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, December 31, 2010


Good Grief!  Eight Posts Later and What Do We Have to Show for the Effort? 
Well for starters, we have covered some elementary business planning methods for creating a sustainability program's:
·         Policies and strategic objectives for an entire institution, and
·         Hospital-function- and unit-specific tactical goals. 

Plus, by employing these planning methods we've created opportunities for "meta-learning" (please excuse the buzz-phrase) in the areas of:

·         Increased leadership and staff awareness of sustainability concepts and the hospital's most-pressing needs, and

·         Initiation of in-house sustainability expertise. 

So, in this post let's take the next step and examine a framework for the program's organization structure, including functions, lines of authority and stakeholder roles.    But, before we get into all of that, there is a bit of paper work to complete. 

Sustainability Program Documentation
The activities described in the last several posts fleshed-out much of the first element in sustainability program development:  Definition of Sustainability Program Policies, Strategic Objectives and Tactical Goals. (Refer to the first three bullet points in Question Set 1, "Creating the Sustainability Program and Assuring Executive Buy-In" in the August 18, 2010 post.)   With the development of these high-level program requirements, it is time to document them and make them readily available to all of the organization's internal and external stakeholders.  Of course, their inclusion in the hospital planning and accountability management systems, which were discussed briefly in the last post, is just one part of this corporate transparency activity. 

As with so many aspects of sustainability, healthcare has an advantage in program documentation by being a bit late to the party.  The International Organization for Standardization (ISO) provides readily adaptable formats and management criteria for documenting, managing and distributing sustainability program policies, objectives and goals.  They can be found in the ISO 14000 standard for environmental management systems (EMS), as well as in the new advisory standard, ISO 26000, Guidance on Social Responsibility.  

To make it even easier to use ISO 14000/26000 and other such formats, several EMS software applications are available to make program documentation a relative breeze now and in the future.  Check out such applications as CSRware's Energy & Sustainability Management and Sustainable Supply Chain modules, Intelex's ISO 14001 Environmental Management Solutions™, and Hara's Environmental and Energy Management™ to name just a few. 

Please keep in mind that I am not endorsing these or any other software applications.  I'm simply offering them as examples of what is available.  Your hospital may find it far easier and cheaper to simply format the policies, objectives and goals as a part of the institution's existing document management system.

Further, I am not suggesting that your hospital pursue ISO 14000 certification at this time.  Rather, I am simply suggesting that by documenting the policies, objectives and goals in ISO 14000 format now it may be easier to use them in the future.  This is especially true for accreditation, certification, award program and corporate transparency efforts. 

O.K., Now Let's Discuss the Sustainability Program's Organization Structure
The efforts to this point in the program's development process have simply used ad hoc groups within the existing hospital management structure.  However, to actively manage and strengthen the program it is necessary to define and implement:
·         Specific roles
·         Lines of authority, and
·         Work processes. 

This doesn't mean that most hospitals and regional integrated healthcare systems need to create stand-alone sustainability bureaucracies.  Nor, does it mean that they need to staff-up with a lot of sustainability professionals.  We all know how far these ideas would get in the current economic climate. (However, behemoth organizations the size of Kaiser Permanente, Humana and HCA might want to consider it.)   It simply means leaders and staff need to know who's going to do what on an ongoing basis within the program using the existing hospital personnel resources. 

Ultimately, each hospital's sustainability program management structure will be tailored to the unique needs of that institution.  The following discussions provide a strawman for designing such a management structure.  In case you are not familiar with the concept, the idea behind a strawman is to:

Beat the stuffing out of it and put it back together any way that works best for you.

First, we'll take a look at the strawman organization chart in Figure 7, which shows candidate sustainability program participants.  Then, we'll briefly consider typical responsibilities for each role shown on the chart.   Please note that the key Sustainability Program Champion position is discussed out of the hierarchical order shown on Figure 7 (Click on figure to enlarge).

Figure 7

Program Leadership Roles – The sustainability program leaders are the Board of Directors and its Corporate Social Responsibility (CSR) committee, the Chief Executive Officer, the Sustainability Program Oversight Group members, and the Sustainability Program Champion.

·         Sustainability Program ChampionThe Sustainability Program Champion is the contact point for the entire program.  As such, s/he is the primary program designer, technical expert, change agent, controller, facilitator, teacher, mentor, coach and sometimes butt-kicker up and down the organization chart.

In addition to battle-tested sustainability expertise, this kind of responsibility requires significant position, referent, technical and persuasive powers in the organization.  As shown on Figure 7, typical titles reflecting such power include:
  • Chief Sustainability Officer
  • Vice President, Sustainability, and
  • Sustainability Director.
Such titles also entitle the holder to significant compensation in recognition of the job-security and career risks inherent in creating and growing a major transformational program.   What risks, you ask?  As discussed in earlier posts, effective sustainability programs mean that other leaders and staff often have to be moved out of their professional and emotional comfort zones.  Don't be surprised when some of them fight back against the Sustainability Champion in the most vicious and under-handed of ways.  A change agent's job is not for the faint of heart.  So, make the Sustainability Champion's compensation worth the effort and occasional anguish.    

