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Remember when going green was too expensive for hospitals? Those days are gone, and now hospitals and systems can't afford not to embrace sustainability.

The value of establishing an environmental stewardship program is better understood now than ever before. Yet at the same time, health care systems have to run leaner and embrace transformational change. So the question is not so much why we need to do this work, but how can we get it done amid so many competing priorities?

Hospitals don't have to reinvent the wheel. The American Hospital Association's Sustainability Roadmap for Hospitals provides tools for health care organizations to establish successful and efficient sustainability programs.

Maximize the Board's Role

A successful environmental stewardship program must first align with the mission, values and strategic direction of the organization. A program can be inspired from the highest levels, with trustees and C-suite leadership, or from the ground up, with managers and front-line staff.

Trustees are in a critical position to lead change and encourage their organization to keep moving along the sustainability continuum. They may be motivated by the hospital's mission, its community or its finances. They can contribute ideas from their own organizations and the community as well as share the hospital's plans with the community. An active and visible role from the top can be profoundly helpful both to a fledgling program and to one that is more mature.

"There is an opportunity for trustees to pollinate the board and the organization with fresh ideas and information," says Bob McCoole, senior vice president of the facilities resource group at Ascension Health, the largest faith-based system in the country. "Trustees also can make a big difference by communicating support directly to those who handle the work. When we receive acknowledgment from a trustee, it validates the connection between work and mission. If trustee support is invisible to associates, it's a missed opportunity."

C-suite Identifies Successes

Data can inspire organizational leaders to push sustainability. With the everyday pressures of labor, budget, accountability and cost concerns, executive bandwidth is limited. Whether the metric is energy
use or recycling rates, it can be motivational.

A pivotal moment can occur when a C-level leader looks across the organization and notes both bright spots (facilities that consistently outperform others) and trouble spots (facilities that could do better) and asks why. When C-level leaders acknowledge, celebrate and share successes, others are motivated to do better. Likewise, if staff at struggling facilities understand that they will get help instead of getting fired, they are more likely to disclose problems. This is an organizational shift toward sustainability that leaders can drive and support.

A successful sustainability program must prove and reprove its viability by establishing clear metrics for every project; collecting accurate, uniform information; and consistently measuring and reporting results.

Financial metrics are part of that requirement. Because the financial benefits of sustainability have been demonstrated, a sustainability leadership council is free to develop strategy, establish priorities, allocate resources and approve financial decisions. Social and environmental drivers align the sustainability program with the organization's mission and values, completing the commitment to the so-called triple bottom line, a framework that measures financial, environmental and social performance.

Green Teams Flourish

With the commitment of C-level leaders, staff from various departments come together to form a sustainability committee or green team. A green team might include participants from such areas as environmental services, safety, facilities, nursing and medical staff, radiology and purchasing. These departmental leaders are empowered to make change happen. Together, they manage, educate, communicate, monitor, collect, measure, report and inspire.

"We don't have to convince people to pursue sustainability," says Lois Sechrist, senior analyst, facilities resource group, Ascension Health. "Everyone understands why.

"Even in today's rapidly changing health care field, when associates are asked constantly to adjust to change, we see instant support for new environmental initiatives," she notes. "When people see what's happening at other Ascension Health facilities around the country, they get inspired. There is a collective spirit of acceptance because everyone is expending that extra effort, and it just continues to build."

Green teams operate knowing they have the support of the system's parent organization, she adds.

Three Case Studies

The financial, environmental and social components of sustainability's triple bottom line motivate organizations in different ways, but often the social connection is what inspires change. Social benefits include employee and community satisfaction and wellness. Employees are inspired to do better when they know their actions will have a positive impact on others. Three case studies demonstrate this.

Healing garden: Employees at Borgess Medical Center in Kalamazoo, Mich., walked by a neglected courtyard space every day and never really noticed it until Executive Secretary Sharon Ritchie wondered if tomatoes could be planted there. That idea blossomed into a thriving vegetable garden with an abundant harvest that benefits people in need.

Named after the sister who once tended flowers there, the Sister Anastasia Healing Garden has doubled each year under the care of a master gardener and many volunteers. With plants donated by a local greenhouse, the garden comprises 1,500 square feet of tomatoes, green peppers, squash, green beans and more. Community food programs such as Loaves & Fishes, Hospitality House and Sisters of St. Joseph received more than 3,600 vegetables in 2012, and were honored to join Borgess Medical Center staff in a formal dedication ceremony for the garden earlier this year.

Unbottled water: In a country where running water is safe and accessible, bottled water is everywhere, resulting in millions of bottles of plastic waste, not to mention the energy burden of production and delivery. Executives who attend meetings at Ascension's headquarters in St. Louis, Mo., however, rarely find bottled water. The sisters of the Daughters of Charity, some of whom serve as Ascension trustees, are largely responsible for inspiring this change. The Daughters' mission calls them to do work across the globe, including engaging in efforts to provide access to clean water in countries like Guatemala and to raise awareness of water as a worldwide issue.

"We recognized that we were taking water for granted," McCoole says. "We have clean, safe water available to us whenever we want, while people in other parts of the world struggle to have enough. We could not ignore the profound disconnect between the sisters' mission and our actions."

The sisters' commitment served as an impetus for change not only at the system office, but throughout the organization as well. And at Ascension meetings at conference centers and hotels, not serving bottled water is in the venue contracts, according to Sister Bernice Coreil, Daughters of Charity, senior executive adviser to the president.

Sustaining scraps: Food waste is a challenge for any hospital. It's heavy and costly to dispose, and good alternatives, while available, can be difficult to implement. But at Our Lady of Lourdes Memorial Hospital in Binghamton, N.Y., nothing goes to waste. Scraps from the cafeteria and patient trays are separated into animal edibles and garbage for composting.

The scraps are kept in cold storage and collected three times a week by a local composter who delivers the feed to subsistence farmers and processes the food garbage into compost. He returns a certain amount of compost to Our Lady of Lourdes for landscaping and for water retention along the nearby river bank.

Last year, food scraps from the hospital produced 26 tons of animal feed and 20 tons of compost, but cafeteria administrators and staff wanted to do more. Their green attitude laid the foundation for eliminating all Styrofoam cups and containers, and served as the impetus for a zero-waste holiday dinner. Their next project? To make all meat and dairy offerings antibiotic-free.

New View of Stewardship

"Trustees have always had a stewardship responsibility for their organizations' futures, but usually associated it with finances," Coreil says. "Now there is realization that safeguarding the environment and cocreating healthier communities by working together within the broader health ecosystem is how to strengthen their legacy for the future."

When an organization engages in the sustainability conversation up, down and across, embraces the changes required to support sustainability, and publicly acknowledges its achievements, a culture of stewardship naturally emerges.

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Laura Brannen ( is senior environmental performance consultant at Mazzetti, San Francisco, and was a partner in developing the Sustainability Roadmap for Hospitals.