Sustainable Hospitals
Plan-Do-Check-Act
This material is taken from Chapter 4 of:
An Ounce of Prevention: Waste Reduction Strategies
for Health Care Facilities
by Glenn McRae, Hollie Shaner and Connie Leach-Bisson;
American Society for Healthcare Environmental Services of the American Hospital Association (ASHES)
1993
Used by permission.
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Tools for Identifying Materials Management Problems
 
To be useful, a waste assessment must be conducted properly. The goals of a waste assessment should be to:
 
  1. Collect information
  2. Discover opportunities
  3. Enlist the support of area personnel
  4. Educate area personnel
 
The following multistep approach provides in-depth information and serves the purpose of educating and enlisting the support of the area department head. It also gives a barometric reading up front of the level of commitment and issues the hospital will face as implementation progresses in the specific area.
 
As potential for the program is assessed and implementation proceeds, the assessment person should keep these four steps in mind: Plan, Do, Check, and Act. They represent a successful management process in total quality management, which is becoming a common strategy for hospitals.
 
 
 
 Plan 
 
 
A. Initial Contact
The assessment person should contact the department head, explain his or her role and describe the hospital's commitment to waste reduction and recycling and the simple benefits it offers, such as better utilization of health care dollars. The assessment person should establish the important link between high-quality health care and the environment.
 
A typical introductory conversation should include the following information:
  • Who
    (Clearly indicating the assessment person's identity, role, and responsibility): "Hello, my name is _______________, and I am the coordinator for the hospital's recycling team."
     
  • What
    (Indicating what is going to happen and what is needed from the department head): "The hospital is planning to start recycling in all departments over the next year, and we are in the process of working with each department to see how this can best be done. I'd like to meet with you and explore some possibilities for environmentally responsible waste management options in your area. That is a fancy way of saying, I'd like to talk to you about recycling and some simple shifts you might be able to make that would help the hospital save money and resources."
     
  • Why
    (Seeking the department head's support and buy-in): "Recycling will help cut costs and make an important contribution to the community's environmental quality. Your input is vital to this process, because this is your work area and you are the expert when it comes to understanding the dynamics of activity, space issues, and so on. For a recycling program to work, it must be convenient and designed with the specific user in mind."
     
  • When
    (Explaining when the change will take place and how the department head fits into the schedule): "We have three months to put all our plans together before the hospital recycling programs will go facility-wide. I would like to meet with you in the next two weeks if possible. I'll bring a floor plan of your area, so that we can discuss specific strategies for further improvements in managing waste from your department and I can take notes and learn from you."
A conversation such as the preceding sets the stage for a collaborative effort because it does the following:
  1. It identifies up front the fact that changes need to be made to make the best use of hospital resources and that the hospital fully supports this effort.
     
  2. It identifies that the input of the manager of that area is valued and needed, and recognizes that creating a sustainable system designed to meet the waste needs of the staff of that unit without compromising patient care or impinging on current work styles is the assessment person's primary objective.
     
  3. It anticipates but does not invite resistance. If there is resistance, the assessment person should listen carefully to the concerns and take notes if necessary. The department head's concerns should be considered in later planning. Through effective and positive communication, resistance can be turned into collaboration. In many cases, resistance does not come from a lack of interest in recycling, but rather from other problems that a specific department has experienced that need to be addressed first.
The assessment team will be working with the department over a long period of time. Creating a recycling program goes far beyond placing containers and collecting materials; it is an ongoing problem-solving process that requires good relationships and skills. Here are some do's and don'ts to remember when conducting a waste assessment.
 
 
Do's and Don'ts of Conducting a Successful Waste Audit
Do's
Think it through.
Create a planned approach that is logical and can be easily explained. Be flexible--you will be working with lots of people for whom this is not the highest priority. Be aware of and sensitive to the needs and concerns of different departments.
LISTEN to everyone--do not ignore anyone--often the best suggestions come from the most unexpected sources.
Have a careful and consistent method to document your findings.
Protect yourself; don't take short-cuts if you are sorting trash as part of your assessment--wear protective gear (eye protection, gloves, etc.)
Don'ts
Don't let your enthusiasm carry you away... focus it and it will be contagious.
Know your own biases--don't assume you know the outcome before you look carefully at the problem.
Don't be discouraged by a "no can do" attitude or resistance on the part of other employees.
Don't be pushy--seek out cooperation--make it convenient for those who have to help you Don't expect this to happen over night--set realistic timelines, even just to get the waste assessment done.
Don't ignore the housekeeping staff or trash handlers--they can provide the most intimate knowledge of what is thrown out--seeking their input early on will help get their support for later implementation.
Don't ignore clinical staff; they often handle the materials last before they are thrown out. Don't sort through people's trash without their permission--you are not a trash cop and do not want to be perceived as one.
 
