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 17, 2011


The last 10 posts addressed the design, implementation and operation of a systematic environmental sustainability program for healthcare and other organizations.  However, this post – while continuing to emphasize systematic approaches – shifts the blog's focus to advanced needs-assessment and problem-solving methods starting with the critically important environmental sustainability concept of lifecycle assessment (LCA). 

Basic LCA concepts and applications are discussed in this post.  In the next two posts, rudimentary step-by-step methods will be described so that readers will actually be able to start using this invaluable analytical tool.    

Among the various environmental sustainability needs-assessment and problem-solving techniques, LCA is one of the more thorough methods for identifying opportunities-for-improvement (OFI – pronounced "oh-fee").   Even though it relies to a degree on technical analyses, its ultimate goal is to drive all wastes – financial, social and environmental – out of an organization's activities.  As such in a business context, LCA is primarily an organizational management tool that helps:

  • Increase operational and administrative efficiencies, thereby reducing costs, efforts and risks, and

  • Incorporate green and social-benefit attributes into existing and new products and services, thereby enhancing customer loyalty and attracting new customers in support of revenue growth. 

Why is LCA important?  Think of it as the conceptual cradle-to-cradle – i.e., closed-loop – framework for all environmental sustainability efforts.  At its simplest:

LCA identifies all of the possible adverse environmental impacts of resource inputs, work activities, and outcomes or outputs at every step in a product or service's value chain.

With this information, an organization can then obviate or mitigate adverse environmental impacts to reduce its operating and administrative inefficiencies in terms of costs, efforts and risks. 

The LCA concept grows in importance for an organization over time.  Here's why:  when an environmental sustainability program is first started, it's easy to just work on those activities touted by the various green-advocacy organizations, like:
  • Energy conservation improvements and greenhouse-gas (GHG) reduction tracking
  • Better controls on solid and hazardous waste management, and
  • The greening of the procurement process. 

However, once these "low-hanging-fruit" issues are under control, it may be difficult for an organization like a hospital to identify its own unique OFI's.  This is where various needs-assessment methods, especially LCA, become increasingly important in finding less-than-obvious opportunities.   

LCA's Hybrid OriginsWhere did the LCA idea come from?  Although it has engineering and scientific features arising out of the environmental impact assessment disciplines, it is equally rooted in basic business management and industrial engineering concepts starting with supply-chain and value-system management. 

Let's look at its origins by defining a basic business and logistics management idea, supply chains.  A supply chain involves:

The movement and storage of raw materials, work-in-process inventory and finished goods from point of origin to point of consumption.

Did you notice how this definition of supply chain stops at the point of consumption?  That's not very sustainable, is it?  You're right!  It's missing the reverse-logistics element!

(Definition:  Reverse logistics is the discipline of planning, implementing, and controlling the efficient flow of materials, production inventory, finished goods and related information from the point of consumption to the point of origin for the purpose of recapturing value or proper disposal.)

Well, as you might imagine, such conceptual limitations have inspired others to expand the supply chain idea.  For example, Harvard professor Michael Porter expanded it in these paraphrased terms by introducing the idea of value systems: 

A value system includes all of the supply chains of an organization's suppliers, the organization itself, the organization's distribution channels, and the organization's downstream buyers and so on until the product or service has reached the end of its useful life.

As products – as well as services – pass through all sourcing, production and distribution activities in order, they should gain some value.

Further, it's through this idea of value systems that value-engineering methods arose.  Value engineering is a body of operations management and industrial engineering techniques that identifies and removes unnecessary expenditures, thereby increasing value for producers and their customers.  The basic idea of value engineering is this:

For every dollar put into production and/or service delivery, the organization should have more product and/or service capacity to sell by eliminating waste.

It's not too hard, then, to understand that each activity in a value system presents significant risks to the desired achievement of value gain.  In standard value engineering terms, the risks that diminish or prevent value gains include: 
·     Delays
·     Mistakes
·     Defects
·     Waste, including financial, solid, hazardous, gaseous, aqueous and energy wastes
·     Work-arounds and rework, which are two rather insidious forms of waste in healthcare settings
·     Accidents, and
·     Negligence.

