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2009–2010 ENVIRONMENTAL SUSTAINABILITY REPORT

Taking Care of the Environment in the Environment of Care The Next 100 Years


Table of Contents Overview.......................................... ii Opening Statement..........................1 2009–2010 Achievements................2 Key Environmental Challenges.........3 2011–2013 Commitments................3 Environmental Governance..............4 Our Five Focus Areas.......................6 Managing Our Energy Intensity.......7 Managing Our Water Intensity.......11 Managing Our Materials.................13 Managing Our Waste.....................15 Managing Our Air Emissions..........17 Presbyterian Green Team...............18 Consolidated 2010 Performance Indicators....................................19

Central New Mexico Region CIMARRON ANGEL FIRE ESPAÑOLA RIO RANCHO ALBUQUERQUE

TUCUMCARI CLOVIS CORONA

SOCORRO

CARRIZOZO CAPITAN RUIDOSO

In-Scope CNM Facilities: 3 Hospitals 16 Clinics, urgent care, rehabilitation and wellness facilities 3 Service and maintenance facilities 1 Administrative office (recycling only)

Overview About Presbyterian Healthcare Services

Presbyterian Healthcare Services (Presbyterian) is a not-for-profit integrated healthcare system of hospitals, a health plan and a growing medical group. For more than 100 years, Presbyterian has been committed to a single purpose: improving the health of the patients, members and communities we serve. Over 8,800 employees and volunteers work at 44 facilities across New Mexico. Our hospitals, physicians, caregivers and insurance plans serve more than 660,000 New Mexicans, caring for one in three New Mexicans with at least one of our services.

Report Boundaries

This report covers the period from 2009 to 2010 with a balanced account of the environmental aspects and impacts of our Central New Mexico (CNM) operations. Report topics focus primarily on facilities due to their critical role in operations and the significant environmental impact of commercial buildings in general. Performance measures in this report reflect the performance of occupied and fully operational CNM facilities owned by Presbyterian, which we refer to as “in-scope facilities.” Facilities that are under construction, vacant, or leased to (or from) a third party are excluded from this report, with the exception of the Presbyterian Administrative Center (PAC), a complex of four leased buildings. This report does not include the PAC in measures for energy, water and emissions, because we do not have direct control over capital investments in efficiency improvements for the building systems there. We have included the PAC recycling efforts and performance measures, because recycling progress relies solely on Presbyterian employees who work at the PAC, rather than the building systems in operation there. For a complete list of facilities, refer to page 19. This report is the first in a series of environmental sustainability reports. It is our intent to expand coverage of future reports to the entire Presbyterian system.


Opening Statement By its very nature, the delivery of health care has significant environmental impacts upon local communities. Hospitals attract traffic and noise, produce myriad waste streams and require tremendous amounts of energy and water. Clinics do so on a smaller scale, and administrative and back-office functions consume resources and generate waste as well. Presbyterian is no different— our facilities require energy, water and materials to fulfill our healthcare mission. Byproducts of these services are emissions and waste. To secure our success in the next 100 years, we recognize that creating an exceptional Environment of Care includes taking care of the environment. This report examines the environmental aspects and impacts of our CNM operations, shares our successes and outlines our areas for improvement. Although this is our first formal environmental report, environmental stewardship is not new to Presbyterian. Energy efficiency, water conservation, materials management and recycling efforts have taken place throughout the organization for decades.

Thanks to the environmental stewardship of individual employees, departments and facilities over the years, we are now poised to build on earlier accomplishments. Looking forward, our key environmental challenge is to develop a formal, system-wide approach to environmental stewardship. In 2010, we laid the groundwork by reviewing the environmental aspects of our operations as well as our environmental governance structures, policies, programs, performance measures and reporting practices. These internal environmental reviews helped us to assess our impacts and identify gaps and improvement areas. As a result, we developed three-year environmental performance goals and applied for and received the Silver Level recognition in the New Mexico Environment Department’s Green Zia Environmental Leadership Program for Presbyterian Hospital and Presbyterian Kaseman Hospital. Between 2011 and 2013, we intend to develop a formal, enterprise-wide environmental governance structure and implement an environmental per-

Creating an exceptional Environment of Care includes taking care of the environment. formance measurement, monitoring and reporting process. Our approach will focus on quantifying impacts, improving performance and integrating environmental stewardship into our existing quality program. Once these initiatives are in place, Presbyterian will be well positioned for the next 100 years. Thank you for reading this report and sharing your comments with us.

Jim Klein Director, Facilities Engineering for Central New Mexico

2009–2010 Environmental Sustainability Report  |  1


2009–2010 Achievements Key Accomplishments in 2010 Environmental performance goals and key performance indicators: We developed six three-year goals through our public commitment to the New Mexico Environment Department’s Green Zia Environmental Leadership Program, listed on page 3. Environmental governance and policy: We performed an environmental policy review and analysis to identify policy and governance gaps to be addressed in 2011 and 2012. Employee engagement and awareness: We launched the Presbyterian Green Team campaign in August 2010 to promote employee engagement and environmental awareness, and we scheduled ongoing activities through 2011. Employee recycling program: We implemented a rolling, CNM-wide break room recycling program that will be deployed across facilities between August 2010 and December 2011. Green purchasing policy: We revised our purchasing policy in September 2010 to include environmentally preferred purchasing language, which is a first step towards developing a green purchasing program and training series by year-end 2012.

