Project completed as part of the Calgary Zone, Alberta Health Services Green Team Competition, 2025
Team members
- Dr. Bhavneet Kahlon – Nephrologist (bhavneet.kahlon@ahs.ca)
- Arooj Nazir – Quality & Process Improvement Consultant (arooj.nazir@ahs.ca)
- Jelena Poprzen – Clinical Quality Improvement Consultant
- Monica Veness – Clinical Quality Improvement Consultant
- Claire Barber – Associate Vice Chair Planetary Health for the Department of Medicine
- Kiran Dhiman – Research Coordinator & Precision Health Student
- Anuk Ghimire - Nephrologist
Setting / patent group: Patients receiving hemodialysis in a Canadian Hospital
Issue:
Outpatient hemodialysis (HD) units generate a substantial amount of environmental waste and emissions due to their reliance on single-use disposable items, such as plastic cups, lids, straws, and spoons. They also use significant volumes of energy and water to launder hospital-provided blankets. HD patients, who attend treatment multiple times per week for several hours at a time, are part of a system that unintentionally drives high resource consumption, making these units a key area for targeted environmental improvement.
Intervention:
Aim: To reduce the use of single-use plastic items and facility blanket laundering by 50% within 6 months at Sunridge Hemodialysis Unit, through patient participation in bringing reusable water bottles and personal blankets.
Studying the system
The BYOBB initiative at Sunridge Hemodialysis Unit progressed through several stages starting in early May 2025. Key stakeholders included Infection Prevention and Control (IPC), who conducted a risk assessment and provided hygiene guidelines for patient-owned items; Contracting, Procurement and Supply Management (CPSM), who supplied item-level cost and material data for disposables; Nutrition, Food, Linen & Environmental Services (NFLES), who provided blanket laundering cost estimates; and Operations and Site Staff, who supported process mapping and manual data collection. The Centre for Sustainable Healthcare (CSH) was also engaged to support carbon footprinting
Process mapping revealed gaps in understanding around blanket distribution and disposable item use, prompting the Gemba walk to observe clinic operations and collect baseline data. The walk confirmed high blanket usage (about 90 daily) and frequent use of disposable plastic items, with staff generally supportive but noting feasibility concerns due to patient mobility and storage limitations.
Barriers included delays in operational approval and incomplete cost data from CPSM. Equity considerations were built into the intervention, recognizing that many patients are elderly and rely on public transit, so the initiative remains optional to ensure care and comfort are not compromised.
Implementation
The team has a clear implementation plan. Next steps include developing patient and staff education materials, planning a phased rollout, and monitoring uptake.
Outcomes:
The potential benefits of this change are modelled below based on data collection provided by the Nephrology Improvement Team and current supply ordering practices, projected across 12 months.
Clinical: The project is not expected to directly alter clinical health outcomes. Having blankets and bottles from home may improve patient experience. Patient experience will be assessed following implementation. Equitable access has been considered with blankets and cups still available for all patients who need them.
Environmental:
Based on current supply ordering and data from the Nephrology Improvement Team, a 50% reduction would mean approximately 11,754 fewer blankets laundered and 2,598 fewer single-use cups used over 12 months.
- 3,936.36 kgCO₂e saving in blanket laundering
- 36.372 kgCO₂e saved in single use cups
- Total annual saving: 3,972.7 kgCO2e, equivalent to driving 15,339 km in an average car.
Financial
- A saving of $15,000 CAD is estimated.
Social
- Decreased staff motion involved with provision of facility-provided blankets.
- Improvement of supply management knowledge and processes within the team
Key learning point
A key learning from this project was the importance of securing early operational support to avoid delays, such as those experienced in obtaining approval for the Gemba walk. Initial stakeholder meetings revealed gaps in understanding clinical processes and supply management, which were only clarified through direct observation. Barriers such as limited storage space, patient preferences (e.g., ice over water), and added staff workload for data collection also emerged. However, early engagement with IPC and NFLES strengthened the project’s feasibility by ensuring infection control compliance and enabling environmental impact measurement.
Despite the above challenges, the project remains highly adaptable to other outpatient HD units due to similar workflows, supporting both sustainability and patient-centered care.
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