Creating a Triple Bottom Line in Your Medical Group for Social, Economic, and Environmental Sustainability

Published on : August 19, 2010

Creating a Triple Bottom Line in Your Medical Group for Social, Economic, and Environmental Sustainability

Creating a Triple Bottom Line in Your Medical Group for Social, Economic, and Environmental Sustainability

 “First, Do No Harm” is the Hippocratic Oath embraced by physicians.  As a core value of health care, this oath serves as a solid foundation for physicians to pursue excellent service, evidence based medicine, and quality outcomes.  Whether written or inherent through its culture, every medical group has a vision, mission, and strategic efforts that guide its future direction and operational framework.  The author challenges all medical groups to formally expand their healthcare efforts to include a sustainability focus.

Rarely a day goes by that there isn’t some mention of “going green” or pursuing some sustainable project in business and industry.  With this in mind, physicians and medical practice managers are called to explore the feasibility of creating an infrastructure for sustainability as a business focus.  This “call to action” for the medical group is meant to create a triple bottom line for social, economic, and environmental sustainability.

It’s More Than Just a Check List

Sustainability is not the next fad or trend.  While it may seem like a “hot topic”, it can not and will not go away. Its success will be driven by governmental, community, and business efforts to maintain a healthy environment and use resources more wisely.  Sustainability is an underlying approach instead of a level of activities.  While it is easy for a medical group to choose a couple of green projects to work on, that approach is narrow in focus and limited for long-term success.  A more balanced approach and one with lasting effect revolve around defining how sustainability will be part of the organizational culture and infrastructure of one’s medical group.

Organizing Sustainability Around a Strategic Planning Process

Many times a visionary leader can be the catalyst to accelerate a sustainability effort.  However, without that catalyst, executive leadership and the Board of Directors need to embark on a strategic process to identify how to organize their sustainability efforts.  As education and learning are pursued on this topic, it will be discovered that there are many different ways to approach sustainability.  Research into what leading medical groups are doing will show that it is possible to develop a sustainability plan that can be integrated into the medical group’s guiding principles[1] and strategic initiatives.  For example, a strategic goal of improving efficiency in the Supply Chain Management Cycle can lead to a sustainability goal of working with suppliers to reduce package waste and an objective of using certified paper suppliers.  Organizing sustainability around a strategic planning process will allow for a carefully planned approach to healthier medical group.


[1] Sample Sustainability Principles:

  • Minimize all waste and ensure that contaminated waste is disposed of in a responsible manner.
  • Purchase and use recycled products as financially feasible.
  • Limit use of non-renewable resources.
  • Reduce and eliminate use of toxic substances, e.g. chemicals, furniture, cleaning products
  • Seek multiple ways to reduce energy use
  • Collaborate with stakeholders and community on developing sustainable efforts
  • Measure sustainability results to evaluate performance

Environmental Sustainability ~ Simply Complex?

Environmental sustainability is probably the most easily understood concept on a micro-level with reducing, reusing, and recycling products, but a more complex issue on a macro-level.  An example could evolve around paper recycling.  As a medical group begins to recycle office paper, magazines, and newspapers and struggles with collection methods, sorting, and pick-up, it learns that it can expand its efforts by purchasing paper with recycled fiber or certified through vendors that practice safe effort not to deplete forests.

Suddenly a simple practice can turn into a complex social dilemma.  While many medical groups get a jump start on sustainability by focusing on easy projects and pilot programs, a strategic plan for sustainability will guide the medical group in future decision making on capital projects, building design, supply chain management projects, and program development.  A strategic plan helps to guide the organization on the depth, breadth, and scope of sustainability efforts.

Economic Sustainability

Economic sustainability focuses on the financial feasibility of an effort.  An economic model may evaluate direct and indirect costs, capital start-up, return on investment, and sunk costs.  Some efforts may be pursued for reasons of safety and reduction of risk with few measurable short term results while others may be pursued because they save money and reduce the carbon-foot print of resources used.  Creating a balanced scorecard helps to determine the impact of efforts in a medical group.  Sustainability can collectively save money, make money, and cost money.  The challenge is to create a balance that meets multiple priorities.

