Wednesday 30th May 2018  
Go green
Private hospitals are sustainable
Visiting recently the Svalbard Archipelago at the far North of Europe, I observed how fragile the wilderness is. The respect of environment is not a declaration but a fact to be included in everyday life, at home and moreover in our organizations. European Private Hospitals are engaged in Sustainable Development. Today begins the European Sustainable Development Week 2018, and the May edition of the UEHP Newsletter is proud to demonstrate the implication of private facilities, which have reached the highest international “green” standards. We support positive experiences from the first blueprint of a new hospital building to waste management projects. Specific investments are required, but the most important satisfaction is to express the professional involvement of hospital teams for the same sustainable goal: to offer the best services for patients and to protect our planet altogether!
Dr Paul Garassus
President of UEHP
Patient mobility: UEHP makes its voice heard in EU and outside
This month, the UEHP Secretary General, Ms Ilaria Giannico, was invited to speak about patient mobility and the position of Private hospitals in two different congresses:
3 - 5 May, Izmir: 8th International Health Tourism Congress
14 - 15 May, Athens: European Medical Tourism & Global Healthcare
European Medical Tourism & Global Healthcare, Athens, 14 - 15 May
Ilaria Giannico, UEHP Secretary General
International Health Tourism Congress, Izmir, 3-5 May
Family picture at the 8th International Tourism Congress
Same topic but different questions, conclusions and results
In Turkey, being outside EU, the discussions were more focused on trying to understand which possibilities does the EU directive 2011/24 open for cooperation with non-EU countries.
In Athens the discussions focused more on what are the difficulties and obstacles affecting the real implementation of the Directive on cross border healthcare and what should be done at all levels, from the regional one to the international one to foster its full adoption in Europe.
Ms Giannico stressed that private hospitals in Europe promote patients mobility as well as the right of the patient to choose where to be treated. UEHP recognises the full potential of the cross border Directive and believes that it is a unique chance to offer competitive healthcare services “on time” to a well informed patient, thus contributing to reducing waiting lists in all Member States. 
1st Iberian Summit on Private Health, April 2018, Madrid 
From l.to.r. : Hans Martens (European Health Economics Expert), Dr Paul Garassus (President of UEHP), Dr. Enrique Ruiz Escudero (Health Advisor, city of Madrid), Cristina Contel (President of ASPE), Oscar Gaspar (President of APHP), Carlos Rus (ASPE Secretary General).
European health systems are unfeasible without the collaboration of private healthcare. This is the main conclusion of the report "Private Hospitals in Europe: Supporting Sustainable Health Systems" written by Hans Martens, Senior Advisor of the European Policy Center, in collaboration with the European Union of Private Hospitals (UEHP). This document has been presented at the 1st Iberian Summit on Private Health organized by the Alliance of Private Health of Spain (ASPE) and the Portuguese Association of Private Hospitals (APHP), which was held on April 26 in Madrid.
This study raises a reflection on the role played by the private health sector in Europe, which is constantly developing. Likewise, the study defends the place that private healthcare has to occupy in a very competitive environment; an environment in which one must bet on the professionalization of management and strategies adapted to the current situation, in which a broad offer characterized by innovation constantly prevails.
As explained by Cristina Contel, President of ASPE, "private healthcare is a fundamental economic driver and is crucial to ensure the sustainability of health systems, not only in Spain but throughout Europe. Private healthcare is essential to guarantee high-quality healthcare at the highest level to all citizens". Dr Paul Garassus, President of UEHP, stated that without the private healthcare sector, it would be impossible for public services to meet the demand of all citizens. In this respect, the private healthcare sector should not be seen as simply complementary.
The percentage of the Gross Domestic Product (GDP) that Spain and Portugal allowed to Health is similar. Both countries are among those with the highest percentage of health expenditures allocated to private healthcare (33.8% in Portugal and 29% in Spain) according to figures from 2015, which are above the OECD average.
According to Oscar Gaspar, President of the APHP, "elements such as the recognized excellence in the provision of care, management flexibility, staff management, the ability and willingness to invest and, in particular, the place of the patient at the heart of the health system, render the private hospital sector attractive for Portuguese citizens, which are free to chose their institutions."
