Environmentally Preferable Purchasing
(EPP)
"HOW TO" Do EPP in Hospitals

This is a product of the Environmentally Preferable Purchasing workgroup of the Hospitals for a Healthy Environment cooperative project between the US EPA and the American Hospital Association.

The major topics addressed in this Chapter are:

Other issues related to Environmental Preferable Purchasing projects include:

What is Environmentally Preferable Purchasing (EPP)?

  EPP is the act of purchasing products/services whose environmental impacts have been considered and found to be less damaging to the environment and human health when compared to competing products/services.

  EPP also includes the gradual and ongoing process in which a hospital continually refines and expands the scope of its efforts to select environmentally sound, healthy and safe products and services.

  A hospital's choice to implement EPP is an important part of a larger system of a hospital’s practices that support the integrity of both business and environmental decisions.

  EPP may be as simple as buying recycled paper or as complex as considering the environmental impact of a product at each stage of its life, from when it is manufactured to when it is disposed of as waste.

Back to top

Flow-chart of steps to implement an EPP program:

What are the benefits of EPP?

By carefully selecting goods and services, hospitals can:

  significantly improve their impact on the overall quality of the environment

  reduce costs due to lower overhead, avoided waste disposal, liability costs or occupational health costs

  provide a healthier environment for patients, workers and employees through reduced exposure to cleaners, solvents, paints, and other hazardous materials

  leverage positive publicity and promotion potential

Back to top

Why is the purchasing stage so important?

  Purchasing departments are the central point for nearly every product or service procured for the hospital.  This makes it an effective point to apply actions to improve environmental impact.  It is at this stage of money transfer and contract development that vendors can best be influenced.

Back to top

Why is it less costly to make improvement at the point of purchase?

  Correcting a problem close to its source is less costly than taking action downstream. This is what EPP is all about. If the environmental impact can be addressed as early as possible, overall costs will ultimately be lower than pollution abatement later on.

  Downstream corrections are more costly in terms of many resources, including dollars, labor, technical complexity, and adverse publicity.

Experience has shown that each time a problem goes unchecked, it will cost about 10 times more to fix later on.

  Consider a mercury thermometer: If one buys a mercury-free thermometer, the cost of preventing mercury from being introduced to the environment is merely the cost of the thermometer. If a mercury thermometer is purchased   and it breaks, the cost now includes the hazardous material clean-up. If the mercury thermometer is placed in the trash; the cost of preventing mercury from entering the environment includes pollution prevention equipment on the incinerator. At each step, the cost multiplies rapidly.

How Costs Increase the Further Downstream a Problem is Addressed

Reference: C. Galligan, SHP, using data from Mercury Elimination and Reduction Challenge (MERC), "Mercury in the Health Care Sector: The Cost of Alternative Products", November, 1996, pp 14-24

Back to top

Setting Up the Environmentally Preferable Purchasing (EPP) Team

An EPP team is comprised of hospital professionals from different areas working together to foster a new purchasing culture. This team coordinates its activities with the facility-wide environmental team and the product review committee(s).   The leader of the team should be someone whose administrative responsibilities include ensuring that the EPP Project is fully implemented.

  Why is an EPP team necessary?

• The diverse perspectives of members from various departments can challenge current practice and promote innovative solutions. A team works together to create pilot projects and provide effective solutions to obstacles.
• If each department is part of the process, there will be greater buy-in to changes in practices and products.
• A dedicated team can motivate Purchasing and other departments to implement environmentally preferable purchasing.
• The facility-wide environmental team is looking at the whole picture, and may not have the focused effort to implement environmentally preferable purchasing

  Do we need a separate EPP team?

• Some hospitals may find that their product review committee is sufficiently interested in EPP that they can work as an EPP team.
• Some hospitals may find that the facility-wide environmental team is interested enough in EPP that a separate EPP team is not necessary.

  The team members should include:

• representation from all relevant departments
• someone with management responsibility
• people who have a passion for and understanding of the ecological focus of the team.