Awards and Recognition ENERGY STAR certification, 2009 and 2010 The U.S. Environmental Protection Agency (EPA) recognized Presbyterian Hospital as one of the nation’s most energy-efficient hospitals, with 24 percent lower energy consumption than the average U.S. hospital.1 Green Zia Silver Level recognition, 2010 Presbyterian Hospital and Kaseman Hospital were designated as Silver Level organizations by the New Mexico Environment Department’s Green Zia Environmental Leadership Program.2 Water Pretreatment Gold Award, 2007 through 2010 Presbyterian Hospital and Kaseman Hospital have received the award from Albuquerque Bernalillo County Water Utility Authority, Industrial Wastewater Pretreatment Program, Environmental Compliance Division for four consecutive years.

2  |  2009–2010 Environmental Sustainability Report


Key Environmental Challenges Through the environmental reviews we performed in 2010, we identified five key challenges, which drive most of our current and future environmental sustainability efforts: ∙∙Reducing energy consumption and associated costs while meeting growing healthcare needs ∙∙Minimizing the environmental impacts of our operations while maintaining exceptional quality of care and patient safety ∙∙Changing perceptions of environmental stewardship as a “feel-good” notion and instead encouraging our culture to view it through the lens of resource efficiency and financial sustainability ∙∙Ensuring a good return on investment (ROI) on our large-scale projects ∙∙Managing and measuring the environmental aspects of our operations through a strategic, integrated, quality-oriented approach

2011–2013 Commitments Presbyterian has developed six environmental performance goals for the 2011–2013 timeframe. These goals are public commitments made to the New Mexico Environment Department as part of our 2010 application for the Silver Level of the Green Zia Environmental Leadership Program.

Environmental Performance Goals 1. Develop enterprise-level green purchasing program by year-end 2012. Amend purchasing policy to include green purchasing criteria and develop procedures for assessing environmentally preferred products and services across all eight Value Analysis Teams (VAT). Goal is met when all eight teams have green purchasing procedures in place for evaluating products and services. 2. Develop CNM environmental “footprint” by year-end 2011. The footprint measures energy (electricity and natural gas), water, waste (and diversion rates) and greenhouse gas (GHG) emissions using a 2010 baseline year. Goal is met when all 2010 measures are collected, consolidated and reported. 3. Implement employee Green Team by year-end 2011. The Presbyterian Green Team campaign will promote employee engagement and environmental awareness throughout the organization. Goal is met when 75 percent of state-wide facilities have Green Team representation. 4. Establish state-wide break room recycling program. Recycle aluminum and plastic at 75 percent of CNM facilities by year-end 2011. Expand to regional facilities by year-end 2012. 5. Measure and improve recycling rates. Establish 2010 baseline recycling diversion rate for all participating facilities and increase each facility’s diversion rate by 10 percent by year-end 2013. 6. Develop and implement an environmental management system. Develop and implement an environmental management system for Presbyterian Hospital and Kaseman Hospital by yearend 2012 and for Presbyterian Rust Medical Center by year-end 2013.

2009–2010 Environmental Sustainability Report  |  3


Environmental Governance In order to develop a more strategic, integrated and quality-oriented approach, we need to establish an environmental governance framework.

The social and economic aspects of Presbyterian’s operations are well managed through integrated strategic planning processes, quality programs and stakeholder engagement practices. While social and economic governance flows from the Board of Directors to all levels of the organization, governance of the environmental aspect occurs mainly at the operating group level and tends to focus on specific operations and departmental policies in areas such as spill control, disposal methods and materials handling. Our challenge is to develop a formal, enterprise-wide approach to environmental stewardship that aligns with the Presbyterian Egg, Annual Rhythm and Quality Plan. We must first establish an environmental governance framework that includes an environmental management system and an overarching environmental policy. Such a framework will provide organizational structure, context and expectations for Presbyterian’s environmental performance. In 2010, we focused on identifying gaps, selecting key performance indicators and developing processes for measuring our environmental footprint. These efforts established the foundation for developing a strategic, integrated and quality-driven approach to environmental governance in the coming years.

SOCIAL, ECONOMIC & ENVIRONMENTAL GOVERNANCE ORGANIZATIONAL LINE OF SIGHT Board of Directors Management Committee

SOCIAL

ORGANIZATIONAL INTEGRATION

ECONOMIC [Risk]

Business Units Operating Groups Key Functions Staff

ENVIRONMENTAL

Presbyterian Egg, Annual Rhythm & Quality Plan Task-Specific Policies & Procedures Personal Egg

Governance of the social and economic aspects of operations flow from the Board of Directors to each individual staff member. Environmental governance is less developed, creating organizational risk.

4  |  2009–2010 Environmental Sustainability Report


Environmental Stewardship and the Presbyterian Egg

What does the environment have to do with the Presbyterian Egg? We view environmental stewardship as an integral component of the Egg and the way we operate and plan for our future.

Environmental stewardship aligns with our purpose to improve the health of the patients, members and communities we serve.

An enterprise-wide environmental management system reinforces the goal for One Presbyterian.

Our vision and values guide our environmental decisions. High performance—demonstrated through excellence, innovation, teamwork and trust—is exemplified in our environmental initiatives, our accomplishments and the goals we set.

An exceptional Environment of Care requires the efficient use of resources. Environmental initiatives to conserve energy and water and to minimize waste not only lower our operating costs, but also support our affordability and financial sustainability goals.

Spotlight on Regulatory Compliance

In the summer of 2010, the New Mexico Environment Department Hazardous Waste Bureau (HWB) conducted a hazardous waste Compliance Evaluation Inspection at Presbyterian Hospital.3 Based on the inspection, HWB designated the hospital as a Small Quantity Generator of hazardous waste. The HWB found 12 violations related to labeling, storing and handling of hazardous materials as well as signage and training for materials handling. We immediately corrected all 12 violations, well before we received the formal audit report. In addition, we performed an internal audit and site visit at all facilities that handle hazardous waste to ensure total compliance throughout the CNM region. Because we proactively corrected the source of the violations and took steps to prevent future incidents, the HWB levied no penalties. We believe that the environmental management system to be implemented will prevent future incidents.

