While sustainability is no longer considered a new concept, it certainly remains an emerging growth sector, especially within the health care environment.

Ten or more years ago, the term sustainability was sparingly addressed within health care organizations. There were very few part-time, let alone full-time, sustainability managers. Today, however, sustainability is discussed routinely in health care facilities, and is breaking free from its relegation to "other duties as assigned." Sustainability has grown to be a relevant, challenging health care pursuit that is environmen­tally sound and also can be financially rewarding.

Finding financial help

Health care organizations no longer view sustainability through the limited prism of recycling, but as being aligned with their missions and promoting health for their patients and communities. Many organizations now engage their marketing departments, further leveraging community relationships through their sustainability initiatives.

While this new level of sustainability awareness and commitment is on the rise, operational resources are still at a premium. This poses significant challenges to building a viable, effective program. Sustainable opportunities and initiatives have grown so significantly in the past decade that there is a fiscally prudent argument to assign the human and financial resources required to reap the benefits of a sustainability program.

Defining sustainability is crucial to successfully building a program. Because sustainability is such a widely used term and is described in so many ways, it leads to some confusion. Primarily, though, most people look at sustainability as the long-term responsibility and maintenance of our planet's environmental, economic and social elements.

In health care settings, this is viewed and measured by the stewardship of environmental and financial resources as well as measuring long-term environmental impact (i.e., carbon footprint, sustainable food and energy, water use and waste reduction mandates). In many states, there are existing or looming regulatory requirements addressing these issues, further defining the scope of sustainability.

To successfully acquire resources and establish an effective program, recruiting C-suite leadership support and establishing a return on investment strategy will support sustainability efforts. Aligning the regulatory, environmental, community, marketing and financial benefits will go far in attaining senior leadership support.

The triple bottom-line model of "people, planet and profit" provides a basis for defining relevance and value for sustainability programs. Utilization of this unique paradigm has driven many significant progressions in sustainability. Simply put, the model addresses the needed balance and consideration of social equity (people), environmental (planet) and economic (profit) impacts. In alignment with health system and community values, it provides a road map for uniquely designed sustainability programs.

Requesting allocation of resources in health care often can be a tough sell. With human and financial resources at a premium, a submission of benefits and challenges is a prudent course. Benefits range from tangible financial rewards (i.e., cost reductions in energy, water and waste streams) to those not as easily quantified (i.e., environmental benefit, community commitment and perception of patient well-being). Challenges can include getting staff to accept changes in practice, having staff manage waste streams at generation, and crafting sustainable initiatives to individual facilities.

An excellent resource called "Greening the Bottom Line" (www.greeningthebottomline.org) provides a realistic and achievable funding model aimed at implementing sustainable initiatives. The authors recommend utilizing a portion of financial gains realized through sustainable implementations to broaden initiatives and to reap additional environmental and fiscal benefits.

Developing green teams

Staff resources can be even more challenging to obtain than simple financial support. However, two consistent characteristics of successful sustainability programs are a designated program leader and employee engagement through utilization of green teams.

There is usually a core group of passionate potential green team members available and willing to volunteer in most facilities. Every effort should be made to make these teams multidisciplinary to maximize organizational impact. Facilities, materials management, clinical, laboratory, information technology, marketing, environmental services and food services departments should be represented.

Members who are both formal and informal leaders should be sought. For instance, students from local universities in the field of ecology and related studies may be interested in volunteering as well.

Once C-suite leadership support has been defined, a sustainability program leader established and resources identified, there are many areas that can benefit from a sustainable initiative. Defining a clear set of organizational goals and objectives will best utilize what resources are available.

To find opportunities, brainstorming with green teams or engaging in a friendly competition for departmental projects is a great place to start. The sustainable websites listed in the sidebar at right are excellent places to identify low-hanging fruit to make an immediate impact.

Membership in a health care sustainability group can afford access to information that will spark interest and support. Some memberships are available for little or no cost. Memberships that carry greater expense can provide excellent support to mature programs and assist evaluation of future projects.

Green team projects often include the following elements:

  • mission and vision statement recommendations and policy guidelines that include using two-sided defaults on computer printers or ensuring that monitors are turned off at night;
  • environmentally friendly purchasing by using an electronic products environmental assessment tool or reprocessing some items;
  • applying sustainability standards to food service by providing healthier foods, composting food waste and purchasing from local farms;
  • reducing waste through such measures as conducting waste audits, recycling and diverting construction debris;
  • using safer chemicals by eliminating or reducing the use of products that include mercury or other potentially hazardous materials;
  • practicing green cleaning and utilizing reusable textiles;
  • reducing the use of utilities such as energy and water;
  • promoting successes by applying for sustainability awards.

