest” and
most sustainable around. To that end, Kaiser Permanente has played a key role in
developing nationally recognized green building strategies for the health care sector.
Working with architects, engineers and public health care advocates, Kaiser
Permanente helped to design and pilot test strategies for the Green Guide for
Health Care and the more recent Leadership in Energy and Environmental Design
(LEED) for Healthcare rating system — both premier tools for building facilities
that are healthier for employees, patients, communities and the environment.
Several of Kaiser Permanente’s buildings have received the U.S. Environmental
Protection Agency’s Energy Star certification. This signifies that a building’s
energy performance rates in the top 25 percent of facilities nationwide.
In 2012, Kaiser Permanente adopted a policy to pursue LEED Gold certification
for all new major building projects. The Westside Medical Center in Portland,
Ore., set to open in 2013, will be among the first LEED gold-certified hospitals
in the Portland area, using green power sourcing and water-conservation
features. One of our California data centers was the first (and currently the
only) data center in the world to achieve LEED EB—Leadership in Energy and
Environmental Design for Existing Buildings—Platinum certification.
Finding Safe Alternatives to Harmful Chemicals
Exposure to toxic chemicals in everyday life has increasingly become a health
concern. Unfortunately, many products used within the health care industry
contain harmful chemicals—products such as cleaners, solvents, disinfectants,
plastics, and building materials such as flooring and paint. At Kaiser Permanente,
we’re committed to researching and sourcing safer alternatives to reduce harmful
exposure to our patients, staff, and communities.
Our Sustainability Scorecard was developed in 2010 as a way to rate our suppliers
on how eco-friendly and non-toxic their products are. It encourages our suppliers
to increase their offerings of environmentally responsible products and enables
Kaiser Permanente to better choose products that are safer for our patients, staff
and communities. Most of our environmentally preferable product choices—such
as intravenous bags manufactured without PVC and DEHP—are either cost
neutral or cost less than the more toxic products.
Reducing Greenhouse Gas Emissions
Greenhouse gas emissions contribute to climate change and the rise of pollution
and disease. As a health care provider, we understand that it’s our responsibility
to try to limit our greenhouse gas emissions, even as we increase our health care
services. By reducing our reliance on fossil fuels, we are working to mitigate
climate change and create healthier communities.
Kaiser Permanente has been at the forefront of embracing clean energy solutions,
developing standards for sustainable building in health care, and looking for ways to
cut back our energy consumption.We have deployed 15 megawatts of solar power
and four megawatts of fuel cell energy across our facilities, part of a larger plan to
use sustainable energy sources to reduce the total greenhouse gas emissions of Kaiser
Permanente’s operations by 30 percent by the year 2020 (compared to 2008).
Environmental
Stewardship
Many of the solutions that are good for people’s health
are also good for the planet.
At Kaiser Permanente, we recognize
that healthy communities and a healthy
environment are critical to the health and
wellness of every person. Creating these
has always been central to our mission.
We are dedicated to environmental
stewardship, and we aspire to provide
health care services in a manner that
protects and enhances the environment
and the health of communities now and
for future generations.
Kaiser Permanente has been committed
to the environment since our founding
in the early 1940s. Our Environmental
Stewardship program is part of our
Community Benefit work and is
anchored in promoting the health of our
communities. Healthier communities
with healthier people are more resilient
to disease. By eliminating or mitigating
environmental contributors to disease, we
help people lead healthier lives.
To encourage healthy environments,
we lead or support innovative efforts
throughout our organization to decrease
waste and pollutants, conserve water and
energy, promote sustainable agriculture
and food procurement, and take steps to
reduce our carbon footprint.
kp.org/green