Climate Action Strategies at Kaiser Permanente
Joe Bialowitz, Environmental Stewardship Project Manager
August 26, 2009
Copyright Kaiser Permanente 2009
Outline
Presentation goals:
• Why Kaiser Permanente and other health
care organizations have global warming
concerns
• Understand health care’s climate footprint
• Review Kaiser Permanente’s climate
action plan
• What have we done?
• What are we working on?
• How does this tie in to your work?
Page 2
Kaiser Permanente’s Evolving Role as a
Total Health Organization
Do Good Things
Ensure access
to high quality care
and coverage
Page 3
Make an Impact
Be Accountable for
All Our Impacts
Address the conditions
of health in the
physical, social,
natural environment
Understand our ecological and
economic footprint, and their
impact on community health; act
accordingly; set a good example
Kaiser Permanente’s Environmental Stewardship
Council
Our Environmental Stewardship Council has identified
the following four environmental focus areas to guide
our work:
Page 4
Climate Action
Safe Chemicals
Sustainable Food
Waste Reduction
Organizational Guideline on Climate Action
Kaiser Permanente will:
• Understand climate change
• Assess climate-related impacts
• Commit to continuous improvement
 Take practical actions to limit emissions of carbon dioxide and other
greenhouse gases
 Help reduce the carbon footprint of the communities we serve by
supporting:
a) appropriate land-use and transportation decisions
b) development of appropriate local food systems
• Support industry standards
• Inform public policy
Page 5
Effects of Climate Change
Climate change is causing
health effects that potentially
impact Kaiser Permanente’s
ability to fulfill our promise of
quality, affordable health care
• Global climate instability increases
the demand for health care
• Cost of energy and water likely to
continue increasing while supplies
diminish
• Threats to forests and biodiversity
threaten availability of potential cures
for diseases
Page 6
Health Effects of Climate Change
A few examples:
• ↑ Temperature + ↑ UV radiation + primary
emissions = ↑secondary air pollutants
(ground-level ozone, particulates)
• ↑ extreme heat episodes = ↑ electric power
use = ↑ emissions & pollutant formation
• ↑ Temperatures + ↑ CO2 = ↑ Ragweed in urban
locations = ↑ risk of asthma & allergy
• ↑ Biomass + more arid conditions = ↑ risk of
wildfires = ↑ risk of injury & ↑ air pollution
Source: CA Department of Public Health
Page 7
Kaiser Permanente’s Greenhouse Gas
Inventory
Direct Greenhouse Gas Emissions in 2007 by Kaiser Permanente
Fleet vehicles
1.6%
Medical gases
(estimated)
9%
Emergency power
generation
0.2%
Natural gas
23%
Purchased
electricity
66%
Page 8
Kaiser Permanente’s Greenhouse Gas
Emissions Trend
C02 emissions (metric tons)
New construction and increased energy use associated with electronic medical
records are two key reasons why our combined CO2 emissions from use of
electricity and natural gas grew by more than 10% between 2005 and 2007:
400000
350000
300000
250000
Electricity
200000
Gas
150000
100000
50000
0
2005
Page 9
2006
Year
2007
Kaiser Permanente’s Greenhouse Gas
Emissions Trend
Energy efficiency initiatives for building systems and electronic equipment have
helped to decrease our emissions intensity per square foot since 2006:
40.00
National average
for all hospitals =
>30 lbs/sqft
35.00
36.40
33.66
35.10
30.00
lbs/sqft
Source: DOE (2003
CBECS)
25.00
24.88
22.90
24.58
lbsC02/"AboveTheLine"sqft
20.00
lbsC02/gross sqft
15.00
“Above The Line” sqft = Medical
Services, Hospital Services,
Outpatient Pharmacy, Optical,
Other Benefits, & Health Plan
Admin
10.00
5.00
2005
2006
Year
Page 10
2007
“Below the Line” sqft = Regional
Admin, Property Management,
Program Offices, Parking, &
Vacant/Under Construction
Energy-based Climate Action Strategy
Harvard University’s campus GHG reduction plan
New Construction
350000
Assumes 15% growth
Green New Construction
Assumes 15% growth & 50% less
GHG intensity per square foot
300000
Reduction in Metric Tons CO2 Equivalent
Energy Conservation
- Building Upgrades and Retrofits
- Occupant Education
- Green Construction & Renovation
- Controls Upgrades
250000
200000
Generation Efficiency
150000
- Cogeneration
- Steam & Chilled Water Efficiency
- Fuel Mix
- Electric Utility Selection
Renewable Energy
Generation
100000
On or off site solar, wind, biomass,
geothermal
50000
Carbon Offsets
- Reforestation
- Renewable Energy Purchases
- White Tags
0
2008
Page 11
2009
2010
2011
2012
2013
2014
2015
Source: Harvard University
2016
2017
2018
2019
2020
Broad-based Climate Action Strategy
Breakdown of NHS England 2004 Emissions
Travel
18%
Procurement (not
including
pharmaceuticals)
39%
Building energy use
22%
Pharmaceuticals
21%
Source: NHS England Carbon Emissions: http://www.sdu.nhs.uk/page.php?page_id=93
Page 12
Broad-based Climate Action Strategy
Page 13
Organization-wide Risk Assessment To Determine the
Most Significant Contributors to Global Warming
Excerpt
from risk
assessment
Page 14
Goals Based on Risk Assessment and Overall
Priorities of the Organization
Kaiser Permanente is linking its Sustainable Energy Strategy with
its Climate Action Plan to pursue GHG emissions reductions
through organization-wide activities in the areas of:
