Sustainability Initiative Part 6
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Assignment
Week 6 Individual Assignment: Sustainability Initiative, Part 6
Week 6 Individual Assignment: Sustainability Initiative, Part 6
Assignment Content
Resource: Annotated Bibliography Template
Finalize your sustainability initiative by combining parts 1 through 5 of the sustainability initiative assignments:
Sustainability initiative proposal
Analysis of the costs and benefits associated with your initiative
Evaluation of how your initiative will improve patient care and outcomes
Evaluation of how your initiative will reduce waste
Suggestions for community partnerships and education programs
Petition to the leadership for resources to enact the initiative
Compile a 6- to 8-page paper of your sustainability initiative. Include diagrams, flowcharts, and other visuals that support your initiative.
Create an annotated bibliography that contains each article you identified in the Weeks Two through Five Article Search assignments and include it in your paper.
Create a Summarize the initiative, discuss short- and long-term sustainable needs, identify obstacles, and emphasize the benefits of the initiative.
Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
Format your assignment according to APA guidelines.
Running head: SUSTAINABILITY INITIATIVE IN A HOSPITAL 1
SUSTAINABILITY INITIATIVE IN A HOSPITAL 4
Sustainability Initiative in a Hospital
Students Name
Institution
Date
Sustainability Initiative in a Hospital
Introduction
Sustainability is becoming a vital concern in the modern health care setting. Due to its high demand, it has developed into an important concept adopted by the majority of the health care setting to enabled hospitals to cut the cost of operation while offering quality customer services. Sustainability initiative, in this instance, is defined as ways in which organizations seek proper options in place to create quality services, which not only leads to cost reduction but also improve customer satisfaction. Most health care centers minimize cost by enabling access to treatment services on time, improving the patient’s outcome, and minimizing the time the patients stay in hospitals. The health care setting I have chosen, in this case, Mercy Medical Center, which provides health care to patients.
Roles of departments
In this health care setting, various departments deal with discharging of various health services provided by the hospital. The emergency department deals with medical treatment with no prior appointments. Most of the cases here may be life-threatening; therefore, the initial treatment must be extended to cover all forms of illness, including assessing the vital organs. When the patients are not responding to treatment or seriously injured, they are taken to resuscitation areas. Here they are attended by mostly one doctor and two nurses with training on trauma and advanced cardiac life support training, according to ( Lockey, Lin, Cheng,2018). High-level testing may be done here, such as testing blood, CT, or MRI scans, to determine if the patients should be discharged or admitted for further treatments.
The intensive care units are where patients who are in critical conditions are placed in life-supporting equipment, so as they can be closely monitored by highly trained doctors and nurses who monitor their responsiveness to medical treatments to ensure they recover. Radiology is where the test of images is done, that is where many diseases are diagnosed, and treatment progress is monitored to be able to speculate the outcome. It is achieved by performing x-rays, CT scans, and ultrasounds on the patients. Pathology or the laboratory is a department that deals with testing fluids and secretions from the patient’s body to determine the infections. Standard tests conducted include blood tests, urine tests, and stool tests to identify any forms of infection.
Energy sustainability
Cutting energy consumption leads to a reduction in operating costs in the health care facility. After doing research and analyzing the information collected, I realized there is a lot of inefficiency usage of energy in health care. I notice there is need to benchmark the energy performance in the hospital using Agency (EPA’S) Energy Star Portfolio Manager, which is a free tool that allows facilities to track their energy usage and compare to their energy use intensity measurement to national average according to ( Kono, McNulty, Abramson,2020).
Data collection methods used
Through holding forums with the hospital staff and customers, I was able to get ideas, their opinions, and their thoughts on anyways they may like changes relating to the lightings or power usage in the hospital. In this forum, I was also able to note any problems that might occur in case of any changes done on how energy is utilized there. This, therefore, enables one to have a basis on all the plans. Also, through holding interviews with friends and individuals from other hospitals who provided the best insight as most of them have solved or encountered such challenges of energy mismanagements and have been able to solve them.
Method to adopt in minimizing the energy wastage
Through the energy initiatives, energy utilization reduction can be achieved in various ways, upgrading the lighting system in place by use of LED lighting, which is more efficient and has a longer lifespan than the commonly used incandescent lamp. Heating and cooling of unoccupied areas in the hospital should be reduced, such as in empty halls. There is also the use of sensors to turn off the various machines in the hospital when they are not in use. By sensitizing the workers in the hospital on the importance of energy conservation can also contribute to the reduction of unnecessary usage of power when not required.
