Green Practices at Ascension

1 FY20 ENVIRONMENTAL STEWARDSHIP REPORT Cover Photo: Heart Pavilion, Ascension St. Vincent’s Riverside, Jacksonville, FL. The building design incorporated green elements such as daylighting and views to nature for patients and visitors. Photo by Sue Root Barker

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1.  Medxcel Landscape team’s annual spring flower installation at Ascension Providence Hospital, Mobile, AL. 2.  Ascension System Office (St. Louis MO) team members participate in creating meal packets for World Food Day. 3.  Medxcel Landscape team in Alabama planting knockout roses for Earth Day 2020. 4.  Shelley Chapman, Medxcel Project Analyst and Zack Hayden, Medxcel Facilities Coordinator assist with a community food drive at Ascension St. Vincent Hospital, Indianapolis, IN.

2 FY20 ENVIRONMENTAL STEWARDSHIP REPORT

Letter from the COO In our mission to provide spiritually centered, holistic care which sustains and improves the health of individual and communities, we recognize that many actions have an impact both locally and globally. Our choices directly affect patients, associates, our communities and the world. By leveraging the environmental, financial and social intersections of green practices, we create significant benefits to the planet and people under our care.

With that in mind, Ascension’s Environmental Stewardship Program seeks to help our sites of care meet the needs of the present without compromising the ability of future generations to meet their needs. Our program hinges largely on the contributions of Green Teams: appointed associates at each facility, tasked with mitigating the local facility’s impact on the natural environment.

FY20 ENVIRONMENTAL STEWARDSHIP REPORT 3 Introduction

n FY20, Green Teams collaborated with Environment of Care committees at each hospital I to drive green practices despite a sweeping pandemic. Activities included the following:

Q1 & Q2 Green Teams met monthly or quarterly to implement projects using best practices and toolkits developed by the Ascension Environmental Stewardship Program Steering Committee. Green Team chairs participated in quarterly System Green Team calls to share ideas across Ascension ministries. Green Teams reported on energy, water, waste management and Green Team activities at Environment of Care meetings at each hospital. Feast of St. Francis activities were held on October 4 to honor the patron saint of ecology and animals.

Q3 & Q4 As the pandemic hit, Green Teams paused most activities to focus on COVID-19 response. However, since many environmental stewardship activities are embedded into daily work, Ascension associates continued to reduce the environmental footprint of Ascension facilities while creating healing environments that are safe for patients, visitors and associates. Despite an unusual year, Ascension’s Mission continues to challenge us to care for God’s creation, recognizing that our communities reap the rich benefits of environmental stewardship. In this year’s report, you’ll read some of the ways Ascension associates have made that possible. We hope you are inspired to explore ways that you, too, can make a difference.

4 FY20 ENVIRONMENTAL STEWARDSHIP REPORT Letter from the COO

Healthcare’s impact on the environment is significant and inextricably linked to the health of the communities and patients in our care. Every Ascension associate should be proud of the many accomplishments described in this report, but our environmental stewardship work is not done and needs to expand.

In addition to our current efforts around energy Craig Cordola conservation, waste management and recycling, Executive Vice President and COO, Ascension environmentally preferred purchasing and the use of renewable fuels, this year Ascension will develop a long-term strategic plan for environmental impact and sustainability. We’ll work across our ministry to set goals to improve our efficiency, resiliency and sustainability as we continue to provide the healthcare our communities need and future generations deserve.

Your Role in Environmental stewardship fosters a culture where every person understands that stewarding our natural resources is a fundamental, individual responsibility Environmental at Ascension. Stewardship The way we care for the earth has deep social, health and economic ramifications. We believe sustainability is our moral responsibility, reflecting key elements of Catholic Social Teaching: Concern for the environment calls us to respect human life and dignity. As the world becomes increasingly interdependent, we have a call to promote the common good and the virtue of solidarity. In caring for the environment, we have a special responsibility to the poor and vulnerable, who are the most affected and least heard.