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Benchmarking
Building systems
Efficient delivery of care and service
Plug loads
Food
Transportation
Waste reduction
Employee engagement
Benchmarking and Building Systems: ENERGY
STAR Performance Ratings
Building-specific, campus-specific, region-level, and system-wide
benchmarking, goal-setting, dashboarding and best-practice sharing
Site Characteristics
Rating Scale
100
75
Operational change
50
Retrofit Candidate
25
Confirm data and set immediate
goal of improving rating by 10
points within 1 year
0
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Apply for ENERGY STAR label,
and share best practices
Benchmarking: Conserving Energy by Conserving
Water
KP Hospitals vs. Other's Water Benchmark Comparison
Water efficiency comparison for hospitals, 2008
200,000
182,699
180,000
160,000
135,222
140,000
Average
Annual
Gallons
per Bed
120,000
107,143
100,000
80,000
60,000
40,000
20,000
0
KAISER PERMANENTE
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OTHER U.S. HOSPITALS
OTHER CALIFORNIA HOSPITALS
Benchmarking
Major accomplishments as of August 2009:
•
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Greenhouse gas inventory (Climate Registry)
Energy audits
Water use (40% below average U.S. hospital)
Goals
Measure and report:
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Eco-Health Footprint (Global Health and Safety
Initiative’s new calculator tool to help measure and
manage carbon emissions, resource intensity, and
toxic pollutants)
Energy performance ratings for existing and new
buildings
Waste volumes
Building Systems: Energy-conserving Building
Standards
Page 19
Building Systems: Energy-conserving Building
Standards – Major Accomplishments
Between 1994 and 2009:
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Installed 100 acres of cool roofs
Lighting occupancy sensors (10% decrease in lighting energy use)
Light fixtures (30% more energy efficient than average)
Building automation controls systems maximized energy efficiency
Adopted an energy efficient HVAC (heating, ventilation, air conditioning) design
standard
Installed co-generation plants in 7 hospitals (~45% decrease in energy to heat
water and ROI of ~20%)
Windowpanes with low emissivity glass (50% to 70% reduction in solar heat)
Goals:
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Adjust design templates to achieve ENERGY STAR rating of 75 or greater for
each hospital and medical office building planned for construction.
Establish targets for improving the energy performance (in BTUs/sqft) of
existing building portfolio
By 2011 reduce the combined annual water use of the hospitals, medical office
buildings and commercial office buildings by 5%
Building Systems: Sustainable Energy Scorecard
for Kaiser Permanente’s Regions
Energy Program Element
NCAL SCAL
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Sustainable Energy Sponsor
Web-based / Enterprise enabled Utility Billing System
Energy Star Benchmarking
GHG Tracking
Audits
Demand Management
Retrocommissioning
Renewable / Sustainable PPA
Commodity Procurement
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In Place
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HI
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In Progress
OH
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MAS
Not Started
Key Energy Program Elements are already in place or underway in several regions
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Building Systems: Onsite Renewable Energy
Generation
Major accomplishments as of August 2009:
•
Solar photovoltaic array at Modesto Medical Center
Goals:
•
Page 22
Install 5 megawatts of new onsite solar energy
generation this year
Building Systems: Onsite Renewable Energy
Generation
Major drivers:
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Page 23
Reduce Kaiser Permanente’s impact on global
warming
Element of National Energy Strategy
Hedge against future regulation
Lower long-term energy costs
Eliminate risk of electrical cost fluctuations
Diversify supply
Brand benefits
Retain Renewable Energy Credits
Onsite Renewable Energy Generation
Page 24
Building Systems: Roof-mounted Solar Array
Page 25
Building Systems: Solar Field
Page 26
Building Systems: Solar Carports
Page 27
Efficient Care and Service Delivery
Major accomplishments as of
August 2009:
• Electronic medical records
• In-house distribution networks for
specimen, supplies and equipment
• In-house and mail-order pharmacies
• Email-your-doctor
Goals:
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• Evaluate technologies for recycling
anesthetic gases and establish targets
for reducing emissions of waste
anesthetic gases
• Engage members to take advantage of
efficient delivery models such as mailorder prescriptions, email-your-doctor
and mobile clinics
Plug Loads
Major accomplishments as of August 2009:
•
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Electronic Product Environmental Assessment Tool (EPEAT) Silverrating for all newly deployed laptop and desktop computers in 2008
Timers and occupancy sensors for vending machines in California
Goals:
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EPEAT Gold-rating for all newly deployed laptops and desktops in
