Texan by Nature is excited to recognize Texas Health Resources (Texas Health) as a 2021 TxN 20 honoree for their leadership in conservation and sustainability. Texas Health’s commitment to conservation, their projects, programs, best practices, and lessons learned are an example and inspiration for us all.

Texas Health Resources was recognized as a 2020 and 2019 TxN 20 honoree as well! Read the 2020 write-up and the 2019 write-up.

Honoree Industry and Size: Healthcare – Enterprise

Company Overview: 

Texas Health Resources (Texas Health) is one of the largest faith-based nonprofit health systems in the U.S. and the largest in North Texas in terms of patients served. Texas Health is headquartered in Arlington, Texas, and has a team of more than 24,000 employees across 27 hospitals that serve as acute care, short stay, rehabilitation and transitional care facilities that are owned, operated, or a joint-venture with Texas Health. The system also has more than 350 community access points through physician offices, behavioral health facilities, and surgery, imaging, and fitness centers. Texas Health strives to improve the health of people in the communities it serves and aims to operate sustainably through operational effectiveness, innovative care, and a high-performing culture. In 2021, Texas Health ranked No. 7 on the Fortune 100 Best Companies to Work For® list, its highest-ever ranking, as well as No. 1 for the seventh consecutive year on Fortune’s Best Workplaces in Healthcare and Biopharma list. Texas Health is on the 2021 People Companies that Care list and has been recently recognized by the Texas Hospital Association and American Hospital Association for its community health improvement and clinical quality efforts. 

What is Texas Health’s conservation and sustainability mission and why is it important to your culture?

“As one of the region’s largest employers, Texas Health is responsible for caring for 7 million people living in 16 counties. As a nonprofit, we must carefully steward the resources in which we are entrusted so that we can fulfill our mission. We do this by intentionally looking for ways to operate efficiently, forging strategic affiliations to leverage our shared resources, and designing programs that close care, cost, and consumption gaps.”

– Barclay Berdan, Texas Health CEO

The Mission of Texas Health is to improve the health of the people in the communities we serve. Conservation of resources is vital to Texas Health’s long-term sustainability and to the well-being of the people living in the communities we serve. Texas Health strives to be mindful of its footprint by consistently implementing sustainability efforts and looking for ways to improve.

As a health system, conservation is much more than simply using less energy and water. It’s about providing the most affordable, accessible, and appropriate resources that improve people’s health. Not only is conservation about making strategic investments to operate more efficiently and consume fewer materials, but it is also about reducing health disparities, addressing social determinants of health, and improving the health outcomes for North Texans who have limited to no resources at all.

Within our walls, we have taken steps to conserve natural resources. Texas Health strives to be mindful of its footprint, implementing constant sustainability efforts and consistently looking for ways to improve. From energy-efficient buildings to repurposing and recycling waste materials and low water-use irrigation, Texas Health is committed to conservation.

As a High Reliability Organization, Texas Health works to reduce any strain on both the natural and manmade resources we depend on to succeed. Only through prudent management can we lower operating expenses and the cost of care, achieve community health improvement goals, implement innovative business practices, and reduce the potential to harm for generations to come.

How is conservation and sustainability a part of Texas Health’s business strategy?

Texas Health proactively seeks ways to reduce waste and optimize efficiency with our hospital, which operates 24/7, and many of our other buildings are open several days a week. This saves money and reduces impacts on health and the environment. We focus on reducing consumption of:

• Energy: We incorporate efficiency into new building design and retrofit older equipment, lighting, and other systems to reduce expenses and carbon emissions. We conduct regular energy audits to monitor consumption and identify reduction opportunities.
• Water: To help sustain the growing North Texas population’s water needs, we use low-flow toilets, waterless urinals, and water-efficient irrigation systems. We also participate in the North Texas Healthcare Laundry Cooperative, which allows us to wash linens using 50% less water, chemicals, and energy than traditional laundry services. Additionally, to keep wastewater and stormwater discharges from exceeding local and state limits, we routinely inspect and test our water delivery systems as required by code. We also monitor long-term water availability by staying apprised of restrictions, forecasts, and storage capabilities.
• Materials: We conserve materials by buying less, reusing and recycling what we can, and responsibly disposing of what we must. We have established policies and protocols that reinforce the safe handling, storage, and disposal of materials to comply with local laws and regulations. A national waste disposal company trains our staff on how to handle medical and other hazardous waste properly. The company also removes chemicals, pharmaceuticals and other materials from our facilities. We divert hundreds of thousands of pounds of materials, including medical devices and single-use products, from landfills through recycling, reusing, or reprocessing initiatives.
• Supply Chain: Our supply chain management, specifically the creation of our for-profit supply solutions company, OnHand, is important to our business strategy. (See question, “What conservation and sustainability programs and projects does your company lead and participate in?” for more information on supply chain and diversity efforts).