The Sustainability Champion's accountabilities should be drafted by the Sustainability Program Oversight Group for amendment and assignment by the CEO or one of her/his designated direct reports.

Unless your hospital is relatively small and under-resourced, job titles to avoid for the Sustainability Champion are specialist, coordinator and manager.   Why?  Because hospital specialists, coordinators and managers – who typically have transactional capabilities and responsibilities rather than transformational ones – rarely have the leadership clout, position authority and change-agent skill sets required to lead major new initiatives. Let's face it, few status-conscious board members, C-level executives, vice presidents or directors are going to effectively respond to the earnest efforts of a hard-working specialist, coordinator or staff-level manager residing way down in the bowels of the organization chart.

That is why in the broader economy bleeding-edge companies have chief sustainability officers, sustainability vice presidents and sustainability directors. They recognize that sustainability is a major business management function that demands a significant amount of leadership, experiential and intellectual horsepower to measurably achieve an enterprise's people, planet and profit (3-P) objectives with least cost, effort and risk.

However, due to the relative newness of the subject, few healthcare institutions currently hold this critically important insight. At far too many hospitals considering sustainability initiatives, first impulses are to form yet more committees or appoint low-level coordinators and managers to do "green busy-ness" projects. These are, of course, normal – and often ineffective – impulses within the industry for any kind of new program.  

·         Board of Directors and Its Corporate Social Responsibility (CSR) CommitteeConsisting of two or three members, the CSR Committee acting on behalf of the entire board of directors is responsible for:

o        Initially evaluating whether the hospital should implement a sustainability program, i.e., the "go/no-go decision."   Then, assuming a "go decision"

o        Drafting and periodically revising the hospital's high-level sustainability policies – including the guiding principles, programmatic objectives and general requirements – to achieve 3P objectives with least cost, effort and risk throughout the entire closed-loop lifecycles of its services

o        Monitoring the hospital's overall sustainability progress and prescribe policy-level corrective actions as needed.

o        Drafting the CxOs' sustainability accountabilities.

o        Providing observers to the Sustainability Program Oversight Group.

As with any board committee, the CSR committee submits its findings and recommendations to the whole board for collective action. 

·         Chief Executive OfficerThe CEO is the board's primary agent for implementing its policies at the hospital's administrative and operational levels.  As such, the CEO is responsible for adequately balancing priorities and marshalling resources to create new capabilities and resolve performance issues in timely and cost-effective ways.  With these responsibilities it is easy to see how important the CEO is to the success or of a sustainability program. 

However, with all of the competing demands for the CEO's time and attention, the detailed sustainability program work must be delegated to others who will provide her/him with:

The right information to make the right decisions at the right times.

In this case, the delegated parties are members of the Sustainability Program Oversight Group, which is facilitated by the Sustainability Program Champion. 

·         Sustainability Program Oversight GroupThe Sustainability Program Oversight Group should consist of five to seven high-ranking leaders.  Members should be drawn from the ranks of the Chief Operations Officer, Chief Financial Officer, Chief Administration Officer, Chief Medical Officer, Chief Nursing Officer, Chief Information Officer, Chief Strategy Officer, Ancillary Services Director, Facilities Director, Risk Management Director and Marketing Director.  Of course, a permanent member of the group is its facilitator, the Sustainability Program Champion.   

There should be set membership terms of no less than one year.  Further, the start and end dates the members' terms should staggered on a quarterly basis to assure experience continuity within the group. 

The titular head of the group is the CEO.  However, the CEO may want to delegate day-to-day group leadership responsibilities to one of her/his direct reports.

Reporting to the CEO, the group's primary responsibilities include the following.

o        Draft periodic revisions to the program's strategic objectives, tactical goals, and management processes for executive approval.

o        Draft quarterly schedules for strategic objective and tactical goal implementation for executive approval.  Demonstrate in this scheduling that adequate consideration has been given to the hospital's other organizational effectiveness initiatives.

o        Using recommendations from the Green Teams (see description below) for sustainability projects, define, assign and communicate specific unit-level and/or personal capacity-creation and performance-improvement accountabilities prior to the start of each fiscal quarter.

o        Assure that capacity-creation and performance-improvement projects have adequate resources to succeed, especially in the area of program-participant workloads.

o        During each fiscal quarter periodically monitor project progress to successfully achieve the capacity-creation and performance-improvement accountabilities on time and within budgets.

o        At the end of each fiscal quarter formally assess projects and celebrate their success.  Or, in the case of unsuccessful projects, define the root cause of failure and take effective corrective actions without punishing people for the sins of the work process. 

Program Support Roles – Accountabilities for the following program support functions are levied and tracked by the Sustainability Program Oversight Group.

·         Corporate Planning FunctionThe corporate planning function supports the sustainability program by incorporating it as a key element, foundation block or pillar in the hospital's overall strategic, tactical, budgetary, and unit-level planning, accountability and control systems and processes. 