FY20 ENVIRONMENTAL STEWARDSHIP REPORT 5 Leadership

he success of the Environmental Stewardship Program hinges on the leadership, coordination, education and accountability at each site of care. In this section you’ll Tlearn about Ascension’s commitment to greenhouse gas emissions reductions and how Ascension demonstrates leadership in healthcare sustainability.

Climate change and how it impacts health is an ongoing concern. In the white paper Ascension is evaluating Climate Change is Harming our Health from the Medical Society Consortium on reduction goals for greenhouse Climate and Health, five points are outlined: gas emissions (GHG) in line 1. There is a scientific consensus about human-caused climate change. with the Paris Climate Accord. 2. In communities across the nation, climate change is harming our health now. GHG emissions are divided 3. The health of any American can be harmed by climate change, but some of us face into three sectors: greater risk than others. SCOPE 1 4. Unless we take concerted action, these harms to our health are going to get much worse. 5. The most important action we can take to protect our health is to reduce heat- trapping pollution by reducing energy waste and accelerating the inevitable transition to clean renewable energy.

Direct emissions from health care facilities

SCOPE 2 Ascension demonstrates leadership in healthcare sustainability through collaboration with leading US health systems in several organizations. Health Care Climate Council, part of Health Care Without Harm, works to amplify public and private responses to climate change with mitigation, resilience and leadership solutions We Are Still In - Ascension signed the healthcare “We Are Still In” in support of the Paris Climate Agreement The American Society for Healthcare Engineering (ASHE) Sustainability Committee is Indirect emissions from purchased energy focused on energy and water efficiency and greenhouse gas reduction strategies in the design and operation of healthcare facilities. Practice Greenhealth/ Healthier Hospitals Initiative/ Market Transformation Groups SCOPE 3 provide environmental solutions for the healthcare sector and lend support to create greener workplaces and communities. The US Green Building Council (USGBC), through the Leadership in Energy and Environmental Design (LEED) green building rating system, has a mission to transform the way buildings and communities are designed, built and operated, enabling an environmentally and socially responsible, healthy, and prosperous environment that improves the quality of life. All indirect emissions, not included in Scope 2, that occur in the value Healthcare Plastics Recycling Council is a coalition seeking to inspire and enable chain, including both upstream and sustainable, cost-effective recycling solutions for plastic products and materials used downstream emissions in the delivery of healthcare.

6 FY20 ENVIRONMENTAL STEWARDSHIP REPORT Award Winners

ictories call for celebration. In this section you’ll learn about the many Ascension ministries who received awards for their outstanding performance in environmental Vstewardship in FY20.

AWARD FY20 Environmental Stewardship

Ascension Green Teams will be celebrated with Environmental Stewardship Champions Awards: Energy; Waste Management; Overall Participation. 2019 Energy Star certifications – Ascension St. Vincent’s Clay County; Ascension St. Vincent Fishers; Ascension NE Wisconsin – Mercy Campus

Ascension St. Vincent’s Riverside was recognized with an Environmental Excellence Award from Practice Greenhealth. 2020 ASHE Energy to Care Awards – – Ascension Seton Shoal The Greenhealth Partner for Change Award recognizes healthcare Creek; Ascension St. Vincent Anderson; Ascension St. Vincent’s facilities that have implemented a significant number of Blount environmental programs and continuously improved and expanded these programs on the path to sustainability.

The Kansas Department of Health and Environment (KDHE) recognized Ascension Via Christi with an Environmental Ascension Seton Smithville was awarded 1st place in the Small Stewardship with Distinction Award. KDHE’s annual award Hospital Category for the Texas Association of Healthcare program recognizes projects that eliminate or reduce the Facilities Management (TAHFM) Energy Roundup. generation of pollutants or wastes at the source or projects that conserve natural resources.

FY20 ENVIRONMENTAL STEWARDSHIP REPORT 7 Year in Review

espite the challenging year, the Environmental Stewardship Program continued to find opportunities that impacted the healing environment: In this section you’ll learn about Dthe various events that occured in FY20 supporting the Environmental Stewardship Program.