What are Texas Health’s short and long-term goals as they relate to conservation and sustainability?

Moving into the future, Texas Health is committed to seeking new opportunities for conserving resources in all areas of their business and community operations.

For example, as the leader of a group purchasing organization, Texas Health sources high-quality equipment, medical supplies, and environmentally friendly products at a lower price. Texas Health saves $20 to $30 million in procurement costs for their supply chain. To stimulate regional economic growth, the system also purchases locally when feasible, and from minority and women-owned enterprises. (See question, “What conservation and sustainability programs and projects does your company lead and participate in?” for more information on supply chain and diversity efforts).

Texas Health also will continue to incorporate efficiency into new building design, retrofits, and upgrades to older equipment, lighting, and other operational systems to reduce expenses and carbon emissions. To monitor consumption and identify reduction opportunities, we conduct regular energy audits of our facilities.

Who at Texas Health is leading your conservation and sustainability efforts and what are some examples of employee engagement in conservation and sustainability at your company?

Conservation and Sustainability Leadership

Senior leaders from Finance, Supply Chain Management, Real Estate and Engineering make up the primary leadership team overseeing most conservation and sustainability initiatives/efforts. They are: Rick McWhorter, EVP and CFO; Brian Craft, SVP, Hospital Financial Operations; Brian Holmes, VP, Facilities Development/Construction; and Shaun Clinton, SVP, Supply Chain Management. Areas managed by these leaders span systemwide in our locations across our 16-county service region. 

At Texas Health, oversight of our high reliability initiative, clinical care, quality and safety, financial well-being, environmental conservation efforts, community service, and caring for underserved communities span many areas of the organization. Many departments are focused on ensuring that they meet the health and well-being needs of the people in their communities in the most holistic, safe, and efficient ways possible.

Employee Efforts: 

Texas Health’s employees care deeply about the health of the planet and support the company’s sustainability efforts through volunteerism and everyday actions to embed sustainability at home and at work. Their passion to create a healthier, more sustainable plant, along with their insights and ideas, has helped ignite some of Texas Health’s key initiatives. For example, Texas Health’s GreenTeam Colleague Resource Group (CRG) promotes awareness, provides education, and works to make environmental sustainability a relevant part of every employee’s role and responsibility. 

Texas Health also offers a robust Community Time Off (CTO) program, managed through Texas Health’s Community Affairs Department, where employees can volunteer up to one work shift a year on paid time to a charity of their choice. 

Texas Health employees contribute more than 11,000 hours annually working at more than 400 local non-profits on paid time and most give many more on their own time. A number of those projects are focused on conservation and sustainability, including food banks, farmers’ markets, community gardens, tree planting and park revitalization efforts. In spite of the pandemic, in the fall of 2020 Texas Health nurses volunteered nearly 1,000 hours to administer 5,000 influenza vaccines at 65 drive-through community events; 53 of the clinics targeted underserved communities with the greatest need.

When our CTO program was paused because of pandemic restrictions, Texas Health launched the Kindness Is Open! campaign with numerous opportunities for employees to volunteer virtually or from home, including:

• Working with United to Learn by creating a video or using a live virtual channel to share hobbies and your typical workday, and encourage children to explore new activities.
• Participating with Vogel Alcove on virtual story times by recording yourself reading a children’s story using your phone or other camera device. The focus is on children’s books about caring, love, learning concepts, family or any fun concept books for ages birth through age 4. These recordings were used in places caring for families who were experiencing homelessness. 
• Joining the North Texas Food Bank social media ambassador program to help spread the word about hunger and the mission to feed food-insecure children, families and seniors in our communities. 
• Creating handmade cards for VNA Meals on Wheels to distribute to clients when delivering meals. 

What conservation and sustainability programs and projects does Texas Health lead and participate in?

Supply Chain Management – Support in the Pandemic

Texas Health is committed to providing caregivers with the resources they need to protect themselves while safely caring for patients. In a pandemic, when global competition for personal protective equipment (PPE), masks, gowns, and ventilators was fierce, Texas Health worked nonstop to make sure we had adequate supplies across the system. Our Supply Chain Management teams are among the unsung heroes in our battle against COVID-19. They kept us operating safely and allowed us to care for our patients and each other.

Our relationship with Premier, a group purchasing organization, allowed us to invest in domestic mask and isolation gown manufacturing. These strategic investments are part of our overall plan to source critical supplies locally or in the U.S.

Texas Health’s strong financial position going into the pandemic allowed us to purchase all the supplies we could source, including PPE for front-line caregivers. While Texas Health received CARES Act funding from the federal government dispersed to hospitals and systems to help weather the pandemic, we did not need to take advantage of other federal funding relief sources. 

