Creating and Managing Sustainability Programs

Published on : August 19, 2010

Creating and Managing Sustainability Programs

Creating and Managing Sustainability Programs

It shouldn't be much of a surprise that leaders at your hospital may be thinking about going green.   First, there's all of that au courant media coverage.  Then, there is the fact that your institution is dedicated to making an altruistic difference in the lives of patients, staff, their families and the community.  It only makes sense for leaders to be thinking, “While we're at it, let's do something nice for ol' Mom Earth!”

So goes the reasoning of:

  • That shake-up-the-status-quo board member, who recently introduced a new green policy proposal
  • The image-conscious executive, who just returned from a conference where s/he learned lots of brand-new green buzzwords, and/or
  • The hopelessly quixotic department director, who is always leading the charge for the latest in trendy performance improvements.

Is Your Hospital Really Up for This?

However, somewhere in the recesses of your mind, red flags are a-flying and you are wondering:  "Whoa!  Haven't I seen these starry-eyed behaviors before?"   Why, yes, you have.

Remember how excited everyone at the hospital was when each of those messianic gurus and snake-oil-salesmen promised:  “If you will only believe in my one magic secret-to-success, all your problems will disappear.”

Now, focus on these.

  • Harken back to the fun everyone had during implementation of the electronic medical record system.
  • Or, better yet, consider this hot potato:  Are you still figuring out how to force-fit continuous-production-flow manufacturing methods into custom-work clinical environments?
  • Oh!  And don't forget the never-ending stream of management-miracles, the flavors-of-the-month.

Ah!  You're catching on.  Going green involves more than just forming another free-range committee to set out on yet another idealistic journey to do green stuff and perhaps – no, make that probably – waste a lot of scarce resources along the way.

Going green is a major organizational change; it can be as difficult as those other recent whole-house transformation initiatives.  Further, if it is truly an important change for your hospital, it can't be dismissed as just another flavor-of-the-month when the going gets tough.  Face it now rather than later:  The going will get tough.

Management?  We Don't Need No Stinkin' Management!  Oops!  Yes We Do

Anyone who has been around healthcare for a while is familiar with one of the favorite adages of Dr. Donald Berwick, the president and CEO of the Institute for Healthcare Improvement (IHI), “Every system is perfectly designed to produce the results it gets.”

Underneath this simple proclamation are these essential management concepts:

Organizational structure – or the lack thereof – drives behaviors.  Collective behaviors over time determine – for better or worse – performance quality in the short-term and organizational culture in the long-term.  (See Figure 1)

For sustainability program development to succeed, this means serious planning, organizing, controlling and leading to achieve the institution's green objectives with least effort, cost and risk.  Egad!  We're talking about real organizational management here.

What does real green management look like?  Well, consistent with contemporary management approaches, green management must be systematic.  That's going to be hard to do in a lot of healthcare organizations.

Like it or not, the political decision-making model prevails at the expense of the rational decision-making model in far too many institutions.  Need proof?  Just consider why the positions, concepts and methods promoted by IHI and its cohorts have gotten so much attention.

The All Important Key Definitions

Before we go on, let's define environmental sustainability in an organizational management sense.  Then, let's see how it fits into the larger concept of corporate social responsibility (CSR).

Sustainability is the way an organization creates value by maximizing the positive social, environmental and economic effects of its activities while minimizing their adverse effects to:

  • Manage risks, including – but not limited to – environmental, health and safety regulatory compliance
  • Reduce costs by eliminating all waste, especially environmental wastes
  • Grow revenues with green-attribute services and products, and

  • Build intangible assets, such as competitive advantages, through organizational transparency.

Notice how John Elkington's entire triple-bottom-line CSR concept is integrated into this definition of sustainability.  The triple bottom line is a true-cost-accounting concept that considers the full impact of business decisions in terms of ecological and social values, as well as economic value.  It is also known as The Three P's of Corporate Responsibility, i.e., people, planet and profits.

What Does a Hospital Have to Do to Become Environmentally Sustainable?

Okay, let's get focused.  If you talk to one expert, sustainability is all about facility design.  Talk to others and you'll learn its all about energy, product and service lifecycle assessments, waste reduction/reuse/recycling (3R's), greenhouse gases (GHG), green information technology, green procurement, marketing, public relations, and on and on and on.  Whew!

Who is right?  Collectively, all of them; individually, none of them.  So, beware when listening to "experts".   Technical specialists tend to view broad disciplines, such as sustainability, in terms of their own narrowly defined subset activities.   There is nothing wrong with that.  In fact, we expect specialists to have that kind of laser-like focus.

However, when an organization first starts working on sustainability, it needs to take a S.W.O.T. (pun intended) at determining all – not just a few – of its strengths, weaknesses, opportunities and threats.  It can't do that well if it distracts itself by prematurely focusing on only a few specialty aspects of the discipline.  The risks are ineffectual efforts and wasted resources ending in the frustration of program failure.

Yes, there are a lot of specialties that need to be considered in a hospital sustainability program.  Many of them are shown in Figure 2.  So, with all of these sustainability specialties, how does a hospital decide on which ones to work?

With the hospital's rapid-cycle continuous-improvement (CI) management system that links – a.k.a., hardwires – strategic intentions to operational activities, of course.  You know, the one that enables the hospital to systematically:

  • Define and prioritize its most pressing needs every fiscal quarter
  • Design adequately-resourced projects to meet the highest-priority needs
  • Assign and track accountabilities
  • Measure project progress and, when necessary, take immediate and effective corrective actions, and
  • Celebrate successes.

Uh-oh!  Sorry for bringing that up.  Your hospital may not have an effective, highly structured, whole-house CI management system despite a flurry of clinical quality-improvement busy-ness.