Laudato Si’ is the encyclical letter from Pope “I am very pleased that the theme chosen for 5th Anniversary Francis, On Care for our Common Home. the 2020 Season of Creation is Jubilee for of Laudato Si’ This document provides an ethical and the Earth, precisely in this year that marks moral underpinning for the Environmental the fiftieth anniversary of Earth Day. In the Stewardship Program. 2020 marks the 5th Holy Scriptures, a Jubilee is a sacred time to Anniversary of its publication. Each year, remember, return, rest, restore, and rejoice.” particularly since the publication of the “We have to realize that a true ecological Encyclical Laudato Si’, the first day of approach always becomes a social September is celebrated as the World Day approach; it must integrate questions of of Prayer for the Care of Creation and the justice in debates on the environment, so as beginning of the Season of Creation, which to hear both the cry of the earth and the cry concludes on the feast of Saint Francis of of the poor. Each community can take from Assisi on the fourth of October. During this the bounty of the earth whatever it needs period, Christians worldwide renew their for subsistence, but it also has the duty to faith in the God of creation and join in prayer protect the earth and to ensure its fruitfulness Pope Francis at a General Audience May 20. VATICAN MEDIA and work for the care of our common home. for coming generations.” – Pope Francis, Laudato Si’, 2015

St. Francis is the patron saint of ecology Feast of St. Francis and animals. The Feast of St. Francis is an – October 4 opportunity for Green Teams to create awareness of the Environmental Stewardship Program and share the opportunity to join the local Green Team. FY20, Ascension St. Vincent’s Riverside sponsored a lunch to learn about the St. Francis statue on the hospital campus. Pet supplies were collected for the Jacksonville Humane Society.

Earth Day – April 22 Earth Day has special meaning for us, given our mission focus on sustaining and improving the health of individuals and communities we serve – especially those who are poor and vulnerable. On Earth Day, we offer prayers of thanksgiving for our planet and encourage all associates to conserve the many resources that we have on the earth. Similar to years past, Medxcel Landscaping teams beautified hospital campuses and communities in honor of Earth Day.

8 FY20 ENVIRONMENTAL STEWARDSHIP REPORT Green Team Carolyn Koehn, Medxcel Regional Director, Emergency Management, Environment of Care and Safety supporting the Ascension Kansas and Oklahoma communities was featured in an Associate Associate Spotlight Spotlight for her leadership and longstanding support of environmental stewardship. Carolyn works closely with Facilities to document and share the work they do to reduce energy use. She has worked with Kansas State University for several years with intern programs that brought students into Via Christi facilities to complete environmental stewardship projects.

We know that healthcare operations are complex, but I “ continue to be amazed at the potential for energy savings and water conservation in our facilities, and how challenging it is to coordinate waste reduction projects. ”

A Chemical Engineering intern from Kansas State Intern Program University worked with Ascension Via Christi in 2019. Focused on Toxic The project focused on toxic material use including Materials; identification and replacement using the four categories listed below. More than 80 Environmental Identification and Protection Agency (EPA) Toxic Substances Control Replacement Act (TSCA) chemicals were identified, with continuing research on safer alternatives. 1. EPA’s Toxic Substances Control Act priority chemical use 2. The Safer Chemicals protocol from Practice Greenhealth, with a focus on healthy interiors 3. Medical devices containing DEHP and PVC 4. Green cleaning products for environmental services

The 2020 Environmental and Ecological Engineering intern at the Medxcel Central Office identified Intern Program and assessed opportunities for sustainability activities in administrative offices. The student from Focused on Purdue University developed recommendations to implement sustainability, health and wellness Sustainability practices in office settings and for those working at home due to COVID-19. The intern’s pilot in Administrative program can be implemented across Ascension office-based settings such as the System Office in Offices St. Louis and regional offices across all ministries. Data assessments included energy and water consumption, sustainable procurement, waste management and green cleaning, as well as information on access to healthy food and wellness initiatives.