  Membership may include:

• Central Services
• Clinical Staff
• Communication/Public Relations
• Environmental (Ecology) Team
• Environmental Services
• Facilities Operations (Physical plant, operations, logistics, and security)
• Financial Services (Accounting)
• Food Services
• Group Purchasing Organization (GPO)
• Infection Control
• Laboratory services
• Materials Management (purchasing, contracting and distribution services)
• Prime Distributor
• Risk/Safety Management
• Waste Management / Housekeeping

Back to top

Determining Goals and Objectives of the EPP team

1. Consult with facility environmental team to determine where EPP may help the institution fulfill the institution's main environmental goals.

2. In order to decide what goals to set, it is often useful to determine what concerns or burning environmental issues a hospital already has. Tackling an existing problem, such as mercury spills, environmental violations, or occupational health problems often guarantees support at all levels.

3. In setting goals, examine available resources that can help you implement actions to achieve your goals.

4. Decide on environmentally preferable purchasing goals that are specific, measurable, and to be completed in a set time period, such as:

• Increase purchase of recyclables or reusables 30% by the next fiscal year.
• Reduce packaging waste or total solid waste 20% in 12 months.
• Reduce energy or water use 10% every six months for 5 years.
• Reduce purchase of products that become hazardous waste by 10% in next contract.
• Reduce purchase of mercury-containing products 80% by next year.

Back to top

Actions to Implement Environmentally Preferable Purchasing

1. Request support for EPP goals from top management in the form of policy statement, Request for Proposal language, job descriptions, or other support.

2. Develop policies and procedures to ensure the implementation of the environmentally preferable purchasing practices:

• Determine in writing who is responsible for ensuring that policies are followed and how they will be held responsible (for instance, through periodic reporting).
• Develop an audit process so that performance is periodically reviewed. The audit process should incorporate a system for the celebration and duplication of successes, as well as the recognition and rectification of projects or products that did not work. Determine in writing who is responsible for the audit process.

3. Investigate various methods of implementing an EPP program:

• Creating a Preferred Vendor Program
• Creating Lists of Preferred Products/Chemicals to Avoid
• Working with a GPO

4. Using the measurable goals determined above, choose a small, manageable pilot project such as:

• Replacing mercury sphygmomanometers with aneroid equipment in one department
• Working with histology lab to find mercury-free replacement for specific reagent in specific process
• Including environmental criteria, such as battery recycling or energy efficiency, in next major equipment or service solicitation.

5. Develop an implementation timeline.

• The timeline should be realistic and allow for research and evaluation of alternatives, education of affected parties, and continuous evaluation of pilot.
  
• Be creative when deciding on method(s) to achieve goals. Reducing hazardous waste from the histology lab could involve changes in practice (not using more solvent than necessary), capital equipment expenditures (buying an autoanalyzer that uses micro-amounts), or  procedure (switching to a less toxic fixative). Involve workers from that department in soliciting ideas for how to meet the goal.
  
• Continuous evaluation should be part of any EPP program. Set in place mechanisms for obtaining continuous feedback from employees and product users, evaluating that feedback and using it to improve the program or a specific product. Create a tracking system.

6. Determine educational needs to implement EPP. Education is a critical part of successful implementation.

  View a chart of the education and training needs on EPP for hospitals

  View information on the importance of communication.

  A slide presentation on what is EPP and it's role in getting a hospital to attain its environmental goals.

The EPP team should consult with the in-service training department to discuss educational needs, such as education of:

• purchasers and users on the need for EPP
• top management on what support is needed to implement EPP
• how new products/practices will be evaluated and what feedback is desired
• how to use the new product
• new employees at orientation
• vendors, manufactures, distributors, and GPO
• other affected parties

Back to top

Implementation of Specific Goal/Pilot Project:

1. Implementation:

• If goal involves replacement or focus on specific product, work with product selection committee or standardization committee in hospital and GPO to determine process (for instance, writing environmental specifications for a Request for Proposal.
• Determine and publicize timeline for implementation of specific goal
• Determine who is responsible for ensuring timeline and goals are met
• Determine performance characteristics and items that should be used when evaluating a product.  For example, EPA's EPP Guidance to Federal agencies has identified 5 guiding principles to consider when applying EPP to specific acquisitions.
• Determine educational needs to implement EPP project. Create a written plan for education of affected parties regarding implementation of this particular project, including who is responsible for the education. Review annotated Chart of Educational Needs or shorter List of Educational Needs to determine specific needs for this project. Review importance of communication .
• Implement purchase

2. Continual Improvement:

• Determine if measurable goal was met
• Request feedback from affected parties
• Review process
• Incorporate feedback into action plan for next project or improvement of this one.
• Keep records and track progress.

