A Few Notes about This Blog

This blog shares my insights on the design, introduction and active management of effective sustainability programs in hospital settings. Unlike the thousands of discussions on sustainability's altruistic, conceptual and technical aspects, though, this blog approaches the discipline from organizational management and development perspectives.

Over the past few years there has been a lot of discussion in the trade media around the American Hospital Association's new "Sustainability Roadmap for Hospitals," which complements the association's excellent work in its recent "Executive Primer on Hospital Environmental Sustainability." (

With the AHA - as well as Practice Greenhealth, Healthcare without Harm and other organizations - staking authoritative claims to the topic, why do I think it necessary to add my two cents? Here's why. The AHA executive primer covers several of the big concepts any good sustainability program should have. Further, its roadmap details many of the high-level steps needed to create and run it. However, neither will be able to adequately explore institution-specific details for successful organizational design, change management and program effectiveness.

That's not a failing of AHA's superlative work; it is simply recognition that when it comes to management programs, such as sustainability, one size does not fit all. Each hospital needs to custom design its own sustainability program to meet its specific needs, including working within its resource limits and opportunities. Helping you and your institution work through the details is where this blog comes in.

The first few blog posts address basic concepts, including the special challenges healthcare delivery organizations face whenever they create new performance capabilities. After that the discussion will shift to the key questions a hospital – or, any other organization for that matter – must answer in creating and running a sustainability program and, by extension, an all-encompassing corporate social responsibility program. Then, the discussions dive into the "how-to-do-it" details with a big emphasis on anticipating and controlling obstructions to success.

Rather than prescribe rigid off-the-shelf methods that may have worked well elsewhere – yet, might not work so well at your hospital – these discussions will pose key questions that must be answered by the best minds at all levels of your institution to create a customized program.

This blog is a serialized body of work. So, if this is your first visit, I highly recommend that you start with the oldest post date and work forward from there. The entries will make a lot more sense that way.

For those of you who work in other industries, substitute the words "hospital" and "healthcare" used throughout the posts with the name of your industry or company. You'll probably find the information in this blog fits your field and organization quite well.

Lastly, if you are a sustainability professional, I would be honored if you sign-up to follow this blog and share it with your colleagues. Also, please feel free to share your views and experiences.

Thank you for stopping by.

Wednesday, October 20, 2010

The First Linkage Step: Defining a Hospital's Sustainability Tactics

The last post examined a method to define a focused list of strategic objectives that fit within the five sustainability program elements of:
·     Program
·     Compliance
·     Efficiency
·     Revenue and
·     Transparency. 

So, you may be thinking:  Alright!  We're finished with this long, drawn-out planning stuff, right?  Now, can we jump in and start doing sustainability stuff?  Can we, can we, can we, please?

Not so fast, partner.  If this approach to sustainability program development was just another healthcare flavor-of-the-month:

·    The true-believers would now be turned loose to perform emotive homages to Mom Earth welling-up from deep within their well-intentioned hearts, and

·    The sustainability heathens would be left to shirk their responsibilities with dazzling passive-aggressive impunity.  

However, this approach is not another flavor-of-the-month.  Nor, is it yet another hopelessly romanticized "journey" meandering through the halls-of-healing.  Instead of figuratively wandering off on another quixotic adventure, with this sustainability-as-a-business-proposition approach:

The hospital's leaders get focused and stay put to get a little work done.

As such, this post discusses a method by which the sustainability program's strategic objectives are used to craft tactical goals and targets for discrete hospital functions and departments.  These goals and targets are parts of the critically important links between strategic intentions and day-to-day work activities.

My Favorite Rant-and-Rave from another Angle
You may be wondering again: 

"Why is it necessary to spend so much time and effort to link strategic intentions to day-to-day activities?"

Aren't the big-bucks functional and department leaders supposed to be doing this already?

One would think.  After all, that's the way things work in those big old-economy companies like Proctor and Gamble.  Proctor and Gamble and other business giants use Peter Drucker's Management-by-Objectives (MBO model. The reason MBO works extremely well at these companies is because they have legions of MBAs whose jobs involve translating strategic objectives into measurable results at the business-unit and profit/cost-center levels. 