FY20 ENVIRONMENTAL STEWARDSHIP REPORT 9 IntroductionBig Wins

he Environmental Stewardship Program continues to challenge us to act as stewards of God’s creation and operate at our full potential by identifying and implementing Tsolutions to minimize our impact on the natural environment and the communities we serve. In this section you’ll learn about some of the big wins and successes the program accomplished in FY20.

■ Ascension exceeded its Department of Energy Better Buildings Challenge goal to Medxcel Energy, Design reduce energy use 20% across the acute care hospital portfolio by 2020 from a 2008 & Construction for baseline. Ascension Facilities PHASE I PHASE II JULY 2008-JUNE 2017 JULY 2017-JUNE 2020 Achieved Better Buildings Transition to Medxcel Challenge Goal Energy Program

SQUARE SQUARE 35M FEET 23% 48.1M FEET 8.8% Acute Care Energy Acute Care Energy Hospital Cost Hospital Cost Portfolio Reduction Portfolio Reduction

METRIC METRIC $53.3M & 1.1M TONS $34. 3M & 150K TONS Energy Cost Carbon Dioxide Energy Cost Carbon Dioxide Avoidance Emmission Avoidance Emmission Avoidance Avoidance

■ Construction Waste Identification and Waste Reduction requirements were added to the Ascension Design & Construction Standards. A 50 percent landfill diversion rate will be required for all demolition and/or construction projects, if commingled recycling is available in the market.

■ An FY20 roof renovation and landfill diversion initiative incorporated white membranes applied to existing roofs, minimizing demolition and waste. Dedicated roofing crews completed 23 restoration projects that included 193 roof sections and 700,000 square feet of roofing. 2,500 tons of roofing materials that would otherwise go to the landfill were recycled. To put this number in a visual perspective, this is equivalent to 2,500 cars stacked on top of each other.

■ Ascension worked with its preferred furniture supplier on 15 Michigan renovation projects in 2020. 21 tons of furnishings were diverted from the landfill and beneficially donated to a parochial school in Detroit; Detroit Public Schools; and World Medical Relief.

Ascension Providence Hospital, Mobile, AL, after roof replacement.

10 FY20 ENVIRONMENTAL STEWARDSHIP REPORT ■ Using the Practice Greenhealth awards process, the Environmental Stewardship Program Greening the has identified 20 hospital waste streams to understand additional opportunities to divert Supply Chain solid waste from the landfill. Municipal solid waste diversion from landfill will become an Ascension systemwide goal in FY21-FY23.

■ The Resource Group partners with existing vendors that have strong green practices to learn from those suppliers and to leverage Ascension’s purchasing power to bring green products and services to market.

FY18 FY19 FY20 Target ■ The chart to the left illustrates Ascension’s waste stream profile as compared to 2019 data provided by Practice Greenhealth. The data is expressed as tons of waste by type, as a percent Municipal Solid Waste 79.1% 80.4% 82.6% <65% of total waste volumes. To provide environmental and financial benefit, it is better to have lower percentages of solid and egulated medical waste, and greater volumes of recycling and Diversion / Recycling 11.7% 11.5% 10.4% >28% diversion waste streams.

Regulated Municipal Solid Waste percentages went up and recycling percentages went down in FY20 Medical 8.9% 7.8% 6.8% 6.1% due to COVID-19 PPE disposal in Q4. Regulated Medical Waste percentages went down due to Waste lower inpatient volumes in Ascension hospitals. Hazardous Waste / 0.3% 0.2% 0.2% 0.4% Pharma ■ Ascension’s office supply and construction materials partners are developing product ● Ascension ● PGH award-winning hospitals selection databases that identify products with green attributes such as recycled content, safer chemicals and energy efficiency. This will make it easier for specifiers to evaluate performance and price while selecting greener products.

■ Ascension continues to demonstrate success with its FDA-approved medical device reprocessing program. In FY20, Ascension hospitals collected 1.4 million devices, resulting in $19 million in savings and 700,000 pounds of waste diverted from landfill. Since the program inception in FY13, 4.5 million pounds of waste has been diverted.

