BEST PRACTICES FOR DESIGNING, OPERATING AND MAINTAINING SUSTAINABLE FACILITIESG

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Systemwide ThinkingAround Sustainability

By Janet Brown

Sustainability is a growing trendin the healthcare sector, movingfrom hospital to clinic to privatepractice. It is garnering the atten-tion of healthcare system leaders

who are asking big questions about what thesustainability structure looks like for a multi-facility system. Where does sustainabilitylive? Who’s in charge, and how do systemsbalance systemwide and site-specific goals?

I. Creating a System Structure Creating the system structure to support

ongoing work is like combing out a big knot.It can be challenging, requiring time, patienceand a gentle hand or progress comes to a halt.Top-down mandates and cookie-cutterapproaches may not be the first step in sys-temwide strategies. Taking the time and teas-ing out the knots slowly, without tugging toohard, are wise first steps. Too forceful a handmay result in pain and frustration.Untangling one’s own knots provides a pre-ferred degree of control. Generally, an individ-ual facility has its own areas of interest andactivities under way around improved envi-ronmental performance. Teaching a facilityhow to untangle its own knots is a necessaryprerequisite for systemwide improvement.

Sorting and gathering information, as wellas casting a “sustainability net” to identifywhich individuals are tackling greening activ-ities, are important first steps in understand-ing the variety of individuals and activitiesinvolved across a system’s multiple locations.The first cast may catch nothing – one canselect a different net, a different hook or a dif-ferent body of water and try again. This is nosmall task. Inviting individual facilities to agreening call or to hear a webinar may onlyget a handful of responses at first offer.“Sustainability,” as a word, may get lost intranslation. But by spelling it out (e.g., who isworking on green building, energy, green

energy procurement; working with EnergyStar; implementing greener cleaners, localfood sourcing and bike clubs), you may startgetting some attention. The rewards of peo-ple, initiatives and stories will slowly revealthemselves.

Awards, local press, and internal articles innewsletters and on intranet sites are a nextimportant step to help communicate the var-ious successes already realized at individualfacilities and throughout the entire system.This can help set a positive tone for workingtogether. Recognition for existing programs isimportant before going further. Those earlyadopters can help others by sharing their sto-ries of how they got started and their win-winscenarios.

II. Uncovering the Challenges Less rosy scenarios may be uncovered as

well, like internal or external obstacles, tech-nical challenges, lack of support, and failedattempts. Some facilities may be yearning fora mandate to give some weight to their inter-est, where local support has been minimal orvoid altogether. Some speak of their effortsbeing seen as troublemaking or unwelcome.And then there are the majority of facilitiesthat fall somewhere in between: they have

accomplished some good work, but the groupwould value additional support and leader-ship to enhance their efforts and use the sys-tem to gain leverage in the marketplace andenhance their public health benefits.

Building on cost-saving efforts can getthings going in the right direction. Throughpromoting other desired outcomes like safety,risk management, regulatory compliance andmission demonstration, facilities can worktoward embedding sustainability into the cul-ture of their organizations and across theirsystems. Corporate offices and other admin-istrative areas can engage as well, realizingmany things can be done outside of the clin-ical environment to add to the overall impact.

Recognizing each individual facility’s uniqueculture and management structure warrants aflexible approach. Maybe one site needs a newgreen team, another may focus work at theEnvironment of Care Committee and yetanother through their healing team with apatient-focused model of care. A coordinatedeffort that captures the activity and metrics andpackages them in a way that starts to documentthe sustainability journey helps solidify a groupapproach. It also helps to create a consistentvisual for the facility and system activities.However, if an existing committee structure is

GREEN GUIDE FOR HEALTH CARE

This column is provided by the Green Guide for Health Care, the healthcaresector ’s first quantifiable, sustainable design tool kit integrating enhancedenvironmental and health principles and practices into the planning, design,construction, operations and maintenance of facilities. The Green Guide pro-vides the healthcare industry with a voluntary, self-certifying metric tool kit ofbest practices that designers, owners and operators can use to guide andevaluate their progress toward high-performance healing environments.

For more information, or to download the Green Guide for Health Care Version2.2, visit the Green Guide Web site at gghc.org.