2009
Determine percentage of ENERGY STAR labeled printers and set
target for increasing this percentage
Determine the most energy-intensive medical equipment and set
target for improving energy efficiency
In 2010 all equipment and appliances provided by builders of new
California Kaiser Permanente hospitals have to be ENERGY STAR
labeled if ENERGY STAR is applicable to that equipment or
appliance
Reducing Carbon Footprint by Reducing Waste
Page 30
Waste Reduction
Major accomplishments as of August 2009:
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Patient meal preference software reduces waste
Single-use device reprocessing reduced waste by ~208,198
pounds, avoided ~$90,000 of waste disposal costs and saved
~$5.7 million in medical device costs
Resold or rendered into raw materials and recycled 74,000
pieces of Kaiser Permanente’s electronic equipment
Recycled 100% of building materials generated from
demolition of warehouses at construction site of new hospital
Standardized service process for document destruction
improved diversion of paper waste to recycling stream
Goals:
•
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Sustain and, where possible, expand existing programs
Food
Page 32
Food: The Impact of Agriculture Policy on the
Environment
• The Gulf Dead Zone
• Corn and soybean
monocrops
• Extensive use of
fertilizers and pesticides
• Soil erosion
• Concentrated Animal
Feeding Operations
• Groundwater
contamination
• Air quality
• Antibiotics for livestock
Source: Lustig, 2008
Page 33
Food
Major accomplishments as of August 2009:
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Hosting 30 farmers markets and farm stands in 4 states
Locally grown produce is part of inpatient meals at 23 of our
hospitals
Ad campaign and partnerships with community groups to
promote healthy eating
Goals:
•
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Page 34
Increase percentage of our overall food spend allocated to
foods that are more sustainable than conventional alternatives
Support development of local food systems featuring locally
grown, sustainably farmed food
Transportation
Page 35
Impact of Car Culture on the Environment
California’s Greenhouse Gas Emissions by Sector 2004
(Gross emissions: 433.3 MMT CO2e)
Page 36
Air Resources Board. Greenhouse Gas Inventory.
http://www.arb.ca.gov/cc/inventory/data/graph/graph.htm
Transportation
Major accomplishments as of August 2009:
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Ad campaign and partnerships with community groups to
promote active living and building parks and bike paths
Successfully encouraged our largest materials distributor to
join the EPA Smartway program
Rightsizing initiative for our courier vehicles (conserved
20,786 gallons of gasoline and saved $79,610)
Videoconferencing (avoided ~5,000 metric tons of C02
emissions in 2008 and saved ~$2.5 million)
Goals:
•
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Page 37
Sustain and expand accomplishments above
Reduce business travel by 25% in 2009
Employee Engagement
http://insidekp.kp.org/insidekp/reduceyouruse/index.htm
Page 38
Employee Engagement
Major accomplishments as of August 2009:
•
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Reduce Your Use campaign encourages Kaiser
Permanente physicians and employees to reduce
consumption of resources
In 2008, staff eliminated the use of 240,000 sheets of
paper and 20,000 disposable bags
Goals:
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Page 39
First half of 2009 campaign: “Get Tapped In” to
reduce bottled water use
Second half of 2009 campaign: “Lights Out on Global
Warming” to conserve energy
Lessons Learned: Benchmarking
An annual GHG inventory is a crucial first
step toward measuring and managing
emissions. An automated utility bill
payment system facilitates tracking of
energy use and GHG emissions.
Page 40
Lesson Learned: Work With Others to Build
a Social Movement
GHSI is a coalition of health care
systems and organizations
working to sector wide
movement working together to
transform the way hospitals
build, buy and operate their
facilities
• Open source sharing of information
and best practices
• Group purchasing to transform the
market
• Research to document benefits,
improvements, outcomes
http://www.globalhealthsafety.org/
Page 41
Moving Forward: Key partners for success
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Direct Energy: KP-IT, NFS, P&S, Green Teams
Supply chain: P&S, Green Teams
Food: P&S, Nutrition Services, Green Teams
Transportation: Commuter programs, HR, KP-IT,
Green Teams
Pharmaceutical manufacturing: Pharmacy
Adaptation of care and service delivery to mitigate
global warming and adapt to its health effects:
Medical groups, DOR, UCDA, Green Teams
Industry standards: GHSI, Climate Registry
Public policy: Industry associations and health
advocacy groups
Resources
For additional information about environmental stewardship at
Kaiser Permanente, please visit our Green Resource Center:
www.kp.org/green
Or visit our Green Teams web site:
http://kpnet.kp.org/ehs/green_team/index.htm
Or contact:
Joe Bialowitz, Environmental Stewardship Project Manager
joe.bialowitz@kp.org
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