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.

Sunday, March 20, 2011


I would love to say this is the wittiest, most lively post to date.  But, I can't.  As a process description, this post has as much liveliness as an engineering specification.  That said, though, like any well done engineering spec, it is indispensable.  So, suck-it-up and just wade on in.  Some of the most important ideas for creating a hospital sustainability program are lurking in here. 


In the last post we examined the details of a possible organization-structure template for a hospital sustainability program.  Now, let's look at how all of the policies, plans, people and projects discussed so far might fit together in a fast-track, continuous-improvement (CI) management process. 

I say "might" because even though I have successfully applied the process illustrated in Figure 8 – including the design and implementation of the United States Marine Corps Base Camp Pendleton's first benchmark environmental management system – each healthcare institution needs to custom-design its own program management process.  (Click on the figure to enlarge.)  Remember, what makes perfect sense at one institution may not at another.


The October 20, 2010 post discussed the first step in linking strategic intentions to administrative and operational activities.  That step is the definition of the hospital's sustainability tactics.  As noted in that post, there is a second complementary linkage step:  the design and successful completion of capacity-creation and performance-improvement projects by specific administrative and operating units, as well as cross-functional teams.  This post describes one of many possible systematic approaches to the second linkage step.  

As with so many of the suggestions in this blog, Figure 8 is offered only as a strawman that can be disassembled and rebuilt to meet the specific needs of individual organizations.  So, after answering the 10 sets of rudimentary sustainability management system questions from the August 18, 2010 post, a hospital needs to modify Figure 8 through additions, deletions and resequencing.

In case you are wondering how this post differs from the August 18th one – i.e., A Rudimentary Model for a Sustainability Management System – that post posed essential design questions for a sustainability program.  Whereas, this post shows how some organizations have answered such questions to define their programs' management work processes. 

Figure 8 illustrates answers – at least partially – to the 10 sets of design questions in a flow diagram format.  In this layout it is fairly easy to see the work process's underlying four-part structure.

           Inputs – Elements 1 through 7 provide the process's inputs

           Input-Transforming Work – Element 8 is the work that creates new sustainability capabilities and/or resolves performance issues

           Outcomes/Outputs – Element 9 reviews the efficacy of the work-activities, and

           Process Restart – Element 10 restarts the iterative process in consideration of work outcomes and outputs, as well as lessons-learned. 

O.K., it's quiz time.  Where have you seen a four-part work process like this before?  That's right!  It's Shewhart's Plan/Do/Check/Act (PDCA) Cycle expressed in slightly different old-school industrial engineering terms!  

Because it is anchored in the PDCA concept, this CI sustainability management process model is fully compatible with any total quality management (TQM), Lean or six-sigma methods your institution is currently using.  Isn't that a relief?  Rather than replace anything you are currently doing, this process model complements and builds on your institution's more progressive management methods. 

Using the PDCA-based structure discussed above, let's consider how each of the 10 elements in Figure 8 function to provide a fast-track, closed-loop sustainability program management process.  Please note that the references below to "Elements" pertain to the activities shown on Figure 8, whereas the references to "Question Sets" pertain to the 10 sets of rudimentary sustainability management system questions in the August 18, 2010 post.

As the PDCA-cycle Plan Steps, the first seven process elements shown on Figure 8 are critical for creating the overall program and defining an institution's most-pressing sustainability needs.  They also provide the means to design capacity-creation and performance-improvement projects, as well as assign accountabilities for successfully completing those projects.  While some of the elements focus on longer-term strategic and tactical tasks, others deal with shorter-term – i.e., quarterly – activities to assure rapid-cycle responses to an institution's most-pressing needs. 

           Element 1:  Creating the Sustainability Program and Assuring Executive Buy-In (See Question Set 1) Senior leadership – i.e., the Board of Directors and the Chief Executive Officer – mandate the definition of the sustainability program's strategic objectives, tactical goals, corporate policies and standard operating procedures. 

           Element 2:  Setting Near-Term Organizational Priorities for Sustainability (See Question Set 2) The Sustainability Program Oversight Group identifies the sustainability strategic objectives and tactical goals that need to be implemented during the next fiscal quarter.  Refer to the December 31, 2010 post for details on the oversight group's composition and activities. 

           Element 3:  Sensing Organizational Sustainability Performance (See Question Set 3) The corporate decision-support function collects and analyzes enterprise and unit-level poor sustainability performance data and information for each of the sustainability topics shown both on Figure 2 in the August 17, 2010 post and Figure 8, above. 

           Element 4:  Creating the Sustainability Program's Shared-Governance Function (See Question Set 4) The Sustainability Program Oversight Group creates and staffs a green team for each sustainability topic shown on both Figure 2 in the August 17, 2010 post and Figure 8, above.  Refer to the December 31, 2010 post for details on green team composition and activities. 

           Element 5:  Producing and Distributing Goals-and-Issues Lists to Green Teams (See Question Set 5) Each fiscal quarter the corporate decision support function sends a “goals-and-issues” list for each sustainability topic to its responsible green team.

           Element 6:  Prioritizing the Organization's Most Pressing Sustainability Needs and Prescribing Sustainability Project Goals and Accountabilities (See Question Set 6) Each green team produces a short-list of the institution's most-pressing needs for its particular sustainability topic.  Then, for each of these needs it sets a measurable performance goal and project completion date.   Lastly, it identifies the best-suited administrative or operating units or cross-function team to achieve the goal.

           Element 7:  Initiating Projects to Achieve Sustainability Goals (See Question Set 7) Each green team forwards its project proposals to the Sustainability Program Oversight Group for final selection and formal assignment of project design and completion accountabilities for the next fiscal quarter.  Then, the responsible green team provides project design and oversight support to the accountable operating or administrative unit or cross-function team.   Under the green team's guidance, the accountable unit or team designs its capacity-creation or performance-improvement project.

Input-Transforming Work As the PDCA-cycle Do Step, Element 8 in Figure 8 is where projects are completed to achieve the sustainability project goals set in Element 6.  
           Element 8:  Completing and Supporting Projects (Question Set 8)  The project work is undertaken, actively managed and completed by the accountable unit or team in accordance with the project plan.

Outcomes/Outputs As parts of both the PDCA Check and Act Steps, Element 9 is a key function in actively managing sustainability project performance.  It is the process's primary programmatic monitoring activity wherein variances and non-conformances to project plans are detected and effective corrective actions are implemented to assure achievement of project goals. 

           Element 9:  Assessing Project and Program Progress (Question Set 9) At the end of each fiscal quarter the Sustainability Program Oversight Group assesses the success or failure of each project.  That is the Check part of the element.  Then, moving on to the Act part, successes are celebrated.  However, in the case of project failures, the root causes are determined and corrective actions are defined and mandated.  Lessons-learned are shared with internal and external stakeholders, as are other other transparency concerns.

Process Restart Element 10 completes the PDCA Act Step.
           Element 10:  Sustaining the Program (Question Set 10) Once Element 9's activities are completed, the information on project successes, failures, corrective-action mandates and lessons-learned are linked through Element 10 to the corporate decision support function's activities in Element 3.  The project failures, corrective-action mandates and adverse lessons-learned are then included in the decision support function's activities to identify new sustainability needs.  Also, although not shown on Figure 8, Element 9 periodically links back through Element 10 to Element 1 to assist in future sustainability strategy and tactics planning activities.


With this post, the basic approach to creating a hospital sustainability program is complete.  The next several posts will examine the details of an essential sustainability program analytical technique, lifecycle assessment (LCA).

In the Next Post:  Lifecycle Assessment for Healthcare Organizations