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.

Tuesday, August 17, 2010

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 former president and CEO of the Institute for Healthcare Improvement (IHI) and Administrator of the Federal Centers for Medicare & Medicaid Services:

“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 – actively drives or passively enables 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 - Click on the figure to enlarge)

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).

Throughout the entire closed-loop lifecycle of a product or service sustainability is the way an organization creates value by maximizing the positive social, environmental and economic effects of its activities while minimizing their adverse impacts.  This involves:

• Managing risks, including – but not limited to – environmental, health and safety regulatory and industry standards compliance

• Reducing costs by eliminating all waste, especially environmental wastes

• Growing revenues with green-attribute services and products, and

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

Notice how John Elkington's 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 from a Management Perspective 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 professional subsets. 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 missed opportunities, ineffectual efforts and wasted resources ending in the frustration of program failure.

Yes, there is a lot of specialties that need to be considered in a hospital sustainability program. Many of them are shown in Figure 2 (click on figure to enlarge). 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 – all of its strategic intentions to all of its operational and administrative 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, in the next post 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 expanded in scope 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.

IN THE NEXT POST:   A Rudimentary Model for a Sustainability Management System