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, August 18, 2010

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 continuous-improvement (CI) management system.

However, rather than overwhelm you with the details of management system design, let's just go through 10 sets of essential questions.   These questions enable a hospital to consider all of the fundamental elements of a sustainability management system.  Further, they allow an institution to scale the level of its activities to fit within its own resource opportunities and limitations.  As such, this approach is a far cry from simply aping another organization's ill-fitted management systemas has been done far too many times when it comes to healthcare performance-improvement initiatives. 

If you look closely, you may notice that these questions cover the big themes in the Malcolm Baldrige National Quality Award criteria and the ISO quality (9000) and environmental (14000) 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 (click on the figure to enlarge), the result should be a custom-designed sustainability program with a fair chance of being effective.

Question Set 1 – Creating the Sustainability Program and Assuring Executive Buy-In

• How will senior leadership - i.e., board members and C-level officers - mandate the definition of the hospital's comprehensive suite of sustainability strategic objectives, tactical goals, hospital policies and standard operating procedures?

• How will senior leadership assure adequate budgetary and other resources to support the mandated objectives, goals, policies and procedures?

• How will these objectives, goals, policies, procedures and budgets be made readily available on a need-to-know basis to internal and external stakeholders?

• Further, who among the board members and C-level officers will be the program champion(s)?

• How will the program's organizational structures be defined, including functions, lines of authority and stakeholder roles?

• How will executive accountabilities for sustainability program success be set and incentivized?

• How will stakeholders be prepared to participate competently, willingly and enthusiastically in the sustainability program?

Question Set 2 – Setting Near-Term Organizational Priorities for Sustainability

• How will senior leadership identify the specific sustainability objectives and goals that need to be achieved during the next fiscal quarter?

Question Set 3 – Sensing Organizational Sustainability Performance

• How will the hospital's decision-support function collect, analyze and sort enterprise- and unit-level poor-performance information into sustainability categories like those shown on Figure 2 in the August 17th post?

Question Set 4 – Creating the Sustainability Program's Shared-Governance Function

• 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 – Producing and Distributing Goals-and-Issues Lists to Green Teams

• Each fiscal quarter how will the corporate decision-support function prepare and send a “goals-and- issues” list for each sustainability topic to its responsible “green team”?

Question Set 6 – Prioritizing the Organization's Most Pressing Sustainability Needs and Prescribing Sustainability Project Goals and Accountabilities

• How will each green team prioritize the information it receives each fiscal quarter from the senior leadership and the hospital's decision-support function to create a topical short-list of the hospital's most-pressing sustainability needs?

• How will green teams distinguish "quick-fix" opportunities from larger sustainability initiatives?

• For all of the green teams, how will information on worthy, lower-priority sustainability needs be maintained for future reconsideration?

• 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 – Initiating Projects to Achieve Sustainability Goals

• How will senior leadership receive the project proposals from the green teams each fiscal quarter?

• Further, how will leadership:

     o Evaluate the proposals using triple-bottom-line criteria, including returns-on-investment (ROI)?

     o Select projects to be completed in consideration of all of the hospital's other most-pressing needs?

     o Assign and track project design and completion accountabilities?  And,

     o Allocate and commit financial and other resources to enable successful project completion?

• 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?

• How will the green teams assist accountable units and cross-function teams in designing capacity-creation and performance improvement sustainability projects?

Question Set 8 –  Completing and Supporting Projects

• How will accountable units and cross-functional teams successfully complete their projects on-time and within budgets?

• How will the green teams oversee and support their respective sustainability projects – including the securing of additional resources, if needed – to assure the accountable units and cross-functional teams provide quality performance on-time and within authorized resource allocations?

Question Set 9 – Assessing Project and Program Progress

• 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 new capabilities and performance improvements be sustained?

• 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 – Sustaining the Program

• 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, C-level officers, other leaders, 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.

IN THE NEXT POST:   A Quick Summation Before Diving into the Details