3. If Goal Was Successfully Met:

• Publicize success to the hospital and the wider community
• Assess possibility of expansion of pilot project or determine next specific goal
• To determine next specific project, consider introducing additional environmental considerations, raising the measurable goal, or expanding the program
• Track and report on progress

4. If Goal Was Not Met:

• Do not be discouraged!
• Determine causes of not meeting goal (check out Common Obstacles for help and suggestions)
• Brainstorm on how to correct the shortcoming and move forward — be creative!
• Choose an interim goal or pilot to implement to get back on track
• Move forward on new goal or pilot

Back to top

Issues related to Environmentally Preferable Purchasing

Chart of Educational Needs Existing Resources Common Obstacles Tracking Publicity Group Purchasing Organizations Negotiating with GPOs Preferred Vendors Program Creating Preferred Products Lists Communication Validity of Vendor Claims

Back to top

Existing Resources

EPP related websites and documents Vendors Third Party Certification and Environmental Labeling Services ISO 14001 Other Hospitals/Health Care Organizations Universities Specifications Used By Others Alternative Products Directory of General Pollution Prevention Assistance

Back to list of other issues

Back to top

Vendors

Vendors represent a potential source of information on environmental attributes of products and services. Vendors should be able to describe material characteristics, energy savings, handling/disposal and/or regulatory costs, and end of life characteristics as well as take-back, re-manufacturing or recycling schemes. Just like any other characteristic, the purchaser will look for some validating information regarding the accuracy of vendor claims. Validation may take the form of independent testing or certification.

  Performance Contracting is the industry term for financing the replacement of inefficient equipment with the payback resulting from the energy savings from utilizing new /more energy efficient equipment. Vendors should be able to calculate these costs for you. Make sure they include maintenance, personnel, and regulatory costs, as well as consideration of durability or possible disposal problems for hazardous components.

 

Back to Index of Resources

Environmental Labeling and Third Party Certification Services

  Environmental Labeling Organizations develop specifications or definitions for environmentally preferable products and in most cases certify products that have met those standards. The International Standards Organization (ISO) has developed quality standards for environmental labeling programs as part of its ISO 14000 series. A Labeling Organization will be able to tell you if it complies with the ISO 14000 requirements.

  Third Party Certification Services certify that a product meets a specific standard. Some third party certifiers use an environmental label to designate whether a product meets a specific environmental criterion. Other services will certify that a product made by a particular supplier meets your criteria and will work with you to determine the accuracy of claims.

  Hospitals can use these standards by:

• Using in their solicitations the same specifications already developed by these organizations.
• Deciding to buy only products in a certain category that have been certified by one of these organizations.
• Working with a third party certifier to validate the claims of a vendor

  Some labeling or certifying organizations specialize in a certain product area (such as sustainable forest products or consumer products), and some offer a broad spectrum of products or specifications.

  For more information on Environmental Labeling and Certification:

Global Ecolabeling Network
The Global Ecolabeling Network (GEN) is a non-profit association of ecolabeling organizations from around the world. This page links to specifications of all their members.

International Institute for Sustainable Development
The International Institute for Sustainable Development has compiled information on using environmental labeling and third party certification.

Chlorine Free Paper Consortium
Chlorine Free Paper Consortium certifies paper made without chlorine and lists chlorine-free products they have certified.

The European Union Ecolabel Scheme
The UK has information on how the European Union Ecolabeling Program works and how to use it.

Scientific Certification Systems
Scientific Certification Systems is a private third party certifier that will work with vendors and purchasers to certify environmental claims.

Canada Environmental Choice Program
The Canadian government has developed an environmental labeling program for a wide variety of products. Here you can check out their specifications and find out which products are certified.

Eco-Rating International
Eco-Rating International is a private third party certifier that focuses primarily on the assessing and rating a company's environmental performance.