The value of many small-bore sustainability activities should not be dismissed or undervalued. In fact, small changes can create big impacts. For example, "greening" the operating room (OR) seems difficult and nonproductive. However, consider that in a health care system with 20 ORs, changing from disposable gowns to a reusable textile gown provides an opportunity to eliminate more than 300,000 disposables being landfilled, with savings of more than $150,000 annually.

Other projects, often in the area of environmentally friendly purchasing, are more complex and time-consuming but provide commensurate return. Recently, for example, local investors presented an opportunity to build a model sustainable laundry. This laundry reduced water used from 1.7 gallons to less than a half-gallon per clean pound of laundry produced. Within the community, this eliminated the use of more than 20 million gallons of water annually.

Tapping outside resources

For programs in startup, this list of activities can seem much like being charged with climbing Mount Everest. Success, for sustainability programs or climbing Everest, is predicated in much the same way.

A first step is required and, of course, another step must follow, and then another. Success in one sustainability project boosts morale and confidence and makes each successive step more exciting. Applying for awards is a great way to energize green teams. Publicizing sustainable accomplishments is a great motivator and can create excellent community-relations opportunities.

Health care sustainability programs experiencing success do so in part because they measure and report successes. So, with each area of sustainability focus, there should be a baseline measurement, with defined goals and ongoing measurements.

For example, waste streams and energy consumption routinely are measured in most health care organizations. The information often is available by building or site. Energy bills and waste-recycling weight receipts provide readily available data for tracking.

The Healthier Hospitals Initiative (http://healthierhospitals.org) has several achievable objectives in its "Less Waste" and ""Leaner Energy" challenges.

For the less waste challenge, two goals include:

  • achieve a 15 percent recycling rate;
  • reduce regulated medical waste to less than 10 percent.

For the leaner energy challenge, two goals include:

  • track energy use and greenhouse gas emissions through the Energy Star portfolio manager, a joint project of the Environmental Protection Agency and the Department of Energy;
  • reduce energy by three percent from baseline.

Likewise, Practice Greenhealth (http://practicegreenhealth.org) has the "Making Medicine Mercury-Free Award" and the "Partner for Change Award."

Each of these organizations has many more challenges and awards upon which to focus.

There also are tools now available through some of the organizations referenced in the sidebar on page 45 that assist with tracking and reporting sustainability progress. For instance, creating and maintaining a sustainability scorecard is an effective way to stay front and center with C-suite leadership.

Reporting should be a standing agenda item whenever possible. Providing scorecard reports at leadership meetings supports sharing these results at departmental meetings and recognizes the accomplishments of the green team. Many organizations not only have intranet and Internet websites highlighting their progress, but also have trademarked their sustainability programs.

Scorecards, awards and environmental impacts are all available for staff, patients and communities to see.

Unlimited potential

Effective sustainability programs provide unlimited potential to impact the health of communities in a positive way.

Sustainability programs with C-suite support, multidisciplinary green team support, resources, vision, goals and employee engagement combine for a proven path to success. HFM

Greg May, CHESP, is director of environmental services, linen and sustainability at UC San Diego Health System. He can be reached at gmay@ucsd.edu.

Sidebar - Sustainability resources

Need more information on setting up a sustainability program? Check out the following resources.

  • Association for the Healthcare Environment (www.ahe.org). The primary organization for health care environmental services and waste management, AHE offers a number of resources through its website.
  • Health Care Without Harm (http://noharm.org). This website has many excellent resources. Especially valuable is its information on the elimination of toxins.
  • The Healthier Hospitals Initiative (http://healthierhospitals.org). This site provides direct and easy-to-follow guidelines for implementing sustainability programs and setting goals. It is very helpful to those establishing programs or desiring to add structure or direction to an existing program.
  • Practice Greenhealth (http://practicegreenhealth.org). This health care-focused membership group provides excellent tools for decision-making and purchasing, including case studies.
  • The Story of Stuff Project (http://storyofstuff.org). This is a great site packed with information and resources.
  • Sustainability Roadmap for Hospitals (www.sustainabilityroadmap.org/). AHE, the American Society for Healthcare Engineering and the Association for Healthcare Resource & Materials Management have collaborated to produce this website, which provides strategic planning resources, how-to guides, tools and case studies.