One medical group switched to a new bio-hazardous vendor that resulted in annual cost savings of $10,000.  The effort also reduced accidental employee needle sticks, improved employee productivity, and resulted in sharps needle containers being reused once the needles were processed by the vendor.  It was a sustainable effort with many other benefits including cost savings.  And another effort to reduce waste resulted in $28,000 annual savings through reduction in use of waste containers.  However, another initiative to phase out use of Styrofoam and replace with recycled paper products created additional costs of $24,000.  By saving $38,000 through other sustainability efforts, the decision to spend $24,000 to eliminate Styrofoam was easier to decide since it fell within the scope of the organizations’ strategic priorities and balanced costs and savings.

Social Sustainability

Social sustainability recognizes that nothing can be done alone or in a vacuum.  There is value in building relationships as a way to foster community engagement and commitment to sound environmental, labor, and social practices while achieving economic success.  Collaborating with key community stakeholders leads to projects with multiple dimensions that yield synergistic sustainable outcomes.  For example, a medical group could decide to promote social sustainability through building of a garden where none existed in the past.  It could partner with community neighbors to plant an organic garden on small plot of land.  The process could lead to additional developments to host a farmers’ market and participate in a food distribution network.

From this effort could come healthier food, reduced use of fuel for locally grown food, and a stronger bond with the community to expand its reach and focus on good nutrition.  See Table I for more ideas.  From a public relations perspective, the effort could create good will and allow the community to see the organization as more than just a provider of care, but a partner in community benefit.  The process could help to build trust with the community, lay a foundation of collaboration, and show that “acting as a unit” takes time to develop.  So many new ideas and efforts are born out of simple steps.


Sample Social Sustainability Programs

Light-Bulb Exchange Program (Through a grant funded effort with the community, exchange out light bulbs to energy efficient bulbs.  Shows community collaboration, good will, and a broader commitment to energy savings.)

Chemical Rounding/Reduction of Toxic Chemical (Work with community to round up toxic chemicals that were historically being dumped down a drain or placed in a landfill.  Example products include unused paint, car oil, unused cleaning products, unused automobile products, and other toxic chemicals.)

Repairing/Donating Medical Equipment/Products (Taking items historically thrown away in a waste bin and donating them to charitable organizations who serve as a resource and get the products to Third World counties that need them.  Examples include medical supplies, medical equipment, and medical furniture.)

Contracting with Vendors Who Follow Fair Labor Practices (Inventory vendors on their fair labor practices including employment of women and minorities, provision of competitive wages and benefits,  and supporting a safe work environment.)

Planting a Garden with the Community (Identify a plot of land to create a community garden shared by all parties involved.  Provides local access to healthy food.)

Participating in a Farmer’s Market (Invite local farmers to the medical group and offer the community to come and participate in the distribution and sale of fresh food.)

The Net Effect of Sustainability

By development of a strategic advantage approach for sustainability, an organization can evolve from performing a level of activities to managing for strategic value.  By creating an effective organizational design, collaborating and learning from others, and creating a consistency in action, it can create a positive bottom line for social, economic, and environmental sustainability.  In the words of 2007 Medical Group Management Association’s Physician Executive of the Year A. Gus Kious, MD, who inspires those around him with a sustainability commitment, “Every day we can make a positive difference in our patients’ lives with an individual passion to ‘patients first’, a commitment to ‘act as a unit’, and a worldwide focus to sustainable practices.  Take action and create an environment that is safe and healthy for all of us.”

About the Author

Michael O’Connell, MHA, FACMPE, FACHE, is Vice President of Operations and Physician Services for Huron Hospital in East Cleveland, Ohio, a Cleveland Clinic hospital.  He directs all professional and support departments including radiology, laboratory, pharmacy, cardio-pulmonary, physician billing, security, housekeeping, patient transport, nutrition services, engineering, maintenance, registration, medical records, and Environment of Care.  He administers physician service activities of the hospital including negotiating and managing physician contracts, compliance initiatives, physician recruitment, and physician billing strategies and has developed physician recruitment strategies for a multi-specialty group of physicians.  He is also the hospital’s Corporate Compliance Officer and Chairman of the Patient Grievance Committee.