Green Seal
Green Seal is a private, non-profit organization that sets environmental standards and awards their environmental label to products that meet their environmental criteria. Specifications and names of certified products are available on this website. products.

The Forest Stewardship Council
The Forest Stewardship Council has published criteria defining responsible forestry and accredits organizations that certify wood from responsibly managed forests.

 

Back to Index of Resources

ISO 14001

 ISO 14000 is a series of standards developed by the International Standards Organization (ISO) on environmental quality in operations. Check out the ISO website for more information on this standard.

  ISO 14001 certification requires the development of an environmental management system (EMS). The EMS model specified in ISO 14001 provides a foundation for an organization's sound environmental performance.

  Many businesses require suppliers to be registered or eligible to be registered as ISO 14001 compliant as a condition of doing business with them. Healthcare facilities should consider if this requirement could be built into some of their contracts.

 

Back to Index of Resources

Other Hospitals or Health Care Organizations

Check out case studies and consider asking another hospital for details on how they implemented environmentally preferable purchasing at their facility.

 

Back to Index of Resources

Universities

Some environmental questions can be quite complex, requiring more in depth analysis and discussion. Sometimes the answers may not be clear. Reviews of scientific literature or discussions with University professors may be useful. The University of Massachusetts-Lowell’s Sustainable Hospital Project, for example, has a web site with many links to information sources and is available to answer questions.

Back to Index of Resources

Specifications Used By Others

The EPA is compiling a database of environmental specifications used by others. This is public information and all specifications listed can be used by any organization in their solicitations.

Environmental Specifications for Medical and Scientific Products

Environmental Specifications for All Products

Back to Index of Resources

Alternative Products

  More and more internet resources are becoming available to identify alternative products. Check these sites for specific information:

• Sustainable Hospitals Project at University of Massachusetts at Lowell
  The Sustainable Hospitals Project lists alternatives to products that otherwise would contain mercury, PVC, or latex. Names of manufacturers are provided with links to manufacturer sites:
  
  • Fever Thermometers
  • Batteries
  • Industrial Thermometers
  • Sphygmomanometers
  • Gastrointestinal Tubes
  • Pressure Gauges
  • Laboratory Chemicals
    
• Health Care Without Harm alternatives to PVC products
  This page lists brand names of alternatives to products that otherwise would contain PVC.
• Illinois Waste Management Resource Center Alternatives to Mercury in Medicine This page lists generic alternatives to equipment, clinical and laboratory devices, lab reagents and laboratory tests that otherwise would contain mercury.
• Purdue University/US EPA Mercury Use Reduction and Waste Prevention in Medical Facilities This page lists generic alternatives to equipment, devices, and laboratory chemicals that otherwise would contain mercury.

  Back to Index of Resources
  

What are some EPP obstacles in hospitals?

  Purchasing systems in hospitals usually do not take disposal, insurance, and other costs into account.  This makes justification of increased up-front purchasing costs (even if a cost savings in the long run) potentially difficult.  For example, a non-mercury thermometer could be higher in price than its mercury alternative, but the mercury thermometer may be more expensive if potential cleanup and disposal costs are factored into the purchasing decision.

  Environmentally sound products may not be readily available, or their properties may be different from the product currently being used:

• When alternatives are not easily found, it is important for a hospital to communicate their desire for environmentally favorable products to suppliers and manufacturers.  Many manufacturers choose not to redesign existing products for fear of jeopardizing relationships with customers. This feedback provides the driving force for development of better products.
• When alternatives are available, it is essential for hospitals to evaluate them and work with the manufacturer to overcome any cost or performance problems. It will also be necessary to provide training to end users on the proper use of the alternatives.
• Increased demand for environmentally preferable products will also help lower prices and improve quality, as companies ramp up to large scale production, as markets expand, and as environmentally-designed goods and services become everyday items.

  Accounting practices hide the financial benefits of EPP

• Adjust financial evaluation procedures to consider costs and benefits beyond the purchase price of a product or service.  The purchase price is not the only cost related to the product.
• Integrate "total cost assessment" procedures into contracts with service and product providers.

  Products available to a hospital are sometimes limited to a list of products contracted through a Group Purchasing Organization (GPO).

