What hospitals waste

Excellent ProPublica article on the waste in healthcare.

Link to the full article:  ProPublica: What Hospitals Waste

Talk to experts and many agree that waste would be a good place to start. In 2012 the National Academy of Medicine estimated the U.S. health care system squandered $765 billion a year, more than the entire budget of the Defense Department. Dr. Mark Smith, who chaired the committee that authored the report, said the waste is “crowding out” spending on critical infrastructure needs, like better roads and public transportation. The annual waste, the report estimated, could have paid for the insurance coverage of 150 million American workers — both the employer and employee contributions.

UCSF reviewed all the preference cards for each surgeon, which specify how the operating room should be set up before each operation. The hospital now makes sure the set-up doesn’t include supplies that aren’t actually needed, preventing a significant amount of the waste.

In a separate study in the December edition of JAMA Surgery, Zygourakis and her colleagues showed each UCSF surgeon his or her direct costs per procedure in comparison to other surgeons in the institution. Most doctors were unaware of operating-room costs. Then they gave them an incentive: Their departments would get a bonus if they reduced costs by at least 5 percent.

The median surgical supply costs dropped by 6.5 percent in the group of surgeons who participated — a savings of about $836,000 over one year — while the control group’s costs increased by almost 7.5 percent.

Nine billion and one....

Original post:  Mar 11, 2015

I just sat down to write this post with a cup of coffee. I used the Keurig machine. It's a convenient way to get a single cup. You pop in a K-cup and the machine sets out brewing a single mug of java.

I'm not the only one. It's estimated that there will be 9 billion K-cups used over the course of the year. That generates a very large amount of trash.

Unfortunately, the overwhelming majority of these K-cups are not recyclable. John Sylvan, the inventor of the concept explains:

“No matter what they say about recycling, those things will never be recyclable,” Sylvan said. “The plastic is a specialized plastic made of four different layers." The cups are made from plastic #7, a mix that is recyclable in only a handful of cities in Canada. That plastic keeps the coffee inside protected like a nuclear bunker, and it also holds up during the brewing process. A paper prototype failed to accomplish as much.

And because the K-Cup is made of that plastic integrated with a filter, grounds, and plastic foil top, there is no easy way to separate the components for recycling. A Venn diagram would likely have little overlap between people who pay for the ultra-convenience of K-Cups and people who care enough to painstakingly disassemble said cups after use.

Keurig is hard at work on creating a greener version. Older models of the Keurig will also allow for the use of specialized plastic K-cups with metal filters that can be emptied and reused multiple times. Unfortunately, the newer version uses a copyright protection scheme built into the lid which does not allow these methods.

While Sylvan regrets the waste he unwittingly created by inventing this device, he is hard at work on his next idea:

Disruptors, it seems, gonna disrupt. Amazing as it would be if Sylvan were about to capitalize on that and upend the company that once bought him out, he is doing okay either way. When he was bought out of Keurig in 1997, he turned around and bought stock in Green Mountain for $3.20 per share. He sold the stock a couple years ago when it broke $140. He also recently started a new company that sells solar panels, partly to atone for the environmental problem he believes he created. The company is called Zonbak, which means “sun bucket,” in Dutch.

Here is a link to the original article:  How Bad Are K-Cups for the Environment? — The Atlantic

Another article from Mashable:  9 billion Keurig K-Cups likely ended up in landfills last year

Side effects of consumerism

Original post:  Dec 1, 2014

Here in the US, we just followed up the annual celebration of Thanksgiving with a new American tradition. Black Friday was given that name because it's estimated that some stores can do 20% of their annual sales over the weekend following the Thanksgiving holiday.

Ironically, the roots of this decision go back almost eighty years. Thanksgiving was traditionally celebrated on the fifth Thursday of the month until FDR officially made it the fourth Thursday to help extend the Christmas shopping season for retailers.

Mondays are trash pickup days on my street. It's quite easy to tell who recently acquired a major purchase by watching the types of empty boxes that land on the curb. Unless you take the time to recycle, 50" flat screen TV boxes are pretty hard to hide!

As more corporations strengthen their environmental programs, they are beginning to find that reducing the amount of waste materials is not only good citizenship, it can also help the bottom line. One way to help control costs without affecting product quality is to streamline packaging. That can result in fewer raw materials used which can help lower transportation and storage costs. This article in the New York Times quotes a director at Cisco:

“It’s good for Cisco, it’s good for our customers and it’s good for the environment,” said Kathleen Shaver, director of sustainability, risk and compliance at Cisco Systems, which says it has eliminated 1.9 million pounds of packaging this year. “Costs are reduced, not just with material you’re not buying, but with the material you’re not shipping and the material you’re not disposing of.”

All of this push to generate higher consumer sales does add up:

The volume of packaging is still vast and growing. Globally, consumer goods are encased in about 207 million tons of packaging each year, worth $384 billion, estimated a 2013 report from the Ellen MacArthur Foundation, using analysis by McKinsey & Co. consultants. Packaging could increase 47 percent by 2025, driven by increasingly wasteful practices and the worldwide growth of middle classes with rising purchasing power, the report predicted.

In the United States, packaging makes up about 30 percent of all municipal solid waste, down from 36 percent in 1970, said Susan Selke, interim director of Michigan State University’s School of Packaging. The overall amount of municipal waste, though, has more than doubled in that time, the U.S. Environmental Protection Agency says. “Industry is paying attention, but not enough attention yet,” Ms. Selke said.