However, hospitals – as well as other technical specialty organizations, such as engineering/architectural firms, research organizations and IT companies – usually only have a few MBA's.  Further, these odd management creatures are often tucked away from the general populations of technocrats so they won't annoy anyone.  As a result, there aren't many functional and unit leaders who are professionally qualified to translate an organization's strategic intentions into effective results. 

What's the fix?  Remember the earlier discussion around Stanford Professor Jeffrey Pfeffer's idea:

“More important than having a strategy is the ability to implement it.”

And, of course, there's always that adage that CMS Administrator, Dr. Donald Berwick, likes to use:

“Every system is perfectly designed to produce the results it gets.”

Without intentionally doing so, these two thought leaders hint that MBO as originally conceived by Drucker doesn't always work in technical-specialty enterprises.  At the same time, though, their ideas can be stretched to suggest that MBO management systems can work when modified to fit the continuous-improvement management system model by adding a linkage element.  

As noted in earlier posts, there are two main components of linkage:

·    Tactical qualitative goals and quantitative targets focused on specific organizational functions and units; and,

·    Projects at the operations and administrative levels to achieve the tactical goals and targets by creating new capabilities and resolving performance issues.

So, let's dig into the first part of linkage: defining those tactical goals and targets.  We'll save the project part of linkage for later discussions.   

Converting Strategic Objectives into Tactical Goals and Targets
The process for converting strategic objectives into tactical goals and targets is conceptually easy.  Simply list all of the strategic objectives sorted by the program's five elements down one axis of a matrix and then name the hospital's principle organizational functions out on the other, as shown on Figure 6.   (Click on the figure to enlarge.)   Of course, each hospital should modify the set of functions on this generalized figure to reflect its own in-house conditions.

Then, at each intersection on the tactics matrix, describe what that particular hospital function should do to achieve the objective in question.  It is important to recognize that not every matrix intersection warrants a tactic.  Further, tactics need to be formatted in terse, action-verb terms like these: 

·    Who? – As in which function, department or ad hoc cross-functional team

·    Is going to do what? – In terms of a function- or unit-specific goal and/or measurable performance target

·    By when?  And,

·    How will success be unambiguously determined?

Let's look at just few of the possible tactics that might be developed using a sample strategic objective from the last post:   

Within the next 3 years the hospital will reduce its energy expenses by 20 percent while sourcing 50 percent of its energy from sustainable producers.

·    Tactic 1 – By the end of the first fiscal quarter of 2011, the facilities department in collaboration with the sustainability program champion will complete a house-wide energy-use audit by contracting with an industry-leading outside auditing firm.  Energy reduction opportunities in the audit report will be provided to senior leaders via the sustainability program champion for executive action.

·    Tactic 2 – Following the recommendations in the audit, a house-wide energy-use reduction program will be designed and implemented under the direction of the sustainability program champion in each administration and operations unit by the end of the second fiscal quarter of 2011.  Administrative and operations unit managers will be held collectively responsible through the hospital's performance incentive program for establishing and maintaining a house-wide statistically significant energy-reduction trend.   

·    Tactic 3 – Supporting Tactic 2, by the end of the second fiscal quarter of 2011, the information systems department will complete and implement a focused action plan for reducing electricity use in information systems to substantially support the achievement of the 20-percent energy-expense reduction goal.

·    Tactic 4 – By the end of the fourth fiscal quarter of 2011, the purchasing department in collaboration with the facilities department will identify on-grid sustainable-source electricity suppliers and enter into purchase agreements enabling substantial progress toward achievement of the goal to obtain 50-percent of the hospital's electricity from sustainable sources.

Lastly, each tactic needs to be assessed to determine if it can be accomplished using available labor, equipment, work space, vendor support and supplies.  If not, the tactic needs to clearly state what additional resources may be needed. 

Tactics Teams
So, who is going to do this work?  Do you remember those folks who helped senior leadership conduct the SWOT analysis and draft the broad program objectives?  They are those ambitious up-and-comers who are not on the hospital's usual-suspects list. 

