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.

Friday, August 27, 2010

Make a Formal Go-Decision to Create the Sustainability Program and Set the Hospital's Green Policies

The next several posts will consider the questions in Question Set 1, Creating the Sustainability Program and Assuring Executive Buy-In. (Refer to August 18, 2010, A Rudimentary Model for a Sustainability Management System.)

The All-Important Go-Decision for a Sustainability Program
In creating any new program that affects the overall performance of a hospital, it is important that senior leadership make a well-reasoned and documented decision to proceed. In other words, it needs to make an unambiguous "go decision." In the case of major initiatives, such as sustainability programs, the board of directors should take the lead through a resolution.

Why all the fuss? Why can't operations- and administrative-level mangers simply be left to do what they think is best?

Formal decisions-to-proceed by the highest levels of leadership are needed because major programs consume valuable resources that are also needed by competing hospital functions and units. Senior leaders are responsible for making sure competing units and functions receive adequate resources to successfully achieve their missions.   It's the essential idea behind The Rolling Stones' lyric:

"You can't always get what you want
But if you try sometimes you might find
You get what you need"

Further, resource consumption must result in specific and adequate returns-on-investment (ROI) if the hospital is to fulfill the "prime directive of finance," the ultimate organizational objective. Of course in sustainability programs, ROI assessments must consider the additional dimensions of social and environmental costs and benefits. Senior leadership also has responsibility for these outcomes.

Money-Grubbing 101
Although the triple-bottom-line concept assigns co-equal status between financial, social and environmental performance, in practical applications the prime directive ekes-out a bit of preeminence on behalf of financial performance over the other two . . . and for good reason.

Let's define that strange Trekkie-sounding term, the prime directive of finance. Every organization must obey it; it's the "No Money, No Mission" concept. The only way this can be done is by balancing all activities within an organization's resource limits and opportunities.

Of course, the no-money, no-mission concept looks a bit different at for-profit, not-for-profit and public hospitals. For example, because of the body of law regulating for-profit corporations – particularly publically traded corporations – their view of the concept is this:

The only reason for-profit organizations exist is to increase the wealth of equity holders.

Yup, it's cold, hard capitalism at its best – or worst – depending on your perspective. Unless a for-profit is financially healthy enough to produce profits – and therefore build-up the balance sheet – it may not survive.

Before those of you at not-for-profit and public hospitals start feeling a bit smug, remember your organizations also have a prime directive of finance:

An organization must secure adequate financial resources to sustain and expand its mission.

In either case without money – i.e., the financial dimension of the triple bottom line – the social and environmental missions are not possible at any organization. Sacrilege? Maybe, maybe not. It's something to ponder, though, isn't it?

Now, Set the Hospital's Sustainability Policy
So, with every hospital facing no money, no mission realities, it behooves senior leadership – i.e., the board of directors and C-level officers – to formally state the high-level policy on environmental sustainability. And, they might as well set this policy in the go-decision's board resolution discussed above.

Guiding principles, programmatic objectives and general requirements must be defined for the whole hospital in the sustainability policy. Also, the policy must state the priority for these mandates relative to the hospital's other declared intentions and requirements. As you're no doubt beginning to realize, these considerations set the extent of sustainability activities, as well as their limits.

For hospitals just now starting to go green there are advantages to be had thanks to all of the existing sustainability programs outside the healthcare industry that are just waiting to be benchmarked. Further, because many of these programs have excellent corporate transparency elements, their policies are readily available via the Internet. So, when it comes to drafting the go-decision and policy statements for a board resolution, don't reinvent the wheel. Simply google the phrase "corporate sustainability policy" and start benchmarking. (Remember how benchmarking was characterized at the end of the August 17th post?)

One thing you may notice with some online policy statements is the addition and comingling of specific objectives, tactics and targets. For the sakes of brevity and subsequent program flexibility, I'd suggest that your hospital resist the urge to include them in your policy statement.  Leave the definition of strategic objectives, tactical goals and specific administrative and operational improvements for later stages in your program's development.

Irrespective of whatever benchmarked and original content is included, write the policy in the context of the green efficiency concept, i.e.:

Achieve the hospital's people, planet and profit objectives with least cost, effort and risk throughout the entire closed-loop lifecycles of its services and products.

Further, just because the green efficiency concept states that objectives must be achieved with least cost, effort and risk, it doesn't mean they can't be set at the highest breakthrough-performance levels.  Of course, they can be set at low levels, too.  But, these considerations must be made by the policy's authors and adopters.     

Which leads to the next question:  Who's going to write the policy?  Drafting the sustainability policy for board approval is a terrific opportunity for the C-level officers to involve individuals at all levels of the hospital organization in a major shared governance activity.  A key advantage of including a wide representation of management and staff is early, broad and continued support for the program.  The importance of this approach cannot be overstated when it comes to effectively managing all of the program's subsequent changes.

IN THE NEXT POST:  The Prelude to Setting the Sustainability Program's Strategic Objectives and Tactical Goals