■ Ascension participates in the Healthier Hospitals Initiative, Safer Chemicals protocol for furniture Safer Chemicals and finish specifications to eliminate the use of formaldehyde, per-and poly-fluorinated compounds (PFAS), polyvinyl chloride (PVC), antimicrobials, and flame retardants.

■ Through Ascension’s preferred furniture supplier, 95 percent of the $25 million furnishings purchases in FY20 were compliant with the HHI protocol.

■ Medxcel Safety Officers employ Material Safety Data Sheets (MSDS) in annual audits to identify chemicals of concern and convert to safer alternatives. Surgery personnel participate in anesthetic gas education to learn about gases that are less damaging to the environment.

■ The Environmental Stewardship team worked with The Resource Group to evaluate 30 Strategic Planning consulting firms for an FY21 engagement to design bold new strategic goals, governance and operational structure for Environmental Impact and Sustainability.

■ To minimize single-use, disposable food service items, Green Teams promote No-Straw Fridays Green Team and work with the hospital food service program and gift shops to implement reusable mug and Activities & Reports cup sales with discounts for drink refills from Hospitals ■ Ascension hospitals host on-site vegetable & herb gardens, healing gardens and butterfly gardens. Park and highway clean-up work days are organized as associate engagement events at several Ascension hospitals.

■ The Ascension Florida sites of care used the Lean manufacturing 5S (Sort, Straighten, Shine, Saving $720,000 Standardize, Sustain) workplace organization method to tackle a large storage room filled with 60 excess hospital beds were identified, repaired and transferred to Ascension equipment, furnishings and beds. (See Savings call-out). Sacred Heart Bay, which had been severely damaged by Hurricane Michael. Ascension Nursing, Pharmacy and Performance Improvement; Medxcel Safety and Facilities; The project resulted in an Ascension Florida capital cost avoidance of $720,000 The Resource Group; TouchPoint Environmental Services; and TRIMEDX team members compared to the purchase of new beds. collaborated to reduce clutter and improve productivity.

FY20 ENVIRONMENTAL STEWARDSHIP REPORT 11 Wellness and You

scension’s Food & Nutrition Services provider is actively Aengaged in the Environmental Stewardship Program. In FY20, Ascension hospitals were provided with cage free eggs, Fair Trade coffee, 100% rbgh-free milk and yogurt, reduced antibiotic turkey and chicken and sustainable seafood. 260,000 pounds of local produce was purchased, a three- fold increase over FY17. In aggregate, 82% of food purchased for Ascension hospitals met sustainable and local criteria. The Imperfectly Delicious Produce program uses fruits and vegetables that would be discarded or unharvested due to shape, size and appearance, helping to mitigate 50% of produce that does not leave farms due to imperfections. The Waste Not food preparation tool in Ascension kitchens teaches awareness of production waste, over production, serving size and proper planning before food products are out-of-date or unused. Promotions in Ascension cafeterias include Eat Local and Seasonal produce guides and plant-focused menu items.

scension’s Environmental Services partner has long-standing Abest practices employing green cleaning products and methods. Green Seal and Ecologo products comprise 30% of total environmental supply purchases for Ascension hospitals. Hydrogen peroxide cleaning products are used in all Ascension facilities. Due to COVID-19, there is a shift away from green cleaning products to increased investment in disinfectants recommended by the EPA and CDC. Innovative cleaning methods include micro-fiber mops and rags that use less water and cleaning chemicals; and detergent- free, electrostatically-charged water solution for general cleaning and floors.

12 FY20 ENVIRONMENTAL STEWARDSHIP REPORT With many associates working from home due to COVID-19, there is an increased focus on gardening, fitness and family activities. Here’s what you can do to help

Use nontoxic cleaners and disinfectants to reduce exposure to harmful chemicals and improve air quality in your home. Reference Centers for Disease Control (CDC) to make decisions that will protect you and your family during a COVID-19 outbreak. HEALTHY HOME Add indoor plants to help produce oxygen and absorb carbon dioxide.

