1. AIA Chicago Healthcare Knowledge Community The Advocate Health Care Environmental Stewardship Story Al Manshum Vice President Facilities & Construction February 29, 2012

2. Agenda About Advocate Advocate’s Environmental Stewardship Journey Drivers/Motivators Recognizing Our Impact on the Environment & Doing Something about it Facing Challenges Looking Forward

3. About Advocate Advocate Health Care, a not-for- profit, faith-based organization, is the largest integrated delivery system in the Midwest. Named a Top 10 System in the United States for quality and efficiency, Advocate includes more than 250 sites of care including 10 hospitals, two integrated children’s hospitals, the region’s largest employed medical group and one of the largest home care company in the state of Illinois.

4. Advocate Health Care 30,000 Associates 9,000 Nurses 10 Acute Care Hospitals Two Integrated Children’s Hospitals 6,000 Affiliated Physicians 650 Residents and Fellows 250 Sites of Care

5. Our Mission Advocate’s mission is to serve the health needs of individuals, families and communities through a wholistic philosophy rooted in our fundamental understanding of human beings as created in the image of God. Advocate's faith-based heritage and healing ministry began more than 100 years ago and is grounded in our affiliation with two faith traditions, the United Church of Christ and the Evangelical Lutheran Church in America.

6. Stewardship Partnership Equality Excellence Compassion Our Values

7. Our Environmental Stewardship Journey 2005LEED Gold sought for Patient Tower 2005First Site Green Team formed 2006Additional Green Teams formed 2007Sustainable Design Guidelines Established 2008Green Council established 2009Green Strategy adopted and initiatives identified 2009Focus on Culture Change 2009Advocate receives 1 st “System for Change Award” from PGH 2010LEED Gold achieved 2010Advocate becomes a Founding Member of HHI 2011Hired an Environmental Stewardship Manager 2011Advocate seeks LEED Gold on three additional buildings 2012Advocate restructures the Sustainable Operations Council

8. Environmental Stewardship Drivers/Motivators 1 st - MVP Focused Wholistic Philosophy Stewardship Partnership Excellence Compassion

9. Environmental Stewardship Drivers/Motivators 2 nd – Clinically Relevant & Ethically Sound Hippocratic Oath “I will prevent disease whenever I can, for prevention is preferable to cure” “I will remember that I remain a member of society, with special obligations to all my fellow human beings…” “First Do No Harm”

10. Environmental Stewardship Drivers/Motivators 3 rd – Corporate Citizenship 1 of 7 “Marks of Citizenship” Faith-Based Identity Community Partnership Public Policy Leadership Justice and Compassion Valuing People Environmental Stewardship Responsible Governance Electronic Recycling – Earth Day 2010

11. Environmental Stewardship Drivers/Motivators 4 th – Church Supported UCC -2007 “One thing is certain: for the love of the earth and one another, we may not remain indifferent...our faith is bold to respond.” ELCA – 2008 “The ELCA is committed to caring for God’s creation, and we are striving to be good stewards of earth’s resources.”

12. Environmental Stewardship Drivers/Motivators 5 th – Bottom Line Driven Conserves Resources Invest Savings into our Future

13. Environmental Stewardship Drivers/Motivators Examples of Annual Savings $1,900,000Medical Device Reprocessing $125,000Printing Reductions $3,300,000Energy Reductions $ 250,000Waste Reductions $5,575,000TOTAL SAVINGS Equal to $111,500,000 revenue on a 5% operating margin

14. Environmental Stewardship Impacts Construction Energy Waste Paper Purchasing Chemicals Food Transportation The Operating Room

15. Environmental Stewardship Impacts What are we doing? Advocate SPECS - Safe, Patient Focused, Efficient, Cost Effective, Sustainable - Preferred Partner Selection Process Sustainable Construction Guidelines - Sustainable Site - Indoor Air Quality - Energy - Water - Materials - Innovation Construction

16. Environmental Stewardship Impacts 2015: 20% Reduction in Energy and CO2= 10,000 Cars/Yr in CO2 Emissions Energy

17. Environmental Stewardship Impacts 2015: 20% Reduction in Electricity = 7,000 American Households Energy

18. Environmental Stewardship Impacts What are we doing? Construction - Targeted capital for Facility Infrastructure - Value-based decision making - Commissioning all projects Energy

19. Environmental Stewardship Impacts What are we doing? Operations - Restructure Facilities - Tracking/Benchmarking - Focus on Performance - Operations Checklist - Retro-commissioning - Training & Education of Facilities Staff - Educating all associates Results: 11% Energy Reduction by 2011 Energy

20. Environmental Stewardship Impacts 2012 Target: Reduction to 1.7 lbs/adj. pt. day= Reduction of 800,000 lbs of Infectious Waste 2012 Target: 30% of Total Waste Recycled= 5,400,000 lbs Waste

21. Environmental Stewardship Impacts What are we doing? Construction - Recycling Construction Debris - Using materials that can be recycled Waste

22. Environmental Stewardship Impacts What are we doing? Operations - Identify waste streams (Regular, Regulated Medical, Recycling, Hazardous, Pharmaceutical) - Reduce, Reuse, Recycle - Proper segregation of waste - education - Tracking/Benchmarking - Awards 201195% Construction Recycling Results: 27% Recycling 1.75 lb/apd Regulated Medical Waste

23. Environmental Stewardship Facing Challenges Culture Change Accountability Cost

24. Environmental Stewardship Facing Challenges Culture Change Top Down – Bottom Up Executive Management Support - Champion the Cause - Communicate Goals/Progress - Recognize Success - Lead by Example

25. Environmental Stewardship Facing Challenges Culture Change Marketing & Community Partnerships Education - New Employee Orientation - Computer Based Training

26. Environmental Stewardship Facing Challenges Accountability Measure and Track Performance Include Environmental Stewardship in Job Accountabilities Tie Performance to Reward - Key Result Areas (KRAs)

27. Environmental Stewardship Facing Challenges Cost Focus on Cost Saving Measures First to offset any additional costs Return on Investment (ROI)

28. Environmental Stewardship Looking Forward Advocate Health Care - Culture Change - Sustainable Buildings - Sustainable Operations - Sharing our Story

29. Environmental Stewardship Looking Forward Health Care Sector - Green is becoming “Mainstream” - Healthier Hospitals Initiative (HHI) - Green Campaign - Look for Value - Clinical - Financial

30. Recap Motivators Impact Challenges Future

31. "When we tug at a single thing in nature, we find it attached to the rest of the world." - John Muir