Kimball Sustainable Healthcare is a women-led sustainability healthcare startup that helps hospitals to conserve resources and improve environmental performance.

Zabble wanted to connect with KSH to share their important Zero Waste mission-drive work in the healthcare industry. It is known that there is a high cost to poor waste management in healthcare. The U.S. healthcare system generates over 7,000 tons of solid waste everyday, and 10% of the nation's total greenhouse gas emissions. Zero Waste in healthcare can move the needle as a solution for climate change if its practices are adopted nationwide.

KSH Mission:

We help healthcare organizations conserve resources and improve environmental performance by building the tools and partnerships to prevent waste and support quality, safety and value.

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About Erika Kimball

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‍What motivated you to pursue consulting for health care environmental sustainability management and start KSH?

A: I began working on hospital sustainability projects when I was a nurse. Seeing the amount of waste and single-use plastic products that I generated each day while working to improve patient health, the environmental impact of healthcare seemed out of step with our mission. I knew that there had to be a better way, so I started launching initiatives to prevent waste and promote sustainability in about 2006. What began with volunteer projects in my nursing unit has grown organically into a sustainability consultancy. Kimball Sustainable Healthcare is unique in that we leverage the culture and expertise of healthcare to conserve resources and improve environmental outcomes.

‍Zero Waste Compliance Planning

What is Zero Waste Compliance planning?

A: Many municipalities are setting zero waste targets and regulations designed with the entire community in mind. Hospitals are key to the success of any municipal zero waste plan. However, hospitals and clinics have special constraints around safety, budget, and workflows. The way to meet municipal targets and the needs of healthcare clients begins with partnership and a thoughtful compliance plan to adapt new waste streams, processes, outreach and management to the healthcare setting.

What are the biggest compliance gaps you have noticed with your clients?

A: The most common compliance gap is in an item being placed in the wrong bin. The underlying causes include lack of information, lack of proper bin infrastructure, and behavioral lapses.

After completing a zero-waste compliance plan do you follow up with clients to assess the follow-through of the plan? ‍

A: A zero-waste compliance plan is just the beginning of the process. The next step is designing a waste management system that ensures each person along the waste management process has the tools and information needed to properly manage the material in hand at any time.

What areas do Hospitals struggle with the most to stay in alignment with the plan?

A: The biggest challenge in healthcare waste reduction is complexity. The number of unique waste streams, the increasing complexity of medical devices, and the number of people that need to know sorting information creates a barrier to success. To meet this challenge, KSH works to standardize and simplify materials collection infrastructure, process, and messaging to create a common foundation for materials collection streams across the facility.

A: Another challenge is the need to manage zero waste healthcare as a practice rather than a project. Zero waste requires active management just like any other healthcare quality practice, such as handwashing. This challenge is actually an opportunity, as zero waste management practices support quality, safety and resource efficiency. The goal is to align this work with existing quality practices.

Net-Zero Carbon Goal

‍As Hospitals are increasingly focused on minimizing their carbon footprint, how does KSH utilize waste reduction and disposal planning to scale and align with one’s overall carbon reduction goals?

A: Around 10% of U.S. carbon emissions are generated by healthcare. Over 70% of those emissions are related to supply chain. Decarbonizing the supply chain involves two concurrent strategies: source sustainable products, and maximize the useful lifecycle of those products and their inputs. The summary version of this plan is: buy better, and take good care of our things. KSH helps to build the systems and practices that make it easy for healthcare clients to take better care of their things. We work to keep value inside of healthcare institutions and out of the waste bin, providing savings to invest in healthier products and processes.

Initiating Zero Waste and Recycling Programs within Hospitals

‍Thinking about the clients you have worked with in the past - how are most tracking their waste?

A: Waste tracking should inform three major indicators: weight, cost, and quality. The industry standard for waste tracking is monthly tracking of each waste stream by weight and cost.

What gaps do you see?‍

A: One common data gap when measuring volume and cost is tracking how full bins are when they are serviced. Many waste streams are billed by the number of bins pulled. Understanding bin capacity provides better data and highlights opportunities to optimize service frequency. Quality data is a big opportunity for healthcare. Materials collection is a complex process that requires feedback to ensure success along every step. Data should be timely, actionable, and shared with relevant stakeholders. Zabble may play a role in creating easy, proactive audit tools for healthcare facilities to track quality management as well as bin capacity.

What upstream and downstream solutions are quickly adopted and which solutions are met with the most resistance to change?

A: The initial implementation of any solution is quickly adopted, whether it is introducing a reusable supply or establishing a new recycling collection. The challenging part is creating the program infrastructure that makes any solution a success. This involves assessing the environment where the new solution is being introduced and creating a materials care plan from point of disposal to collection to final processing.

Engagement with Clinicians, Staff and Stakeholders

KSH knows that engaging front-line staff is key to a successful facility-wide clinical waste reduction program - if starting from scratch, what initial steps need to be taken to set them up for success? What is not being considered that prolongs progress?

A: Frontline staff are the experts in how waste is generated and handled. New waste management processes assume frontline staff will adopt new disposal practices. Their expertise and engagement is absolutely necessary to program success. This begins by including this team during the planning phase.

Are there stakeholders not initially considered?

A: One important stakeholder to engage early on is hospital leadership. Waste prevention activities are very tactical, but program success looks like culture change. Using formal leadership and engagement systems to support a zero waste program creates the permission structures and behavioral shift needed to create meaningful change.  

A: Another key stakeholder group is waste haulers and management companies. Waste management is a relationship business built on cooperation and shared understanding among entities. We can increase healthcare waste quality and diversion by sharing standards, processes, and feedback among generators and processors.

Is the waste collector the end all be all? Do Hospitals have the power to leverage their purchasing power with their waste collectors for greater transparency and support for non/regulated waste disposal?

A: Hospitals can leverage their purchasing power to source better materials, but also to implement better materials management partnerships. This can be achieved by selecting and managing vendors to partner and share sustainability data, quality standards and outcomes, and insight into operations and downstream partners. The pillars of sustainability are shared goals, collaboration, transparency and a commitment to continual improvement. Zero waste involves integrating these principles into our waste management processes.

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Health Care Hurdle for Zero Waste

What do you want as an outcome in the industry?

A: The vision of Kimball Sustainable Healthcare is 'Healthcare that uses healthy inputs, in optimal amounts, making minimal waste that is processed in a way that benefits the planet.' Healthcare has the materials, information, and technology needed to radically improve waste management today. Our goal as a company is to help the industry see beyond the current waste-intensive system, and implement products and processes that align with the health goals of healthcare.

What is the biggest hurdle you have noticed in your experience that hospitals need to overcome to be Zero Waste?

A: Zero waste represents a major change in the healthcare system. Hospitals are built for stability, which create structural barriers to change. My goal is to build the will, capacity, and imagination to redefine the industry's relationship with healthcare materials.  

Call to Action:

Big thank you to Erika Kimball for taking the time to have this conversation with us and initiate a discussion to spearhead healthcare to the 21st century!

Share this blog with Sustainability and Hospitality leaders at hospitals seeking guidance on their Zero Waste journey and visit KSH to learn more about their services.

If you would like to share your zero waste journey and participate in a Q&A, contact the Zabble Team.