Cristina Indiveri is associate vice president, program services and contract services for environmentally preferred sourcing at Vizient.

Cristina Indiveri

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As the health care industry learns to live with COVID-19, health care leaders are refocusing their attentions on pre-pandemic priorities, looking for actionable, measurable ways to improve the health and safety of all the patients and staff they serve.

Cristina Indiveri, associate vice president, strategic programs at Vizient

They need look no further than the procurement practices in the supply chain, where many products contain harmful chemicals or shipped in ways that cause excessive carbon emissions. 

Healthcare organizations can reduce harm - and improve the health of their communities - through sustainable procurement, the procurement of goods and services whose life cycle has a reduced impact on human and environmental health when compared to competing products.

The hospital supply chain is filled with opportunities for improvement. From flooring and furniture to syringes and masks, much of what hospitals and health care organizations purchase negatively impact our communities and the people who live in it. The extent of this harm is yet unknown.

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While in the womb, our children are already being inundated with industrial chemicals, pesticides, pollutants and toxic waste. One investigation into umbilical cord blood detected an average of 200 man-made chemicals, some that were cancer-causing or otherwise toxic, which can cause birth defects or abnormal development in animal tests.

As we continue to learn more about the impact of purchases that the health care industry makes, we needn’t wait to make a change. Recent research shows that the supply chain is responsible for 

Organizations can begin putting their purchasing strategies in closer alignment with their care strategies now. To operate responsibly, it is essential that we consider how our purchases impact patients, caregivers and the environment and steer our procurement processes to reflect sustainable values.

Last summer, I worked with a large West Coast health care organization to create a sustainable procurement plan. When we began the venture, the hope for making a real change felt overwhelming and seemed daunting. By the end of the process, we had developed a workable plan that when implemented will provide measurable outcomes of success.

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A product impacts the environment across every stage of its life cycle from the fossil fuels used to source and manufacture raw materials to transportation, use and disposal. 

Sustainable procurement aims to measure and minimize harmful product impacts, build an economy for healthy products and services, and maximize the lifecycle of the products. It involves avoiding 

, devising and using a sustainability scorecard to evaluate and compare products, and committing to purchasing products that are certified sustainable when possible.

The first step we took in our sustainable procurement plan, was to develop procurement metrics - benchmarks for spend and how to measure a reduction in environmental impact, such as reducing or eradicating chemicals of concern. We then developed criteria using seven measures of sustainable procurement.

 Are the product’s raw materials renewable, recycled or responsibly sourced? For example, in the case of some types of face masks, plastics are made from fossil fuels which are non-renewable and cause serious environmental damage.

 Does the product contain chemicals of concern, such as flame retardants or phthalates that have been shown to negatively impact health? In the creation of certain products, fossil fuels can be mixed with chemicals that may cause cancer.

 Will this product be in use longer than the alternatives? For this metric, we weigh the lifecycle of goods, materials, and equipment with a bias toward those with a longer service life and waste reduction. Single-use facemasks (used once per each care episode) could be replaced with reusable facemasks that are less dependent on fossil fuels.

 Can we capture and reprocess or otherwise divert this product and its packaging from the landfill? Certain disposable products cannot be recycled or reprocessed.

 Is this a locally or regionally made/grown option? While many products are made overseas, organizations can sometimes select options that are available domestically, reducing transportation and carbon emissions.

 Does this product consume fewer resources (energy, water, space) than other options?

 Is this product less dependent on fossil fuels for its extraction, manufacture, distribution, and disposal than other options?

Once we had established our criteria, we turned our attention to purchasing—what areas the organization was already doing well in, where it could improve and in what areas it wanted to lead. This would help inform what products to target in our one-year plan. 

The organization was already well-sourced in supporting local vendors, particularly in cleaning products and agriculture. It wanted to improve at purchasing reusable items. Finally, it wanted to be a leader in choosing water-efficient products.

After surfacing our priorities, we turned each of them into action items through the discussion of critical activities - key considerations, milestones and timing, participating departments and required resources. The plan includes signaling our intention to internal colleagues and the supplier community.

Most importantly, the plan requires commitment from the C-suite to endorse organizational goals, support them with resources and help prioritize based on the organization’s perspective and history. In the case of this West Coast hospital, various working groups meet regularly and each department has a champion to ensure representation.

Once the teams are in place and plans are implemented, it will be important to mark every accomplishment and celebrate every met goal.

The organization I worked with is creating and finalizing an environmentally preferred purchasing policy that will guide sustainable purchasing now and in the future. Its plan for sustainability may begin to look different over time but most importantly, the plan provides a powerful template for change.

The health care sector must hold itself responsible for its climate footprint. The stakes are high for patients and caregivers alike and the time to create change is now.

Cristina Indiveri is associate vice president, strategic programs at Vizient, a healthcare performance improvement company.

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