In any case, let's look at what is needed to create a CI management system with a scope limited to sustainability.  Who knows?  You may end-up providing a good working model that can be scaled-up to manage the institution in its entirety.  That's because the best ideas are always stolen by others and eventually claimed as their own.  It's called benchmarking.

A Rudimentary Model for a Sustainability Management System

It sounds fancy and somewhat imposing, doesn't it:  a rudimentary model for a sustainability management system?  Fact of the matter, though, it has the same basic features of any proper CI management system.

Rather than overwhelm you with the details of management system design, let's just go through 10 sets of essential questions.  If you look closely, you may notice that these questions cover the big themes in the Malcolm Baldrige National Quality Award criteria and the ISO9000 (quality) and ISO14000 (environmental) management system standards.   It should be no surprise, then, that when the answers to these questions are detailed using the 5W's & 1H + Check format shown in Figure 3, the result should be a custom-designed sustainability program with a fair chance of being effective.

  • Question Set 1 – How will senior leadership mandate the definition of the hospital's comprehensive suite of sustainability strategic objectives, tactical goals, corporate policies and standard operating procedures?   Further, who among the C-level officers will be the program champion(s)?   How will executive accountabilities for sustainability program success be set and incentivized?
  • Question Set 2 – How will senior leadership identify the specific sustainability objectives and goals that need to be achieved during the next fiscal quarter?
  • Question Set 3 – How will the corporate decision-support function collect, analyze and sort enterprise- and unit-level poor-performance information into the sustainability categories like those shown on Figure 2?
  • Question Set 4 – How will senior leadership create a "shared governance" function using "green teams," each of which will be responsible for addressing one or more of the sustainability topics listed on Figure 2?
  • Question Set 5 – How will each green team prioritize the information it receives each fiscal quarter from the corporate decision-support function to create a topical short-list of the hospital's most-pressing sustainability needs?
  • Question Set 6 – How will each green team set specific, measurable triple-bottom-line performance goals for each of its most-pressing sustainability needs?  Then, how will it identify which profit- or cost-center(s) or cross-functional team(s) should be responsible for achieving the performance goal?

  • Question Set 7 – How will senior leadership receive the project proposals from the green teams each fiscal quarter?  Further, how will leadership:
    • Evaluate the proposals using triple-bottom-line criteria
    • Select projects to be completed in consideration of all of the hospital's other most-pressing needs, and
    • Assign and track project design and completion accountabilities?

Then, beyond the direct activities of the sustainability program, how will leadership integrate triple-bottom-line concepts into efforts to meet the hospital's other most-pressing needs?

  • Question Set 8 – How will the green teams oversee and support their respective sustainability projects to assure the accountable units and teams provide quality performance on-time and within resource allocations?
  • Question Set 9 – How will senior leadership assess in triple-bottom-line terms the success or failure of sustainability projects at the end of each fiscal quarter?  How will successes be celebrated?  How will root causes of failures be determined and corrective actions prescribed consistent with the concept of:  "Never punish people for the sins of the work process?"  How will lessons-learned be accessibly archived and shared internally and externally?  How will the sustainability program's status and progress be reported to stakeholders in a greenwash-free manner using such approaches as the Global Reporting Initiative (GRI).
  • Question Set 10 – How will senior leadership restart the process for the next fiscal quarter, including linking the corrective action prescriptions from Question Set 9 back into Question Set 3, above?

Simple, eh?  Not really.  Remember, this is a major organizational development effort.  Big and nasty change-management demons reside in the details.

Beside the demands placed on the clinical, ancillary and administrative staff, going green will certainly be a transformational challenge for the board of directors, senior leadership and the hospital's organizational-development and performance-improvement professionals.  But, it is doable – and sustainable in the business management sense of the word – with their strong, unwavering and hands-on participation.


As we all know, going green is a worthy altruistic objective.  However, it is also a major organizational challenge if a hospital is to measurably achieve meaningful sustainability objectives with least effort, cost and risk.  Of course, as with any major change, it can be dismissed as just another flavor-of-the month.

So, before making a "go" decision, leadership must thoroughly understand that going green means achieving break-through performance in the:

  • Management of sustainability and other CSR risks
  • Reduction of sustainability-related costs
  • Creation of new green revenue streams, and
  • Leveraging of greenwash-free competitive advantages through transparency.

Assuming a "go" decision, senior leadership must then create and effectively run a rapid-cycle CI management system that enables all functions and units in the hospital to identify, prioritize and respond effectively to their most-pressing sustainability needs.  Further – and this is critical – it must do these things within the context of all of the hospital's other most-pressing needs.

This approach is a far cry from impetuously forming a few green committees to do ill-defined green things.   Rather, it is a systematic approach that not only achieves important environmental quality goals, but also benefits patients and other stakeholders while financially strengthening the hospital.   As such, you and your hospital's leaders and staff may find it worth the effort.

About the Author

In his technical field, corporate environmental sustainability, William Borges MBA has successfully directed more than 100 sustainability, environmental management system, public policy assessment, environmental research and analysis, and pollution-control projects. As a principal environmental scientist, he initiated and directed the sustainability/environmental management consulting practice and Asia market-entry program at Midwest Research Institute, operator of the U.S. Department of Energy's National Renewable Energy Laboratory.

He is currently advising a consulting firm listed in Engineering News Record's Top 20 on the design, implementation and management of a sustainability program in the United Arab Emirates.  The program would guide the design, construction and operations of a 2,500-acre aerospace industrial complex at an international airport.  He is also producing a lifecycle assessment for a U.S. defense contractor selling mobile field hospital structures to the Canadian Department of National Defense.  In 2009, he developed two new undergraduate business management courses – "The Sustainable Organization" and "Environmental Management Systems" – for the worldwide University of Phoenix system. Email: [email protected]