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, February 19, 2012


This is the last of three posts on lifecycle assessment (LCA) methods.  Part A (August 17, 2011) considered basic definitions and concepts.  Then, Part B (September 25, 2011) explored work processes for defining a:
  • LCA project scope (Step One), and
  • Product or service's lifecycle (Step Two).

This post, Part C, outlines processes for:
  • Assessing significant impacts (Step Three)
  • Prescribing obviation and mitigation measures (Step Four), and
  • Integrating LCA information into a hospital's environmental sustainability program management system (Step Five).

Step Two, Define the Product or Service's Lifecycle, borrows from industrial-engineering problem-assessment methods.  In contrast, Step Three borrows from physical-, biotic- and social-science impact-assessment methods. 

These methods – which are commonly used in environmental impact reports (EIR), statements (EIS) and assessments (EIA) – enable the identification of sustainability-related "junk" throughout the closed-loop lifecycle of a value system.  Once identified, this junk can be avoided, eliminated or minimized to achieve organizational goals with least cost, effort and risk.  

Let's get started by taking a look at:
  • What an "impact" is and isn't – plus, why it's important to avoid assessing "positive" impacts to prevent appearances of "greenwashing"
  • The typical categories of environmental and other significant impacts, such as health and safety ones, as well as Global Reporting Initiative (GRI) concerns
  • How to prepare a matrix-format impact-assessment worksheet using Step Two's LCA flowchart, and 
  • How to define an impact’s causes and assess its risk in terms of frequency, severity and exposure.

Then, we'll examine some completed sections of an actual LCA impact assessment.

What Impacts Are . . . and What They Aren't For the purposes of this discussion, an environmental impact is:

A significant adverse change in the natural or human environments.

Readers in the United States who are familiar with EIA laws and guidelines will realize that this definition is based on the strict California Environmental Quality Act definition of an environmental impact. 

This strict definition precludes assessments of "positive" or "beneficial" impacts.  By doing so, attention is focused exclusively on "identifying and removing junk" from proposed projects, value chains and lifecycles. 

Further, this definition precludes a form of greenwashing where intentional or inadvertent attempts are made to balance, buffer, neutralize or otherwise excuse bad impacts with good ones. As a result, this failsafe definition is especially useful in preventing corporate leaders, marketing staff and others from embarrassing an organization – or worse – through good-intentioned misuses of LCA findings.

Typical Categories of Environmental and Other Significant Impacts – There are two causes of adverse impacts:
  • Those human activities that affect the environment, and
  • Those human activities that can be affected by the environment.

Further, there are all kinds of ways to categorize these environmental and human impacts, including:
  • Short- and long-term
  • Direct and indirect
  • Cumulative, chronic and acute
  • Site-specific, local, regional, global, etc., and
  • Avoidable and unavoidable.

To assess impacts, these categories need to be matrixed with physical, biotic and human environment considerations, including: 

  • Physical impacts involving:
    • Atmospheric conditions
    • Geologic resources
    • Aquatic and marine resources
  • Biotic impacts involving:
    • Ecological systems
    • Botanical resources
    • Zoological resources, and
  • Human impacts involving not only physical and biotic impacts, but also those associated with such cultural factors as:
    • Land use activities, including facility design, construction and operation
    • Micro and macro economic activities
    • Energy production and use
    • Chemical, biologic-agent, ionizing-radiation and other hazardous material use
    • Controlled and uncontrolled gaseous, aqueous, solid, hazardous and energy waste releases
    • Health and safety at the organization, community, regional and/or larger geographic levels
    • Demands on public infrastructure and services
    • Transportation and other logistics systems
    • Protection of prehistoric and historic resources
    • Social justice inside and outside an organization, and
    • Aesthetics.

Plus, there are more detailed human impact categories defined by the Global Report Initiative (GRI) and other social responsibility standards, including:
  • Human rights indicators
  • Labor practices and decent work indicators
  • Society indicators
  • Product responsibility indicators, and
  • Economic indicators

A Matrix-Format Impact-Assessment Worksheet Based on a LCA Flowchart – As you've seen above, there are dozens of assessment factors to consider in defining adverse changes and their significance.  Believe me; you don't want to juggle this complexity in your head . . . and risk certain madness!  

Why should you, especially when there is a far simpler and saner method that uses a fill-in-the-blanks worksheet like Figure 13?  Even better, yet, if your hospital's sustainability program ever becomes sold on the value of LCA's, you might be able to convince the leaders to buy a LCA software package to make things easier for experienced lifecycle assessors.

Figure 13, LCA Impact Assessment Worksheet, is based on an actual LCA worksheet produced in 2010.  In addition to considering environmental impacts, this worksheet considered health and safety risks, too.  (NOTE:  Although you can click on the figure to enlarge, the font is too small to be useful.  Download the original MS Excel™ file from https://docs.google.com/open?id=0B-43ksRRuoFQZGNjYzIwZWEtY2NjYi00YWIyLWEzMGMtODEwODlkZTA3OWRj .)