• In this case, it is essential to express the desire for environmentally preferable products to GPOs.  If possible, create a written agreement with the GPO that commits them to working to improve your hospital with greener products.
• In some cases, the GPOs may suggest alternative products that are currently available.
• More importantly, GPOs can strongly influence suppliers and manufacturers on availability and cost of environmentally preferred products by working with suppliers to provide such products, writing environmental specifications into solicitations, or indicating their preference for environmentally superior products.

Users may be resistant to change, even if there is agreement that the change is desirable.

• Introducing environmentally preferable products and services is best supported by the participation and creativity of staff at all levels.  Limited pilots involving end users may eliminate perceptions that environmentally preferable products do not work.
• It is especially important to include in the selection process employees who actually use the products.
• The opportunity to re-think practices and select new alternatives frequently allows staff to implement innovative ideas with benefits that extend well beyond the scope initially planned.

Back to list of other issues

Tracking System

Tracking systems can help you reach your goals, assist you in identifying and financially justifying environmentally preferable products and services, make it easier to measure achievement of goals, and integrate environmentally preferable purchasing into every day decisions. Tracking systems vary from easy and low-tech to sophisticated tracking software. Examples include:

• Require yearly or quarterly reports from vendors on environmentally preferable products purchased
• Manual Tracking - Purchasers can use simple notes or codes on their ledgers or in computer purchasing systems to start simplified tracking of environmentally preferable purchases.
• Automated tracking software where environmentally preferable products are automatically marked as such
• Bankcard tracking software
• Systems to track costs of waste segregation; waste disposal; spill clean-up; health, safety, and environmental (HSE) regulatory reporting and compliance; HSE education; and inventory obsolescence back to the responsible departments and products and services purchased by those departments.

Back to list of other issues

Publicity and celebrating success

  Environmentally preferable purchasing programs need widespread support to maintain continual enthusiasm.

  Use data to create easily interpreted environmental indicators for publicity:

• "Recycled paper purchases saved 455 trees and 8000 gallons of water this year."
• "Replacement of histology reagent prevented $3500 of hazardous waste disposal costs this quarter."
• Report on the total percentage of all purchased items having recycled content."
• Publicize reduction in garbage volume or weight over time.

  Label environmentally preferable products to educate staff and patients

• This memo printed on 100% post-consumer recycled paper
• Mercury-free sphygmomanometer

Develop an awards program for employees who contribute successful ideas on environmentally preferable purchasing projects. Make sure you also award employees who contribute to continuous improvement or have solutions to problems they have pointed out, but wait until the review period for pilots to ensure that the awarded idea actually works.

Back to list of other issues

Group Purchasing Organizations (GPO's)

  Group Purchasing Organizations buy in volume for their member hospitals to achieve discounts on pricing. Benefits of Group Purchasing Organization membership for hospitals include reduced supply costs, product standardization, and market leverage. Often members must commit to buying a specified volume through the GPO contracts or must commit to buying only products available through the GPO for certain items. This can limit how much the hospital can change the products it buys without involving the GPOs.

  Hospitals committed to environmentally preferable purchasing must work with their GPOs to implement such a program. Hospitals must tell their GPOs that they desire cost-competitive environmentally preferable products and must tell the GPO what "environmentally preferable" means to them.

GPOs themselves can implement environmentally preferable purchasing strategies. They can include environmental criteria or questions in their "Requests for Proposal" and can bring up environmental issues in regular meetings with their suppliers. Because of their buying power, GPOs can be instrumental in influencing the products a manufacturer offers.

Back to list of other issues

Negotiating with Group Purchasing Organizations

  Group Purchasing Organizations provide a way for hospitals to save thousands of dollars a year, but if the hospital does not bring environmental issues into the negotiations, opportunities for increasing environmental performance may be lost.

  Catholic Healthcare West, when negotiating with Premier, a national Group Purchasing Organization, put these points into the Operating Principles of the Catholic Healthcare West-Premier Partnership:

• Premier and Catholic Healthcare West will support the Coalition for the Environmentally Responsible Economies, the Health Care Without Harm campaign, and reduction of the volume and toxicity of the medical waste stream.
• Premier will assist Catholic Healthcare West in identifying products that contain mercury and PVCs.
• Premier will consider the environmental impact of a product or service when selecting goods and services.
• Premier will communicate the desire for environmentally favorable products to manufacturers.
• Premier will work with Catholic Healthcare West to resolve conflicts between Catholic Healthcare West's environmental policies and Premier's policies.

