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What is CERS?


The operating room (OR) is the epicenter of today’s hospital with a recent study by the McKesson Group estimating that the OR generates 42% of the hospital’s revenue[i]. A primary source of hospital admissions, the OR also drives significant costs related to equipment, supplies and personnel – the OR is the leader in medical supply usage for the entire hospital[ii]. A recent study estimated supply costs at 56% of the total budget of the operating room – dwarfing salary costs at 35%[iii]. The OR also generates huge volumes of waste. The OR produces between 20 to 30% of a hospital’s total waste volume[iv], despite the OR’s diminutive spatial footprint.

As the healthcare sector continues to define the benefits of environmental sustainability in a healthcare environment, it makes sense to focus on those departments with the highest costs, greatest inefficiencies and/or largest volumes of waste. Thus the OR is a key target for greening efforts in many facilities. The Greening the OR Initiative is an effort to bring together the body of knowledge around sustainable interventions in the OR, substantiate it with data and case studies, and develop best practices for implementation that can be shared across the sector. The potential financial benefits of these interventions are significant; with millions of dollars in potential savings for the sector should widespread adoption of these interventions occur.


Practice Greenhealth has launched a Greening the OR Initiative designed to examine different green interventions in the Operating Room (OR) that also have positive implications for safety, quality, cost-reduction and efficiency. As clinical leaders in the OR setting, physicians have a unique ability to recommend, pilot and implement emerging best practices. Put simply, surgeons, anesthesiologists and physicians who perform surgery have an extraordinary amount of influence in spearheading the use of new processes, products and practices in the OR. Practice Greenhealth is interested in working in collaboration with these stakeholders to evaluate and substantiate data around different interventions in the OR setting, and are proposing a mechanism that will foster collective dialogue and allow for objective evaluation of key sustainability initiatives in the OR. Thus, Practice Greenhealth is now working with a set of noted surgeons to form a leadership council to explore, examine and vet these interventions as well as substantiate and publish organizational success stories.

Strategy for the Council for Environmentally Responsible Surgery

Broadly speaking, (CERS) is designed to expand the number of physicians in the OR who are committed to Greening the OR, who may be willing to offer their expertise in reviewing and vetting key interventions and who express a willingness to move others in that direction. A demonstrated commitment by a core group of these clinical leaders will catalyze widespread engagement across the sector and can build momentum for large-scale implementation of green best practices in the OR setting.

The initial elements of the fledgling initiative include:

  • To identify and approach physicians in the OR who have an interest in science-based evaluation of environmental best practices and support hospital leadership in its goal of creating a more sustainable organization;
  • To work with a core group of clinical leaders to determine an appropriate strategy for moving the initiative forward;
  • To build a set of opportunities for those participating to guide the work of others and thereby influence both the surgeon and anesthesiology communities.  Such opportunities may include:
    •  Writing articles for trade publications and mainstream media that will create a buzz relative to the initiative and the work of participating physicians;
    • Responding to specific requests from the press for interviews;
    • Producing and publishing peer-reviewed articles on different successful operational interventions;
    • Speaking engagements with a wide variety of audiences;
    • Engaging in survey, pilot or research activities;
    • Participating in education and training activities relative to the work of the Council in a variety of modes, i.e. instructor-led training, video modules/presentations, webinars and e-learning modules, to name a few examples; and
    • Initiating clinician roundtables across the country in collaboration with Practice Greenhealth.
  • To refine the opportunities listed above in terms of detail and purpose;
  • To build an outreach strategy to engage new surgeons, anesthesiologists and physicians who perform surgery in the effort;
  • To pilot or implement key “green” operational interventions


Certainly the management of an OR can be extraordinarily complicated, but Practice Greenhealth agrees that carefully calculated improvisation is critical – and indeed the integral factor in innovating new best practices that continue to evolve from and improve upon current practice. Practice Greenhealth is turning to physicians in the operating room, in the hopes that these professional groups can provide leadership in developing a science and data-driven path to move forward on the ultimate goal of Greening the Operating Room.

Drs. Copley-Woods, Andrade and Makary have agreed to act in a leadership role and in collaboration with Practice Greenhealth and will assemble a group of 10-12 colleagues that will act as a steering committee for the fledgling initiative. The steering committee will assist in the formulation of plans, distribution of responsibilities, determine appropriate recruitment activities and serve as leaders in the various aspects or segments of the initiative. Practice Greenhealth envisions this group meeting via phone periodically to review progress, alter plans as necessary and to share results as they occur. The size and composition of this core group is a flexible and moving arrangement that can be manipulated by the leadership if needed.


This initiative will be loosely tied to the Greening the OR Initiative (GOR).  Interactions will include acting in an advisory capacity to the GOR, participating in select activities of GOR, contributing to the body of knowledge being built through GOR, and pulling from the many and varied outcomes of GOR to build an ever stronger case for moving the Council along. By and large however, the initiative will be independent and develop plans and strategies pertinent to its long term goal of bringing increasing numbers of physicians along the path to sustainability in the OR.

Beyond the core group, as mentioned earlier in this document, a much larger contingent of physicians would be involved on a broad scale, endorsing the initiative and participating in one or more of the opportunities listed above. The structuring of the Council needs to be flexible enough that busy, time-strapped but interested clinicians can participate on an a la carte basis – participating in the activities which resonate and match their interests most.

[i]McKesson Information Systems Inc. and the Healthcare Financial Management Association. Achieving Operating Room Efficiency Through Process Integration. Accessed on May 20, 2010 at:

[ii]Farmer, A. and Merbler, K.Cost Accounting in the Operating Room. TriNet Healthcare Consultants Inc. Accessed on April 15, 2010 at:

[iii]Park, K. and Dickerson, C. “Can efficient supply management in the operating room save millions?” Current Opinion in Anaesthesiology. Vol. 22. Issue 2. Pp 242-248. April 2009. Accessed on April 15, 2010 at:

[iv]Roy K. Esaki, MD and Alex Macario, MD.“Wastage of Supplies and Drugs in the Operating Room.” Medscape Anesthesiology. Accessed on April 20, 2010 at:

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