Good environmental practices – perspectives from the diagnostics industry

1. APFCB Good environmental practices – perspectives from the diagnostics industry Dr. Alistair Gammie

2. Agenda • Mega-trends of Sustainability • Business and Legislation • Green Hospitals • Green Laboratories • Examples from Siemens

3. Megatrends are changing the world … Health spending has grown faster than the GDP in almost every country of the OECD in the past 15 years! Fixed schemes with decreasing reimbursement rates require considerable efforts for efficiency improvements! Highest CO2 concentration since 350,000 years ago! Already ~1°C temperature increase! The average life expectancy increased from ~35 years to ~65 years within one century! In 2050, 9 billion peoplewill live on our planet! Picture Source: Michael Grabscheit_pixelio.de Source: Stern review, E&EC, UN

4. …and the global mega trends have impact on healthcare systems worldwide Healthcare global trends Impact on healthcare stakeholder groups • Patients • Rising awareness of health and self-management • Participation in medical decisions • Increasing demand for prevention Demographic change and aging population • Providers • Cost pressure resulting in trend for more efficient (standardized processes) and effective (evidence-based and personalized) healthcare delivery • Enhanced competition • Establishment of standards-of-care • Rising complexity Industrialization of healthcare Personalized medicine • Politics/wider public • Need for stabilization of national healthcare systems Innovative diagnostic and treatments methods • Payors • Cost pressure and increasing competition • Patient empowerment • Health promotion programs

5. Today's hospital management needs to cope with new challenges to be sustainably profitable Increasing energy costs CO2 emission reduction targets set for whole economies by governments in % +22% +23% By 2012 (Kyoto) By 2020 (Bali) -5.2 -6.0 -8.0 -21.0 -20.0 -30.0 World NL EU GER EU GER 2009 2011 2009 2011 Heating oil Gas Green Green Financial limitations Increased competition Changing reimbursement systemand global financial situation requires cost reduction by efficiency increase for healthcare providers Increased competition and public awareness requires health care providers to deliver high quality medical services Quality Efficiency Source: U.S. Energy Information Administration Short-Term Energy Outlook, September 2011

6. Business and Legislation • Definition: • Excellent organisations have a positive impact on the world around them by enhancing their performance whilst simultaneously advancing the economic, environmental and social conditions within the communities they touch.

7. Business and Legislation • Definition- Sustainability is the capacity to endure. • ISO14000- Environmental Management • Globally Countries continue to enact new legislation • Australia – VEET Carbon pricing, Environmental Upgrade Agreements Act 2010 • SG- energy conservation act • Japan – Act on low carbon city development • China – 30% of all new buildings to be green

8. 1 2 3 4 5 Quality Green 6 7 8 9 10 11 12 13 Efficiency The Green+ Check covers 40 areas in the hospital Energy efficiency management Heating and cooling (HVAC) Hot steam generation Building Electrical energy Information and communication Lighting Water Suppliers Helium Medical equipment Paper Waste Energy efficiency management Heating and cooling (HVAC) Hot steam generation Building Electrical energy Information and communication Lighting Water Suppliers Helium Medical equipment Paper Waste Strategic focus Process management Occupancy Employees Financial results Medical equipment IT Communication Building layout Purchasing Logistics Food supply Care Emergency handling Surgery Research and teaching Patients Employees Referral system Society Resources Medication Security/safety Quality management Medical quality Follow-on treatment Research and teaching 1 Green+ Radar 2 3 4 5 6 Green 7 8 Qualität 9 Umwelt 10 11 12 13 Green 14 15 16 17 18 19 20 Efficiency 21 22 23 24 25 26 27 28 29 30 Effizienz 31 32 33 34 Quality 35 36 37 38 39 40

9. Consolidation of instruments. An effective method of saving power. 10.000kW/year GNU Free Documentation License.

10. Light, space and energy savings • By saving 25m2 by consolidation, you can save the equivalent in light-power, required for a contemporary fridge/year 500 kW/year

11. Order entry and Paper GNU Free Documentation License.

12. Consolidation Of Tubes GNU Free Documentation License.

13. Consolidation of aliquots: A customer report Ca. 1600kg ofPolystyrene

14. Laboratory Chaves Is there a way to balance economical and ecological demands in Healthcare? Reference Environmental Value Laboratory Dr. Joaquim Chaves is one of three pillars of the Joaquim Chaves Group, which also includes Imaging and Oncology Centers. This leading private healthcare institution serves more than 5,000 patients every day. Anticipating the changes in the Laboratory testing market, the Lab looked for a solution that allowed it achieve faster results without affecting quality. At the same time, it had to make sure not lose profitability. As a result, the company turned to Siemens. “With Siemens, we not only had the sense that we were purchasing advanced analytical equipment, but also that we were finding global solutions for modernizing the company at various levels”, said Dr. Carlos Cardoso. • Less instruments reduces energy consumption as well as CO2 footprint • Water consumption down 40 % • Better Waste Management: • Solid waste reduced by 61 % • Liquid waste reduced by 74 % Challenges • Market consolidation and the economic crisis demand greater competitiveness • Increasing operational cost from energy and water consumption, solid and liquid waste disposal • Increased awareness of environmental issues • Need to implement industry innovative solutions to differentiate Siemens from competition 1,000,000 plastic tubes have been saved each year! Solution Key Features • With Siemens LabCell Automation Solution and Instrumentation, the lab was able to improve efficiency by consolidating tubes and reducing analysis periods while increasing quality standards • Workflows were streamlined and lab costs were reduced • Higher profitability and increased competitiveness through reduction of costs and waste while also achieving a positive impact on natural resources and the environment Customer and Patient Value • Reduction in time to deliver results by 59% • Reduction of up to 50 percent in volume of blood collected from each patient • 18 workstations to 8 • Lab costs reduced by 30% After LEAN comes GREEN! Portuguese Philosopher

15. Siemens Healthcare • Development of Personalised Education Planning web based training for customers and staff • Rework of Centaur spare parts packaging – reduced shipping 25% fresh air across continents • Redesign of instrument GUI’s for easier training and use • Review of kit boxes and components to eliminate waste* e.g. concentrated reagents • Review of next Gen equipment for power saving, easier maintenance, ease of use.

16. Siemens Healthcare • Use of overview GPS to route FSE’s more efficiently • Building systems control lighting and heating to minimise wastage of energy • All waste is sorted and recycled • All business mileage is monitored to ensure that unnecessary meetings are prevented. • Cycle to work schemes, car sharing and incentives to drive low CO2 cars

17. Siemens Crystal • Use of Live Meeting rather than travel to a meeting place • Installation of light sensors in office buildings to reduce energy • Hot desks and home working to reduce travel and floor space • Mileage monitoring to eliminate unnecessary journeys • GPS monitoring of FSE’s to divert them for the most efficient service provision

18. Final Thoughts “Every profession bears the responsibility to understand the circumstances that enable its existence.” ― Robert Gutman “The greatest shortcoming of the human race is our inability to understand the exponential function.” ― Albert A. Bartlett