People, Planet, Profit

Published on : June 22, 2010

People, Planet, Profit

People, Planet, Profit

Human health and environmental health are deeply and inextricably linked where Human health requires environmental health. Healthcare delivery systems are in a unique position as care takers, large employers, and key community leaders to influence and impact the triple bottom line: commitment to people, planet, and profit.

Determinants of human health can be simplified into three broad categories:

  1. Physical environment.
  2. Social and economic environment.
  3. Individual characteristics and behaviors.

Healthcare sustainability in the hospital environment interconnects with all three of these determinants.


“Corporate responsibility” is a widely accepted business phrase used to describe self-regulation of corporate practices that are in the best interests of key stakeholders including, but not limited to, shareholders, employees, customers, the community, society, and the environment at large.

Healthcare sustainability is one dimension of corporate responsibility that honors the triple bottom line as observed by: economic performance, social responsibility, and environmental benchmarks. Research demonstrates that health care systems which embrace healthcare sustainability have lower long-term operation costs due to improved maintenance systems, increased hospital capacity, reduced staff sick days, as well as improved recruiting and staff retention advantages. The health care industry is quickly evolving to incorporate sustainability as an integral part of daily business operations.

The adoption of sustainability practices will greatly impact the industry as healthcare ranks among the highest industry users of energy, highest producers of waste, and is a significant consumer of resources. These practices yield an industry with a large environmental footprint that is frequently unmeasured.  Capital budgeting evaluations typically do not include environmental impacts, costs or savings. The current lack of transparency results in decisions that may have prematurely overlooked sustainable management strategies, despite potentially significant long-term environmental and financial savings.

The Green Standard: What is a Healthy Hospital?

A healthy hospital provides a net positive environmental benefit to the community while supporting the hospital’s underlying mission. A healthy hospital measures its environmental footprint. This assessment helps quantify sustainable operations and qualify resource stewardship on behalf of patients, staff, and the community at large. A healthy hospital embraces the triple bottom line, delivering healthcare that is socially responsible, environmentally sound, and economically viable. A hospital that provides care to the community in a safe, healthy manner fulfills its obligation to conserve, protect and preserve resources through partnerships and individual actions.

Sustainability in Healthcare Management Defined

Sustainability in the health care industry encompasses topical aspects ranging from energy efficiency to climate change initiatives. The positive financial, social, and environmental influences of healthcare sustainability are measurable and transparent.

Sustainability in Healthcare Management is an emerging business segment. Implementation of operational and maintenance strategies that capitalize on sustainability principles and “going green” are new and widely adopted initiatives.

Multiple healthcare delivery systems are implementing the role of a Sustainability Coordinator as part of their corporate strategic plans. Sustainability Coordinators have the opportunity to act as internal, permanent agents to catalyze change in the health care arena by providing a palette of strategies for adopters of environmentally sustainable management practices. For instance, Sustainability Coordinators organize a strategic and operational framework for planning treatment centers built without materials linked to cancer, cleaning systems free of chemicals that trigger asthma, and hospitals with healthy food, fresh air, and sunlight. Sustainability Coordinators also develop capital budgeting evaluations that can be applied to a variety of sustainable operational approaches to raise the economic valuation of incorporating environmental management practices.

Developing a Sustainability Program

The basis for a strong sustainability program is striking a balance between managing operational and strategic goals. Implementing operational goals related to cost savings focuses on three overarching areas: Energy Management, Waste Reduction, and Water Management. To achieve environmentally sustainable operational goals and the associated capital benefits, it is important to create a comprehensive operational program that includes strategic goals related to creating a green culture.

  • Energy Management: Capital budgeting evaluations can be applied to a variety of energy management approaches that raise the economic value of management projects, such as utility costs and facility maintenance.
  • Waste Reduction: Hospitals are often the largest polluters within the communities they serve. Waste reduction is vital for a successful sustainability program, as it can act as a key motivator to increase employee engagement and support for future sustainability initiatives.
  • Water Management: Health care has a unique opportunity to demonstrate leadership in water sustainability. Localized environmental issues of water availability and quality are transforming, in many communities, into sustainability challenges that demand ongoing balancing efforts to satisfy competing needs.
  • Environmentally Preferable Purchasing (EPP): Environmentally Preferable Purchasing is the front door to a sustainable health care organization by strategically integrating supply chain management practices governed, in part, by environmental directives.
  • Sustainable Foods-Healthy Foods in Healthcare: Promoting the health of the community starts by promoting and practicing healthy lifestyles. The food served and consumed in hospitals is intrinsically linked to the way that patients, guests, and staff relate to the environment.
  • Capital Improvements-Building a Green Future: Multiple healthcare institutions have begun embracing commitments to environmentally friendly building design by incorporating Leadership in Energy and Environmental Design (LEED) standards. In such instances, executives recognize the financial, environmental and social rewards of pursuing “green” building retrofits as well as the potential for long-term reduction in operational costs.
  • Health Information Technology: Despite modern healthcare’s dependence on information technology, little attention has been paid to environmentally sustainable Health Information Technology (HIT) practices. There will continue to be profound implications of sustainable HIT systems on care delivery as the healthcare industry transitions from a paper-centric environment to an IT-centric environment.
  • Alternative Transportation: The way in which health care employees commute to work impacts the quality of the environment. Reducing single occupancy vehicles helps to reduce an organization’s carbon footprint. Furthermore, the ways in which hospital supplies are transported also impact the healthcare’s environmental footprint.

