Sustainability for Healthcare Management

A Leadership Imperative

Carrie R. Rich, J. Knox Singleton, Seema S. Wadhwa

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351997669
• Edition: 2
• Topic: Economics
• Subtopic: Development Economics
• Index: Economics

• includes healthcare sustainability syllabus created and taught by one of the authors at the School of Nursing and Health Studies, Georgetown University
• brings together in one publication key components and concepts of environmentally sustainable healthcare operations
• includes cutting-edge materials from the leading membership organization on healthcare sustainability in the US, Practice Greenhealth

1

HIPPOCRATES WAS RIGHT

FIGURE 1.1 What is sustainability?

A told story

FRED: I think, probably, the most painful moment of my life was when I had to go in front of the Chairwoman of the Board at my first big-time job as the newly minted Chief Executive Officer (CEO) of Memorial Hospital. I followed a seasoned CEO who served 35 years, since the hospital was founded. I mistakenly thought that a change in leadership and fresh perspective would be a welcomed, easy undertaking. And there I found myself, confessing that I didn’t have all the answers to the concerns which the Board expressed. Little did I know that the prior CEO had actually retired ten years before his announcement was made. In fact, just about every major stakeholder of the institution had lost faith in the organization. That is the backdrop in which the Chairwoman of the Board requested that the hospital “go green” as a top priority. As the CEO, “going green” was not exactly at the top of my priority list. I just couldn’t imagine how going green would impact any of the dozen problems that I thought were in the way of the institution going forward.

The Chairwoman didn’t seem to understand that we were in a life-or-death situation as an organization. We were an institution that couldn’t borrow money. We had lost the confidence of our admitting physicians, had the highest employee turnover rate of any hospital in the county, and we were generally thought of – by both elected officials and local business leaders – as somewhere around the World War I era in terms of our corporate responsibility. Ignoring all that, the Chairwoman wanted me to focus on “going green.” Give me a break! I was doing all I could just to survive. Forget the sustainability stuff.

Where did sustainability come from anyway?

The current sustainability movement originated with the World Commission on Environment and Development (more commonly known as the Brundtland Commission), which was convened by the United Nations in 1983. In its report, Our Common Future, the Commission defined sustainable development as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs” (1987, p. 43).¹ The Commission established that environmental crisis is typically broken down into a complex system of interconnected problems. These problems are caused primarily by human activities that overburden the Earth’s natural environmental capacities. Localized problems concerning air quality, water quality, soil depletion, species loss, habitat loss, food production and energy supply are often related to one another in falling-dominoes fashion. Physical environmental problems are almost always linked in a vicious spiral with specific social conditions. Economic, political and cultural factors drive changes to the physical environment and affect the Earth’s natural systems. Changes to those systems, in turn, force often dramatic and sudden changes in human society. For instance, crude oil and refined fuel spills from tanker ship accidents in the Gulf of Mexico, France, Kuwait Sundarbans and Ogoniland have devastating impacts on the ecosystem, population health and economic development, among other factors. Further, climate change, which was still largely a speculative hypothesis at the time of the Brundtland Commission’s meetings, has emerged as one of the most prolific global dilemmas of our time. In short, environmental changes – both natural and manmade – impact community health and are reason for healthcare leadership to pay attention to sustainability.

(Bartels and Parker, 2011, p. 43)

What are the drivers of sustainability?

Understanding the drivers of sustainability is important for today’s healthcare leaders, whether at the board, executive, middle-management, practitioner or trainee/educational level. Regrettably, there is often a paucity of understanding of sustainability and the variables that drive or influence its adoption in many, if not most, of these populations.

FRED: I’m hearing more and more of my peers say, “I think we need a sustainability program. We need to be involved.” What’s driving this sustainability movement? The truth is, I don’t have the answers yet. So I phoned my friend and colleague Knox Singleton, Chief Executive Officer of Inova² in Northern Virginia. Inova hosted its first sustainability conference in 1992, long before sustainability in healthcare was commonly part of leader conversations. So Knox, why did you champion sustainability at Inova back in the day?