Expected outcomes
The cost of energy is expected to go down, given that energy is 50% 0f a health care facility managers budgets according to (Maiorano, 2018). These initiatives will help in saving approximately 20%-30% of the energy used in the hospital. Since the lighting in hospital and machine and equipment operation used in health care contribute to the highest usage of energy by using smart lighting and upgrading to LED, it will lead to usage of low energy, therefore, minimizing the cost of operation.
Conclusion
The health care can achieve their goals by adopting energy efficiency initiatives. The major goals of a hospital are to be able to offer quality services to its customers at cost-effective means. Energy is one of the important utility in hospital operations and activities and It should be utilized in ways that there is a value obtained on its use. Therefore initiative that minimizes energy wastage should be encouraged and widely applied to reduce the cost of running the hospital.
References
Kono, J., McNulty, M. K., & Abramson, B. (2020). Raising the Bar: Comparing Building Energy Benchmarking Methods.ASHRAE Transactions,126(1).
Lockey, A., Lin, Y., & Cheng, A. (2018). Impact of adult advanced cardiac life support course participation on patient outcomesa systematic review and meta-analysis.Resuscitation,129, 48-54.
Maiorano, J. (2018). Beyond technocracy: Forms of rationality and uncertainty in organizational behavior and energy efficiency decision making in Canada.Energy research & social science,44, 385-398.] Running head: SUSTAINABILITY INITIATIVE IN A HOSPITAL 1
SUSTAINABILITY INITIATIVE IN A HOSPITAL 4
Sustainability Initiative in a Hospital
Students Name
Institution
Date
Sustainability Initiative in a Hospital
Introduction
Sustainability is becoming a vital concern in the modern health care setting. Due to its high demand, it has developed into an important concept adopted by the majority of the health care setting to enabled hospitals to cut the cost of operation while offering quality customer services. Sustainability initiative, in this instance, is defined as ways in which organizations seek proper options in place to create quality services, which not only leads to cost reduction but also improve customer satisfaction. Most health care centers minimize cost by enabling access to treatment services on time, improving the patient’s outcome, and minimizing the time the patients stay in hospitals. The health care setting I have chosen, in this case, Mercy Medical Center, which provides health care to patients.
Roles of departments
In this health care setting, various departments deal with discharging of various health services provided by the hospital. The emergency department deals with medical treatment with no prior appointments. Most of the cases here may be life-threatening; therefore, the initial treatment must be extended to cover all forms of illness, including assessing the vital organs. When the patients are not responding to treatment or seriously injured, they are taken to resuscitation areas. Here they are attended by mostly one doctor and two nurses with training on trauma and advanced cardiac life support training, according to ( Lockey, Lin, Cheng,2018). High-level testing may be done here, such as testing blood, CT, or MRI scans, to determine if the patients should be discharged or admitted for further treatments.
The intensive care units are where patients who are in critical conditions are placed in life-supporting equipment, so as they can be closely monitored by highly trained doctors and nurses who monitor their responsiveness to medical treatments to ensure they recover. Radiology is where the test of images is done, that is where many diseases are diagnosed, and treatment progress is monitored to be able to speculate the outcome. It is achieved by performing x-rays, CT scans, and ultrasounds on the patients. Pathology or the laboratory is a department that deals with testing fluids and secretions from the patient’s body to determine the infections. Standard tests conducted include blood tests, urine tests, and stool tests to identify any forms of infection.
Energy sustainability
Cutting energy consumption leads to a reduction in operating costs in the health care facility. After doing research and analyzing the information collected, I realized there is a lot of inefficiency usage of energy in health care. I notice there is need to benchmark the energy performance in the hospital using Agency (EPA’S) Energy Star Portfolio Manager, which is a free tool that allows facilities to track their energy usage and compare to their energy use intensity measurement to national average according to ( Kono, McNulty, Abramson,2020).