2009–2010 Environmental Sustainability Report  |  5


Our Five Focus Areas Simply stated, our operations require energy, water and materials and in turn produce waste and emissions. To secure our success in the next 100 years, we recognize that creating an exceptional Environment of Care includes taking care of our environment. In order to focus our efforts, we examine our environmental impact and performance in five areas: energy, water, materials, waste and emissions.

Energy

Emissions

Presbyterian’s operations rely on electricity, natural gas, diesel and other fuels.

Emissions are tied to our energy use. Indirect emissions are associated with our consumption of electricity. From a greenhouse gas accounting perspective, we “own” the emissions associated with the energy we consume, even when it is generated by a third party at a remote plant. Direct emissions are produced from combustion engines—including 110 automobiles, light- and heavy-duty trucks and vans in our vehicle fleet— on-site emergency back-up generators and other equipment. Boilers, furnaces and other gas-fired building systems also produce direct emissions.

Waste

We have diverse regulated and unregulated waste streams. Regulated waste involves specific storage and disposal procedures. Municipal waste is trash we throw away, which ends up in landfills. Recycled waste includes construction waste, cardboard, plastic, aluminum, medical equipment, rechargeable batteries and office paper.

Water

The healthcare sector is a water-intensive industry. Activities such as food preparation, cleaning, heating and cooling, equipment sterilization, domestic sanitation and landscape irrigation all require water. We pre-treat industrial wastewater before it is returned to municipal sewage treatment facilities.

Materials

Materials include all the supplies and devices we purchase along with their associated packaging. Managing materials is connected to waste reduction efforts through re-using supplies and recycling.

6  |  2009–2010 Environmental Sustainability Report


Managing Our Energy Intensity

Electricity Usage

Presbyterian has a history of capitalizing on opportunities for energy efficiency throughout our facilities. In 2009 and 2010, Presbyterian Hospital earned ENERGY STAR certification from the EPA as one of the country’s most energy-efficient hospitals. While we’ve performed well in terms of energy management, we face increasing energy demands and rising utility rates. In 2010, an estimated 35 percent of the CNM facilities management operating budget was spent on natural gas and electricity.4 As our local utility’s thirteenth largest commercial electricity consumer, we spent $3.4 million in electricity in 2010. To address these challenges, we are focusing on our most energyintensive buildings and identifying opportunities to save energy at these facilities. We are also piloting on-site renewable energy systems as an approach to offset future utility rate increases and reduce emissions.

What We’ve Accomplished

We compiled our electricity usage and associated GHG emissions for in-scope facilities from 2000 to 2010 (page 17).5 Results for 2009 and 2010 are encouraging, showing a slight decline from a 2008 peak. We attribute these reductions to energyefficiency improvements over the past few years. To reduce consumption in our most energy-intensive facilities, we implemented a series of lighting retrofits, building system upgrades and roofing replacements: ∙∙Lighting retrofits include replacing incandescent bulbs with more efficient compact fluorescent light (CFL) bulbs, which provide better lighting quality from fewer bulbs, as well as installing occupancy sensors in conference rooms and public and patient restrooms. As of March 2011, the electric utility reserved $122,228 in rebates based on lighting retrofits.6 ∙∙Building system upgrades—many of which qualify for electric utility rebates—include installing air handling units and energy management systems, and upgrading controls, boilers, motors and cooling towers. These retrofits began in 2009 at Presbyterian Hospital and Kaseman Hospital and will continue through 2011 at our Montgomery and Forest Hills locations. ∙∙Replacing gravel roofs with ENERGY STAR membrane roofing at multiple facilities has reduced building cooling costs.

Purchased electricity (MWh) at in-scope facilities 2008

57,688

2009

56,659

2010

56,464

Intensity (kWh per sq. ft.) 2008

25.59

2009

25.14

2010

25.05

Consumption of purchased electricity has decreased in both 2009 and 2010. Trend data from 2000–2010 with associated GHG emissions are shown on page 17.

68%

Projected reduction in energy for parking lot lighting from replacing incandescent lights with high-efficiency LED fixtures in 2010 and 2011.7 Natural Gas Usage Natural gas (MMBtu) at in-scope hospitals 2009

134,374

2010

151,199

Intensity (therms per sq. ft.) 2009

0.88

2010

0.99

We’re compiling a ten-year history of natural gas consumption. These results show a two-year profile of CNM hospitals, which consume the most natural gas.

2009–2010 Environmental Sustainability Report  |  7


We have also pursued opportunities for energy efficiency in new construction. The Presbyterian Rust Medical Center, expected to open in 2011, was designed with energy efficiency as a guiding principle. Learn more about the project on page 9.

What We’re Planning To Do

To minimize the impacts and costs associated with our energy consumption further, we have identified three key actions: reduce energy consumption, explore on-site renewable energy generation and monitor energy usage patterns. CNM facility managers were tasked with reducing energy consumption by five percent as part of their 2011 performance targets.8

Sustainable Arithmetic

$249K − $102K $147K

Minimum annual savings from program + reserved rebates Estimated program costs Net savings

PMG Montgomery Clinic 2010 and Projected Usage (MWh) 600 400

30% 50%

200 0

Solar Energy reductions Purchased electricity

2010

Projection

We project a 30–50 percent reduction in purchased electricity from 2010 usage based on the on-site solar generation system and planned energy-efficiency improvements.