KNOX SINGLETON: As CEO of Inova, the drive to adopt sustainability as an organizational priority was largely a result of our employees; our employees then and now think about sustainability and really care about it. I’ve found that young people, especially, are increasingly educated or fired up about everything related to sustainability. Of course, the people who were young in 1992 are middle-aged today!

FRED: Knox, I notice the same thing. The younger employees behave as though sustainability is a given, or should be. And that may very well be. It’s us “seasoned” and experienced folks, we’re the ones who need to be educated about sustainability, it seems, not the other way around.

KNOX: I think that’s a fair assessment, Fred. Generally speaking, young leaders believe the notion that environmental responsibility is a core value that they should practice in their personal and professional lives. To some degree, it’s sort of a “secular faith” that all of us have a duty to address the environmental problems of the world. Just like service to others, sustainability appears to be a universally held value to younger generations.

FRED: I think I’m starting to get it, or at least be more open-minded to the idea of sustainability as a leadership priority.

KNOX: I’m sure you’d agree that part of the challenge in leading an organization is defining the higher order values that guide the purpose of why employees engage in the work we do.

FRED: Sure, of course. We’ve adopted the Studer model [Studer, 2004] of patient service for that very reason.

KNOX: Then your employees are familiar with Quint Studer talking about the two key attributes people want from their employment experiences. First, people want the ability to have an impact upon their work environment and team. Second, people want to feel like their work has purpose as part of a larger community.³ They want their work to contribute to some purpose greater than their own self-interest. Some people find purpose in faith or a specific religion. Some people seek purpose by being a positive, good person, helping others and sustaining the world. Whether the affiliation is religious or not, these values transcend human differences; they are core, high-level values common to most everyone.

FRED: [Gazing out the window, rapping his pen on the desk] I sure have a lot to think about.

KNOX: Me too. I’m still learning about sustainability. The challenge remains how to meld health improvement with engagement around sustainability into a holistic leadership style.

FRED: Well that’s good to hear, to be honest. This sustainability stuff is still a bit disconnected for me.

KNOX: I think that if you look at the core of healthcare, beyond making people better, it’s rooted in the Hippocratic Oath to “First, do no harm.” Today, many healthcare employees feel that purpose in responsibility for care of the planet. They believe in equity through shared use of natural resources. Remember: the principal reason why I embraced sustainability as a leader was that I felt it was one of the core values of many, many people who work within our healthcare family. Many employees understand that failure to use resources responsibly can have unintended, negative consequences on the environment and health of the community. Sustainability is in line with what Hippocrates had in mind.

THE STUDER MODEL

Two aspects of work that employees value about their employer:

• People want the ability to have an impact upon their work environment and team.

• People want to feel that their work has purpose as part of a larger community. They want their work to contribute to a purpose greater than themselves.⁴

WHAT IN THE WORLD IS A TABLE OF TABLES?

A table of tables is a decision-making tool used to prioritize the values and drivers of a given industry and/or market sector. This leadership tool may be used to evaluate the case for healthcare sustainability. The sustainability-leadership table of tables is one such tool that resulted in clear patterns, ultimately creating vision alignment for this book. Vision alignment achieved through the table of tables frames sustainability concerns in the context of a framework that resonates with healthcare leadership.

The sustainability-leadership table of tables

Sustainability may be used as a tool to frame leadership priorities, and ultimately may be used to enhance alignment among stakeholders around the promotion of hea...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright page
• Table of Contents
• List of figures
• List of tables
• Foreword
• Preface
• Acknowledgments
• 1 Hippocrates was right
• 2 From governance to operations
• 3 Saluting the captain of the ship: process engagement + health information technology
• 4 Waste not, want not: process improvement + waste management
• 5 The long and winding road (leads me home): employee engagement + transportation
• 6 Good-bye fried chicken, hello healthy, sustainable food: patient satisfaction + sustainable foods
• 7 Through the looking glass: cost + energy management
• 8 Before a baby’s first breath: safety + chemical management
• 9 Downstream without a paddle: quality + Environmentally Preferable Purchasing
• 10 Building brand, literally: growth/brand + green building
• 11 Water changes everything: community benefit + water management
• 12 Environmental ethics in healthcare management
• Appendix
• References
• Index