Data collection methods used
Through holding forums with the hospital staff and customers, I was able to get ideas, their opinions, and their thoughts on anyways they may like changes relating to the lightings or power usage in the hospital. In this forum, I was also able to note any problems that might occur in case of any changes done on how energy is utilized there. This, therefore, enables one to have a basis on all the plans. Also, through holding interviews with friends and individuals from other hospitals who provided the best insight as most of them have solved or encountered such challenges of energy mismanagements and have been able to solve them.
Method to adopt in minimizing the energy wastage
Through the energy initiatives, energy utilization reduction can be achieved in various ways, upgrading the lighting system in place by use of LED lighting, which is more efficient and has a longer lifespan than the commonly used incandescent lamp. Heating and cooling of unoccupied areas in the hospital should be reduced, such as in empty halls. There is also the use of sensors to turn off the various machines in the hospital when they are not in use. By sensitizing the workers in the hospital on the importance of energy conservation can also contribute to the reduction of unnecessary usage of power when not required.
Expected outcomes
The cost of energy is expected to go down, given that energy is 50% 0f a health care facility managers budgets according to (Maiorano, 2018). These initiatives will help in saving approximately 20%-30% of the energy used in the hospital. Since the lighting in hospital and machine and equipment operation used in health care contribute to the highest usage of energy by using smart lighting and upgrading to LED, it will lead to usage of low energy, therefore, minimizing the cost of operation.
Conclusion
The health care can achieve their goals by adopting energy efficiency initiatives. The major goals of a hospital are to be able to offer quality services to its customers at cost-effective means. Energy is one of the important utility in hospital operations and activities and It should be utilized in ways that there is a value obtained on its use. Therefore initiative that minimizes energy wastage should be encouraged and widely applied to reduce the cost of running the hospital.
References
Kono, J., McNulty, M. K., & Abramson, B. (2020). Raising the Bar: Comparing Building Energy Benchmarking Methods.ASHRAE Transactions,126(1).
Lockey, A., Lin, Y., & Cheng, A. (2018). Impact of adult advanced cardiac life support course participation on patient outcomesa systematic review and meta-analysis.Resuscitation,129, 48-54.
Maiorano, J. (2018). Beyond technocracy: Forms of rationality and uncertainty in organizational behavior and energy efficiency decision making in Canada.Energy research & social science,44, 385-398.] Running Head: WEEK 3: ARTICLE SEARCH 2
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WEEK 3: ARTICLE SEARCH 2
2
Week 3: Article Search 2
Students Name
Institutional Affiliations
Week 3: Article Search 2
The World Health Organizations article supports the sustainability initiative that I am developing for my selected health care setting by providing recommendations on how the quality of health care can be improved in a healthcare facility. It mentions how pregnant women should be given priority in health care facilities at appropriate times. Newborns are also supposed to be cared for as soon as they are born. The women and children are also supposed to receive proper protection against hospital-acquired illnesses. The article also mentions that a healthcare setting has to have a healthy and clean environmental setting to provide better care to patients. Communication channels should also be effective, and health caregivers should always be prepared to attend to the needs of patients at all times. Women should not be placed under pressure, pain, or harm during prenatal, childbirth, and postnatal period.
References
WHO (World Health Organisation). (2020). 10 Ways to improve the quality of care in health facilities. Retrieved August 01, 2020, from https://www.who.int/news-room/feature-stories/detail/10-ways-to-improve-the-quality-of-care-in-health-facilities Running Head: WEEK 3: SUSTAINABILITY INITIATIVE, PART 3
1
WEEK 3: SUSTAINABILITY INITIATIVE, PART 3
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Week 3: Sustainability Initiative, Part 3
Students Name
Institutional Affiliations
Week 3: Sustainability Initiative, Part 3
The patient services offered in Maryland health centers include Surgery, pediatric services, emergency services, addiction counseling, and cancer treatment. Several services were affected by my sustainability initiative, for starters, patients in intensive care units and in emergency sections were more likely to avoid cross-infection because of the expanded hospital rooms and more bed installations that made sure that patients maintained a two-meter distance and that they were offered more personalized care, due to the energy-efficient technology used as for the customer care services provided by the health care facility, waste disposal and cleaning improved because there was a more organized way of disposing of waste substances due to environmentally positive bins being placed all over the hospital within and also outside (Chand et al., 2020).
