While the successes have been invigorating, greening an existing operation isn't exactly quick or easy. There's also the question of cost any time an organization makes changes, complicated by particular concerns associated with health care: roundthe- clock operations and patient safety. But if anything, say green-hospital advocates, patients have fewer problems in environmentally friendly surroundings—they're exposed to fewer toxic materials, they breathe cleaner air, and they enjoy more sunlight and increased access to views of natural areas. "The bottom line is to absolutely not impact patient care in any negative way," says H2E's Brannen. Riley points out that she's seen green materials undergo greater scrutiny before being approved for use than do their conventional counterparts. "One might well ask," she observes, "are we placing patients at undue risk with the present chemicals and product selections?"

That's a question that consultant Jan Stensland, who helped Kaiser Permanente forge its green health-care policies, answers in the affirmative. "Formaldehyde is a known carcinogen and a respiratory irritant," says the interior designer and green materials expert. The ubiquitous methanol byproduct also features prominently in the manufacture of carpets, cleaning products, and paint. Polyvinyl chloride, or PVC—one of the cheapest plastics available and a component of everything from building materials and water pipes to clothing, upholstery, and IV bags—has been dubbed the "poison plastic" by the Center for Health, Environment, and Justice and implicated in endocrine disruption, leukemia, and cirrhosis of the liver. "In good conscience, how could a health-care [organization] assemble a facility with known carcinogens?" asks Stensland. "That would be a huge disconnect in a value system."

DHMC switched to PVC-free IV bags in 2006, and staff are currently evaluating rubber and quartz flooring, as well as a

Housekeepers like Nellie Perkins regularly compare green cleaning products to their conventional counterparts so they can choose the least toxic, most effective product for the job.

PVC-free pseudo-vinyl upholstery fabric, to eliminate PVCs from future additions or renovations. "We have a much more vulnerable population—people here are immune-suppressed," says DHMC's Dahlstrom, who urges staff to seek out benign alternatives to conventional products, from carpet tiles to roofing materials. "We have a higher obligation, a moral imperative, to maintain a facility that [meets] a higher standard than many other industries."

Beyond the moral imperative, advocates say people-friendly, planet-friendly choices tend to be profitable, as well. In 2006, DHMC diverted more than 900 tons of waste from ending up as landfill and estimates the net benefit from recycling and reuse at nearly $600,000 for the year. And it's not just big and/or rural institutions that can benefit. Even cash-strapped, inner-city Huron Hospital in East Cleveland, Ohio, has seen $50,000

Dartmouth-Hitchcock now has almost two decades of
experience at optimizing facilities' performance while mitigating their environmental impact, at implementing low-toxicity purchasing agreements, and at cultivating a climate where
every employee takes
personal responsibility for
minimizing waste.

900

Tons of waste recycled at DHMC in 2006 and thus diverted from landfills

$48,000

Annual savings at DHMC from recycling laboratory solvents such as xylene and ethyl alcohol

$600,000

Net annual savings from DHMC's recycling and reuse programs