A hospital’s mission is inextricably tied to the issue of sustainability. After all, without a sustainable operation, there is no hospital.

Sustainability goals usually refer to money saved, energy conserved, waste diverted, water recycled, or any other easily understood metric. But a clear connection between sustainability and a hospital’s mission, in an understandable language and with a factual basis, rarely occurs. 

The connection between sustainability and mission must extend to effective management of the healthcare environment, social interaction between patient and healthcare provider, community-based healthcare approaches, and the utilization of current technology.

The mission must have measurable goals and objectives that support sustainability, and the ability of the health system to thrive in its ecological, social, and economic environment.


Effective management of the healthcare environment
Environmental sustainability has assumed a large role in the collective conscience of the American public; environmental stewardship is an expected norm for healthcare providers. Corporate social responsibility (CSR) reports and triple bottom line (3BL) reports are standard responses to that consciousness.

Many hospitals in existence are nearing the end of their life span and will undergo renovation or replacement. The management of these buildings and properties in a sustainable manner is an obvious next step. Renewable energy, energy conservation, access to mass transportation, recycling, building reuse, and green building design and construction are but a few of the sustainability issues that the healthcare industry can directly impact.

Conservation is a viable mission objective that is seen as a positive impact on the planet, people, and profit.

When the mission objective includes the patient-centered medical home (PCMH) services model, the management of care is a centrally located, team-oriented continuum of coordinating and tracking care over time, from prenatal and physical fitness to long-term and palliative care.

While it is not always practical to construct brand new facilities to house these all-inclusive services, a concerted effort through renovation, reuse, and alliance partnerships can accomplish this robust mission goal.


Social sustainability between patient and provider
Social sustainability refers to the ability or opportunity that each individual has to create or experience a full existence in terms of intellectual, emotional, spiritual, and physical health.

Unquestionably, the focus on social sustainability is at the heart of the human mission of the healthcare industry. While healing patients is the primary outcome of that mission, providing access and teaching opportunities about preventative behavior and wellness are equally important.

Part of the PCMH function is to focus on equitable access and quality of access of patients to providers, beginning at the boundary of the region, city, and neighborhood. The health mission is experienced in the physical environment: the path from house to provider that inspires wellness and respite for patients, visitors, clinicians, and administrators.

The mission must also inspire clinicians and administrators to become models of nutritional health.

Partnership alliances can extend to cafeterias, whole food grocers, farmers markets, or private restaurants. For instance, a weekly farmers market at a hospital campus could provide local produce to the food service operations, invite neighbors to have access to healthy foods, and be a supportive wellness benefit for PCMH participants.

Patient outcomes, wellness, healthy living—these are all components of social sustainability with which healthcare providers should strive to equip themselves, thereby influencing those to whom they provide care. In fact, these components should be the easiest to accomplish since hospitals are full of trained, educated, and experienced personnel with the very expertise needed.


Community-based healthcare
Owners of healthcare property, as well as those who provide services, are looking toward a broader view of healthcare—toward population health. Individual campuses are challenged to define their contribution to the health of the community in which they are located, from micro to macro settings.

While hospitals must operate in a positive financial state, economic sustainability speaks to more than a hospital producing a profit. Economic sustainability means, in part, that facilities continue to offer healthcare services to those with inadequate means to pay.

With not-for-profit hospitals, that is often part of their central mission, but it should resonate with all healthcare facilities in the community. A primary strategy for healthcare providers maintaining profitability is seeking solutions to preventative care.

Healthcare systems also may need to consider a broader strategy of integrated services that specialize in prenatal care, health/fitness promotion, and primary disease prevention. Facilities and services directed at these functions may require collaboration with nonhealthcare providers, such as for-profits, not-for-profits, philanthropists, and foundation trustees.


Sustainability through technology
The meaningful use of documentation-related practices, such as electronic health records (EHR), represents a sustainable technological advantage that has the potential to cut costs, make sharing of patient information easier, and decrease medical errors.

Technology is also advantageous for monitoring and managing patient health. It can be used to not only treat disease but to also diagnose disease and communicate treatment. For example, wireless communication devices used by key staff in hospitals and remote sites, such as a doctor’s office or even a life-flight helicopter, can be essential to providing care outside of any one room, department, or building—in real time.

This instant communication exchange decreases overhead costs and enables effective resource management, not to mention it minimizes the fatigue of staff that would otherwise be made to literally run from one crisis to the next.


Sustainable metrics
Attempting to remove the ambiguous characterization of sustainability and sustainable development, rating systems appeared to allow for an objective assessment, or a measurable assessment of sustainable practices, such as: Leadership in Energy and Environmental Design (LEED); Green Guide for Health Care; British Research Establishment Environmental Assessment Method; Green Globes—Continual Improvement of Existing Buildings for Healthcare, among others.

Each offers a system of credits given to healthcare providers to address sustainable operations and management of entire healthcare facilities and building portfolios. The assessment is derived from an electronic survey that allows for benchmarking. Feedback, recommendations, and guidance are provided to enable improvement to practices.

Regardless of the adopted method of metrics, provisions must be made for monitoring of all criteria to ensure continual support of the healthcare mission. 

The cost of healthcare has grown at an unsustainable rate. Financial and legislative pressures have increased to manage and control the economy of healthcare delivery. Who does or does not have access to healthcare, and the quality of the care received, are serious issues to be resolved.

The “gree
ning” of healthcare vies for attention on nearly every healthcare leader’s priority list, especially those facing smaller revenues, profitability challenges, and major reforms to healthcare delivery.

At the heart of their mission, healthcare leaders must become promoters of sustainability beyond the standard greening factors, where a new frontier of hybrid solutions will meet their health mission.

Mission-supported sustainability is one of the central strategies that must be examined. Now is the time to creatively envision a new wave of sustainable approaches for our nation’s healthcare environments. Mission-supported sustainability encourages development that connects to the triple bottom line—planet, people, and profits. HCD


Bob Siebenaller, AIA, NCARB, LEED AP BD+C, ACHE, is a Healthcare Division Manager at SSOE Group. He can be reached at 419.255.3830 or bob.siebenaller@ssoe.com.