Please note that omission of the GRI factors from Figure 13 is not a suggestion that they should be excluded from your hospital’s LCA's.  It's simply a matter that their inclusion here would complicate this blog discussion far more than it already is.  So, feel free to add in those GRI factors that are important to your hospital.


Impact Assessment Method
Okay, now that you’re familiar with the various types of impacts, let's get started on a basic assessment method.  First, we'll transfer information from the LCA flowchart produced in Step Two to the LCA Impact Assessment Worksheet.  Then, we'll explore a process to define and assess significant adverse changes. 

  • Step 3A:  Transfer Information from the LCA Flowchart – Complete the following tasks in Columns 1 and 2 of the worksheet.  Please note that these instructions assume ideal conditions where all necessary information is readily available.  You’ll need to make adjustments to this assumption as you realize:

In the real world, there is no such thing as “ideal conditions”.

    • First Column – Enter the name of the applicable lifecycle phase from the LCA flowchart into Column 1, “Lifecycle Phase".

    • Second Column – For each lifecycle phase, tersely list all of the major work activities shown on your LCA flowchart in Column 2, “Work Activities”.  (Note:  This may take an additional bit of “out-on-the-operations-floor" research to create a realistic and complete list of activities.)

    • Third, Fourth and Fifth Columns under the Heading of “Work Activity Inputs” For each “Work Activity” listed in the second column state the types and quantities of input materials (Column 3), water (Column 4) and energy (Column 5) required to accomplish it. 

    • Sixth through Eleventh Columns under the Heading of “Waste Discharges” – For each “Work Activity” listed in the second column, state the composition of the waste discharges and sort those discharges into Columns 6 through 11, as appropriate.  Then, state the rate of each waste discharge.

  • Step 3B – Impact Assessment in Terms of an Adverse Change's Frequency, Severity and Exposure – With the basic analytical inputs entered onto the Figure 13 worksheet, let’s continue with the impact assessment sections.   For each of the “work activities” and “waste discharges” answer these complex questions in consideration of the various types of environmental and other significant impacts discussed above: 

    • Have there been, are there currently, or will there be any adverse changes to the physical, biotic or human environment resulting directly or indirectly from a work activity or an associated generation of waste?  If so, what are the changes?

    • Have there been, are there currently, or will there be any work-activity and waste- discharge risks arising from extant physical, biotic or human environmental conditions?  If so, what are the risks? 

For each change or risk:

    • State the change or risk’s contributing factors in terms of what caused, causes or will cause the change and then state what has been, is being or will be changed

    • Explain why the change or risk should be considered adverse in both qualitative and quantitative terms when possible.  

    • Describe the adversity’s past, current and/or future temporal characteristics.  Then, explain how these temporal characteristics contribute to the impact’s adversity, Be sure to consider these temporal characteristics: 

      • The frequency and duration(s) of change, and

      • Whether the change or risk will be a one-time “acute” or an ongoing “chronic” or “cumulative” issue.

Enter this information into the worksheet’s Columns 12 through 19, as appropriate. Please note that individual work activities and waste discharges may have multiple physical, biotic and human environment impacts. 

As you might have guessed by now, not all adverse changes are significant in terms of:
    • Severity of change
    • Frequency of occurrence, or
    • Size of an exposed population or amount of a resource.

Therefore, it is important that when we identify and describe a potential adverse impact that we also assess its relative significance to other impacts using the Failure Modes Effect Analysis (FMEA) technique introduced on Figure 4 (September 8, 2010) .  To save you from having to hunt it down, the part of that figure used for assessing adverse risks is slightly altered and presented again as Figure 14. (Click on the figure to enlarge.)

Use the criteria and formula on Figure 14 to characterize the relative degree of risk for each of the adverse impacts.  Then, enter the risk score for each impact in Column 16.  When all of the impact assessments are complete, calculate a “significance cut-off point” to determine which impacts require obviation and mitigation measures.


  • Example from an Actual LCA Impact Assessment – Figure 15 shows an actual LCA impact assessment using a worksheet similar to the example in Figure 13.  (Click on the Figure to Enlarge.)  It addresses a small portion of environmental – as well as health and safety – impacts associated with an LCA phase called “Decontamination during Operations and Maintenance”.   The assessed product is a mobile field hospital structure, which is used by governments and NGO’s around the world to provide healthcare services in the field.


The definition, assessment and short-listing of significant impacts, as described in Step 3, above, produces a body of actionable information.  This information requires organizational management and technical responses to adequately mitigate existing problems, as well as to avoid or minimize risks of future ones.  This step in the LCA process outlines many of the basic tasks involved in obviating and mitigating significant impacts.

