The sponsor has presented plans to address these impacts to ensure that the proposed project will comply with the environmental and social requirements - the host country laws and regulations and the World Bank/IFC environment and social policies and the environmental, health and safety guidelines. The information about how these potential impacts will be addressed by the sponsor/project is summarized in the paragraphs that follow.
- Site selection and land acquisition:
UFH does not own any land or buildings. All of its operations in Beijing and Shanghai are in leased premises, acquisition of which that did not involve physical or economic resettlement. The Shanghai United Family Hospital (SHU) is located approximately 10 km from the city center in a residential and commercial neighbourhood and the SRC clinic is located in the Minhang District, more than 20 km from the city center. The Beijing United Family Hospital (BJU) is located around 18 km from the urban center, around 7km from the 2nd road ring, in a residential and commercial area. The new downtown clinic is located on Jianguomen Dajie in the St. Regis Hotel in the central business district, downtown Beijing. The Shunyi Clinic is located in the Pinnacle Plaza in the Shunyi District, which is more than 25 km from Downtown Beijing and in a heavily-populated area.
- Management systems for environmental, health and safety and social issues:
UFH’s operations are compliant with the JCIA standard; BJU’s operations are in the process of being accredited and SHU’s are scheduled to be assessed in 2006. The Joint Commission International Accreditation (JCIA), a division of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is the largest accrediting body for healthcare organizations in the United States. JCIA is an authoritative organization specializing in accrediting hospitals that are outside the USA. The JCIA Standards for medical quality and service quality are the highest standards presently achievable for a hospital and this is recognized internationally by its peers and the World Health Organization (WHO). In compliance with the standard, UFH has developed policies, systems and procedures to manage environmental, health and safety and social issues and for hospital management.
These areas are addressed under the following standards of JCIA:
- patient care, safety, rights and education;
- prevention and control of infection;
- facility management and safety;
- staff qualifications and education;
- governance and leadership;
- and management of information.
- Air emissions from on-site incinerators, boilers and/or generators:
For both BJU and SHU, electricity is sourced from the local power supply. As of June 2005, BJU installed two natural gas-fired boilers to operate the air conditioning system. It is expected that the emissions will meet World Bank/IFC requirements and this will be confirmed by future monitoring. SHU operates a natural gas-fired boiler and its backup power generation is provided by a diesel oil-fired generator which complies with WB/IFC requirements. UFH does not operate any incineration facilities; all medical and hazardous wastes are collected for disposal by licensed waste companies.
- Resource conservation and refrigerant selection:
While UFH operates new facilities and its equipment and plant are resource efficient, opportunities to reduce energy and water are discussed at weekly meetings of its Environment of Care Committee. UFH’s Engineering Department has implemented several initiatives to reduce resource consumption, including controlling the fresh air supply during hot and cold seasons to maximize energy savings; adjusting the pressure of the steam supply to 3-5 kg/cm2 when the sterilizer is not in use; and minimizing the use of lighting whenever possible.
Most chilling capacity at BJU is provided by an absorption chiller. HCFC 22 is used in the back-up chiller which is seldom used but is regularly maintained. At SHU, both the air conditioning system and the chiller use HCFC 22 as refrigerant. Continuing use of HCFC 22 is permitted in China in under the Montreal Protocol for Ozone Depleting Substances.
- Management of water use and liquid effluent:
Bottled water is used for drinking or medical purposes. Water used for the operation of the boilers and facility cleaning is sourced from the municipal water supply and treated by ultra filtration and deionization water systems. BJU uses approximately 100 m3/day or 40,000 tons of water each year, half of which is estimated to be used for the steam boiler. SHU expects to use approximately 30 m3/day of water.
BJU’s discharges around 80 m3/day of wastewater comprising boiler thermal discharge water, water discharged from toilet sanitary facilities and domestic use, and clinical discharges. At BJU, wastewater is pre-treated with chlorine disinfectant prior to its discharge to a sewage and water treatment plant operated by the local municipality. While actual monitoring results are not publicly available for this facility, the local regulatory requirements for the facility are compatible with WB/IFC guideline limits.
For SHU, rainwater will be discharged to the municipal sewer system and wastewater from the clinic operations will be treated with chlorine disinfectant prior to its discharge to the ChangNing Hospital’s sewage treatment plant. The final discharges of the ChangNing Hospital treatment plant are discharged to the municipal treatment plant which is required to meet local regulatory requirements. The allowable limits for these discharges are compatible with WB/IFC guideline limits for most parameters. It can be concluded that SHU’s contributing wastewater will materially meet local and WB/IFC guideline limits as it receives treatment from both the ChangNing Hospital and municipal treatment plants.