Reduce energy consumption In October 2010, we began implementing a three-year program to monitor and reduce electricity and natural gas consumption at Presbyterian Hospital and Kaseman Hospital. We contracted a national firm to monitor and recommend no- and low-cost improvements to building systems and operations. The program is expected to provide benefits that significantly exceed its cost. It guarantees at least $139,000 in annual cost savings, and the electric utility has already reserved $110,000 in conservation rebates based on the program improvements.9 The rebates alone are expected to exceed the program cost. Even without these rebates, we would anticipate a return on investment period of 8–11 months. Generate renewable energy In late 2010, we completed a vendor RFP to install a 40-kilowatt solar photovoltaic electricity generation system at the PMG Montgomery clinic in the summer of 2011. This pilot program will evaluate and optimize the benefits of investing in on-site electricity generation systems. Preliminary engineering analysis indicates that the new system will generate 65 MWh annually. Combined with other energy-efficiency improvements at the site, the system could reduce consumption of utility-based electricity by 30–50 percent of current levels.10 Measure and monitor We will continue to track electricity usage and will expand natural gas reporting for all in-scope facilities. To gain an enterprisewide perspective of our overall consumption, we plan to incorporate regional facilities in future reports.

8  |  2009–2010 Environmental Sustainability Report


Environmental Features

∙∙High-performance insulated ENERGY STAR roofing ∙∙High-performance windows and unique window shading to reduce heat gain and loss ∙∙Highly insulated exterior walls ∙∙High-efficiency lighting systems ∙∙High-efficiency ENERGY STAR appliances, computers and equipment ∙∙Low-water landscaping ∙∙Low-flow water fixtures ∙∙High-efficiency, low-temperature boilers ∙∙High-efficiency building system motors ∙∙Heat recovery systems to reduce heating energy ∙∙State-of-the-art building controls ∙∙“Variable Frequency Motor Drives” to reduce energy used by building system motors To learn more, please visit phs.org/PHS/RioRancho or Facebook.com/PresRioRancho

Presbyterian Rust Medical Center

The Presbyterian Rust Medical Center, a state-of-the-art facility expected to open in 2011, reflects our commitment to sustainable health care and to the Rio Rancho community. Vision Presbyterian will create a healthcare system for Westside patients and members that is safe, patient-centered, operationally efficient and flexible, environmentally friendly and technologically innovative. Designing a Sustainable Healthcare Environment We have taken advantage of many of the environmental opportunities that a new construction project presents. In designing the Presbyterian Rust Medical Center, we spent over a year visiting state-of-the-art hospitals and evaluating best building practices, including Leadership in Energy and Environmental Design for Healthcare (LEED-HC) certification.11 Although we decided not to use healthcare funds to pursue LEED-HC certification, we incorporated LEED-HC design elements and features that had a direct patient and staff benefit, reduced operating cost with a reasonable return on investment, and created a clean, non- or less-toxic environment. The result is a high-performing building that exceeds building code requirements and most standards within current green building best practices for energy efficiency, water conservation, waste reduction and recycling, and pollution prevention. We expect it to receive ENERGY STAR certification within 18 months of opening.

2009–2010 Environmental Sustainability Report  |  9


Understanding the Link Between Energy and Water

The Frank Vinke Energy Center at Presbyterian Hospital is highly dependent on water to heat and cool the building. Facility engineers manage a complex gas- and electric-powered system of boilers, chillers, fans, cooling towers and underground thermal storage, optimizing the use and re-use of water throughout every building system in the hospital. With the exception of electricity, nearly all other transmission of energy throughout our facilities occurs through water.

The two main methods of building cooling present a trade-off between energy and water conservation: evaporative cooling towers (wetcooled) require significantly less energy, while air-cooled (dry-cooled) condensers use no water.

Joe Frey checks chiller operations at the Frank Vinke Energy Center at Presbyterian Hospital.

10  |  2009–2010 Environmental Sustainability Report


Managing Our Water Intensity Presbyterian’s location in the southwestern United States, a region prone to chronic drought conditions, compounds the challenge of managing the water intensity of our operations. We are continuously seeking opportunities to conserve water through building system upgrades, domestic and landscape conservation programs and newer, less water-intensive technologies. Currently, we are compiling our water usage to better understand our water intensity and identify additional water conservation opportunities.

18M

Gallons of water evaporated each year from cooling towers at Presbyterian Hospital13

What We’ve Accomplished

Our efforts are focused on managing both the amount of water we use as well as wastewater quality. Water conservation Between 2008 and 2010, we completed building system upgrades to cooling water systems, sink fixtures, water pumps and steam traps to reduce water consumption at CNM hospitals. These projects have a combined estimated water savings of over 2.2 million gallons of water per year.14 In January 2010, we launched a pilot linen program at Presbyterian Hospital. The program enables patients to request new linens at their discretion rather than daily. The pilot program resulted in a 10 percent decrease in laundered linens, representing approximately 20,000 pounds of laundry per month. Once the program is fully implemented, we expect a 20 percent decrease in laundered linens, which translates to an annual savings of 960,000 gallons—nearly three acre feet—of water per year.12

2.2M

Estimated gallons of annual water savings from building system upgrades performed between 2008 and 201014

Wastewater quality Both Presbyterian Hospital and Kaseman Hospital operate award-winning wastewater treatment programs with outstanding compliance records for pre-treating industrial wastewater before it is returned to municipal sewage treatment facilities for processing.

2009–2010 Environmental Sustainability Report  |  11


What We’re Planning to Do

Our water consumption has not received the same level of analysis across facilities as other resource usage has. To address this, we are developing a water footprint that will provide trend data for CNM facilities.

We follow a water-wise approach to landscaping by replacing grass disturbed during facility-related projects with drought-tolerant and xeric plants.

Water conservation is a continual concern, but we must first compile and analyze our water consumption in order to make strategic, factbased decisions.