Well, its time to put them, others like them, and – yes – even some of the usual suspects to work drafting sustainability tactics.  This time, though, these shared-governance helpmates need to be sorted into new ad hoc teams.  Team composition should be based in part on the members' professional specialties and their affiliations with the functions listed on the tactics matrix. 

Don't be surprised that some people will need to work on several teams.  And, don't worry about fine-tuning team compositions for perfect fit and coverage; it probably can't be done.  Close enough is going to be good enough during the early stages of sustainability program development.

Although within healthcare norms this work may sound like a month-long effort, it's not.  So, set short-fused due dates in terms of days and certainly no more than one work week.  While we're on the subject, use this temporal guideline for the earlier work, too.  Sustainability programs are not supposed to create more time-wasting committee activities.  Instead, they are supposed to actually improve hospital performance through green initiatives.   

Completing the List of Tactical Goals and Targets
Once the teams draft sets of possible tactics, they need to complete ranking assessments using the FMEA-based methods shown on Figure 4 in the August 8th post.  Most ranking efforts will use the figure's method for positive situations.  Once ranked, the lists of prioritized draft tactics are forwarded to the program champion, who:

·    Collates the lists

·    Applies the Pareto 20/80 concept to create a shortlist, and

·    Presents that shortlist to senior leadership. 

As with earlier review and amendment activities, senior leaders collectively evaluate the significance of the shortlisted goals and targets from their executive perspectives.  Evaluation criteria should include such factors as:

·    Direct alignment with the most significant strategic objectives

·    Quarterly timing for achieving the goals and targets

·    Availability of adequate resources

·    Possible people, planet and profit returns-on-investment

·    Hospital function, unit or cross-functional team capacities to successfully achieve goals and targets, especially in consideration of other accountabilities competing for the same resources, and

·    Equitable distribution of function and unit accountabilities.

Once evaluated, the senior leaders amend the list with any deletions or additions they feel are necessary. Then, as with the strategic objectives, they need to simplify the tactics list by:

·    Culling-out redundancies

·    Removing any weak goals or targets that really do not rise to a level of significance

·    Combining similar tactics, and

·    Reprioritizing the revised tactics set.

At this point the amended list should be distributed to the various internal stakeholders for review and comment.  This gives stakeholders the opportunity to state the case for any deleted or significantly altered tactics they feel are particularly important.  Their comments and recommendations should be considered and acted upon by senior leaders before completing the final tactics list. 

This is an especially important activity for the tactics team members, who have worked very hard using unfamiliar methods on unfamiliar topics.  Providing them with an opportunity to review and comment on the amended tactics list shows respect for the team members and their efforts.  Whereas, if team members feel slighted by the senior leaders when a recommendation is significantly changed or not included in the final list, they may not continue to support the sustainability program with much enthusiasm.    

Upon completion, the final tactics list should be integrated into the hospital's overall  management processes and systems that control performance improvement accountabilities.  Of course, the final list of tactics should be communicated at this time to all affected internal stakeholders. 

Concomitantly, even though they may not be currently important to the senior leadership, any low-ranking tactics should be recorded by the program champion for formal reconsideration during later planning iterations in the program. 

With this part of the linkage process done, the strategic and tactical planning phase of sustainability program is complete.  The next phase explores the roles and processes of program management. 


A Bit of a Postscript
For years healthcare leaders have been hearing from "experts" that they need to link or "hardwire" all of their hospitals' strategic intentions to their day-to-day operational and administrative activities.  In fact, management system standards like the Malcolm Baldrige National Quality Award, ISO 9000 and the Magnet Hospital program encourage and assess the efficacy of management system linkage.  However, none of them – just like the experts – tell you how to actually do it. 

So, remember the linkage methods discussed in this blog post the next time you hear this old head-scratching discussion around your hospital.  With a little modification, you might just be able to provide your institution what it needs to move ahead in overall management system performance. 

IN THE NEXT POST:   Template for a Hospital Sustainability Program Organization Structure