Health Care Sustainability: Quality and Value Transformation

By: Erika Kimball, RN

It is high time for hospitals to clean up their collective act.  The American Hospital Association estimates that facilities generate up to 25 pounds of waste per patient bed per day, totaling 7,000 tons of waste daily.  Hospitals also use greater than two and a half times the energy of a comparable commercial building, have a significant water footprint, and are large-scale producers of toxic waste.  The environmental effects of hospital operations directly compromise local public health outcomes, contributing to increased rates of asthma, cancer and birth defects, to name a few.

Progressive health care systems are actively greening their hospital facilities and operations, and hospital suppliers are beginning to form innovative partnerships that focus on sustainability as a business strategy.  Despite these promising developments, the hospital industry as a whole has been painfully slow to improve environmental performance.  The major reason for this lack of improvement points to one sad but true fact: change is incredibly difficult in the hospital.

Hospitals are made up of multiple, highly regulated, diverse departments that perform mission critical tasks twenty-four hours per day.  Additionally, current improvement efforts in hospitals focus primarily on quality and value, leaving sustainability to compete for bandwidth.  It doesn’t take much searching to understand the impetus driving current hospital priorities; quality and value are directly tied to hospital referrals and reimbursement.  Health care sustainability leaders can take lessons from industry change makers such as the Leapfrog Group, who thrust quality and value onto the radars of every hospital CEO in the country.

The Leapfrog Group is changing the way hospitals operate, and making strides in quality and value.  If you take a look at strategic inpatient and clinical service initiatives, you’ll see significant resources dedicated to reducing medication errors, improving patient centered care, and maximizing health care outcomes.  The Leapfrog Group is one of the major driving forces in this transformation.

Created in 1998 by a group of large employers seeking to improve the economic value of health care expenditures, The Leapfrog Group leverages employer purchasing power to incentivize hospital quality and safety standards that directly improve outcomes.  Initial efforts focused on reducing preventable medical errors, as described in a 1999 Institute of Medicine report that estimated more Americans were dying each year from medical errors than from motor vehicle accidents, breast cancer and AIDS combined.

The Leapfrog Group initially faced resistance from the health care industry and is still the focus of criticism in hospitals, but there is no doubt that the organization has quickly become a major voice in health care reform.  In 2009, over 1,200 hospitals participated in voluntary reporting.  The group’s focus on transparency, quality and value has set the agenda for hospitals nationwide.

Sustainability complements and supports both quality and value within the hospital setting, and it’s time for health care consumers to demand sustainability just as they demand quality and value.  Waste generation, resource consumption, and use of toxic chemicals not only harm public health, they also reflect inefficiencies in hospital operations that compromise value.  Furthermore, quality initiatives that are achieved at the expense of scarce hospital resources are at risk for failure in the long-term.

The American Hospital Association collaborated with regulatory bodies within the hospital industry to create the Sustainability Roadmap for Hospitals.  The guide offers targets and strategies for hospitals looking to reduce environmental impact.  By linking reimbursement and referrals to environmental performance targets outlined in the Sustainability Roadmap, large employers could effectively make sustainability a priority for the health care industry at last.

**Erika Kimball is a Registered Nurse and a Sustainable Business Professional dedicated to minimizing the environmental impacts of the health care industry.  She is the founder and co-chair of the Green Team at California Pacific Medical Center and has an MBA in Sustainable Management from Presidio Graduate School.