My sustainability initiative also promoted the use of white-colored bins for the disposal of medical waste and blue ones for the destruction of regular trash. The purpose of this was to prevent confusion and protect the hospitals cleaning staff from getting injuries or infections from syringes and other sharp objects. There was a need to hire more cleaning staff to make the hospitals environment more recovery friendly for the patients. Technologically advanced air purifiers, wireless communication, and solar-powered lightings in the rooms of patients and offices promote the use of green energy in other hospitals.
My sustainability initiative will improve patient care and outcomes in the following ways:
The white bin-blue bin initiative will be beneficial in many ways. It will reduce the risk of exposure to dangerous waste substances such as blood and bodily fluids to the patients, health care workers, and the hospitals cleaning staff. Such an action, therefore, prevents the risk of transmission of infections to the parties mentioned above. This initiative will also reduce the expenses that the hospital makes in treating cross-contamination among patients; therefore, most funds directed towards improving personalized care. The cost of treatment incurred by the patients is also more likely to decrease; hence the patients would obtain proper quality treatment at lower prices. This initiative would be beneficial in saving time since the procedure of sorting medical waste from regular waste would be reduced (Chand et al., 2020). This would make it easier for the cleaning staff since they would know that the garbage in the white bags is the medical ones and that they have to undergo treatment before being damaged.
My air-positive initiative would be beneficial to the improvement of patient care and outcome in the following ways. The use of air purifiers would be advantageous to patients with respiratory conditions because the hospital air would be free from the smell of chemicals, medicine, and scents from hospital workers. Air purifiers are also energy-efficient ways of cleaning the air. They, therefore, help in air ventilation as well as cutting down the amount of money spent on paying electricity bills. Lower electricity bills mean that more money gets allocated to other sectors of the facility. Air purifiers would further help in keeping microorganisms free from the hospital atmosphere. Therefore, during situations where there are dangerous and infectious airborne diseases such as COVID-19, the patients would rest easy knowing that the health care facility would be more of a haven for them (Wu & Liu, 2020).
My solar lighting initiative would also go a long way in ensuring that patient care improves because of the suns energy, which powers solar lighting. The hospital would, therefore, incur very little in terms of electric bills (Shalini, 2019). Consequently, the hospital would be adequately lit during the day and night, hence proving that the hospitals management is one that encourages growth and productivity. The patients and health care providers would, therefore, never have to worry about blackouts or power surges. The health caregivers would consequently be able to carry out with their duties during the daytime as well as at night.
References
Chand, S., Shastry, C. S., Hiremath, S., Joel, J. J., Krishnabhat, C. H., & Mateti, U. V. (2020). Water, sanitation, hygiene, and biomedical waste disposal in the healthcare system: A review.Biomedicine,40(1), 14-19.
Shalini, D. (2019). Development of an Energy Management System for Tertiary Care Hospital, with Special Emphasis on Lighting.Indian Journal of Public Health Research & Development,10(11).
Wu, M., & Liu, K. (2020). Air purification in confined spaces.E&ES,446(3), 032072. SUSTAINABILITY INITIATIVE PART 5 1
Sustainability Initiative Part 5
Name of Student
Instructor
Date
Sustainability Initiative Part 5
Energy efficiency is a huge problem in the health care sector given the high energy per unit floor area. To achieve success in the haunt for sustainability energy sustainability initiative, there is need to embrace a comprehensive approach where all shareholders are involved. Within the healthcare facility, the management must coordinate the search for areas where wastages occur due to wasteful usage as well as bulbs that use the least energy without compromising on quality. Outside the health care facility, suppliers are engaged in sourcing and supply of energy saving bulbs to ensure energy lost in lighting the facility is reduced. The hospital will partner with the community through area leaders to conduct awareness on energy use. Patients, family and friends are part of the people who use hospital rooms and they have access and partial control over energy use through lighting, powering devices like phones, laptops, television as well as instant showers. They need to be aware of what they can do to ensure there is energy efficiency.
Social Media Posts
First Post
It is important that we all switch off lights when we have enough natural light. This helps conserve power and saves thousands of Dollars each year in energy costs. Please help us reduce cost of service provision by improving on energy saving. Let us grow this culture within our families.
Second Post
When you go shopping for bulbs to use at home or in your premises, you are making a decision on how high or low the power bills will go. Make this one decision wisely. Choose energy saving bulbs, save a few dollars each day.
