Mark Repenshek, PhD, is the healthcare ethicist for Columbia St. Mary’s in Milwaukee, Wisconsin. He also chairs the facility’s green team and represents Columbia St. Mary’s on Ascension Health’s green team. He felt a career in healthcare and ethics was the perfect intersection of exploring life’s big questions around faith, morality, ethics, and health. Looking back, he recalls the death of his father at a young age and how it led him to question and search for deeper meaning in his life. Through this, he found his true calling.

Repenshek started at Columbia St. Mary’s during a fellowship in 2002 and 2003, and then was hired as the full-time healthcare ethicist. He reports to Vice President of Mission Paul Westrick. In his role, Westrick is charged with ensuring the mission of the organization (sponsored by Ascension Health and Columbia Health Systems) is met. This includes a commitment to care for the poor, and a spiritual well-being of the organization with a continued focus on holistic care, which sustains and improves the health of individuals and communities.

His role is to continuously integrate that mission into everything the organization does. Whether it’s delivering care to a patient, building a new hospital, or engaging the community, everything has a lens of mission first. If it sounds like a tall order, it is. Community needs may increase, though margins are slender. But the community needs would not be met at all if the facility could no longer operate. It is the classic conundrum: “No margin, no mission … no mission, no margin.”

So meeting the needs of the community is balanced with the ability to operate for the long term. This requires prioritization, creativity, collaboration, continuous change, and an ethicist at the table.


The sustainability commitment story at Columbia St. Mary’s

In 2009, Repenshek was participating in a strategic plan development process, and one of the five components was “stewarding resources.” During a presentation from leadership and the board of directors, Repenshek noticed the metrics for this area were all financial. He questioned the metrics to see if stewarding resources should also be an area to measure the natural resources used in running the facility.

Columbia St. Mary’s was building a new hospital, and it was a good opportunity to take a closer look and try to measure some nonfinancial resources—environmental impacts and sustainability. Leadership was supportive and empowered Repenshek to take the lead.

Repenshek had his personal “ah-ha” moment and searched for more information. He found guidance, community, and templates from Catholic Health Association and Practice Greenhealth. He set and accomplished the facility’s first formal environmental goal—to kick off a green team and embed it into the structure of the organization. Past efforts had not endured for the long term.

This was the first time it was attempted with a collaborative team, varying perspectives, leadership engagement, and how-to guidance from outside experts. The next goal was to become a virtually mercury-free facility and to use the Practice Greenhealth Environmental Excellence Awards application as an assessment tool to identify opportunities for improvement.

Columbia St. Mary’s wasn’t the only Ascension Health hospital focused on sustainability. Other Ascension Health facilities, such as the Seton Healthcare Family of Hospitals in Austin, Texas; St. John Hospital and Medical Center in Detroit; Providence Hospital in Washington, D.C.; and Borgess Medical Center in Kalamazoo, Michigan (to name a few) had momentum and got the attention of the system office, which led to a system procedure establishing a formal environmental stewardship program in 2011.

Ascension Health joined Practice Greenhealth for help with strategy, tools, and education. Each health ministry reported its baseline activities as of December 31, 2010, and established at least two environmental goals for the current fiscal year. The entire system has committed to transitioning to reusable sharps containers in 2012.

Robert J. Henkel, FACHE, president of healthcare operations and chief operating officer for Ascension Health, recently committed the organization to serving as a founding member of the U.S. Department of Energy’s Better Buildings program to reduce energy use by 20% by 2020. That’s a big impact from the largest nonprofit Catholic health system (more on this program will be presented at CleanMed 2012).


Sustainability and community health

In line with its core values, Columbia St. Mary’s green team works with the community services department under Director Bill Solberg, LCSW. The department helps identify priorities for the organization based on community needs. Various regional entities collaborate to assess community needs and then identify actionable items for each entity.

The organization is held accountable for these actions and guide strategic planning. For example, in Wisconsin, infant mortality rates are equivalent to some developing countries. In turn, Columbia St. Mary’s developed healthy baby programming to educate new mothers and their families about well baby care.

While the IRS requires not-for-profit healthcare facilities to demonstrate their status through the use of Form 990, Schedule H, not all environmental stewardship activities meet the “community building” definition. There is a section in the form where facilities can add their own narrative, and Columbia St. Mary’s is adding three stewardship activities to their form this year.

The first is food services, including local food procurement, Styrofoam elimination, and the transition to compostable ware and food donation. The second is medication donation. By working with the Dispensary of Hope, the hospital recirculates medications for those who cannot afford to buy them. The facility has 29 clinics participating, and more than $40,000 worth of medication has been donated in just the first month, rather than discarded as waste. And, finally, the third activity to be reported is its green roof. The roof helps with building cooling and water management in an area that has experienced flooding after heavy rains.

Other things the facility is looking at reporting are the pounds of waste diverted from its local landfill due to reprocessing and health impacts of energy conservation efforts with the use of Practice Greenhealth’s Energy Impact Calculator, which translates energy use to health outcomes (more on sustainability and community benefit reporting can be found in HEALTHCARE DESIGN’s April 2011 Green Column).