Over time, we plan to include system-wide water performance programs, measures, compliance and training activities. We also plan to review and update policies and procedures that relate to water consumption and quality. Once we have a formal management and measurement process for overseeing our water intensity, we’ll gain deeper insights into our consumption patterns. When we better understand those patterns, we’ll be better informed to identify additional opportunities for reducing the water intensity of our operations and to set reduction goals. Next Steps Measurement: To better understand how much water we’re using, we plan to track absolute and intensity-based water consumption for the CNM region overall and each facility by year-end 2011. We will begin with 2010 as our baseline year and then measure usage annually. We plan to include statewide consumption after we compile CNM data. Analysis: Once we understand our water footprint, we will look for usage patterns and identify our most water-intensive activities and facilities. We can then determine the best course of action for reducing our highest water use. Action: Any actions to reduce our water intensity must accomplish three objectives: ∙∙reduce our environmental impact ∙∙support and maintain our exceptional quality of care and patient safety ∙∙provide a reasonable return on our investment

12  |  2009–2010 Environmental Sustainability Report


Managing Our Materials Presbyterian’s approach to materials management focuses on reducing exposure to harmful materials, reducing excessive packaging, and identifying and evaluating environmentally preferable products and services through our existing purchasing evaluation process. While we’ve had successful ad hoc green purchasing efforts across the organization, we plan to build on those efforts through a more systematic, integrated approach to materials management.

What We’ve Accomplished Reducing packaging Many medical supplies and devices are heavily wrapped with multiple layers of plastic packaging, and many items are designed for “single use” to be thrown away after one use. Both of these conditions—excessive packaging and single-use products—waste resources and needlessly fill our landfills with recyclable and reusable items. We work with a key supply chain management partner to reduce packaging at our facilities and identify single-use items that can be re-processed for re-use.

600

estimated pounds of packaging avoided per day through the use of reusable carrying totes for supplies at Presbyterian Hospital. All 69 nursing supply areas participate in the packaging reduction program, which began in May 2010.15

Increasing green purchases We purchase a variety of environmentally preferable products and services, including cleaning products and services and office products made from recycled materials. Through partnerships with key suppliers, we have been able to reduce exposure to harsh cleaning products in select facilities. To address latex sensitivities and allergies among healthcare workers, several outpatient facilities such as physical therapy, occupational therapy and rehabilitation are now latex-free. We have also eliminated the use of aerosol sprays in our cleaning supplies.

What We’re Planning to Do

As part of our Silver Level program commitment to the New Mexico Environment Department’s Green Zia Environmental Leadership Program, we set a goal to create a formal, systemwide green purchasing program that will be in place by yearend 2012. The green purchasing program will address reducing the risks associated with exposure to harmful materials and minimizing excessive product packaging and waste.

Performance Goal: Develop enterprise-level green purchasing program by year-end 2012.

2009–2010 Environmental Sustainability Report  |  13


By year-end 2012, all eight VAT teams will have green purchasing criteria in place for evaluating products and services.

The green purchasing program will dovetail into the existing Value Analysis Team (VAT) process, which includes procedures for regular review and management oversight by teams in eight areas: Imaging and Cardiovascular, Information Technology, Integrated Support Services, Laboratory, Patient Care, Pharmacy, Surgical Services and System Services. The only difference to the current process is that the procedures will have an environmental component that includes measurement and verification processes and procedures for tracking and reporting green purchases. Rather than force VAT teams to select the “greener” product automatically, the program simply places the environmental aspects of a product or service on equal footing with pricing and performance considerations. If an environmentally preferable product or service does not compete in terms of price or performance, it may not be selected. To lay the groundwork for these efforts, we modified our procurement policy to include green purchasing criteria in the fall of 2010. By year-end 2012, we will document procedures for assessing environmentally preferred products and services across all eight VAT teams. Our goal will be met when all eight teams have green purchasing procedures in place.

OR Nurses’ Recycling Initiative

Jeri Anagnostelis, OR nurse, is the driving force behind the OR plastics recycling program at Presbyterian Hospital, which collects plastic pre-surgical wraps and drapes, irrigation bottles and packaging from surgical supplies. Thanks to Jeri and her colleagues, OR nurses recycled an estimated 2,160 pounds of plastic from October 2010 through December 2010.16

14  |  2009–2010 Environmental Sustainability Report


Managing Our Waste Regulated waste includes universal (electronics and batteries), hazardous, pathological and pharmaceutical waste. We have a good track record for managing these types of waste according to state, local and federal regulations. Unregulated waste includes municipal waste, construction waste, medical equipment and food waste. Our unregulated waste and recycling efforts present many promising opportunities to reduce waste, increase recycling and, in some cases, generate revenues.

What We’ve Accomplished

Over the course of 2010, we reviewed our recycling efforts for improvement opportunities. The review found that, although we are already recycling in many areas, our efforts are confined to specific departments, purchasing teams or behind-thescenes facilities management efforts. For example, we regularly recycle construction waste, cardboard, medical equipment, rechargeable batteries and office paper, and some employees have even set up their own recycling programs. We are working with suppliers to reduce packaging waste and re-use medical supplies and equipment. While these are impressive efforts by individuals and departments, they are scattered throughout the organization and are not managed, measured or reported through a systematic process. Our aim is to measure the amount of waste we’re generating and the quantity of materials we’re recycling. We also want to determine whether there are opportunities to generate revenue or offset recycling and re-use program costs by selling recycled materials and end-of-life assets to recycling vendors. In order to expand municipal waste and recycling awareness and participation throughout the organization, Presbyterian facilities management began planning a two-pronged approach to formalizing a state-wide recycling program that focuses on employee engagement and facility-level recycling logistics. Employee engagement and awareness efforts fall under the Presbyterian Green Team campaign, which was planned and piloted in the second half of 2010. The campaign is discussed further in the Presbyterian Green Team section on page 18.