It is almost always preferable to avoid – or obviate – adverse impacts.  The most effective ways to do this are alterations to the inputs and work activities in a production or service-delivery process.  Such alterations often involve modification – including elimination – of process steps and/or elimination or substitution of impact-causing materials. 

However, absolute obviation isn’t always possible.  So, the next best thing is to mitigate – i.e., reduce – impact adversity in terms of severity, frequency and/or exposure to an acceptable level.  The same process-alteration concepts used for obviations apply to mitigations as well.

Of course, determining an acceptable level of mitigation can be highly problematic.  What is acceptable to an organizational leader or lawyer may differ from a technical practitioner’s perspective.  Plus, it almost goes without saying that leaders, lawyers and practitioners can be way out of line with regulators' and activists’ views of acceptability.  So, as you gain experience in prescribing mitigation measures remember these little words of wisdom:

You can be legally correct and technically correct.  But, if you aren’t politically correct, too, you ain’t correct!

Okay, how does one go about prescribing acceptable obviation and mitigation measures?  You start by asking questions like these for each significant impact. 

  • Can the causal factors leading to an adverse impact be removed from a production or service-delivery process, thereby eliminating the impact’s risk of occurrence?

  • If the risk of an impact cannot be eliminated, what is the impact’s significance threshold?  In other words, how bad does an impact have to be in terms of severity, frequency and/or exposure before it is considered legally, technically and politically significant?

  • How can the severity, frequency and exposure factors in a production or service delivery process be modified so that the risk of an adverse impact is no longer significant?

By answering these questions, you’ll have a fair idea of what is needed conceptually to avoid or adequately mitigate an adverse impact.  Then, it is a matter of working out the details using the 5W’s-&-1H-Plus-Check format from the August 18, 2010, post as Figure 3, which is reproduced here.   (Click on the figure to enlarge.) 

Answers to these questions, when fleshed out using the 5W’s-&-1H-plus-Check format, produce a fairly detailed action plan for implementing the obviation or mitigation measure.  Summarize this information in Column 20 on the Figure 13 LCA worksheet.

FIGURE 3 (From August 18, 2010)

Figure 16 shows the corresponding mitigation section from the impact assessment presented in Figure 15.  Please note that Figure 16’s format differs somewhat from the one shown on the Figure 13 worksheet.   (Click on the figure to enlarge.)


With the completion of an LCA, the obviation and mitigation measures prescribed in Step 4 to manage the significant adverse impacts assessed in Step 3 need to be included in the hospital’s sustainability management system.  That management system is, of course, the subject of this blog’s first 10 posts. 

The big question is: 

Where do the findings from an LCA – i.e., impact assessments and obviation and mitigation measures – plug into the hospital’s sustainability management system?

Figure 8 in the March 20, 2011, post shows the major functions in a model closed-loop sustainability management system.  (Figure 8 is presented again, below. Click on the figure to enlarge or download the original MS PowerPoint(tm) file at:  https://docs.google.com/open?id=0B-43ksRRuoFQMDJhZDE3OGEtMDgyNC00ZjE2LWFmYzUtOWM4ZWY5OWJkZmVk  .)   An LCA’s significant obviation and mitigation measures enter the management system through the activities of Element 3 on Figure 8.  This is the point where the decision-support function distributes performance data and information to the hospital’s Green Teams.

FIGURE 8 (From March 20, 2011)

You may be wondering why a LCA project team shouldn’t just start implementing the obviation and mitigation measures it defines.  For “quick-hit” and “small-tests-of-change” kinds of measures – i.e., the little ones that can be completed in an afternoon or two – go ahead. 

However, for the more complicated measures requiring significant resources to implement, it’s better to run them through the sustainability management system as proposed projects.  Why?  Because they must be considered in relation to the organization’s other most pressing needs before committing any resources and assigning personal performance accountabilities.  By preventing “loose-canon” projects, the management system assures that all prioritized sustainability initiatives can be successfully completed within the organization’s resource limits and opportunities.


As you’ve seen from this and the previous two posts, LCA is a complex process that has the potential to comprehensively reveal a service or product’s significant adverse impacts.  More importantly, it makes it possible to prescribe effective avoidance and mitigation measures to remove inefficiencies from the lifecycles of entire value systems.  Metaphorically:

A good LCA can comb all the fleas off a dog.

It’s because of this complexity that organizational leaders need to understand there is a lot of easy to identify “low-hanging-fruit” that does not require LCA.  However, once that low-hanging fruit has been “picked” during a sustainability management system’s early iterations, LCA is the go-to methodology to identify and resolve an organization’s major, but less-obvious sustainability problems.

IN THE NEXT POST:   So, You Want to Ditch Healthcare and Become a Professional Sustainability Manager?  Finding the Right Corporate Sustainability Management Degree Program.