Table 1.

Primer and checklist for greener family medicine clinics

FACTORACTIONS
Green values
  • Make a commitment

    • -Where are the ideal places to start? (Pick low-hanging fruit)

    • -What values can you identify that will assist you as you proceed?

    • -What research or measurement techniques might be useful? Consider involving residents

  • Consider curriculum concepts for teaching practices (eg, a quality assurance project for residents). Exemplify an environmentally friendly clinic for students and residents

  • Join with allies (eg, public health, community, municipalities)

Waste management
  • Reduce

    • -Reuse paper printed on 1 side, provided confidential information is not released

    • -Set your printer to double-sided printing. Do audits to ensure that staff and the IT department reset any forms that result in wasted paper

    • -Ensure there is no wasted content on frequently printed documents

    • -Do a mail audit (What journals or other publications are redundant or can be received by e-mail rather than paper?)

    • -Refuse unnecessary packaging from pharmaceutical companies

    • -Find a solution to paper coffee and tea cups in your setting

    • -Contact the Canadian Direct Marketing Association (416 391-2362) to request junk mail be stopped

  • Reuse

    • -Use nonglutaraldehyde sterilizers or steam autoclaves

    • -Use cloth gowns

    • -Stock reusable rather than disposable equipment such as specula

  • Recycle

    • -Recycle paper, glass, plastic, and aluminum; keep recycling bins in areas where these materials are used

    • -Use green-bin (organics) system, if available; this will require staff cooperation and support

    • -Ensure your recycling system is working (What percentage of your recycling actually ends up recycled?)

Energy management
  • Choose energy-efficient equipment

  • Turn down the thermostat at night and on weekends

  • Set your air conditioner 2 degrees higher and your furnace 2 degrees lower

  • Use energy-efficient lighting

  • Turn off computers and other electronic equipment when not in use; set computers to sleep mode at end of day

  • Ensure that windows and exterior doors are sealed

  • Use motion sensors or timed lighting for unoccupied rooms; encourage “lights-off” behaviour in common spaces

  • Use natural light as much as possible

  • Consider a tankless hot water heater on a timer

Buildings and green space
  • Consider less-toxic materials such as cork, hardwood, or linoleum rather than carpet

  • Use paint that is low in volatile organic compounds

  • Consider furniture that does not emit formaldehyde (natural wood or environmentally constructed options)

  • Choose pest management options that are safe for patients, staff, and the environment

  • Choose plants that are drought resistant and do not rely on herbicides or watering to thrive

  • Consider a rooftop garden—might be an option for cooling

Toxin management
  • Ensure safe management of patient drugs and encourage same behaviour from patients. Remind patients of “not down the drain”; be willing to accept unwanted pills; and have a program for safe disposal of drugs

  • Replace mercury thermometers and sphygmomanometers with nonmercury alternatives; dispose of mercury products safely

  • Use effective nontoxic cleaning solutions

Water management
  • Fix leaks

  • Install restrictors (aerators) on taps

  • Reduce or refuse the use of bottled water; consider a department policy against bottled water at events

  • Consider reducing water coolers and install filters on tap water

Transportation (public transit, car pool, bike and car sharing, parking, etc)
  • Find ways to communicate options other than single-driver vehicle options

  • Assist staff and learners with car-pooling options

  • Ensure there is a safe place for bike storage

  • Ensure safety is addressed for all means of transit

  • Encourage teleconferences and videoconferences where feasible

  • Ensure staff have change rooms and showers

Responsible community members
  • Be mindful of space sharing, noise pollution (eg, HVAC systems), light pollution, and organization of meetings (reduce traffic by using technology; consider peak traffic and meeting times)

Purchasing and procurement (includes green cleaning)
  • Purchase environmentally friendly paper with high post-consumer content and chlorine-free bleach; environmentally friendly medical equipment

  • Use certified environmental products such as those approved by EcoLogo, Green Seal, and Forest Stewardship Council

Partnerships and other green initiatives
  • Develop partnerships with municipal programs that focus on environmental initiatives; local and university transit systems (eg, create passes incentives); car-sharing and bike-sharing programs

  • Involve patients

  • HVAC—heating, ventilation, and air conditioning, IT—information technology.

  • Data from Council of Ontario Universities.10