Reproduced with permission from FacilityCare Magazine. Briefings Media Group, LLC Copyright 2010.

working well, it may not be worth disrupting,even if it is different from what any writtenplan sets out to accomplish.

III. Identifying InternalLeaders

Identifying a facility sustainability lead(which is often added to an existing positionfor starters) cannot be done in a cookie-cutterapproach. Chances are one cannot, across theboard, identify a title/department head to leadsustainability at each site across the entire sys-tem. Often, greening activities have alreadystarted, green teams have developed and thelead is the person who stepped up to the platereflecting his or her personal passion. There isno typical lead on this work. It could be adirector of facilities or engineering or an ORnurse, among many other titles. More impor-tant than the title is the individual – someonewho can lead a team, continuously improveupon activities, take a positive approach andmeasure progress and has a direct line to lead-ership and an ability to institute change. Withthe increased interest in greening, the formallead may change, but this early adoptershould be included in the new committeestructure, recognized for spearheading earlyefforts, and continue to be a valuable teammember. Team and diversity are key.

Pulling the various facility leads togethervia conference call on a regular monthly or bi-monthly basis is a way to start to build anoversight sustainability team throughout thesystem. Adding communications, corporateleaders, advocacy, mission, ethics and otherscan pull the individual activities together,connect them to other initiatives, formalizethe effort, and communicate it to staff and thecommunity. This oversight team approach canhelp to benchmark and prioritize. By pullingdata together and sharing it using commonmetrics (e.g., per adjusted patient day, squarefoot), content experts can help others.

Of all the sustainability activities occurringacross the nation, there are some similarapproaches – most often starting with cost-saving measures. Documenting a baseline forenergy, waste and water is a good place tostart to prioritize strategies and measureprogress. Other established strategies aremercury elimination, red bag reduction, recy-cling, energy conservation and lighting retro-fits. The further along the journey, the morevaried the approaches; after a few years, inno-vation and creativity can flourish. The facil-ity can find their sustainability voice andtheir personal narrative. While metrics can beused to track progress, it’s the stories, case

studies and overall experiences that best cap-ture the rich details that speak to the missionand vision of the individual organization. Yes,data; yes, measurement; yes, metrics; and yes– people. Capture the essence of the work,the details, the people and the stories that putsome flavor to the offerings. Research andevidence are critical for guidance and priori-ties, but people and their experiences andfeedback help us all to feel it, where it countsand gives us the motivation to continue, evenwith ongoing challenges.

IV. Conveying How the SystemApproach Works

A systemwide approach to sustainabilitycan help to guide a facility’s green teamdevelopment; standardize data and reportingformats of minutes, policy development,marketing and communications strategy,Web and intranet site development, and newemployee orientation; and much more. Thisgroup, as they get to know and trust eachother more, can identify a systemwideopportunity that they can collectively get

GREENING HEALTHCARE

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Reproduced with permission from FacilityCare Magazine. Briefings Media Group, LLC Copyright 2010.

behind. Systemwide initiatives couldinclude going out to bid for total wasteremoval and management contracts, singlestream recycling, reusable sharps contain-ers, fluid management systems for the oper-ating room, single-use device reprocessing,hazardous pharmaceutical waste manage-ment, or green cleaning contracts. This sys-tem goal setting can be coupled with facili-ty-specific goals like composting, starting afarmers market, signing the Healthy FoodPledge, or using the Green Guide for HealthCare Operations section to baseline andbenchmark performance around specificstrategies. By measuring metrics like totalwaste per adjusted patient day or water use,or adding signposts for program implemen-tation like computer refurbishing and rede-ployment or xeriscaping, for example, sitescan flag the activity reflected in the metricand feed those into senior-level sustainabil-ity dashboards.

These site-specific and system activitiestell a story of individuality and strength innumbers. They can be documented andshared with funders, boards of directors,communities and patients. Further leverag-ing the work by connecting it with safety,quality, mission, research, clinical leader-ship, grants and community benefit firmlyembeds it into the organization, establish-ing it as an integral indicator of perform-ance and success.