Creating Preferred Vendor Program

Some hospitals have created preferred vendor program in order to increase purchases of greener products.

  Any list of preferred products or vendors should have clear and public criteria so as not to raise unfair trade or liability issues.

  There are many ways to create a preferred vendor program. Some businesses require suppliers to do one or many of the following:

• be ISO 140001 certified
• have an environmental management program in place
• maintain and provide a current list of environmentally preferable products
• complete environmental impact questionnaire for total operations or each product line
• track and report on purchases of environmentally preferable products by your organization.

  Another way to prefer certain vendors is to look for suppliers that are willing to work with you to implement your environmental goals.

  The University of Wisconsin has created a software tool that can help hospitals create preferred vendor programs by evaluating the environmental performance of the vendor. The hospital requests environmental information from the vendor, inputs that into the computer, and the program provides a numerical score for the environmental performance of the vendor. In this way, different vendors can be compared and this score can be built into the evaluation of the contract.  This software tool is now available on the Healthcare Resource & Materials Management web site at  http://www.ahrmm.org/info/hcept/index.html .  For more information contact Pat Eagan at the University of Wisconsin.

Back to list of other issues

Creating Preferred Product/Chemicals to Avoid Purchasing List

  Any list of preferred products or vendors should have clear and public criteria so as not to raise unfair trade or liability issues.

  Many chemicals used in hospitals, especially laboratories, become hazardous wastes after use. Alternatives are available for many of these chemicals.

• A list of chemicals targeted for reduction is available in the Chemical Waste Minimization chapter.
• Chemicals containing mercury, including contaminant mercury, are listed in the Mercury Reduction chapter.

  Newton Wellesley Hospital in Massachusetts significantly reduced use of mercury compounds by:

• Identifying mercury-containing compounds currently in use
• Requiring managers in departments using these products to develop a time frame for elimination of the use of these products or processes. If elimination is not possible, the manager must present a rationale for continuing use to the safety committee
• Requiring the safety committee to maintain a readily retrievable log of the mercury-containing products and processes in use, the rationale for continued use, and a time frame for the reconsideration of available alternatives.

(See mercury reduction chapter for more information on Newton Wellesley’s mercury reduction project.)

Back to list of other issues

Importance of Communication

• The facilities department of one hospital decided to replace all its mercury sphygmomanometers with aneroid equipment. After removing the old equipment and installing the new, the nursing department decided it didn’t like the new products and ordered mercury sphygmomanometers through the purchasing department. The facilities department found this out a week later during routine work on the floor when it noticed workers installing new equipment.
  

  Mistakes to avoid The facilities department did not educate the nurses on why the old equipment was being replaced, the dangers of mercury, or how to use the new equipment. The facilities department did not work with the purchasing department to ensure that new purchases for mercury equipment would be refused.

   

  Validating Vendor Claims

    Many vendors are not used to providing specific and accurate environmental information to purchasers. The result is that occasionally, and often unintentionally, products are misrepresented as to their environmental attributes in advertising and vendor claims.

  • For instance, if the purchaser requires a "mercury free" chemical reagent, this should be clarified to indicate whether the purchaser is interested in avoiding chemicals containing trace amounts of contaminant mercury (for instance, down to 1 ppb), or if the purchaser only cares about mercury in excess of 1%. This specification could be further clarified by indicating if independent laboratory testing results or certificates of analysis are required for validation.

    Purchasers should decide what kind of validating information they wish to require from vendors, such as laboratory tests, spec sheets, signatures of verification, or third party certification. The requirements for validating information should be made clear in Request for Proposals or in purchasing specifications and vendors should be given adequate time to prepare such information. Bidder or vendor conferences are useful ways to assure that vendors understand exactly what is required.

   The US Federal Trade Commission has provided Guidance for Consumers on evaluating environmental claims and has also published Guidelines for Manufacturers and Vendors on making environmental claims.

  Back to list of other issues

  Back to top

  Last updated on 3/22/01