·         Corporate Decision-Support FunctionsThe hospital's various data and information capture, analysis and reporting functions support the program by incorporating sustainability performance factors into their respective activities.  These functions should minimally include:
o        Historic and current financial and managerial accounting
o        Clinical performance/EMR tracking and reporting
o        Stakeholder satisfaction tracking and reporting, and
o        Special analyses
Also, key sustainability factors must be included in periodic dashboard or balanced scorecard performance reports provided to administrative and operating units.

·         Information System (IS) Support FunctionWorking with the Sustainability Program Oversight Group and the corporate planning and decision-support functions, the hospital's IS support function participates in the sustainability program on an ongoing basis by automating as many of the data capture, analysis and reporting functions as is feasible within its resource limits and opportunities. 

Program Operations Roles – The detailed on-the-ground work in the sustainability program is done by Green Teams and ad hoc Project Teams.  The Green Teams assess, define and prioritize the hospital's sustainability needs from technical and other special topic perspectives.  They also provide active-management oversight support to the ad hoc Project Teams.  The ad hoc Project Teams design and execute sustainability projects to create new capabilities and resolve performance issues. 

·         Green TeamsThe Green Teams are one of the sustainability program's shared governance features.  Consisting of approximately 3 people each, the green teams focus on one – or possibly more – of the sustainability topics shown on Figure 2 in the August 17, 2010 post.  Ideally, the members should have expertise related to the team's topic.  However, in lieu of expertise, a strong interest and a bit of enthusiasm will do quite nicely in the program's early development phases.   

The Sustainability Program Oversight Group will recruit Green Team members as a part of the hospital's leadership development efforts, as well as set and track their accountabilities.   As with the Sustainability Program Oversight Group, membership terms should be no less than one year.  Further, the start and end dates for each member's term should staggered on a quarterly basis to assure experience continuity within the group. 

Green Team responsibilities include the following.

o        Using inputs from the corporate planning, decision support, IS functions and other sources, each Green Team will assess topic-specific information every fiscal quarter on the hospital's sustainability performance.  From this assessment, the Green Team will produce a Pareto-prioritized list of the hospital's most pressing sustainability needs for its particular topic(s).

o        Prior to the end of each fiscal quarter, each Green Team will present its list of most pressing sustainability needs to the Sustainability Program Oversight Group.  As noted above, the oversight group will select those most-pressing needs that will be addressed in the next fiscal quarter.   Then, it will assign personal, unit-level and/or cross-functional accountabilities.
o        Each Green Team then works with the accountable persons and their ad hoc Project Teams to design an appropriate work effort to achieve the assigned accountability.

o        In situations requiring extraordinary resources for project success, the Green Teams will present the case to the Sustainability Program Oversight Group for action. 

o        Ideally on a biweekly basis – but no less than monthly – the Green Teams will review the ad hoc Project Teams' progress.  When adverse variances and non-conformances occur, the Green Teams will prescribe and track immediate and effective corrective actions to get the project back on course.  When necessary, the Green Teams will consult with the Sustainability Program Oversight Group to resolve issues.

o        The Green Teams will provide formal periodic and end-of-work reports on their project portfolios to the Sustainability Program Oversight Group.  At a minimum, these reports will present objective evidence of project performance and outcomes.  In doing so, the reports will discuss performance issues and the outcomes of corrective actions, as well as prescriptions for next steps. 

·         ad hoc Project TeamsFor each of the hospital's most pressing sustainability needs, an ad hoc Project Team will be formed to successfully achieve the accountabilities assigned by the Sustainability Program Oversight Group.  The associated Green Team will provide oversight support to the Project Team in its efforts.  However, the Project Team is ultimately responsible for project success.

The sizes of project teams will vary.  The terms of Project Team membership are set by the length of the project.  As an ad hoc group, there are no ongoing participation requirements once the project ends. 

Project Team responsibilities include the following.
  • With the advisory assistance of the responsible Green Team, each Project Team will design a plan to accomplish the assigned accountability.  These project plans will include a needs assessment, project scope, work breakdown structure, resource requirements, performance schedule, and – if necessary – project budget for extraordinary expenses. 
  • Each Project Team will successfully executive its plan to achieve the accountability on time and within budget.
  • The Project Teams will submit written periodic progress reports to their respective Green Teams as required.  The reports will include:
o        A summary of completed tasks
o        A description of any variances or non-conformances to the plan
o        An assessment of the efficacy of corrective actions to plan variances or non-conformances
o        A preview of next steps in the project, including their challenges and methods to avoid or adequately mitigate those challenges.

  • All Project Teams will produce a closure report at the end of their projects:
o        Summarizing the work effort and the contributions of team members
o        Providing objective evidence of project success or a root cause analysis of project failure
o        Summarizing lessions learned, and
o        Prescribing next steps, including
§         Recommendations for sustaining the project outcomes, and
§         New actions to resolve issues discovered during the project.


In the Next Post:  The Sustainability Program Management Process
Next time we'll examine how all of the policies, plans, people and projects discussed so far fit together in a fast-track, continuous-improvement management process.