Sustainability and Transparency of Health Investments, Moldavia
From l.to.r. : Ilaria Giannico (UEHP Secretary General), Jane Alop (International Expert, Estonia), Dr Paul Garassus (President of UEHP), Olga Schiopu (President UIMSP), Aliona Grossu (Director UIMSP).
Attracting and Maintaining Investments in Health - an Objective to Ensure Sustainability and Performance of Medical Services in Moldova
On 11 May, the High Level Experts Meeting "Sustainability and Transparency of Health Investments" took place in Chisinau. The event was organized by the Union of Private Healthcare Providers of the Republic of Moldova (UIMSP), the member of the UEHP, in partnership with the Economic Council of the Prime minister of the Republic of Moldova.
The issues addressed by the national and international experts participating at the event touched upon the sustainability of the health system by attracting and maintaining investments; the need to strengthen mechanisms to ensure the transparency and efficiency of the allocation of funds; the aim to promote good practices and health expertise from the EU Member States in the Republic of Moldova.
“It is important to ensure efficient, transparent and evidence-based use of the limited financial resources in any country. In the Republic of Moldova, it is necessary to create a unique database with the performance and quality indicators of all healthcare institutions, which must be permanently updated. We count on the role of such events and professional cooperation to promote the European strategies and practices at the national level as well as to strengthen the image of the Republic of Moldova in the context of ensuring sustainable development based on advanced solutions and innovative approaches.”
The president of the European Union of Private Hospitals (UEHP), Dr Paul Garassus, who participated, is a keynote speaker at the event talked about the future of sustainable healthcare systems a new partnership with European private providers. „The private sector combines a positive attitude towards innovation with strong managerial efficiency. Its role can be to "rationalize" the system and build feasible private public partnerships.” mentioned Dr Paul Garassus
At the event, international and Moldovan experts also discussed potential actions that will ensure the transparency and efficiency of fund allocation in health, the promotion of European strategies and practices, and the establishment of a dialogue and cooperation platform for all parties involved. 
On the margins of the high level experts meeting, the bilateral meeting with the Minister of Health, Labour and Social Protection Svetlana Cebotari as well as the senior advisor on health issues to the Prime-minister Mircea Buga took place, allowing for a more detailed discussion of the potential for future strengthening of the partnerships as well as good practices that could contribute to the reform and modernization of Moldovan healthcare system.
Inflation in Poland is going up
In April the index of consumer goods and services was up by 0.5% on a month-to-month basis, or 1.6% on an annual basis, the Main Office of Statistics [PL: GUS] said. Compared to the same period last year, according to GUS, in April prices of food and non-alcoholic beverages went up by 4.1%, alcohol and tobacco by 1.7%, home-related prices by 2%, health care by 1.4%, education (2.1%), restaurants and hotels (2.8%), recreation and culture (0.9%) and telecommunications (up by 0.1%). Prices of clothing and footwear fell by 3.8%, transportation by 0.1% and other goods and services by 0.7%.
Polish GDP in 1Q18 rose by 1.6% q/q and by 5.1% on a y-o-y basis, according to preliminary GUS estimates. The number is better than expected by economists, who estimated GDP growth at 1.3% q/q and 4.9% on a y-o-y basis. According to the economists, GDP growth rate close to 5%, seen in recent quarters, won’t last. The European Commission expects Poland’s GDP growth to slow down to 4.3% this year and 3.7% in 2019. Meanwhile, according to preliminary GUS estimates, GDP in 2017 totaled PLN 1.982bn.
Energy champions
From l. to r. W. Klumpp ( Mayor), Prof. Dr. Dr. N. Grulke (Medical Director), S. Wahl (Head of Board), A. Dickhoff (BUND e.V.), B. Frieß (BUND Baden-Württemberg), H. Meinel (Secretary), J. Gwinner (District Administrator); Foto: H. Dulling
For German hospitals, sustainability is tiny linked with energy efficiency, so that the technical director is the man. Very early, in 2001, the association BUND e.V (Friend of the earth Germany) has developed the Energy-Saving Hospital Label (Energie sparendes Krankenhaus Gütesiegel), an award any hospital in Germany can acquire upon the evidence of saving energy on a large scale and reducing its CO2 output.