Most sites agree that voluntary programscan only get a facility so far. To get to the nextlevel, leadership can empower departmentheads and establish sustainability criteria as akey decision-making factor, from where tosite a hospital and how big to build to whatvendors to partner with, investments, advo-cacy, staff engagement and overall operations.Firm leadership commitment, strategicvisioning, identification of lead, committeestructure, and clear communication of rolesand responsibilities (which are reflected injob descriptions) create a culture of environ-mental excellence.

Through documentation and reporting ofpositive outcomes (e.g., cost savings,improved safety), facilities are trendingtoward formal language around sustainabilityand the emerging role of the sustainabilityofficer or coordinator. Leaders in health caresustainability efforts have created sustainabil-ity coordinator positions to lead environmen-tal quality improvement initiatives, pull thework together, identify individual versus sys-tem approaches, develop policies and speedup the pace.

V. Sharing Success Stories One example of a successful systemwide

approach is Catholic Healthcare West(CHW). CHW’s leadership has taken a cohe-sive approach to greening by signing on tothe CERES Principles, a formal commitmentto transparency around social responsibility,sustainability and reporting. CatholicHealthcare West’s success is not a mystery.They started their journey in the 1990s andhave persevered to get to where they aretoday, one step at a time, one program attime, one person at a time. Their accomplish-ments are noteworthy. CHW adopted theCERES Principles in 1996. In 2009 100 per-cent of Catholic Healthcare West’s 41 sites inCalifornia, Nevada and Arizona participatedin the environmental reporting that led totheir 2010 sustainability report( h t t p : / / w w w . c h w h e a l t h . o r g /Who_We_Are/Environment/ssLINK/STGSS045842). CHW’s sustainabil-ity work is firmly planted incommunity benefit, well-ness and prevention causes.Their sites are full of cre-ativity and individuality,from gardens, recyclingprograms and bike clubs toart contests and muchmore.

Learn more about sys-tems that have earned

recognition for tackling sustainability activ-ities at the system level by viewing the 2010Practice Greenhealth System for ChangeAward Winners including CatholicHealthcare West, Advocate Health, HospitalSisters Health Care System, CovenantHealth Systems and Cleveland Clinic atwww.practicegreenhealth.org/awards/winners.Many others, such as Kaiser Permanente,Providence Health & Services and CatholicHealth Care Initiatives, share a commitmentto sustainability recognized across the health-care sector. As these leaders demonstrate, sys-tem-wide thinking around sustainabilityleads to systemwide action, resulting in sys-temwide success. F

Janet Brown is director, sustainable operations for Practice

Greenhealth (www.practicegreenhealth.org) and serves on

the 2010 Green Guide Operations Pilot Team. She can be

reached at jbrown@practicegreenhealth.org.

GREENING HEALTHCARE

1996 CHW Board initiates actions on CERES Principles

1997 Joined Healthcare Without Harm – commitment to reduce volume and toxicity of waste stream

1998 CHW begins reprocessing single-use medical devices

1999 Energy audits conducted; florescent lighting retrofits

2000 Linen management program initiated;Reusable pulse oximetry sensors introduced

2001 Environmentally Preferred Purchasing Program instituted

2002 Joined H2E/Practice GreenhealthMercury elimination policy; water saver technology

2003 Instituted microfiber mop system;Began auditing hazardous waste storage

2004 Reusable sharps containers introducedPACS/Digital X-ray Enterprise Adoption

2005 CHW transitions to PVC/DEHP-free IV products;Environmental reporting requirement in corporate contracts

2006 System e-waste program initiative HCWH food pledge-sustainable, healthy food supply

2007 CHW begins compiling emissions data systemwide

2008 CHW joined Global Health and Safety Initiative

2009 CHW approved Comprehensive Chemicals Policy

CHW’s EnvironmentalActions

Our Environmental Actions

Practice Green Health (H2E) Environmental Excellence Reception

Sustainable BuildingDesign Guidelines

Joined CaliforniaClimate Action Registry

Green Guide forHealth Care Implemented for Construction/Real Estate Projects

Reproduced with permission from FacilityCare Magazine. Briefings Media Group, LLC Copyright 2010.