green commuting in healthcare - urban … of healthcare establishments: ... (metra train, cta...
TRANSCRIPT
Green Commuting in Healthcare
Ning Ai, PhD Assistant Professor UPP & IESP
Susan Kaplan, JDResearch Assistant ProfessorSPH
Peter Orris, MD, MPHProfessor and Chief of Occupational and Environmental Medicine UofI Hospital and Health Sciences System
P.S. Sriraj, PhDResearch Associate ProfessorUTC
UTC Seminar Series, April 21, 2016
Agenda• Research Motivation• Project Overview
• Phase I: Case Study in Chicago• Phase II: Nationwide best practices
• Research Methodology• Findings
• Phase I Survey Results• Carbon emission estimates
• Recommendations• Future Research Needs• Acknowledgements
2
https://www.estrellamountain.edu/sites/default/files/page‐images/sustainability/1125‐alternative‐transportation.jpg
Research Motivation
3
Number of Healthcare Establishments:Historical Trend (2004‐2014)
U.S. Total State of Illinois
‐
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Num
ber o
f Establishm
ents
General Medical and Surgical Hospitals Outpatient Care Centers
‐
200
400
600
800
1,000
Num
ber o
f Establishm
ents
General Medical and Surgical Hospitals Outpatient Care Centers
Data Source: US. Bureau of Labor Statistics. 4
Number of Healthcare Workers:Historical Trend (1999‐2015)
U.S. Total State of Illinois
Data Source: US. Bureau of Labor Statistics.
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Num
ber o
f Workers
5
0
100,000
200,000
300,000
400,000
500,000
Num
ber o
f Workers
Healthcare Support Occupation Workers
Healthcare Practitioners and Technical Occupation Workers
Percent of Commuters Driving Alone to Work
Industry Drove Alone All Commuters Percent Drove AloneManufacturing 3,666,014 4,260,931 86.0%Health Care and Social Assistance 7,564,712 8,861,970 85.4%Wholesale Trade 269,068 315,902 85.2%Public Administration 4,430,965 5,274,387 84.0%Transportation and Warehousing 4,597,599 5,503,769 83.5%Mining, Quarrying, and Oil and Gas Extraction 600,402 718,850 83.5%Utilities 83,164 100,268 82.9%Management of Companies and enterprises 80,550 97,401 82.7%Retail Trade 1,130,769 1,383,077 81.8%Information 664,508 818,109 81.2%Finance and Insurance 4,859,220 6,014,860 80.8%Real Estate and Rental and Leasing 1,868,624 2,336,543 80.0%Admin and Support and Waste Mgmt and Remediation 616,904 773,647 79.7%
Educa onal Services 9,985,748 12,744,742 78.4%Arts, Entertainment, and Recreation 2,288,896 2,938,700 77.9%Construction 6,680,236 8,671,736 77.0%Accommodation and Food Services 6,534,995 9,154,007 71.4%Other Services 970,146 1,366,119 71.0%Agriculture, Forestry, Fishing and Hunting 1,127,421 1,588,674 71.0%Source: American Community Survey, Public Use Microdata Sample, 2014
Percent of Commuters That Drove Alone to Work by NAICS Industry
6
Green Initiatives in Healthcare
Missing Element of Alternative Transportation Planning7
Kaplan, Susan, Blair Sadler, Kevin Little, Calvin Franz, and Peter Orris. Can Sustainable Hospitals Help Bend the Health Care Cost Curve? New York, NY: Commonwealth Fund, 2012. 2012. Web. 20 Mar. 2016.
