Drivers and Motivators for Sustainability
Hospital senior leaders may be motivated to take on sustainability projects by, for example, the price of oil, the imperative to save money, community pressures, or regulatory considerations. To get such projects done, however, they are likely to turn to their facility director to develop the action plan and make it happen. The busy director in turn, needs the resources, strategies, and implementation ideas to help develop a plan of action the objective of the Roadmap. Before starting on the journey, though, it is critical to understand the drivers that need to be satisfied through development and implementation of an action plan.
Understanding your organizational drivers and barriers when designing your strategic plan is important to ensure the implementation plan anticipates the barriers, meets the drivers' objectives, and thus maximizes the degree of success the organization achieves. Drivers might include:
For example, there may be a community expectation a driver that the health care organization do something to address climate change issues. At the same time, a potential lack of resources may present a real barrier to successful program implementation. It is critical to play out both the drivers and the barriers during early planning to fully understand the commitments required and the implications of your organization's efforts.
To help in the decision-making process, you may want to use a SWOT analysis tool to assess the strengths (drivers), weaknesses (barriers), opportunities (drivers), and threats (barriers) of each option your facility considers adopting to reach your sustainability goals. Remember, however, that some barriers can be turned into drivers, for example, fixing a weakness and making it into a strength.
Energy Costs and Energy Independence
The potential to save money on energy costs and to reduce our reliance on fossil fuels is a huge driver. Energy costs are certain to rise inexorably and probably dramatically in coming years, putting further pressure on already strained health care budgets. Hospitals consume two-and-a-half times more energy than other commercial buildings, spending more than $8.5 billion dollars annually. These increases will be driven by:
- Supply challenges The United States has insufficient fossil fuel resources to support our energy appetite, and fierce and increasing demand both nationally and internationally will drive up prices of fossil-based energy.
- New rate structures from utility companies
- Climate change law Local, national, and international laws are moving toward regulations that will result in higher prices for fossil fuel-based energy as one strategy to address climate challenges.
| EnergyStar for Healthcare and the U.S. Department of Energy's (DOE) Hospital Energy Alliance (HEA) have challenged the health care sector to significantly reduce energy use. The DOE goal is to see commercial buildings reduce energy consumption by close to 70 percent based on today's building codes. What's clear is that the health care sector can save billions of dollars by reducing its energy use. |
The supply challenges coupled with U.S. dependence on foreign fossil fuel sources affect foreign policy. Some hospitals are defining energy independence as a major driver, pursuing a shift away from energy generated by fossil fuels to help the country become energy independent.
Some energy projects are low-hanging fruit (see the Energy Green Light Projects on this website) and do not present major barriers to implementation. For example, fixing what you have and simply optimizing operations are relatively easy steps. On the other hand, projects that require significant capital, resource expertise, and /or an energy management plan can create barriers to change. Be sure to assess your drivers (strengths and opportunities) and barriers (potential pitfalls and weaknesses) when developing your plans.
Financial Drivers
In addition to opportunities to reduce energy costs, other financial drivers can motivate organizations to tackle sustainability projects. For example:
- Waste costs: Materials consumption in health care facilities costs $10 billion annually in waste disposal costs. The opportunities for cost reduction through smart source reduction and waste management may be as high 40 to 70 percent, or $4 to $7 billion. Reducing the cost of waste disposal especially disposal of regulated wastes, which is more expensive is certainly a driver.
- Water costs: Hospitals are water intensive. Today water is relatively inexpensive in the United States compared to other parts of the world. For example, in Spokane water costs $0.25/100 gallons, in El Paso $0.60, and in San Diego $1.38, compared to $2.86/100 gallons in Glasgow, Scotland. Water prices are predicted to rise around the world (www.worldwater.org/books.html ). So, as large water users, hospitals should begin regarding water as a limited natural resource whose cost will rise; this viewpoint can serve as a driver to launch a significant effort to reduce water use.
- Supply chain: Supply chain costs are rising (along with waste, water ,and energy costs). Assessing opportunities to maximize material, supply, and equipment use can drive down costs while positively affecting other environmental impacts.
| For information about financing sustainability efforts, see Financial Models for Implementing Sustainability Solutions under the Implementation tab on this website. |
Opportunities for Creative Financing. Under the stimulus package, the federal government has begun and is poised to dramatically increase incentives for the clean energy sector. This funding may only be available for a very few years, incentivizing action now.
