“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