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The size and cost of healthcare is increasing. Expenses for all personal healthcare services and products in each state have been growing 4.4% to 7.3% per capita annually. In each state, healthcare spending ranges from $5,000 to $10,400 per person per year. Healthcare spending accounted for 17.9% of the US Gross Domestic Product (GDP) in 2011, and 36.3% of those national healthcare expenditures are for hospital care specifically.


As environmental sustainability becomes a greater priority for the American public, the healthcare industry, with its relative size, costs, waste generation, and expected growth, is under pressure to improve its economic, social, and environmental sustainability.  With these challenges and growing concerns about the US healthcare industry and the general health of the public, healthcare providers are turning towards a preventative model of care, part of which involves environmental health or the healthy interaction of humans with their environment (Fani Marvasti and Stafford 2012).  Hospitals, in particular, are called upon to be designed more sustainably and to improve the environmental sustainability of their processes and procedures (Ficca, Chyun et al. 2000; Phelps, Horman et al. 2006; Verderber, Fauerbach et al. 2008; Younger, Morrow-Almeida et al. 2008; Stichler 2009).  In order to implement more environmentally sustainable hospital building design and medical practices, healthcare decision-makers need proper tools and information about the industry’s current environmental footprint, which aspects of hospital design and function contribute most significantly to environmental and human health impacts, and how changes to the healthcare system might impact its overall sustainability.

Sustainable Healthcare

Life Cycle Assessment of Surgeries in Operating Rooms–Hysterectomies in the US

Hospitals generate nearly 4 billion tons of waste annually and remain one of the most energy-intensive building types in the US.  Improved environmental performance within hospitals is estimated to reduce healthcare spending nearly $5.4 billion in the next 5 years.  This project establishes a hybrid Life Cycle Assessment framework and Monte Carlo uncertainty analysis as tools to help identify the healthcare industry’s baseline environmental performance and to measure the impact of sustainability improvement efforts.  This case study of the four types of hysterectomies conducted at Magee-Womens Hospital of UPMC shows that the production and disposal of single-use materials and devices, and the heating, ventilation, and air conditioning systems have the highest environmental loading within the OR. This study identified upstream material manufacturing as an area for large environmental improvements in healthcare facilities.  For example, single-use cotton materials such as towels and gauze make up only 9% of vaginal and 11% of abdominal hysterectomy municipal solid waste by weight, but the production of these cotton materials accounts for 55-90% of the total environmental impacts of vaginal and abdominal hysterectomies in nearly all categories analyzed.  A Monte Carlo assessment of the hysterectomy LCA showed ranges of environmental impacts based on variability of OR procedures and uncertainty in impact assessment methods.

Thiel, C.L., Woods, N., Landis, A.E., Eckelman, M.E., Guido, R., Sherman, J., Bilec, M.M. (2015).“Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the US.” Environmental Science & Technology, 49(3) 1779-1786. DOI:10.1021/es504719g

Investigating the Impact of Green Healthcare Buildings: A Comparison between a LEED Oncology Unit and  a Traditional Oncology Unit

Evidence-based design (EBD) studies have grown rapidly over the last decade, attempting to link traditional building design to building occupants, with a particular emphasis in healthcare settings. The goal of this study was to understand the impact EBD has on a green building space and support the integration of green building design criteria into traditional EBD metrics.


This study captured the impact of both EBD and green building strategies by analyzing different metrics across a three-year period for the same 28-bed women’s oncology unit spanning the traditional hospital (Unit 2800) space and the new green addition (Unit 5800). Green building features included high-efficiency HVAC and lighting systems, low-VOC products, and HEPA filters while EBD features included decentralized nursing stations, blue and beige color palettes,and acoustic panels. Over 45 metrics based on quality of care, productivity, utilities, expenses, staff satisfaction, and patient satisfaction were statistically analyzed via two-sample T tests.