Marketing the Mission

Of the hospitals that partake in environmentally responsible practices, many fail to highlight their success stories. There is an abundant of opportunities to achieve positive press and community outreach as a result of sustainable operations efforts. Hospitals that are working to be environmentally conscious have both internal and external opportunities to capitalize on positive attention, and in turn, create a baseline culture of sustainability.

Employee Engagement

Environmental initiatives are often deeply rooted in employee interests in supporting a socially responsible corporation. Engaging employees in sustainability initiatives may be used as one employee retention technique. This opportunity is especially significant in the healthcare setting given that health care workers will be scarce for the future, and retention and recruitment will continue to be critical to the success of hospitals and health care systems. For young professionals especially, but not exclusively, the environment is of particular interest. An employer’s stance Vis-a-Vis earth-friendly policies and practices can be a satisfier or the opposite.

Description of Organizations in the Field

There is an emergence of not-for-profit organizations that offer guidance about end goals of sustainability programs. Organizations currently leading the field of healthcare sustainability are highlighted below.

Practice Green health

Practice Green-health provides support for hospital staff through educational webinars, consulting, and three-day training courses offered twice annually for Sustainability Coordinators.

Health Care without Harm

Health Care without Harm is a not-for-profit movement of health care professionals who are focused on the social responsibility component of environmental health care sustainability.

The Green Guide for Health Care

The Green Guide for Health Care provides a self-regulating checklist to assess aspects of sustainable healthcare design and operations based on Leadership in Energy and Environmental Design (LEED) standards.

United States Green Building Council

The United States Green Building Council (USGBC) provides “green” building tools for the architecture, design and construction community through a credit system called Leadership in Energy and Environmental Design (LEED).

Teleosis Institute

The Teleosis Institute is a nonprofit organization that promotes high quality, cost effective, sustainable medical services that benefit underserved populations and the environment.

Concluding Remarks: Sustaining the Future

Every successful environmental program is rooted in a culture of sustainability. Integrating environmental operating principles within a health system will help promote the underlying mission of the triple bottom line: People, Planet, and Profit.

About the authors

Carrie R. Rich is a Healthcare Specialist at Perkins+Will, an international architecture/design firm that specializes in evidence-based facility planning according to Leadership in Energy and Environmental Design (LEED) principles.

She holds an adjunct faculty appointment at Georgetown University, School of Nursing and Health Studies, Department of Health Systems Administration.

Regionally, Ms. Rich serves as the administrative liaison between healthcare administrators and design professionals committed to strategic planning for capital improvements and sustainable facility management. Nationally, Ms. Rich’s responsibilities include academic partnership, research, and education initiatives. Her sustainability commitments support an agenda that compliments the realities of   the healthcare delivery system and understanding policy structures.

Ms. Rich’s view through the administrative lens facilitates integrated health systems planning based on operational processes, administrative vocabulary, and data driven projections. Her experience in healthcare delivery links strategic priority establishment with marketplace forecasting, supporting human centered environments that meet capacity infrastructure needs.

She developed and teaches healthcare sustainability offered to administrators. The curriculum represents an important construct through which health systems training programs can measurably advance resource stewardship goals while reflecting characteristics unique to the healthcare sector. Current students include practicing and future administrators (graduate and undergraduate levels), lawyers, and medical students. Ms. Rich coordinates with the Association of University Programs in Health Administration (AUPHA) and the American College of Healthcare Executives (ACHE) to disseminate healthcare sustainability content to administrators who demonstrate interest in learning about it. She frequently collaborates with industry partners as well as with the United States Department of Health and Human Services and was elected to the 2010 Board of Directors of the National Capitol Healthcare Executives.

Seema Wadhwa is the Director of Sustainability at Urban Ltd. and serves as the Sustainability Engineer for Inova Health System. The Inova Health System is comprised of an integrated community of healthcare facilities including hospitals, nursing homes, emergency and urgent care centers, assisted living communities, and community health and wellness programs. As one of the nation’s most comprehensive healthcare providers, Inova Health System is an industry leader in promoting programs for superior patient care and community stewardship, evidenced by  its commitment to sustainability.

She is responsible for the creation and adoption of sustainable management practices at Inova. Prior to Inova, Ms. Wadhwa spent several years managing engineering design projects. She unites industry experience in the areas of project management and logistical planning with technical leadership in water management, urban design, and environmental engineering.

Her industry experience extends to advising about best practices in green building as prescribed by her professional accreditation as a Leadership in Energy and Environmental Design (LEED AP), enabling a sustainable approach to the design and implementation of healthcare projects. She consistently aligns environmental and engineering best practices with business requirements, including cultural and process change throughout the healthcare system.

Ms. Wadhwa’s leadership in promoting healthcare sustainability initiatives include guest speaking at industry venues, content submissions for national healthcare symposiums, and co-founding the national region alliance on healthcare sustainability with member hospitals, design professionals, and industry partners.