Perceived Challenges of Alternative Commuting in Healthcare
• Often 24/7 service needs • Serving many differing types of populations, including patients, visitors, and staff
• Widely varying shifts, including overnight • Multiple work locations may be involved
8
Inspirations from Seattle Children’s Hospital
• Daily parking only; rates raised over time• $4/day bonus for not driving alone• Shuttle services• Carpool matching• Carpool and vanpool premium parking• Emergency rides home• Reduced‐price transit passes• Walking and biking infrastructure, gear bonuses
9
https://www.seashare.org/uploads/blog/_1800xAUTO_crop_center‐center/photo‐4.JPG
SCH: Commute Calendar (courtesy Colleen Groll, SCH)
10
SCH: “My Impact” Dashboard
11http://www.healthcaredesignmagazine.com/sites/healthcaredesignmagazine.com/files/imagecache/570x360/014_HCD1103_ufig2.jpg
SCH: Reported Results
• “Seattle Children's cyclists ranked #2 in the region's bike‐to‐work challenge, #2 in team, and #3 in bike travel miles.”
• “Seattle Children's alternative commuting efforts have taken 630,000 car trips off the roads and freeways, reduced vehicle miles travelled by 6.5 million miles (the equivalent of 13 round trips to the moon), and saved 235,000 gallons of gas.”
12http://www.healthcaredesignmagazine.com/article/conscious‐commuting‐look‐comprehensive‐transportation‐plan‐developed‐seattle‐childrens‐hospi?page=3
http://thetomorrowcompany.com/wp‐content/uploads/2012/08/green‐transport.jpg
Project Overview
13
Research Goals
• Better understand the commuting patterns of healthcare workforce • Explore the factors that impact commuting behavior• Identify opportunities and suggest policy interventions for reducing transportation‐related environmental impacts from healthcare workforce
14http://my.edgewood.edu/sites/services/Transportation‐Services/PublishingImages/Web%20Logo%20copy.jpg
Two‐Phase Study • Phase I: Exploratory study
• Employee surveys at three hospitals in Chicago• Phase II: Nationwide study
• Emission Estimates• Best practices
• Seattle Children’s Hospital (SCH)• University of Washington Medical Center • UCSF Medical Center • Oregon Health & Science University (OHSU) • University Medical Center of Princeton at Plainsboro (NJ)
15
Research Methodology
16
Survey Study
17
Survey Instrument Design
• Hospital specific
Case Study Hospital Selection
• Out‐patient clinics
Sample Population Selection
• Mix of job types
Survey Adminis‐tration
• Test survey
• In‐person written
Data Entry and Processing
• Multi‐staff verify‐cation
Spatial & Tabular Data Analysis
• Cluster analysis
• Cross‐tab
Participating Hospitals
18
Hospital ID #1 #2 #3Total # of Employees at this location
3173 800 2000
Location Urban Urban SuburbanDistance to the Closest Train Station (miles)
0.3 1.2 2.5
No. of Bus Stops within Half Mile Buffer
91 63 15
No. of Bus Routes within Half Mile Buffer
7 5 2
No. of Rail Stations within Half Mile Buffer
2 0 0
Surrounding Land Uses Mostly institutional buildings. Small parcels of mixed
uses. Mostly residential. A park is nearby.
Large land parcels of institutional buildings. Cul‐de‐sac streets.