This study delved into many aspects of a hospital unit to determine how EBD and green building design features could impact different performance metrics. Of the six metric categories analyzed, quality of care, productivity, and utilities all stayed relatively unchanged from Unit 2800 (traditional/pre-move) to Unit 5800 (green/post-move) with a slight decrease in number of staff needed due to lower census. Expenses, staff satisfaction, and patient satisfaction saw a general upward trend from Unit 2800 (traditional/pre-move) to Unit 5800 (green/post-move).

Campion, N., Thiel, C.L., Focareta, J., Bilec, M.M. (2016). "Understanding Green Building Design & Healthcare Outcomes: An Evidence Based Design Analysis of an Oncology Unit." ASCE Journal of Architectural Engineering. 04016009. http://dx.doi.org/10.1061/(ASCE)AE.1943-5568.0000217

Environmental Impacts of Infant Birthing in a US Hospital

This study analyzes the environmental impacts of birthing procedures in the US using a life cycle perspective.  Using the tool life cycle assessment (LCA), this study attempts to better understand which aspects of each mode of birth significantly contribute to overall environmental impacts and proposes methods to improve those impacts.  The major components evaluated in the LCA were the HVAC, lighting, and machines within the birthing rooms, the surgical instruments and disposable custom packs associated with each procedure, and the sterilization, decontamination, and waste segregation for the end of the life of materials.

The results conclude that energy consumption due to HVAC, the end of life impacts of the disposable custom packs, and the production of the disposable custom packs contributed to the highest environmental impacts for all births. Improvement strategies targeting these categories, such as better HVAC controls, preferred purchasing, and better waste management, will reduce overall environmental impacts associated with each birth procedure. As a preliminary study introducing LCA to the healthcare industry, there are many potential research trajectories.

Campion, N., Thiel, C. L., DeBlois, J., Woods, N. C., Landis, A. E., & Bilec, M. M. (2012). Life cycle assessment perspectives on delivering an infant in the US. Science of the Total Environment, 425(0), 191-198. doi: 10.1016/j.scitotenv.2012.03.006

Evidence-Based Hospital Design of the Children’s Hospital of Pittsburgh of UPMC

The link between building design and human health can be difficult to quantify, though studies have utilized metrics related to worker productivity, indoor air quality, and occupant perception of the building (Kats, Alevantis et al. 2003; Ries, Bilec et al. 2006; Seppänen and Fisk 2006; Loftness, Hakkinen et al. 2007; Wiik 2011).  As green buildings become more common in the US, it is important to understand the building’s link to human health, as well as the building’s post-occupancy performance relative to design expectations (Needy, Gokhan et al. 2007).  This is especially true as the healthcare industry begins to design and build green hospitals (Pradinuk 2009; U.S. Green Building Council (USGBC) 2009; U.S. Green Building Council (USGBC) 2011).


In 2009, Children’s Hospital of UPMC (Children’s) moved into a LEED-certified facility in the Lawrenceville neighborhood of Pittsburgh, PA, demolishing the existing hospital, constructed on the Oakland site in 1926.  Researchers at the University of Pittsburgh partnered with Children’s in 2006 to conduct a comparative longitudinal assessment of the two hospitals to determine the effects of holistic and sustainable hospital design.  This study statistically compares metrics of expenses, productivity, quality of care, staff satisfaction, and utilities between the old hospital and the new, LEED-certified hospital.  Results show no significant statistical difference in Children’s total expenditures, a 10% increase in staff direct care hours, a 5% increase in employee tenure, and a 25-50% drop in turnover and position vacancies in the new LEED-certified facility. Additionally, despite a 300% increase in square footage of the hospital and updates to hospital performance in relation to building codes, utility consumption rates for electricity, water, and gas have actually decreased by nearly 60% per square foot.