 
B. First Meeting
  1. Accompanied by the department head, and with a floor plan in hand, the assessment person should review the current use of the area and types of waste generated, asking such questions as:
    • What do they do in this area/department?
    • Is there an employee lounge?
    • Do staff eat meals here, or is it used more as a conference room?
    • Are there administrative areas? lab areas? patient care areas?
     
  2. Hours of usage of the area should be identified: Is it primarily a day shift area? evening? night? 24 hours a day?
     
  3. What current systems are in place?
    • Trash cans: location? size? number?
    • Recycling containers?
    • Sharps containers, red bag waste containers?
     
  4. Are there any specific types of equipment that generate special wastes (for example, copy machine, fax machine, X-ray equipment, EKG, carpentry equipment)?
     
  5. What opportunities currently exist for staff development?
    • Are there regularly scheduled staff meetings or in-service meetings? (These are ideal times to schedule a solid waste/recycling in-service program to teach staff about the current program and opportunities for expansion.)
    • What other communication routes are in place in that department? Computer notebook? memos? bulletin board? communications book?
    Note the resources for information dissemination.
 
C. Follow-Up Phone Call to Schedule Another Meeting
The purpose of this meeting is to review findings and brainstorm about implementation needs, including:
  • Number of containers
  • Types of materials to be collected
  • Signs
  • Designation of a contact person and scheduling of an in-service (include off-shift staff as well)
  • System to update new employees about the program and procedures
  • System to ensure that per diem staff and agency (outside staff) are made aware of the waste system
  • A feedback system to discuss future improvements or deal with breakdowns
  • A time line for implementation
  • Make the necessary interface with other departments (housekeeping, environmental services) to establish the system change (collection)
 
 
 Do 
 
 
The plan should next be transformed into action. Set a goal for a starting date, educate affected staff about their responsibilities, and obtain appropriate equipment and signage. As soon as the hospital staff responsible for collection are prepared, an implementation day should be scheduled for the department. In preparation for the day notices should be posted explaining when the program will begin and what it will incorporate. This should be done in conjunction with in-service training.
 
On that day:
  1. The collection containers should be installed and the signs posted.
  2. Sites should be inspected to ensure that the containers are placed at the preagreed locations and that adequate signs are in place.
  3. The name and phone number of a contact person should be prominently posted.
This may include a hospital-wide contact as well as a department contact.
 
 
 
 
 Check 
 
 
Follow-up visit. Shortly after implementation, the:area should be checked informally to see how things are going. Feedback should be elicited. One idea is to do an informal survey of the department or to leave a comment sheet in the area for a week or so. Concerns and suggestions should be noted. The assessment team and department should problem-solve together and plan improvements to the system as needed.
 
 
 
 
 Act 
 
 
Changes should be made as needed. Periodic assessments (semiannually or quarterly) are useful to assess the system and update it to meet the needs of the users. Provide feedback to the department on the program's successes to keep motivation high among staff. Be prompt in responding to their suggestions because their continued participation is critical to the program's success.
 
 
 
 
 Hospital Area Waste Assessment Data Form 
 
 
Current Situation:
 
Date:
 
Area:
 
Contact Person:
 
Date:
 
Area    Wastes Generated    Containers    Storage    SD,SP,HD,E
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
 
 
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
 
 
Problems and Solutions:

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
 
 
 
Area Waste Assessment Form (part 2)
 
Obtain blueprint of area
Note how areas are used (times, activities, personnel)
Note storage areas & potential storage areas
Fire code Issues:
Look up--find the sprinklers, heat sensors, smoke detectors
Look around--find the areas of egress
Look down--note traffic flow patterns
Check with Facilities Mgt. to verify smoke & heat detector & sprinklers
When is waste collected from this area?
How often? (scheduled vs. on demand), What times?
By whom? (note chain if handled more than one time, e.g., housekeeper to trash person)
 
Legend
 
SD--Smoke Detector
SP--Sprinkler
HD--Heat Detector
E--Means of Egress
 

 
Tools for Identifying Materials Management Problems
 
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