Throughout the year, Texas Health’s clinical leaders worked closely with Supply Chain Management to forecast the system’s supply needs. We developed a dashboard that incorporated near real-time data to monitor inventory fluctuations, which proved invaluable for determining the impact of various clinical decisions on our stock and consumption rate. This allowed us to monitor immediate needs and respond almost in real-time to protect our caregivers and patients.

COVID-19 exposed the fragility of the healthcare supply chain. Still, our prior experiences and a firm commitment to various domestic partners allowed us to manage and perform at the highest levels throughout surges.

As a group purchasing organization member, Texas Health sources high-quality equipment, medical supplies and environmentally friendly products at a lower price. To stimulate regional economic growth, we purchase locally when feasible and from minority- and women-owned enterprises.

Our vendors must comply with laws and regulations, abide by our business practices and meet our cost, quality, safety, and satisfaction standards. We evaluate their performance annually on approximately 30 criteria, including cost, quality, responsiveness and assurance of supply, and steps to reduce environmental and social impacts. If improvements are needed, we help create action plans. If we see little change in resolving issues, we may terminate a contract.

Our for-profit subsidiary, OnHand, powered by Texas Health Supply Chain Services, helps non-acute care providers and smaller organizations make their supply chains more efficient, affordable, and reliable. Participants receive access to Texas Health’s discounted purchasing contracts, robust materials management information system and operational expertise. This past year, Texas Health assisted several businesses in obtaining the supplies they needed.

During the pandemic, several new members joined the group, including Bass Performance Hall, The Bush Institute, and FC Dallas organizations. Texas Health assisted with their reopening needs, such as PPE for performers and visitors and with meeting their building requirements. 

Supply Chain Management – Diversity, Equity and Inclusion

Texas Health launched a comprehensive diversity, equity and inclusion initiative in 2021 and supply chain management is a significant piece.

Texas Health’s supplier diversity guiding principle is, “The health of our communities is not just based on the care we provide, but the ability to provide fair and equitable opportunities to all.” Another Supply Chain and Finance project is creating a way to identify, track, and support system spending with suppliers, contractors, consultants, and service providers that are Minority and Women Owned Businesses (MWOB). A report to identify and break out such businesses has been developed by the Enterprise Resource Planning team. Research to find an appropriate MWOB benchmark also is underway.

Texas Health Mansfield 

Texas Health Mansfield Hospital opened in 2021 with 95 beds and a medical office building. We used the AIA 2030 Commitment goals and the AIA Framework for Design Excellence as metrics to incorporate the greatest level of energy and water efficiency, healthy building materials, and occupant wellbeing aspects. Use of these tools helped the project achieve a 52% energy use intensity reduction while solar studies determined the best building orientation for a light-filled lobby and main concourse while minimizing solar heat gain.

Conservation features include the following:

• The project team was committed to mitigating the post-development effects to water quality and reliance on municipal water sources. The existing site was for agricultural purposes, and as such was gently sloped, with no natural streams on-site. All stormwater runoff was naturally managed via sheet flow prior to development. The developed site is designed to manage stormwater via sheet flow and underground storm drainage in the parking lots. The storm water is routed through a detention pond to maintain pre-project runoff rates and through hydrodynamic separators to remove trash and TSS prior to release into the municipal storm drainage system.
• Water conservation measures include low-flow plumbing fixtures for a 32% indoor potable water reduction and extensive use of native/adaptive plants with high efficiency irrigation resulting in a 59% outdoor potable water reduction. 
• Building materials and products were vetted through a rigorous specification review process that included analysis of the product’s lifecycle, verified through Environmental Product Declarations, and human health impacts verified through Health Product Declarations, safety data sheets, and emissions testing criteria.
• Efficient lighting and mechanical equipment provide a comfortable, hygienic space and still realize a 60% reduction in overall Energy Use Intensity. Our goal was to provide a building that improves human health and wellness through the responsible use of daylight and with attention toward improved indoor air quality.

In addition, Texas Health will open the Jane and John Justin Tower at its Texas Health Fort Worth campus in 2022. The nine-story patient bed tower will add 144 patient beds, 15 surgical suites, and a new preoperative and postoperative services area to the Texas Health Fort Worth campus, helping to address the healthcare needs of Tarrant County residents and other fast-growing communities the hospital serves.

Blue Zones Project® Fort Worth 

Texas Health’s Blue Zones Project® Fort Worth (BZP) is working with the city of Fort Worth, the Fort Worth Chamber of Commerce, and numerous other city and county governments and community partners to increase health and well-being in the city’s neighborhoods through a multitude of efforts. Among those is the land development for urban agriculture and park revitalization. BZP is the primary driver in creating Fort Worth’s Urban Agriculture Ordinance, allowing vacant lots to be converted to urban farms without rezoning and policy amendments allowing more farmers markets, which are necessary to distribute the produce grown in the urban farms. BZP is also involved in park revitalization efforts and the city’s active transportation plan designed to improve sidewalks, trails, and bike lanes. (See question “How do you see the future of conservation and sustainability evolving, and what role will your company play in that progress?” for more information about future efforts.