Parking Structure/Fees Fee based (can be used for
pre‐tax dollars) Free Free
Participating Hospitals: Employee Transportation Benefit Programs
19
Hospital ID #1 #2 #3
Employee Transportation Benefit Programs
• Transit Benefit Program to pay for transit services using pre‐tax dollars•Discount rate on bike‐share program•Shared parking pass if two or more people regularly carpool together•Online carpooling match program •Discount rate on car–sharing services (cars available on/near campus) • Free intra‐campus and commuter bus shuttles• Showers on campus available for use by bicyclists
• Commuter reimbursement program pays for transit services using pre‐tax dollars
• Public transportation passes/vouchers through pre‐tax payroll deductions• $20 subsidy toward the purchase of a public transit pass/voucher• Bicycle racks on site• Free hospital shuttle between multiple hospitals in the system
Carbon Emission Estimates
20
Emissions = VMT by Travel Mode * Emission Factors by Vehicle Type
APTA Mode Average Speed Bus 12.8 mphHeavy Rail 20.0 mphHeavy Rail 20.0 mphCommuter Rail 32.8 mphFerryboat 8.8 mphSource: APTA
NHTS Mode Average SpeedPrivate Vehicle 28.87 mphPrivate Vehicle 28.87 mphPrivate Vehicle 28.87 mphWalk 4.77 mphSource: FHA
Vehicle TypeCO2 Factor (kg/unit) Unit
Passenger Car 0.368 Vehicle‐MileMotorcycle 0.197 Vehicle‐MileTransit Rail 0.133 Passenger‐MileCommuter Rail 0.174 Passenger‐MileBus 0.058 Passenger‐MileSource: EPA
Source: ACS PUMS. Modes:
Car/Truck/VanBus or Trolley BusStreetcarSubway or ElevatedRailroadFerry BoatTaxicabMotorcycleBicycleWalk
Average Travel Time * Average Travel Speed
Ferry EmissionsCO2 (kg) Per Gallon of Diesel
Ave Passenger Mile per Gallon
CO2 (kg) per Passenger‐Mile
10.25 24.817 0.413 Source: Studies in WA and CA
Results
21
Strong Interest from Healthcare Workers in Commuting Issues
• 141 hospital staff contacted• 135 responded to the survey• 95.7% response rate
22http://1ec3qk2gowcy3luxr31yisiwjdm.wpengine.netdna‐cdn.com/wp‐content/uploads/2013/03/RWR‐Logo‐Figures1‐300x117.jpg
Respondent Statistics
0
10
20
30
40
50
60
Hospital #1 Hospital #2 Hospital #3
23
%
R1: Commuting Mode
24
Hospital 1 Hospital 2 Hospital 3Drive Alone 65% 93% 80%Carpool, car share, taxi 19% 0% 14%Public Transit 30% 7% 20%Bicycle or Walk 7% 3% 2%Other 7% 0% 2%
R2: Influential Factors for Commuting Mode Choice
25
Factors for Taking Alternative Transportation Hospital 1 Hospital 2 Hospital 3Less crime/increased safety 37% 24% 20%Financial savings 33% 45% 24%Financial incentives from employer 28% 38% 16%Flexible work shift hours 28% 21% 16%Quicker trips on public transportation 30% 34% 14%Better quality of sidewalks or paths 23% 34% 8%Discounted or free rides home on weather‐prohibitive days 21% 21% 12%Better service of bus or train 23% 28% 6%Hospital shuttle to/from public transit 23% 28% 16%Better quality of bicycle lanes 23% 28% 4%More parking at transit stations close to home 19% 28% 6%Increased availability of storage/showers close to work site 19% 21% 8%Better service of car‐sharing programs 19% 24% 4%Employer assistance identifying others with whom to share rides 19% 31% 8%More accessible information about options, schedules, routes. 14% 24% 20%Other 12% 3% 4%
R3: Awareness of Employer‐Sponsored Transportation Benefits
26
Hospital 1 Hospital 2 Hospital 3
% of Employees Aware of at least one program 42% 26% 54%
% of Informed Employees Using at least one program 35% 0% 57%
R4: Peak vs. Off‐peak Commuting
27
Hospital #1 Day‐Shift Workers
Night‐ Shift Workers
Unknown
Total Respondents 31 22 4Transportation Mode (% of Respondents)
Drive alone 68% 59% 75%Carpool, car share, or taxi 19% 23% 0%Public transit (Metra train, CTA train/bus, and/or Pace bus) 42% 45% 0%Bicycle and/or Walk 16% 0% 0%Other 6% 5% 25%