In Germany alone, up to 600 million Euros for energy supply have already been saved by the hospitals following the programme, thus avoiding the production of 6 million tons of harmful CO2, without any restrictions to the clinic’s services – often even increasing comfort.
Two private hospitals are among the 49 detaining the energy label. The Luisenklinik Bad Dürrheim in Baden-Württemberg, which has become the Energy-Saving Label for the third time, attesting a continuous ambition to become more sustainable. Despite the increase in the number of beds, the facility has saved another 32.7 % of CO2 emissions since 2012. In the same time, the energy consumption average has been reduced from about 155 to 70 kWh per square meter per year, approaching an energy consumption of a private household.
The Hessische Bergland private clinic is about to renew the label for the second time. Major technical improvements since 2008 have enabled the clinic to become energy efficient.
Climate Manager in hospital
The private clinic Schön in Munich Harlaching has followed the KLIK initiative created by the association BUND e.V and supported by the Federal Ministry for the Environment, which aims at training climate managers in hospital in order to enhance reductions of CO2 emissions by at least 10% with non invasite measures and much more if technical adaptations are chosen. Between 2015 and 2016, the Schön clinic, which has conducted many different projects to become more energy efficient, installed a new cogeneration plant, generating some of the electricity consumed by the hospital and enabling a reduction of its energy consumption by 1.625.000 kWh p.a. (in average the energy needed for 50 hospital beds per year). LED lightnings, equipments usage adaptations, regulation of temperatures in IT rooms, reduction of system pressure for medical gas supply, etc. also led to important energy savings.
Victoria Eugenia Hospital of Seville
Antonio Montero (Director)
"At Victoria Eugenia Hospital of Seville, of Spanish Red Cross hospital, we have made a huge compromise to improve our environmental impact.
We are aware of the impact that our activity can generate in the environment in terms of waste generation, emissions, spillages, etc… That is why we have decided to maintain an organizational policy that incorporates environmental factors as main part of the management, with clearly defined responsabilities, objectives and goals, operational controls, staff training needs and efficient systems of communication.
In that sense, we use management systems based on Quality (ISO 9001 Certificate since 2004) and on Environmental standards (ISO 14001 Certificate since 2007). The next step has been the EMAS registration, which has been done all over Andalucia, fullfilling the european regulations.
The relevance of recording environmental data is that they are made public with an Annual Environmental Report. It includes all the actions and initiatives that the hospital has started up to monitor its environmental impact: quantity of water and energy that the hospital consumes, amount of CO2 emissions that is rejected into the atmosphere, as well as amount of waste generated by its activity. This is a incentive to make a better usage of our resources. Environmental goals help us to fullfill with our commitment.
Thanks to this environmental management system, the hospital manages to minimize waste production and to sort it properly in order to be recycled, to optimize the energy consumption of its building by means of solar panels or energy saving light bulbs, among other things.
EMAS is based on three main pillars:
  • Continuous improvement of the environmental behaviour,
  • Compliance with the legislation ensuring the veracity of the information of the Annual Environmental Report verified by competent public administrations,
  • Staff involvement.
We produce our environmental statement yearly. It is public and includes:
  • The evaluation results on significant environmental aspects,
  • The identification of potential risks and opportunities,
  • The definition of objetives and environmental goals,
  • The maintenance of the environmental management system, for instance data related to the environmental behaviour of the organization.
To obtain this certificate, the Hospital has gone through a strict assessment process each year during the past 10 years, which took into account all the environmental aspects linked to the activities of the structure, as well as the compliance with the current legislation. For the renewal, an environmental audit is carried out to assure that the management system is adjusted and in compliance with the requirements and regulations."
The French State signs a convention with French Hospital Federations
Echoing the 17 sustainable development goals published by the United Nations and in line with the National strategy of ecological transition towards sustainable development (2015-2020) elaborated by the French government, hospital federations representing all sectors, have adopted a convention with the State for the period 2017-2020.
