Making the Business Case for Sustainability at the Duke Ambulatory Surgery Center

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Health care facilities are extremely resource intensive operations due to the multitude of equipment, environmental control requirements, and the constant monitoring required for patient care. Since patient care is the top priority for health care facilities, sustainability and resource efficiency had traditionally not been considered in their construction and operation. This study assesses the cost-effectiveness of various resource reduction opportunities at the Duke Ambulatory Surgery Center (ASC), an outpatient facility in the Duke University Health system. A whole-systems approach was embraced and sustainability opportunities were assessed through five focus areas: energy use, water use, waste generation, opportunities for recycling, and green purchasing. Based on discussions with the client, background research, and various analyses, it was decided that the study would focus primarily on energy, water, and waste for measuring and improving sustainability at the ASC. Energy and water audits were conducted to establish baseline energy use data. A waste characterization was performed to identify the types of waste being generated and their volumes. In addition, a two month pilot recycling program for mixed beverage containers and mixed paper was implemented in order to assess the potential for a permanent recycling program. There are a number of viable opportunities to reduce resource consumption as well as costs in the areas of energy, water, and waste. This study demonstrates opportunities to reduce overall ASC resource usage. The detailed analysis shows that through technological and behavioral changes, significant cost savings can be realized. The cost reductions estimated from energy and water initiatives could be savings or applied to offset other environmental improvements, such as the recycling program which would cost the Center $2,465 per year but also offers many intangible benefits. The ASC can expect a total annual savings of $8,582 based on our recommendations. In addition, these initiatives could be expanded to find additional opportunities for savings at the ASC and throughout Duke University.


Master's project


Nicholas School of the Environment and Earth Sciences





Cheng, Joe, Kara Fedors and Megan Maltenfort (2011). Making the Business Case for Sustainability at the Duke Ambulatory Surgery Center. Master's project, Duke University. Retrieved from

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