How do you see the future of conservation and sustainability evolving, and what role will Texas Health play in that progress? 

For Texas Health, conservation and sustainability remain a focus in all areas of our work — from how we care for our patients within environmentally friendly spaces to how we serve our communities in efforts to improve their health and wellness.

We’ve embarked on a culled produce recovery pilot in partnership with GE Foodland grocery stores. The pilot diverts produce that is culled by grocery stores into the hands of a community-based organization. The produce is either donated for consumption (if still safe to eat) or used for composting. The compost is donated to urban farms or school gardens within Fort Worth. To date, the participating farms have picked up approximately 500-1,000 pounds of food each week from each store. The pounds vary depending on the footprint of the store and  on how often each store culls their produce. We have enlisted the support of Carpool Compost, a commercial and community composting company, that will provide logistics of turning the discarded produce into organic materials for the urban farmers to use.

Texas Health, BZP, and the City of Fort Worth staff are working on a sustainability plan for volunteers and logistics. We are partnering with Carpool Compost to turn discarded produce into organic material for urban farmers. We hope the program can be expanded to all Fort Worth stores to support more urban farms and to grow from not only composting but to be able to donate the food that is perfectly edible to our Good for You Pantries. 

How does Texas Health quantify investment and return on conservation and sustainability?

Texas Health proactively seeks ways to reduce waste and optimize efficiency within their hospitals that are operating around the clock. Not only does this save money, but it also reduces impacts to human health and the environment.  

Texas Health incorporates efficiency into new building design, retrofits, and upgrades older equipment, lighting, and other operational systems to reduce expenses and carbon emissions. To monitor consumption and identify reduction opportunities, they conduct regular energy audits in their facilities. Since 2018, Texas Health retrofitted 1,740 retail locations with interior LED lighting, which reduced consumption by 75,000 MWh for estimated savings of $7.5 million in annual energy costs.

To help sustain the water needs of a growing North Texas population, Texas Health conserves their water use through low-flow toilets, waterless urinals, and water-efficient irrigation and operational systems. Texas Health conserved 80.55 million gallons of water during the last five years, enough to fill 131.6 Olympic-sized pools.

Texas Health strives to think ahead when it comes to conservation. For example, when building and facility engineers began designing Texas Health Frisco, they visualized an environmentally friendly health campus that optimized water conservation. They installed an efficient irrigation system, collected rainfall and air conditioning condensation, and built an underground retention pond that naturally filters runoff. Frisco gets more rain than much of Texas, about 45 inches annually, and these measures will likely save 500,000 gallons of water and reduce utility costs by more than $50,000.

NOTE: This information was accurate in 2019 and likely is still accurate, though exact numbers may not be the same. However, 2020 and 2021 information is not available at this time.

What is the one lesson that Texas Health has learned from your conservation and sustainability efforts that others can take back and think about applying within their own space?

Supply chain within the U.S. healthcare industry has learned that it must value domestic production of key supplies more than in the past. The classic supply chain value equation is that quality, service and cost add up to value, and product availability has always been assumed. What we’ve learned over the past 17 months is that we can no longer assume products will be available when we need them, so we have to add availability to the equation which also means expanding and diversifying our resources. 

Why is Texas an important home or base of operations for Texas Health?

Texas Health is based in Texas. It’s where we serve a service region of 7 million residents and care for more than 2 million annually. It’s also where our 24,000 employees live, work, pray, and play. We are deeply invested in our state and its healthcare industry, through financial and charitable giving as well as through our employees and community partners.

Serving our neighbors and improving community health is rooted in our mission. As a faith-based nonprofit, Texas Health is committed to providing health services and support that lead to measurable, sustainable improvements in our communities. Protecting North Texans’ financial, emotional, mental, and physical well-being is Texas Health’s calling, which takes great pride in the Lone Star State and in its role as a healthcare leader.

In 2020, Texas Health invested more than $756 million back into the North Texas community through community benefit. 

Learn more about Texas Health’s conservation and sustainability efforts here.

Definitions:

• TSS (Total Suspended Solids): a pollutant made up of undissolved particles in water 
• Energy Use Intensity (EUI): a building’s energy use in relation to its size; EUI is calculated by dividing the total energy consumed by the building in one year (measured in kBtu or GJ) by the total gross floor area of the building
• High Reliability Organization: organizations that operate in complex, potentially hazardous domains for extended periods without serious accidents or catastrophic failures