« My sustainable development observatory » has been created. It comprehends 32 questions and 6 targets : governance, society, environment, sustainable procurement, social and economical components.
A first photography of the grade of maturity of health care institutions has been done. A second screening will start in June.
What can already be noticed ?
Only 15 % of the structures have adopted a comprehensive approach of sustainable development in the implementation of their major projects. Only a few have started a CSR certification or labeling process: 55% of respondents do not currently consider such an action, 31% are considering it and 9% have already started.
In addition, 17% of the structures say that they don’t have a sustainability manager and the average percentage of staff in charge of sustainable development actions amounts 1.5%.
In most cases, structures have difficulties to put data together in order to elaborate a masterplan. Indeed, few of them are able to communicate the basic data requested by the observatory: water consumption, energy billed, amounts of wastes, etc. Moreover,over the past two years, when data are provided, we observe a stability of water consumption and waste production, and a significant increase in energy consumption.
Economic and procurement components often reveals difficulties to move from theory to concrete and measurable actions. On the one hand, the sustainability maturity as regard to procurement can be improved as more than half of the structures do not yet include social criteria in their call for tenders.
Finally, the structures seem to be driven mainly by budgetary criteria. Although many structures have identified other indicators than financial, they are not systematically exploited.
The EMAS adventure goes on!
Cliniques Saint-Roch et Clementville, Montpellier (34)
Clinique Clementville, Montpellier
Attesting a longlasting engagement, the clinics Saint-Roch et Clementville in Montpellier have both renewed their EMAS registration for 3 years. They are amoung the less than 10 healthcare institutions, which are curently registered in France. According to Alain Lorente, Deputy director of the Saint-Roch Clinic, ‟From the first pencil strokes for our new establishment inaugurated in 2016, our awareness of sustainable development acquired with EMAS allowed us to have a broader view and better consider certain facts linked with eco-construction, the environmental quality of materials used, the light, -most of the rooms have natural daylight, including the operating rooms-, but also the quality of life at work, with particular attention to the way employees travel, as well as some technical aspects that result in innovative and economical processes.” The private hospitals group Oc Santé, after the successful work of its two pilot plants, now with to deploy the EMAS label on other establishments of the group.
* EMAS (Eco-Management and Audit Scheme) is a voluntary European environmental management and audit system for assessing and improving the environmental performance of organizations.
Priority work areas chosen by the Clinics Saint-Roch and Clementville: reduction of overall environmental impact, promoting quality of life at work and costs reduction.
EMAS registration revalidated for 3 years
Saint-Roch Clinic, Cambrai (59)
The eco-gym of the Saint-Roch Clinic

"EMAS (Eco-Management and Audit Scheme) is a way for us to benefit from an external view of our organization, that of an independent body, to better judge the operational nature of our environmental management system" says Fabien Leloir, risk and quality manager, in charge of sustainable development issues.

The registration, renewed at the end of 2016, is also and above all the recognition of the work done tirelessly for eight years and the tenacity of the teams. "Over the years, we set up indicators that allowed us to define objectives and areas for improvement. We have medium and long term goals. We want to improve our performance from one year to the next, but in terms of reducing our carbon footprint, which is a priority for us, it is necessarily a long-term task. Dr. Joël Cliche, founding president of the Clinic Saint Roch, wants to take his teams even further in the CSR approach with the implementation of the ISO 26000 approach, logical continuation of the EMAS registration. A first evaluation should take place in 2018.
The eco-gym of the Saint-Roch Clinic -labeled HQE and BBC (Low Energy Building)- has benefited from a broad media interest and has received several awards in the past years.
Currently in France, a dozen institutions for health and elderly care are registered EMAS. Two have achieved the ISO 26000 standard on social responsibility.
8 June
UEHP Council meeting
14 - 15 June
European Hospital Efficiency Forum
20 - 22 June
EHMA 2018 Annual Conference
18 - 20 July
Wuxi (China)
Hospital Management Asia: China Edition