Third post
Did you switch off the television set in your room today? Are there idle devices that are still connected to power? It is important that they are only switched on when they ae needed otherwise they should be off. Take control of your power bills. Help us achieve the highest possible levels of energy conservation by switching off nay devices that are not in use.
Fourth Post
There are many people within your circles who dont understand that by simply buying energy saving bulbs, switch off bulbs that are not in use and disconnecting devices that are idle from power could save them a lot. Please spread this information and lest grow a culture of energy conservation. It is a great way of reducing the energy consumption per unit floor area. Running Head: ARTICLE SEARCH 3
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ARTICLE SEARCH 3
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Article Search 3
Students Name
Institutional Affiliations
Article Search 3
My white bag- red bag initiative addresses the issue of dropping the wrong kind of waste in any bin. It encourages the patients and the medical staff to segregate the hospitals waste through dropping reusable waste materials in the white bags and other medical wastes in the red bags. Color coding the bags helps waste disposal to be easy and more efficient, therefore saving the cleaning staff time as well as keeping them away from risking their health when separating the trash for disposal or recycling. The pictorial signage on the bags would also help people within the hospital environment to know the kind of waste that should go into each bag. Visual signage is usually important in helping people to understand instructions better. My initiative also advocates for the placement of these waste bags far from one another to encourage people to drop waste material in the right kind of bags. Placing them side by side would make persons within the hospital to ignore the white bag-red bag rule (Reynolds et al., 2019).
Some of the practices that I can employ in my sustainability initiative include:
Being intentional about my sustainability initiative. I would make the initiative my priority in every way by incorporating it in every aspect of the hospitals operations. I would further assign accountability to the cleaning staff and measure the results.
I am partnering with other employees at the hospital. I would work together with the hospitals cleaning department through training them on how the initiative works and show them how it would be an easier way to reduce waste and manage it, hence conserving resources. Through working with employees, I would get the chance to solicit ideas from them on how to make the initiative better or use a similar idea in a different department within the hospital (Wheeler et al., 2018).
References
Reynolds, C., Goucher, L., Quested, T., Bromley, S., Gillick, S., Wells, V. K., & Svenfelt, . (2019). Consumption-stage food waste reduction interventionsWhat works and how to design better interventions.Food Policy.
Wheeler, L., Guevara, J. R., & Smith, J. A. (2018). Schoolcommunity learning partnerships for sustainability: Recommended best practice and realityInternational Review of Education. HEALTH- CARE WASTES 6
HEALTH-CARE WASTES
Students Name
Institution
Course
Running Head: HEALTH- CARE WASTES 1
Date
Createan infographic that illustrates each type of waste in the health care industry. Include descriptions of the waste, sources for the waste, how much is generated per year, how it is disposed, and solutions for reducing it.
Sources of healthcare waste
Hospital and health services
Laboratories and studies stations
Mortuary and autopsy stations
Animal study and testing laboratories
Blood banks
Healthcare industry
Types of wastes
Infectious wastes
Pathological waste
Sharp wastes
Chemical wastes
General and non-hazardous waste
Pharmaceutical waste
Cytotoxic waste
Reduction methods
Recycling
Creating awareness on risks of healthcare wastes
Strategizing plans on controlling waste products
Disposal methods
Plastic bins
Burning the waste materials
It is acknowledged that of the entire waste created through health-care activities, 85 percent is considered to be general and non-hazardous waste. The other 15 percent is considered to be dangerous materials that may end up to be toxic and infectious to the people. It is approximated that 16 billion injections are then administered annually across the world despite that not all used needles and syringes are well disposed after usage. When open burning is considered as a way of destroying such materials to avoid infections, there might be emissions of dioxins and particulate issues. Thus, there should be measures to make sure there is safe and surrounding management of health care wastes. This is likely to prevent contrary health and surrounding effects from the wastes entailing unintentional release of chemical to the environment then securing the health of patients, workers and the community in general (Diaz et al., 2018).
Types of wastes
Both wastes and by-products entails a varied variety of resources as given bellow;
Infectious wastes
This kind of wastes entails contaminated wastes with blood and maybe other bodily fluids and even stocks of infectious matters from laboratory work. These are things like swabs, bandages etc.
Pathological waste
These wastes are made up of matters like human tissues, organs and even fluids.
Sharp wastes
These are objects like needles, syringes, blades, disposable scalpels etc.
