A well-managed waste stream

The management of waste in hospitals and other healthcare facilities is complex, with a wide array of wastes streams, extensive legislation and many practical constraints such as limited space. Unsurprisingly, the NHS spent over £71million on waste disposal in 2007/08 alone, and this figure is believed to have increased by 20 per cent since then. Yet careful management and efficient solutions can ensure that the cost of waste management is minimised. This article looks at ways that healthcare facilities can look at controlling, and even reducing, their waste costs whilst keeping their waste management systems practical, environmentally responsible and compliant.
Knowing the wastes generated
Without understanding which types of waste an organisation is producing, in what quantities, where in the premises those wastes are generated and what it is costing, it is extremely difficult to control costs and identify areas for cost savings.
Carrying out a characterisation waste audit will help an organisation understand the nature of their waste. This is likely to change over time, new wastes will be introduced and the quantity of wastes that are generated will vary. It may be possible to obtain this information from waste contractors’ management information reports but otherwise, a waste analysis will need to be carried out. Recyclables and even general waste can be physically sorted but for health and safety reasons, other wastes such as food, sharps and other clinical waste need to be visually checked.

Reviewing waste systems
Whilst the management of clinical and hazardous waste requires controlled treatment and disposal, much of the waste generated in healthcare facilities is defined as domestic or general waste, the market for which has changed dramatically over the last few years. The availability of alternative collection services and treatment technologies has increased significantly, offering greater scope for landfill diversion. For example, small volume collections of glass were almost of unheard of 15 years ago and of food five years ago, but now they are both commonplace.
With this in mind, and as waste management requirements change over time, a waste management system that has been in place for many years without review is unlikely to be fit for purpose. An effectiveness audit will help an organisation understand whether they have the right bins in the right places, whether the bins are labelled clearly and whether their waste collection service is appropriate for their requirements.
This information helps ensure that waste practices, and the service delivered by waste contractors meet an organisation’s changing requirements, and that they aren’t spending money on bins and services that aren’t required. Changing an organisation’s waste management methodology, for example the type of storage container used, can achieve far greater impact on cost base than a unit cost reduction.

Moving waste up the hierarchy
Treating waste in line with the waste hierarchy is now required by legislation but it can also be a significant source of cost saving. Waste prevention in offices can include simple steps such as setting printers to automatically duplex print and more involved steps such as refurbishing office furniture, rather than purchasing new desks and chairs, and leasing, rather than purchasing, equipment. Waste prevention in operational healthcare areas is undoubtedly more difficult but steps can be taken in procurement, stock control and product usage. For example, better stock control can reduce the amount of out-of-date products going to waste and improved practices in theatres can prevent whole trays of theatre sets being discarded (for no longer being sterile) where often only one item is used.
Coordinating waste prevention initiatives can be challenging as responsibilities lie across many different areas of the organisation but the cost savings can make the effort very worthwhile. Reuse can also produce cost savings from the reduction in waste. This can include sending items such as unwanted furniture and IT equipment to charities and returning packaging to suppliers.

Using the correct waste streams
The cost of disposing of clinical waste is at least five times that of domestic waste yet sandwich wrappers, leftover food and crisp packets are regularly found in clinical waste bins. Ensuring that only clinical waste goes in these bins is critical to controlling costs and can have the biggest impact on cost reduction. Similarly, disposing of confidential waste costs much more than recycling. Whilst confidential documents such as patient records and letters, must be protected by confidential shredding, recycling non-confidential documents will save money.
At the same time, recyclables that are unclean and contaminated with non-recyclables (particularly food waste, liquids or dangerously, hazardous and clinical waste) will not be recyclable. In this instance, recyclables may be rejected by a waste contractor (requiring the waste producer to remove the contaminants and those materials they have contaminated) or the waste contractor may send the whole load to landfill or for incineration (depending on the nature of the contaminants). In either case, the higher costs will be borne by the waste producer.    
Ensuring the correct waste goes in the correct bin can only be achieved through regular waste analysis and thorough communication, which I come back to later in this article.

Alternatives to Landfill Tax
One in every hundred tonnes of domestic waste in the UK is generated by the NHS and much of this goes to landfill. Whilst their figures relate to 2007 and recycling rates have increased significantly since then, landfill remains a major disposal route for the healthcare industry. On 1 April 2014 the standard rate of landfill tax increased by £8 to £80 per tonne, a cost which is passed on to waste producers. The Chancellor confirmed in the budget that landfill tax will continue to rise from 2015 in line with inflation so these costs are not going to fall in the foreseeable future. More environmentally responsible forms of treatment are becoming more and more cost effective. 
Separating more materials for recycling is a quick and easy way to stop paying Landfill Tax and reduce waste management costs. This can include recycling more of the same materials as well as recycling different materials. A waste audit, as I discussed above, will help an organisation to identify where recycling can be increased. Good communication with those generating the waste in the first place is critical to achieving results.
Food is a heavy waste. If this is removed from domestic waste, the weight of what is sent to landfill will reduce significantly. Food waste generated in kitchens or canteens can be sent for composting or anaerobic digestion to make fertiliser that can be used on agricultural land to grow more food. Residual waste (otherwise referred to as general waste), with food removed, can be processed and used to generate energy‑from‑waste. Recovery is the preferred option in the hierarchy above landfill but only once all recyclables have been removed.

Containers and collection
As I mentioned earlier, an organisation’s waste management requirements will change over time. An effectiveness audit and a review of the management information provided by waste contractors should help an organisation determine whether waste containers and collection service are fit for purpose or wasting money. The right containers and collection frequency is a balance that minimises transport costs whilst meeting practical requirements. Overly frequent collections and bins that are too large or too small can both result in unnecessary waste costs.

Improving communication
Good communication is vital to successful waste management and controlling of waste costs. Patients, staff, visitors and contractors who are generating the waste, need to know what is required of them and why in order to enable and encourage participation. 
Clear signage on, and ideally above, every bin is the first and most important step, particularly as this may be the main way to communicate with patients and visitors. Other initiatives should support this, particularly to ensure staff and contractors are informed and engaged.
Hospitals should communicate to new starters as part of their induction so that they know, from day one, how to use a waste management system correctly and why it’s so important. There should also be training sessions for staff, explaining the legal and financial implications of their waste management decisions. In-house marketing or internal communications teams can help raise awareness, as they should know how best to communicate messages using an organisation’s established channels. Hospitals should ensure communications are professional to help them get noticed and give them a sense of importance. All available communication channels should be used, from posters on notice boards and in-house magazines to Intranets, newsletters and other online media. Additionally, open days can remind staff and regular visitors what is required of them, introduce any changes to systems and tell them about successes
Feedback should be given to staff and other internal stakeholders to let them know what has been achieved, tell them what happens to waste when it leaves the building and thank them for contributing towards the achievements. 
Whilst close management of waste takes considerable resources and the commitment of a wide range of stakeholders, the financial (and environmental) benefits of good waste practices can’t be ignored. Reducing the waste burden on healthcare facilities can help to ensure that ever stretched budgets go on patient care, rather than being spent on avoidable waste.

Alex Mirkovic is Commercial Director of national recycling and waste management broker, Waste Cost Reduction Services (WCRS), a Corporate Member of the British Institute of Facilities Management (BIFM).

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