Ethics and climate

The United Nations climate talks took place from November 28 to December 7, 2011, in Durban, South Africa, where a plan was established to begin no later than 2020. Based on various articles responding to the move, it is fair to state that many stakeholders are not satisfied with the agreement. While funding will be provid
ed to support countries in need of preparedness, there is no mandate about speeding up carbon emission reduction in industrial nations.

According to the Associated Press, “Scientists say that unless those emissions—chiefly carbon dioxide from power generation and industry—level out and reverse within a few years, the earth will be set on a possibly irreversible path of rising temperatures that lead to ever greater climate catastrophes.”1

These are tough times—environmental imperatives balanced with slim margins, rising costs, a tough economy, and a less than clear future. How can a facility afford to act? Let’s think of the alternative. Just as Repenshek described balancing care with long-term success, what’s the value of a long-term success if it’s on an uninhabitable planet?

Leaders in healthcare sustainability are finding that there are enough cost-saving initiatives, like energy, water, and waste conservation, to justify higher costs for recycling, safer materials, carpooling incentives, Styrofoam elimination, and education strategies. The resistance appears to stem not just from the perceived cost, but the long road and degree of “change management” required in a very busy environment.

In the Catholic Health Association’s document, “The Ethics Role,” Ronald P. Hamel, PhD, senior director of ethics, explains the critical role of ethics in healthcare: “Catholic healthcare ethics is central not only to helping shape the culture of an organization, its identity, but also is central to guiding the organization’s decision-making and behavior, its integrity. Ethics should assist the organization to be what it claims to be in regard to identity, character, and culture, and to discern what it ought to do (and not do) in light of who it claims to be.”2

John W. Glaser, STD, senior vice president, theology and ethics, St. Joseph Health System, breaks it down in Catholic Health Association’s “The Ethics Role.” He describes ethics as translating the Christian commandment of “Love thy neighbor.”

  • Structures and behaviors of our global community;
  • Structures and behaviors of societies;
  • Structures and behaviors of organizations; and
  • Habits and behaviors of individuals.

He adds, “A self-unaware and constricted consciousness is one of ethics’ great adversaries.”3


Leadership engagement

Increasing numbers of healthcare leaders are seeing firsthand that environmental stewardship—green building, safer materials, energy and water conservation, transportation plans, healthier foods and waste, and toxicity reduction—link to planetary, community, and worker health and can be fiscally responsible. An increasing number of healthcare leaders are speaking up and operationalizing the environmental mission into structure, staffing, and reporting. Some report that its value as a staff engagement strategy wasn’t fully realized until later and was icing on the cake.

The most successful stewardship programs have leadership engagement; we know this. This usually involves a consciousness, an “ah-ha” moment, and a moment of clarity that many healthcare leaders can describe. Some were moved by hearing a talk by another healthcare leader or attended a meeting, like the World Economic Forum.

Some speak of their own practice as a clinician or a public health advocate, or of their children helping them realize the pivotal role they have and the potential for transformational change. Practice Greenhealth has started capturing these transformative leaders through a series, “Leadership Walks, Talks, and Envisions a Healthier Future,” where healthcare leaders are highlighted from across the country, both through their thoughts and with their actions.

There’s no doubt that changing the way materials and services are purchased, how and with what facilities are built, and the types of programs in place is a long-term, continuous process. Change is hard. But it’s happening.

A sign of change in the sector is the kickoff of the Healthier Hospitals Initiative, a coordinated sector-wide approach based on the premise that how we design, build, and operate hospitals can improve patient outcomes and workplace safety, prevent illnesses, create environmental benefits, and see significant cost-savings.

Practice Greenhealth, Health Care Without Harm, and The Center for Health Design are collaborating with Kaiser Permanente, Catholic Healthcare West, Partners Healthcare, Vanguard Health Systems, Hospital Corporation of America, Advocate Healthcare, MedStar Health, Inova Health System, and Bon Secours Health System (representing 370 hospitals or 6% of the healthcare sector) to challenge the healthcare sector to dramatically improve its environmental footprint, improve patient and worker safety, and save billions of dollars in healthcare costs.

The April kickoff of the program will start a three-year campaign during which enrollees will commit to specific measurable stewardship activities with a coordinated method of data collection. This standardized approach will aggregate data to report back to the sector in both financial and environmental benefit. Getting started strategies will be coordinated online and at CleanMed, the conference for best practices in healthcare sustainability.

Collaboration, partnerships, and creativity can balance fiscal responsibility and environmental responsibility for a healthier future. Then we can all walk, talk, and envision a healthier future. HCD

Janet Brown can be reached at



  1. Max, Arthur, Associated Press, “Climate Conference Approves Landmark Deal”, Retrieved December 11, 2011.
  2. The Ethics Role, Catholic Health Association, Page 6, accessed on December 11, 2011.
  3. The Ethics Role, Catholic Health Association, Page 10, accessed on December 11, 2011.