Plant a tree. Earth Day Network has a goal of planting 7.8 billion trees — one tree for every person on earth. Plant a garden. The easiest vegetables to start out with are tomatoes, bell peppers, cucumbers, basil, and beans. PLANT AND Plant drought-tolerant, native and pollinator-friendly species in your yard to minimize the need for VEGETATION irrigation and pesticides.

Reduce your consumption of meat to help reduce gas emissions. Go meatless on Mondays or Fridays.

EAT SUSTAINABLY Eat local, organic or chemical-free foods to reduce your exposure to pesticides and herbicides.

Replace fluorescent and incandescent light bulbs with LEDs to use less energy.

Purchase Energy Star rated appliances and computer equipment to save energy. ENERGY AND WATER Install water-efficient shower heads, faucet aerators and low-flush toilets to reduce water use. CONSERVATION

Use dishes and silverware instead of single-use food service items to reduce the amount of trash that goes to the landfill. Minimize single-use plastics such as straws, stir sticks, cup lids, storage bags, disposable utensils, water and soda bottles to reduce the amount of plastic trash. REDUCE & RECYCLE Avoid using Styrofoam products. Polystyrene (#6 plastic) is a toxic material that is not recycled. Participate in your community’s recycling program for cardboard, plastic, paper, glass, metal and aluminum to reduce the amount of trash that goes to the landfill. Don’t purchase bottled water if it is safe to use filtered or tap water to reduce plastic production and the need to recycle plastic bottles.

The Triple Bottom Line (Planet, People, Resources) provides a framework to 93% minimize bottled water use. of bottled water includes microplastic particles containing chemicals directly linked to reproductive harm, obesity, organ problems, and developmental delays For the price of one bottle of water, hundreds of gallons of tap water can be purchased. in children. Minimizing the use of bottled water is less expensive and demonstrates a financial benefit, minimizes energy use, shipping and waste and frees up resources to help the poor and vulnerable.

FY20 ENVIRONMENTAL STEWARDSHIP REPORT 13 Introduction

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1, 3, 5, 8. 6. Medxcel Landscape team’s annual spring flower Fresh fruit, vegetables and staple food items on sale for installation at Ascension Providence Hospital, Mobile, AL. associates during COVID response, Indiana sites of care. 2. 7, 14. First Floor Lobby, Heart Pavilion, Ascension St. Vincent’s Personal care item drive at Our Lady of Lourdes Memorial Riverside, Jacksonville, FL. Furnishings and architectural Hospital, Binghamton, NY. finishes that were selected from Ascension Design & 10. Construction standards minimize chemicals of concern Patient Room, Heart Pavilion, Ascension St. Vincent’s such as flame retardants, antimicrobials, formaldehyde and Riverside, Jacksonville, FL. The building design PVC. incorporated green elements such as daylighting and views 4, 9. to nature for patients and visitors. Associates from the Medxcel Central Office, Indianapolis, 11. IN, participate in an Earth Day service project. Community food drive at Ascension St. Vincent Hospital, Indianapolis, IN. 14 FY20 ENVIRONMENTAL STEWARDSHIP REPORT 3 4 5

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12. Pharmacy Renovation, Ascension St. Vincent Jennings, North Vernon, IN. Pharmacy renovations required at all Ascension hospitals incorporated construction waste recycling to minimize waste sent to landfills and comply with regulations. 13. Medxcel Landscape teams maintain properties at sites of care in the Chicago area. 15. Associates from Ascension St. Vincent Hospital, Indianapolis, IN, participate in clean-up along Crooked Creek with Keep Indianapolis Beautiful. FY20 ENVIRONMENTAL STEWARDSHIP REPORT 15 Printed with solvent-free inks using renewable For questions contact Lois Sechrist, ® energy on FSC certified recycled paper, Environmental Stewardship Manager at elemental chlorine free and acid free. [email protected] or 314-495-8303. Sustainability matters–please recycle.

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