Campion, N., Thiel, C.L., Focareta, J., Bilec, M.M. (2016). "Understanding Green Building Design & Healthcare Outcomes: An Evidence Based Design Analysis of an Oncology Unit." ASCE Journal of Architectural Engineering. 04016009. http://dx.doi.org/10.1061/(ASCE)AE.1943-5568.0000217


Thiel C., Needy, K., Reis, R., Hupp, D., Bilec M. (2014) “Building Design and Performance: A Comparative Longitudinal Assessment of a Green Children’s Hospital.” Building and Environment. 78(0), 130-6. http://dx.doi.org/10.1016/j.buildenv.2014.04.001


Bilec, M. M., Geary, M., Ries, R. J., Needy, K. L., & Cashion, M. (2010). “A method for quantifying the benefits of greening a healthcare facility.” Engineering Management Journal, 22(3), 3-11.


Bilec, M.M., Needy, R., Gokhan, N.M., Ries, R., Horman, M., Phelps, A.F., Enache-Pommer, E., Little, S., McGregor, B., and Sheane, C. (2009).  “Analysis of the Design Process of Green Children’s Hospitals: Focus on Process Mapping and Lessons Learned.” Journal of Green Building, (4) 1, 121-134. http://dx.doi.org/10.3992/jgb.7.4.100

Life Cycle Assessment of Various US Custom Packs

Disposable materials contribute to healthcare’s estimated production of 33 pounds of waste per patient bed per day or approximately 5.9 million tons of waste each year. This study analyzed the life cycle environmental impacts of disposable custom packs. A disposable custom pack is a set of sterile, disposable products prepackaged for a specific procedure with the aim of reducing time, errors, and contamination risk


Specifically, this study analyzed 15 custom packs from 12 US hospitals, 2 Thai hospitals, and 1 non-profit medical supply organization; the custom packs are prepared and used for traditional vaginal birth. The environmental impacts from the production, use, and disposable of each custom pack was analyzed using processes LCA. The material componentweights and the greenhouse gas emissions of all 15 custom packs is shown in the Figure below. The average weight of the 12 US packs was 1.25 kg with polypropylene composing an average 58% of the total pack weight. The quantity of cotton in the custom packs was the determining factor for the highest value of GHG emissions, which was almost 17.5 kg of CO2 eq. or 88% of Pack 1. The LCA results conclude that single-use cotton products have significant impacts on the environment.


Streamlining custom packs by focusing on quantity and types of materials significantly affects a hospital’s overall environmental impact. By using design for the environment principles (i.e., source reduction or recyclability) and life cycle assessment in collaboration with clinician input, healthcare institutions can make educated streamlining efforts for their disposable custom packs.

Campion, N., Thiel, C., Woods, N., Swanzy, L., Landis, A., Bilec, M. (2015). “Environmental Life-Cycle Impacts of Surgical Material Supply: A Comparative LCA of Disposable Custom Packs.” Journal of Cleaner Production. 94: 46-55

Minimal Custom Pack Design and Wide-Awake Hand Surgery: Reducing Waste and Spending in the Orthopedic Operating Room

The US health care sector has substantial financial and environmental footprints. As literature continues to study the differences in wide-awake hand surgery (WAHS) and sedation, we sought to better understand the costs and waste generation of these two approaches. We created a minimal disposable custom pack for small, hand surgery. We measured the waste from 178 small, hand surgeries performed via local-only (WAHS) or sedation with either the minimal or the standard custom packs. Patients were also asked to complete a post-operative survey on their experience. Data were analyzed using 1- and 2-way ANOVAs, 2-sample t-Tests, and Fisher’s Exact tests.

WAHS with the minimal custom pack produced 0.3kg (13%) less waste and cost $125 (55%) less in material supplies per case than sedation with a standard pack. Pack size was found to be a larger factor in waste generation than anesthetic approach, but measured waste did not include sharps. While all sedation patients required a driver to attend their surgery, only 32% of WAHS had a driver. WAHS patients reported slightly greater pain and anxiety levels during their surgery, but also reported greater satisfaction with their anesthetic choice, which could be tied to the enthusiasm of the physician performing WAHS. Surgical waste and spending can be reduced by minimizing the materials in the disposable custom pack. WAHS may also reduce waste and spending, and many patients reported greater satisfaction with their WAHS experience, suggesting that WAHS should be more broadly adopted in orthopedics.