In sustainability circles, the waste-reduction mantra is “reduce, reuse, recycle.” Items Reduced ∙∙Medical supply packaging Items Reused ∙∙Medical supplies ∙∙Medical equipment (donated) ∙∙Office supplies ∙∙Office furniture (donated) Items Recycled ∙∙Aluminum cans ∙∙Cardboard ∙∙Paper ∙∙Plastics ∙∙Medical and IT equipment ∙∙Batteries 2009 and 2010 Recyclables (U.S. short tons) Aluminum 0

2009 2010

0.17

Plastics 0

2.05 0.94 0.71

Universal 0

1

2

3

399.52 483.77

Paper

43.89 111.91

Cardboard 0

100 200 300 400 500

We’re making progress in tracking and increasing the amount of recycled waste.17 Cardboard recycling increased by 155 percent from 2009 to 2010.

2009–2010 Environmental Sustainability Report  |  15


Performance Goal: Implement a break room recycling program for aluminum and plastic at 75 percent of CNM facilities by year-end 2011. Progress on Performance

8/10 start

12/11 end

12/10 progress to goal 41% of CNM facilities 75% goal With nine CNM facilities engaged in break room recycling at yearend 2010, we are well on track to meet our 2011 goal.

To address facility-level recycling logistics, we began a pilot break room recycling program at the PAC in August 2010. The PAC recycling pilot, which followed our recycling readiness review process, was well received by PAC employees, facility managers and janitorial staff. Since August 2010, we have been implementing break room recycling programs at CNM facilities on a rolling basis. As of December 31, 2010, 41 percent of CNM facilities (9 out of 22) have break room recycling programs in place, with two facilities reporting recycling performance.

What We’re Planning to Do Waste and recycling efforts The implementation of the break room recycling program will continue on a rolling basis to CNM facilities in 2011, with 19 facilities (86 percent) anticipated to be recycling and reporting performance at year end. We will implement the program at regional facilities in mid-2011 through 2012.18 We will continue to track our waste and recycling efforts through our environmental footprinting efforts. To monitor our efforts, we will report performance using 2010 as our baseline year and then provide quarterly updates. Municipal waste and recycling efforts will be measured by a “diversion rate,” which is a standard environmental measure of the percentage of waste that is diverted from the landfill. Once the baseline diversion rate is measured and reported, we will challenge each facility—with support from the Presbyterian Green Team—to find ways to increase its diversion rate by ten percent by the end of 2013. Integrated waste management plan In the fall of 2010, Presbyterian invited two potential integrated waste management contractors to assess our waste streams and develop an integrated waste management plan. The plan is expected to manage our regulated and unregulated waste. We will discuss our progress in future reports.

16  |  2009–2010 Environmental Sustainability Report


Managing Our Air Emissions

2000–2010 GHG Emissions from Purchased Electricity

Our air emissions come from three key sources: electricity consumption, combustion engines in fleet vehicles and back-up generators and natural gas-fired building equipment.

Metric Tons of GHG Emissions in Carbon Dioxide Equivalents (CO2e)

What We’ve Accomplished

24,000

We completed a ten-year greenhouse gas inventory that includes the carbon dioxide (CO2), nitrogen oxide (N2O) and methane (CH4) emissions connected with our electrical use (referred to as indirect emissions).19 While electricity consumption and associated GHG emissions rose steadily from 2000 and peaked in 2008, both decreased slightly in 2009 and 2010. These results are encouraging and suggest that efficiency and conservation efforts put into place over the past few years are working. Still, we know we have more work ahead to reduce electricity and emissions further. The City of Albuquerque Air Quality Division requires emergency back-up generators to be tested annually for direct emissions. Our generators demonstrated such exceptional performance over the years that the Air Quality Division has waived the testing at CNM hospitals in 2010 and 2011. The waiver enables us to avoid the associated costs of the tests (approximately $17,000 each) and the unnecessary diesel emissions.20

36,000

32,246

12,000 0

Megawatt Hours of Electricity 60,000 40,000

56,464

20,000 0 2000 2002 2004 2006 2008 2010

Electricity usage and associated emissions in 2010 decreased by 2.1 percent from 2008. The rate of increase has also decreased from 70 percent from 2000–2005 compared to 23 percent from 2005–2010.

What We’re Planning to Do

We recognize that energy demands are rising, which in turn contribute to higher emissions. Paradoxically, emissions tied to increasing energy demands to provide health care will degrade the health of patients, communities and future generations, creating a negative feedback loop of energy, emissions and ill health over the next 100 years. The majority of our emissions are linked to our purchased electricity; therefore, our initial focus is on reducing our electricity usage—and where possible, replacing it with zero-emission renewable energy. We plan to calculate and report direct emissions tied to combustion engines (vehicles and on-site back-up generators) and natural gas-fired building equipment (boilers and furnaces). We will continue to analyze our direct and indirect emissions profile in order to develop long-term goals to slow, stop and reverse our emissions trends.

2009–2010 Environmental Sustainability Report  |  17


Presbyterian Green Team Performance Goal: Implement a system-wide Green Team by year-end 2011.

The Green Team is an employee engagement and environmental awareness campaign designed for employees who are interested in promoting environmental sustainability in the workplace and at home.

Growing a Green Team

The initial concept for a Presbyterian Green Team began in 2009. Since then, we’ve made slow but steady steps towards our goal of establishing a state-wide Green Team at 75 percent of our facilities by year-end 2011. Personnel changes, shifting priorities and dedicated resources remain challenges to establishing a solid foundation for the Presbyterian Green Team to flourish. In spite of these challenges, we’ve made the following progress: Joe Candelaria transports recyclable plastics from the OR.