To learn more about how companies are helping to reduce this waste through innovative efforts, follow the link below:

http://www.nytimes.com/2014/11/20/business/energy-environment/packaging-environment.html?ref=energy-environment&_r=1

When in doubt, throw it out? Maybe not....

Original post:  Nov 25, 2014

Every year, Americans discard tons of perfectly good food. Much of this waste can be traced to general confusion caused by the "sell by" or "use by" dates printed on most foods.

Did you know that infant formula is the only food manufacturer legally required to print those dates? Most others print this because it helps ensure that their products are consumed when they are at or near their peak of freshness. It isn't so much that the product expires as it is less desireable.

The USDA has more information on their procedures for food and poultry at this website:  http://www.fsis.usda.gov/wps/wcm/connect/19013cb7-8a4d-474c-8bd7-bda76b9defb3/Food_Product_Dating.pdf?MOD=AJPERES

Here are two clips from the document:

All of this confusion can add up to a lot of edible trash:  Food date labels may not mean what you think they mean | Harvest Public Media

With no explanation or legal definition of a “sell by,”  “use by” or “best by” date, the manufacturers decide on the date based on their own assessment – which, of course, can differ among brands.

So as the date on a package approaches, there are several options as it sits on the shelf. Grocery stores may choose to compost it, donate it, or – like many households – just throw it out. Indeed, each year a family of four in the U.S. tosses away food worth between $1,300 and $2,200, according to Jonathan Bloom, author of “American Wasteland.”

Traditionally, “sell by” dates were meant to provide information to store owners so they can rotate their stock, according to food safety specialist Londa Nwadike. “Best by” and “use by” dates were recommended for the best quality. Nwadike said these dates were intended to help shoppers know not how safe a product is but how long it has been on the market.

It’s also important to note that consuming food before its printed “best by” date isn’t a blanket of protection from illness, especially if the food hasn’t been stored, cleaned and cooked properly.

Lessons from the Cheesecake Factory

Original post:  Aug 8, 2012

Atul Gawande is a Boston area physician who writes extensively about healthcare. His latest article will appear in the upcoming issue of the New Yorker magazine. I found the article to hold some amazing insight about the future of healthcare. It is a long article, but well worth the time. Here is the link to the full article:  Big Med (The New Yorker)

The author opens with an explanation of how the Cheesecake Factory is able to bring high quality food at reasonable prices to a mass audience. The chain is wildly popular and the food is quite good. Through a combination of standardization and relentless quality control, they are able to take complicated recipes and reduce the variation dramatically. The result is a perfect wasabi-crusted ahi at any one of their restaurants all for the same moderate price throughout their chain.

He then compares that to our current healthcare system. In his words, we are getting "greasy-spoon fare at four-star prices." Proven medical innovations can take, on average, fifteen years to become the new norm. Expensive treatments that are proven to have little or no clinical value are routinely ordered. He wonders what might happen if healthcare could adopt some of the best practices of the restaurant industry.

To give one example, he cites the fact that controlling food waste is extremely important to a restaurant. The Cheesecake Factory is able to project demand so well that they only throw away about 2.5% of their food (on average)!

He goes on to discuss his mother's experience with a knee-replacement surgery. John Wright, a surgeon at Brigham and Women's, is reshaping the orthopedic department. He is taking best practices and creating new, standardized procedures for joint replacements. He says, "Customization should be five per cent, not ninety-five per cent, of what we do."

Those changes have not been easy for the staff to accept, but the results have been positive:

...He told me that about half of the surgeons appreciate what he’s doing. The other half tolerate it at best. One or two have been outright hostile. But he has persevered, because he’s gratified by the results. The surgeons now use a single manufacturer for seventy-five per cent of their implants, giving the hospital bargaining power that has helped slash its knee-implant costs by half. And the start-to-finish standardization has led to vastly better outcomes. The distance patients can walk two days after surgery has increased from fifty-three to eighty-five feet. Nine out of ten could stand, walk, and climb at least a few stairs independently by the time of discharge. The amount of narcotic pain medications they required fell by a third. They could also leave the hospital nearly a full day earlier on average (which saved some two thousand dollars per patient).

Gawande then discusses the virtual ICU concept as practiced by the Steward hospital group. There are ten hospitals serving 8,000 patients per year. The centralized command center is not meant to replace the staff on site. They can augment the staff on hand by ensuring that the protocols have been followed and that important warnings are given proper attention.

These changes will bring savings but they will also create a great deal of disruption and uncertainty.

Those of us who work in the health-care chains will have to contend with new protocols and technology rollouts every six months, supervisors and project managers, and detailed metrics on our performance. Patients won’t just look for the best specialist anymore; they’ll look for the best system. Nurses and doctors will have to get used to delivering care in which our own convenience counts for less and the patients’ experience counts for more. We’ll also have to figure out how to reward people for taking the time and expense to teach the next generations of clinicians. All this will be an enormous upheaval, but it’s long overdue, and many people recognize that. When I asked Christina Monti, the Steward tele-I.C.U. nurse, why she wanted to work in a remote facility tangling with staffers who mostly regarded her with indifference or hostility, she told me, “Because I wanted to be part of the change.”

He closes with an interesting flourish:

The critical question is how soon that sort of quality and cost control will be available to patients everywhere across the country. We’ve let health-care systems provide us with the equivalent of greasy-spoon fare at four-star prices, and the results have been ruinous. The Cheesecake Factory model represents our best prospect for change. Some will see danger in this. Many will see hope. And that’s probably the way it should be.