- Management and disposal of solid, hazardous, medical and radioactive wastes:
Clinical and hazardous wastes are collected in specially identified containers within UFH’s premises and removed multiple times daily by the housekeeping staff and placed inside bins in a locked temporary storage area. Housekeeping staff wear appropriate protective equipment and follow infection control policy when disposing of clinical waste. The management of hazardous, clinical and radioactive wastes are controlled through UFH’s JCIA compliant management system. All wastes, including solid waste, are removed daily from the storage area by a government-approved contractor. The contractor is responsible for the offsite incineration of all clinical and hazardous waste. Radioactive wastes, comprising waste film developing solution, are appropriately stored for collection and disposal by an authorized contractor.
- Fire protection and life safety:
As part of its JCIA compliant system, policies and procedures are in place to specifically address life and fire safety issues in compliance with IFC guidelines. Mandatory fire safety training is provided for all new and existing hospital employees and drills of the plan are carried out regularly in accordance with the plan. UFH has duty engineers available on-site 24 hours per day who are in charge of monitoring fire safety equipment. UFH’s operations and facilities are in compliance with all local fire safety laws and regulations and the local government monitors compliance annually.
- Labor and workplace conditions:
UFH employees work an average of 40 hours per week and part-time staff no more than 20. All overtime must be pre-approved except in emergency cases. Management is not entitled to overtime pay and physicians receive compensation leave in lieu of overtime pay. Nursing and non-managerial administrative staff receive 1.5 times regular pay for any approved overtime worked. Nursing staff may not work over 16 hours in one 24 hour period. Staff receive compensation above the minimum wage and commensurate with their job responsibilities and experience. UFH has a zero accident and fatality rate for its operations. UFM’s JCIA compliant management system includes policies and procedures for managing occupational health and safety issues in BJU and SHU.
A number of initiatives are undertaken by UFH’s to safeguard the health of employees and patients. Examples include: an Infection Control Plan in BJU to prevent, identify and control healthcare associated infections and improve patient safety by evaluation, assessment and design of an infection control infrastructure through interdisciplinary collaboration; education of all employees on the importance of “standard precautions” in the hospital to reduce the risk of work-related exposures (e.g. hand hygiene, personal protective equipment, handling sharps, emergency eye washers and showers, appropriate cleaning procedures); provision of an employee health program that screens new employees to prevent, monitor, investigate potentially harmful infectious exposures and outbreaks among personnel and provides care for personnel for work-related illnesses or exposures; and implementation of a policy to manage healthcare workers exposed to blood and body fluids.
UFH employs a full-time training department that provides induction and on-going training for medical and non-medical staff. Training includes but is not limited to, service excellence, infection control, risk management, patient rights, English and Chinese language training, life support, etc.
- Corporate social responsibility initiatives:
SHU has formed a Community Advisory Board, comprised of local experts and residents from a wide range of backgrounds and interests, which meets quarterly to share information with the local community and to receive community feedback.
Every year, each hospital donates 1% of its annual net revenue in healthcare services to Chinese orphans. Additionally, they partner with the American Education and Health Foundation in several projects which include:
- sending medical teams into orphanages (in 2004 approximately 300 orphans benefited from these visits);
- a nutrition program that provides infant formula to orphans and monitors their growth and development;
- a cooperative outreach program with a local hospital in a rural province which allows orphans to get emergency care;
- and first-aid/CPR training programs for orphanage and foster home staff and volunteers.
UFH also works with visiting physicians who come to do charity work in China, providing them the space to do surgeries in its facilities and to teach local medical professionals. As well, UFH is active is facilitating/obtaining healthcare in local hospitals for orphans that might not otherwise be available to them without UFH’s intervention. In this last fiscal year UFH donated just over 3 million RMB in services to over 80 children who received free care at UFH. Additionally an estimated 50 others received care at reduced cost. UFH routinely provides free and reduced cost First-Aid/CPR training to Orphanage & Foster Home staff and volunteers both at its facility and in the care facilities themselves. In addition, SHU has recently donated operating space and nurse staff at cost for neurosurgeries for six orphans and plans to continue to this practice in the future. UFH also plans to take its internal nurse development training program, which helps transitions locally-trained nurses to international standards nursing qualifications, and open it up to nurses from other hospitals.