∙∙Fall 2009: Conducted an environmental survey to understand workforce issues and the needs and concerns of Presbyterian employees “In the era of “Green,” I have always wondered why we have no recycle program. I watch way too much plastic go into the regular trash (specifically in the cafeteria).” “I’m a brand new employee and was quite surprised that as much as Presbyterian cares about patients and employees that there seem to be no active programs for having a “Green Friendly” campus to show we care about the environment as well!” ∙∙Summer and fall 2010: Developed Green Team concept and launched state-wide Green Team recruiting campaign; and piloted break room recycling program at the PAC ∙∙Earth Day, April 2011: Hosted official Green Team “kick off” webinar Looking forward, we will continue to educate and engage our workforce by publishing educational articles, hosting quarterly webinars and developing a Green Team intranet site with tips, tools, presentations and information for Green Team members and interested staff.

18  |  2009–2010 Environmental Sustainability Report


Consolidated 2009–2010 Performance Indicators 2009

2010

56,659

56,464

Energy Electricity purchased for use at in-scope facilities Absolute (MWh) Intensity (kWh per square foot)

25.14

25.05

Natural gas consumed at in-scope hospitals

Natural gas data for all in-scope CNM facilities will be provided in a future report.

Absolute (MMBtu)

134,374

Intensity (therms per square foot)

151,199

0.88

Renewable energy generated on-site

0.99

Future reporting

Total (kWh)

Percent of total electricity

Water

Future reporting

Waste Recyclables at in-scope facilities and the PAC (U.S. short tons)17 Aluminum

Plastics

Paper

0.17

2.05

399.52 483.77

Cardboard

Universal (electronics, batteries)

Municipal waste (U.S. short tons)

43.89 111.91 0.94

0.71

Future reporting

Emissions CO2e emissions produced on-site (direct)

Future reporting

CO2e emissions from purchased electricity (indirect)

19

Absolute (metric tons) Intensity (pounds per square foot) Square footage of in-scope CNM facilities

32,357

32,246

14.49

14.44

2,232,548

In-scope facilities include the hospitals, clinics, and service and maintenance facilities listed to the right. The square footage is used in electricity and emissions intensity measures. The natural gas intensity uses the square footage of CNM hospitals (1,521,558). Out-of-scope facilities are those under construction, vacant, or leased to (or from) a third party: 1011 Coal Avenue SE, 1023 Central NE, 1029 Lead Ave SE, NE Central Cluster (1101-1307 Central NE), 1114 Copper Avenue SE B, 114 Oak Street NE, 115 Cedar St NE, 1648 Alameda, 216 Spruce Street Cluster, 2340 Alamo Avenue SE, 4500 Montbel Loop NE, 8120 Constitution Place NE Complex, 8200 Constitution Place NE (parking lot). The PAC facilities listed to the right are out-of-scope, but included for recycling.

In-Scope CNM Facilities & PAC* Hospitals ∙∙ Presbyterian Hospital ∙∙ Presbyterian Kaseman Hospital ∙∙ Rio Rancho ED (located in 4100 High Resort Blvd SE clinic) Clinics Albuquerque ∙∙ 1325 Wyoming Blvd NE ∙∙ 3436 Isleta Blvd SW ∙∙ 3901 Atrisco Drive NW ∙∙ 401 San Mateo SE ∙∙ 5550 Wyoming Blvd NE ∙∙ Northside PMG, includes 5901 Harper NE, 5900 Forest Hills Drive NE and 6100 Pan American Freeway ∙∙ Healthplex, 6301 Forest Hills NE ∙∙ 8100 Constitution Place ∙∙ 8300 Constitution NE B KPOB ∙∙ 8312 Kaseman Court ∙∙ 8800 Montgomery NE Belen ∙∙ 609 Christopher Road Complex Los Lunas ∙∙ 200 Emilio Lopez Road Rio Rancho ∙∙ 3715 Southern Blvd ∙∙ 4005 High Resort Blvd SE ∙∙ 4100 High Resort Blvd SE Service and Maintenance Facilities Albuquerque ∙∙ 101 Mountain Road warehouse complex ∙∙ 323 Mulberry SE paint shop ∙∙ 8300 Constitution NE, #02 shop Administrative Facilities Albuquerque ** PAC Complex (recycling only) ∙∙ 1801 Randolph Road SE ∙∙ 1801 Randolph Road SE #A ∙∙ 2301 Buena Vista Drive SE ∙∙ 2501 Buena Vista Drive SE