For readers who have been exposed to continuous-improvement problem solving – including Deming, Japanese Union of Scientists and Engineers (JUSE), Toyota Lean, and six-sigma methods – these risk factors should sound familiar.  At their hearts, these interrelated methods strive to get this kind of "junk" out of all work processes.  In regard to value systems, just think of them as big complex work processes that collect a lot of junk over time.   

What LCA Adds to Supply Chain and Value-System ConceptsFor the purposes of environmental sustainability, though, the LCA concept enhances the value system concept with these three additional dimensions:

·     The first dimension, as noted above, is the explicit inclusion of solid, hazardous, gaseous, aqueous and energy wastes on the list of junk to be eradicated.  These wastes are significant because they are the primary casual agents of many adverse environmental impacts.   

·     The second dimension is a clear focus on the upstream, current and downstream lifecycle phases like those shown on Figure 9.  (Click on figure to enlarge.)  Effective management of lifecycle phases generally offers several environmental advantages.  Here are two of the primary ones.
  • By influencing upstream suppliers to become more sustainable, an organization may create specific opportunities for lower production and service-delivery costs.

  • Likewise, specific opportunities may arise by influencing downstream product and service users and end-of-design-life reverse-logistics agents to reduce corporate risks and their associated costs. 

·     And, the third dimension is recognition that all value-chains must be closed-looped through effective use of the 3-R concepts to manage wastes in every lifecycle phase by reducing, reusing, and recycling.

So, as you can see, LCA may be regarded as the most fully evolved set of considerations in value system management.  As such, LCA provides a core organizational management incentive for environmental sustainability program development, i.e.: 

LCA provides the closed-loop production and service-delivery framework spanning a product or service's entire lifecycle within which an organization may achieve its objectives with least cost, effort and risk.

If you haven't figured it out, yet, the field of environmental sustainability is in its "Wild West" developmental stage and this is not an exclusive issue in healthcare.  There are nearly as many approaches to the field's needs-assessment and problem-solving methods as there are buzzwords, starry-eyed acolytes and starving consultants.  As you might imagine, some approaches are right-on-the-mark while others are . . . well, you get the idea. 

It's amazing how complicated LCA can become even in its simplest forms, if you let it.   So, be forewarned.  It's really easy with LCA to fall into that old healthcare trap of paralysis-by-analysis.  Remember, the KISS principle is critical to your success and sanity when first starting to do LCA's.  Please, for your own sake and the sake of your coworkers, keep it simple, stupid!   

To help you keep things simple, explanations of LCA methods in this blog eschew highly advanced industrial engineering approaches, such as one described in ISO 14040:2006 and 14044:2006.  Rather than decode these ISO standards, we'll just focus on LCA's most elementary concepts and processes. 

This, of course, is important for those of you who are new to the sustainability game.  Later, when you've got several LCA's to your credit, you can get fancy . . .  if you ever need to. 

Keep in mind that you may never need to employ some of the more complex, highly quantified methods.  Here's why:  what you are trying to produce with an LCA is merely actionable decision-making information.  This information is used to:

·     Support the organization's sustainability and other policies
·     Provide a rational basis for operational and administrative sustainability initiatives, and

·     Improve organizational performance from a sustainability perspective.

Simple LCA methods, like the ones that will be described in the next post, produce such information quite well, especially in healthcare-delivery organizations.  Here's why this is important.  Unlike manufacturing organizations where rigidly defined and controlled production activities are repeated with predictable precision thousands of times a day, healthcare delivery organizations are quite different. 

Granted, hospitals have numerous well defined and controlled work processes, especially in the ancillary services such as laboratory services and pharmacies.  However, bedside clinicians frequently use complex – and often poorly defined and communicated – decision-tree methods that are based as much on science as experiential preference – and, dare I suggest it, informed intuition – to provide custom-designed care plans for their patients. 

So, to demand industrial engineering precision in the application of LCA methods on loosely defined and controlled work processes in clinical environments may not always be a desirable or even realistic expectation.

In the next two posts we'll delve into the rudimentary methods of LCA.  In the first of these posts we'll examine on a step-by-step basis:
·     Scoping an LCA, and 
·     Defining a product or service lifecycle

Then, in the second post we'll explore:

·     Impact assessment methods

·     Obviation and mitigation prescriptions, and

·     LCA findings and prescriptions as inputs to the environmental sustainability program's management system.