Community Pressures
External public opinion can be a great driver. A health care organization often seeks to bolster its image among external stakeholders neighbors, insurers, regulators, and others. Engaging in sustainability initiatives can help an organization improve its moral authority with these groups and thus improve the organization's ability to compete.
In some progressive communities with vibrant recycling programs and an awareness of sustainability issues, the community health care facility is expected to participate in "going green" at some level. It helps to be prepared when asked, "What are you doing about climate change, or energy reduction?" or "Do you recycle your waste?" and so on.
Also, be sure to work with your public affairs department on a regular basis to share your successes. Even small ones can be a story worth telling.
Regulatory Requirements
| See Climate Change 101 for information about pending national climate change legislation as well as international agreements. See Waste Regulations for an overview of the many types of waste and the regulatory agencies that oversee them. |
Local, state, and federal legislation related to sustainability continues to unfold and ratchet up the performance requirements for all facility types. Hospitals must comply with existing regulations, anticipate those that are coming, and act responsibly as part of an industry movement to do the right thing, thus demonstrating there is no need for further regulation.
Reach out to your state or local government to understand the particulars about your state/region, which can vary quite a bit. Some states and municipalities mandate environmental performance objectives like climate action plans. Some states are just now requiring waste data reporting to meet state recycling goals or to reduce hazardous waste.
Federal facilities such as military-related hospitals must comply with specific federal requirements or executive orders, many of which relate to environmental performance. These can be significant drivers in those facilities.
Climate Change and Environmental Responsibility
Climate change is becoming a driver for more and more facilities. The 2007 assessment report of the Intergovernmental Panel on Climate Change (IPCC) concludes that "warming of the climate is unequivocal" and that human activity has "very likely" been the driving force in that change over the last 50 years. Credible scientists agree that reducing greenhouse gas emissions (GHGs), including carbon, methane, and anesthetic gases, is necessary to stop or slow the warming of the planet.
As a pillar of sustainability, environmental responsibility touches everything on this page:
Resource Use. Increased worldwide resource consumption and associated direct and indirect costs for air emissions, water effluent, and waste disposal will mean that mitigation measures make more and more financial sense.
Water Supply. A sufficient water supply has emerged as one of the nation's and the world's primary resource issues. Concerns about drought, water contamination, and the availability of fresh water need to be addressed to meet the demands of growing and affluent populations.
Energy Use.Visit the Energy Topics section of the Roadmap for a more in-depth discussion of this issue.
Public Relations
The opportunity to promote an organization's commitment to sustainability is a driver that often pushes organizations to actually take a step on the journey. Public relations efforts should address the entire community, both internal (staff members) and external (patients, visitors, and the community at large). A strategic public relations effort can communicate an organization's commitment to environmental stewardship and corporate social responsibility and has a tremendous marketing value that is often overlooked.
Investments in sustainability can also help attract and retain staff members who are proud to work in a facility engaged in the "Greening of America."
Finally, consider pursuing professional award programs that can help a hospital promote its efforts (e.g., ASHE Vista award, AHE Environmental Stewardship Award, Practice Greenhealth awards).
Improved Operations
The opportunity to use resources more efficiently through a comprehensive sustainability program is another driver. Supply chain efficiencies that include environmentally preferable purchasing (EPP) strategies and reduce a facility's energy use, water use, and waste stream can lead to improved resource utilization, improved operations, and reduced costs.
More research needs to be done to quantify direct and measurable staff satisfaction and health outcomes that result from sustainability efforts, but studies already show that these synergies do exist. Some sustainability initiatives can support the healing mission of the organization by improving efficiency, eliminating some levels of errors, or incrementally improving patient outcomes.
Social Responsibility
"Stewardship and Leadership It's the right thing to do" is often heard as a major reason for tackling the issue of sustainability. Sufficient data exists to suggest that environmental health impacts human health, so it makes sense that hospitals take a leadership role in helping to reduce environmental impacts that may affect public health.
Corporate social responsibility (CSR) is a growing movement within the business community that demands accountability for the principles of citizenship and responsible business practices consistent with sustainability imperatives. Health systems in particular have an opportunity to communicate their own CSR efforts through annual reports that describe, for example, commitments to measuring their performance, tracking their results, and striving toward excellence in operations as they reach to achieve their sustainability goals. The importance of CSR is also consistent with AHA's Hospitals in Pursuit of Excellence Program.