2009–2010 Environmental Sustainability Report  |  19


Internal Use: This report is intended for internal use only. Performance Indicators Disclaimer: In this report, Presbyterian Healthcare Services (Presbyterian), including its hospitals and physicians and Presbyterian Health Plan, lists data for several performance indicators and practices. The information in this report is the property of Presbyterian and may not be reproduced or distributed in any manner without the express written permission of Presbyterian. Presbyterian makes every attempt to provide accurate and updated information for the selected performance indicators, but it is understood that Presbyterian makes no warranty or guaranty about the accuracy of this information or representations about the underlying data used to determine performance. End Notes 1. For more information on the ENERGY STAR certification program, visit http://www.energystar.gov/index.cfm?c=healthcare. bus_healthcare. 2. For more information on the New Mexico Environment Department’s Green Zia Environmental Leadership program, visit http://www. nmenv.state.nm.us/Green_Zia_website. 3. The New Mexico Environment Department Hazardous Waste Bureau Compliance Evaluation Inspection at Presbyterian Hospital took place on June 30, 2010. 4. Thirty-five percent of the 2010 CNM facilities management budget reflects natural gas and electrical utility bills for the 2010 calendar year. With water, the estimated percentage would be approximately 37 percent. 5. Purchased electricity (MWh), energy intensity and square footage data are based on in-scope facilities listed on page 19. 6. In March 2011, PNM reserved the rebates as part of its New Construction and Retrofit Rebates Program. 7. The 68 percent projected electricity reductions apply solely to parking lot lighting retrofits to replace incandescent lighting with lowwattage, high-efficiency light-emitting diode (LED) lighting at Northside PMG in 2010 and at Montgomery in 2011. The LED lighting reduces energy usage by 68 percent compared to incandescent lighting. 8. Performance targets for 2011 state that energy consumption will be five percent less than 2010 usage on an annualized basis. Future annual performance targets will be determined based on opportunity analysis of the previous year’s results. 9. The energy-efficiency program contract with EnerNOC, a national energy monitoring and reduction firm, guarantees a minimum of $139,000 in annual gas and electricity cost savings. The reserved conservation rebates of $110,000 reflect PNM commercial rebate incentives of $0.06 per kWh saved through energy-efficiency efforts. Actual utility rebates will be based on PNM’s measurement and verification of the program results. The estimated program cost of $102,000 is based on EnerNOC program administration costs, costs for Johnson Controls to install energy-efficiency systems and controls, and costs associated with training staff to properly monitor and operate the new systems and controls. 10. Affordable Solar performed preliminary engineering estimates for the Montgomery solar photovoltaic electricity generation system. Estimated energy reductions are based on 489.6 MWh of purchased electricity in 2010 and assume a 65 MWh decrease in purchased electricity the first full calendar year of operating the system (13 percent). Energy-efficiency improvements from building control systems and interior and exterior lighting retrofits are expected to decrease electricity usage by an additional 17–37 percent, resulting in a combined reduction of purchased electricity of 30–50 percent. 11. For more information about LEED-HC, visit http://www.usgbc.org/ShowFile.aspx?DocumentID=8878. 12. Source: Going Green in Purchasing, July 2010 internal report provided by Owens & Minor, PHS supply chain management partner. 13. The 18 million gallons of water amount is based on 2010 Energy Center Well Meter Readings provided by the State Engineer Office, District 1. Figure is rounded up to the nearest million. Actual usage is 17,912,000 gallons. 14. The 2.2 million estimated gallons of annual water savings amount is based on a water system upgrade that occurred between 2008 and 2010 at Presbyterian Hospital. The upgrade uses water-efficient cooling processes for post-sterilization process water. Water savings are based on manufacturer estimates. Actual water savings will be verified and reported in a future publication. 15. Source: Going Green in Purchasing, July 2010 internal report provided by Owens & Minor, PHS supply chain management partner. 16. OR plastics recycling measures are based on Waste Management tonnage reports for one eight-yard front-end load recycling container used exclusively for OR plastics recycling. Waste Management empties the container three times a week and provides weight estimates for each pickup. 17. Aluminum and plastic recycling estimates are based on recycling logs completed by housekeeping providers at participating facilities. Volume-to-weight conversions are based on EPA standard volume-to-weight conversion factors for recycled materials. Universal recycling estimates are based on vendor invoices provided by Aircycle recycling vendor. Paper recycling estimates are based on vendor invoices provided by Cintas. Cardboard recycling estimates are based on vendor invoices: Unicor from August 2009 through July 2010 and Master Fibers from August 2010 through December 2010. 18. Participating facilities as of year-end 2010 are Presbyterian Hospital, 200 Emilio Lopez Road (Los Lunas), 3436 Isleta Boulevard, 3901 Atrisco, 401 San Mateo, 5550 Montgomery, 609 Christopher Road (Belen), 8800 Montgomery and PAC. Facilities anticipated to be participating by year-end 2011 are all in-scope facilities and the PAC. 19. Indirect emissions are based on the Climate Registry General Reporting Protocol, Version 1.1, Indirect Emissions from Electricity Use, Tier B/C Method for Default Emissions. Emission factors reflect regional averages of 2004 emission rates for CO2, CH4 and N20 based on grid electricity data for the eGRID subregion, WECC Southwest Grid-AZNM. 20. The generator testing cost avoidance of $17,000 is based on the cost to hire a testing contractor and estimates of load bank and fuel used for the annual testing, which requires all back-up generators to run continuously for four hours.

20  |  2009–2010 Environmental Sustainability Report


Front Cover Photo: The framed photograph shows installers as they began to mount the solar panels for the 40-kilowatt solar photovoltaic electricity generation system at the Montgomery clinic in May 2011. The side image shows a portion of the completed rooftop system. Affordable Solar, a national renewable energy firm based in Albuquerque, New Mexico, performed the installation. References: Links or references to other sites are not endorsements by Presbyterian of any site, and Presbyterian does not have any control over or responsibility for the content of these sites. References to other organizations do not imply an endorsement of those organizations by Presbyterian. Acknowledgement: Presbyterian would like to acknowledge and thank Concept Green, LLC, a woman-owned sustainability consulting and communications firm headquartered in Albuquerque, New Mexico, for its support in developing and designing this report. Concept Green is a nationally Certified WBENC Women’s Business Enterprise. Printing: The original print run of this report was provided by Focus Ink, Inc., a local, independently owned Certified WBENC Women’s Business Enterprise. Body pages are Neenah Conservation® chlorine-free paper made from 100 percent recycled post-consumer fibers. Cover stock is Domtar Earth Choice Cougar® paper made from 10 percent recycled post-consumer fiber. Both papers are Forest Stewardship Council© (FSC) certified.


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Presbyterian Environmental Report - 2010