Chemical wastes
Chemical wastes are inform of solvents and maybe reagents used during preparation for laboratory activities, disinfectant, sterilants and heavy metals within medical devices.
Pharmaceutical wastes
These are substances like unused, expired and contaminated drugs.
Cyctotoxic waste
These are kind of wastes that contains genotoxic matters. They includes substances like cyctotoxic drugs used to cure cancer and their metabolites.
Radioactive wastes
These wastes includes products contaminated through radionuclides materials.
General and non-hazardous waste
Theese are acknowledged to be wastes materials that does not pose any certain biological chemical or danger.
Main sources of health care wastes
Much of the health care wastes comes from hospital and health services, laboratories and studies stations, and mortuary and autopsy stations, animal study and testing laboratories, blood banks and finally from nursing homes for the elderly people. According to the existing information given by WHO, high income nations are noted to be creating an average of 0.5 kg of dangerous wastes in every hospital bed on daily basis. The less developed nations on the other hand are generating 0.2 kg. Nevertheless, both dangerous and non-dangerous wastes are not separated for the well up and poor nations hence coming up with the real amount of dangerous wastes much higher.
Disposal methods
Within the health care settings, the disposable bins situated strategically where used materials are placed after usage for disposable. In most case, such material are burned hence leading air pollutions to the environments. At some point, the healthcare wastes are not well disposed since they are thrown un-treated and can end up causing harm to the people around.
Reduction methods
The health care management needs to have high attention and diligence in order to evade adverse health results connected with poor practices such as exposure to infectious substances or agents (Muluken, Haimanot & Mesafint, 2014). Another approach that can be used to reduce wastes products in the health care industries includes coming up with plans and systems together with firm oversight and control in order to enhance waste segregation. Further, there is need to focus on risks concerns based on health care wastes to ensure people are not at the risk of the same. Some of those products can be recycled as way of reducing waste products in the surrounding (Bush, 2007).
References
Bush, R. W. (2007). Reducing waste in US health care systems.Jama,297(8), 871-874.
Diaz, L. F., Eggerth, L. L., Enkhtsetseg, S. H., & Savage, G. M. (2008). Characteristics of healthcare wastes.Waste management,28(7), 1219-1226.
Muluken, A., Haimanot, G., & Mesafint, M. (2014). Healthcare waste management practices among healthcare workers in healthcare facilities of Gondar town, Northwest Ethiopia. ARTICLE SEARCH 1
Article Search
Name of student
Institution
Date
Article Search
Kaplan et al., provides an overview of sustainable hospital setup and how the same can be used to cut down on costs. The healthcare sector is one of the areas with huge and expensive environmental footprints. Most of the facilities have machines and equipment that run on high energy requirements and therefore there is need to ensure that energy saving mechanisms are implemented to cut down on energy consumptions. This helps ensure energy efficiency in the health care system. Kaplan et al. through their study were able to achieve huge saving after cutting down on energy consumption as well as minimizing on wastages especially on lighting and choice of bulbs. This supports my sustainability initiative based on energy efficiency. Once energy efficiency has been achieved the cost of services is revised accordingly ensuring patients also benefit. Efficiency can be achieved to a great extent by ensuring patience education on use of energy consuming devices in their rooms among other aspects.
Castro et al., 2015 explores several action plans designed to ensure that operating costs and resource consumption in the healthcare sector is reduced accordingly to ensure sustainability measures work to produce positive results. Apart from minimising environmental impact measures are being taken to ensure that wastages are fully cut off. Healthcare sector remains one of the most regulated as well the highest consumer of energy per unit floor area. Given the different scenarios that different hospitals operate there is need to rely on a bench mark for ensuring that there is a standard that can be used to gauge energy use. Castro et al., provides a platform for building sustainability assessment (BSA). This is therefore a key resource in building my energy efficiency sustainability initiative.
References
Castro, M. D. F., Mateus, R., Serdio, F., & Bragana, L. (2015). Development of
benchmarks for operating costs and resources consumption to be used in healthcare building sustainability assessment methods.Sustainability,7(10), 13222-13248.
Kaplan, S., Sadler, B., Little, K., Franz, C., & Orris, P. (2012). Can sustainable
hospitals help bend the health care cost curve?. Commonwealth Fund. Title
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