Staff education about environment starts day 1: environmental stewardship part of orientation

HealthCare Benchmarks and Quality Improvement, June, 2004

Employees at Dartmouth-Hitchcock Medical Center (DHMC), an academic facility in Lebanon, NH, that includes a 400-bed tertiary hospital, research and clinical space, work for an organization that places prime importance on sound environmental stewardship--and they become aware of that fact their first day on the job.

That's because environmental education is an integral part of the orientation process, and every individual who joins the facility must participate in that process. "I get 45 minutes with them, whether they are a janitor or an MD," says John Leigh, recycling & waste minimization coordinator at DHMC. "It's required, and they all get it--regardless of their background."

No doubt it is this determined attitude, along with an extensive program, that made DHMC one of the four hospitals to receive the annual Environmental Leadership Award from the Hospitals for a Healthy Environment (H2E) program, a joint national effort of the American Hospital Association, the U.S. Environmental Protection Agency, Health Care Without Harm, and the American Nurses Association.

"The health of our patients, staff, and community are directly impacted by the choices we make about what products and practices we use," says Leigh.

"As part of the first-day orientation, I bring up the notion that the stuff that we use absolutely impacts the long-term health of the community --so is it not part and parcel of our core mission to be good environmental stewards as we deliver quality health care?"

DHMC started to look at recycling and environmental stewardship in general in 1991, when it moved to its current facility, Leigh says. "This position, however, did not come around until 1995."

The commitment of top leadership is clear, he adds. "They have been refilling this position and moved it from part-time to full-time," he notes.

It's virtually impossible for a health care facility to not be affected by the pollution of the world outside, Leigh explains. "At any stage of a product's life cycle, unfortunately, a certain amount of pollution goes into the environment and can be translated into health care," he says. "A certain amount of pollution occurs quite legally, yet nitrous oxide and sulfur dioxide, for example, are significant pollutants that come out of power plants and are known to contribute to respiratory illness."

With the amount of stuff we purchase, says Leigh, "if we are wasteful in any way, certain products may have a greater impact. Becoming knowledgeable about the preferability of competing products becomes the kind of thing a health care organization our size should get into. We also have to keep up with which products are determined by [environmental] groups to be preferable."

On orientation day, Leigh is given 45 minutes with the employee. "We bring all of them down to the waste management center and let them see how it is we handle the 6 tons of discards per day; we show them where they throw their trash, recyclables, and infectious waste, and how it impacts the individuals who are co-workers of theirs. They get to meet the staff who run the center and physically observe their activities. So, waste is no longer some black hole that is forgotten once it hits the trash bin."

In addition, Leigh covers what employees need to do to properly handle infectious waste, and what gets recycled at DHMC. "We want to make sure that what can be recycled gets recycled," he explains, "And we teach them how to reduce the amount of waste they generate on a personal basis." For example, he says, they are taught different ways to reduce the amount of paper they use--such as using both sides of a sheet of paper when copying.

"I also give them guidelines on how to recycle the many things they will probably have to recycle," he says. "I give them a characterization of our waste stream and show them a graph of how we've be successful in land-filling less as we've increased our recycling rate over the years."

Leigh also impresses on the employees the message that everyone is involved in DHMC's environmental programs. "With 4,600 people working here, we depend on them to carry some of the knowledge they've picked up to the veterans with whom they work in their department," Leigh observes. "I hope the 'newbies' can question what they see as they observe certain practices; and where those that are in place are not what I've told them, it might be good food for a conversation either with the vets or with me. If it's something involving the system, then I have to correct it."

The orientation session is just one part of an ongoing process at DHMC. Leigh provides some inservice training by getting on the agenda for sectional or divisional staff meetings.

"For example, the cath lab staff get together once a month early in the morning before they start the day. I'll get 10-15 minutes on the agenda to make sure to try to correct things I see happening, such as people not doing a great job of recycling, or the improper placement of an infectious waste container," he explains.