Hospital #3 Day‐Shift Workers
Night‐ Shift Workers
Unknown
Total Respondents 35 11 3Transportation Mode (% of Respondents)
Drive alone 86% 73% 33%Carpool, car share, or taxi 14% 9% 33%Public transit (Metra train, CTA train/bus, and/or Pace bus) 26% 45% 67%Bicycle and/or Walk 3% 0% 0%Other 0% 9% 0%
R5: Spatial Distribution of Respondents’ Residence
28
Anecdotal Notes from Survey Respondents
• Daycare at work • Seasonal impacts• Reserved parking • Multiple work locations• Route selection for pedestrians
29
http://www.parentmail.co.uk/wp‐content/uploads/2014/03/Discussion.jpg
Estimates for Carbon Emissions from Healthcare Commuters
All OccupationsHealthcare
OccupationsAll Occupations
Healthcare Occupations
All OccupationsHealthcare
OccupationsAll Occupations
Healthcare Occupations
All OccupationsHealthcare
OccupationsDrive Alone 111,442,130 10,041,772 80.07% 86.33% 11.88 11.93 4.37 4.39 2,143.07 2,151.75 Carpool 13,481,925 780,619 9.69% 6.71% 13.47 12.65 2.21 2.07 1,081.14 1,015.50 Taxi 159,284 9,732 0.11% 0.08% 9.53 8.95 3.51 3.29 1,717.93 1,613.81 Motorcycle 286,240 12,314 0.21% 0.11% 10.63 9.71 2.09 1.91 1,025.73 936.92 Bus 3,857,717 253,362 2.77% 2.18% 9.94 10.41 0.58 0.60 282.53 295.87 Transit Rail 2,750,750 192,125 1.98% 1.65% 15.87 17.40 2.11 2.31 1,034.03 1,133.96 Regional Rail 829,495 39,188 0.60% 0.34% 38.87 38.43 6.76 6.69 3,313.89 3,276.60 Street Car 78,056 5,122 0.06% 0.04% 5.39 5.38 0.72 0.72 351.27 350.43 Ferry 53,237 2,791 0.04% 0.02% 9.15 10.35 3.78 4.28 1,852.09 2,095.47 Walk 4,007,388 196,765 2.88% 1.69% 0.97 1.01 ‐ ‐ ‐ ‐ Bike 918,851 49,095 0.66% 0.42% 3.43 3.43 ‐ ‐ ‐ ‐ Other 1,323,081 48,594 0.95% 0.42%
U.S. Estimated Travel Distance to Work and CO2 Emissions by Mode All Occupations vs Healthcare Occupations, 2014
Estimated Average Distance to Work (Miles)
Estimated Carbon Dioxide Emissions Per Commuter Trip
(kg)
Estimated Carbon Dioxide Emissions Per Commuter Per Year
(kg)ModePercent of WorkersSurvey Sample Size
30
U.S. Commuter on Average: 1,873.58 kg/YearHealthcare Commuter: 1,965.03 kg/Year
Policy Recommendations
31
Key Factors of Implementation
• Great potential of promoting alternative commuting in the healthcare sector Education, especially of new employees
• Better understanding of employees’ needs• Programs tailored to night‐shift vs. day‐shift workers• Economic incentives (and disincentives) as daily reminders of commuting impacts
• Information sharing • Partnerships with transit agencies• One size cannot fit all
32
Limitations and Future Research Needs
• Larger sample size for survey studies • Cost‐effectiveness of alternative transportation programs • Commuter‐Networking• Combined policy approaches
33
Publications Resulted from This Study
• Ning Ai, Susan Kaplan, Peter Orris, and P. S. Sriraj. “Reducing Commuting‐Related Environmental Impacts in the Healthcare Sector: An Exploratory Study.” Transportation Research Board Annual Meeting Compendium, Washington, DC, January 13, 2015. Paper ID: 15‐6057.
• Susan Kaplan, Ning Ai, Peter Orris, and P. S. Sriraj. “Green Commuting in the Health Care Sector: Obstacles and Best Practices.“ Journal of Occupational and Environmental Medicine, 58(2):e34‐8.
34
Images: Oregon Health & Science University tram and bicycle valet
Acknowledgements
• Support by the Illinois Department of Transportation (through a grant from the University of Illinois at Chicago Urban Transportation Center) and the U.S. Department of Transportation National Center for Transit Research (through a grant from the University of South Florida).
• Research assistance from: Erica Burt, Jeff Griffin, Yining Li, Ada Morgan, Jennifer Maddux
35