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Healthcare Development & Architecture

Creating a Culture of Sustainability in Healthcare

Healthcare Development & Architecture

Culture is an embedded mindset. To change a culture, it must be developed and understood by all stakeholders to include input from all of those impacted. This creates buy-in to new processes and provides balance. In the healthcare segment, there is a movement of culture change called person-centered care. This does not only speak to patients or residents being served, but also those providing care and services, families, visitors, product and service providers as well as others spending time within a health care setting.

Sustainability is not a “plaque” on the wall of a building; it is a continuous process of improvement; collectively completed through communication, action, follow-up, and benchmarking. In a sense, continual improvement starts once a building is open and operational.

So, evaluation of operational processes and maintenance procedures is the key to an on-going sustainable approach. Sustainability is a culture that weaves together the fabric of an organization.


On the journey to sustainability, helping individuals and groups make the connection between their everyday activities and the possibilities that are ahead is imperative. Green teams are interdepartmental groups that often organize within a hospital or health care facility to chart and implement sustainability programs and are essential to creating a culture of sustainability within the facility and community.

Additionally, inter-facility dialogue is necessary to creating a wider culture of sustainability in a larger geographic area. Such is the case in Maryland, where health care facilities have recently formed the nation’s first statewide health care sustainability leadership council.

Who knows a hospital or health care facility better than the individuals whose job it is to clean and operate it? The environmental services and facilities staff are the eyes and ears of an institution and know more about the efficiencies and inefficiencies than anyone else.

For example, they can identify locations that are lit when unoccupied; faucets and pipes that leak or drip; excess use of toxic cleaners; entryways for pests; opportunities for recycling as well as others.

Nurses and clinical professionals are in a position to identify “bedside” opportunities for improving facility sustainability. For example, they can pinpoint where there is a need for “right sizing” waste collection containers; opportunity for procuring reusable materials instead of throw a-ways or single use items.

Nurses, who are the end user of many products, understand the connection between environment and health and can bridge the gap between basement and boardroom.

Hospital managers including purchasing, facility, dietary, nursing, marketing, community benefit, clergy, and more are in a position to spearhead projects, audits, case studies, and best practices. Often learning from peers, the literature, or at conferences, this segment of the health care culture is aligned to help the rubber meet the road.

For example, in Veterans Administration (VA) hospitals there are GEMS (Green Environmental Management Systems) Coordinators and Energy Managers that team to support integrated sustainability practices.

Every culture needs an executive champion to advocate for sustainability programs within the institution and publicize the excellent results to the community and abroad. Executives can help remove institutional barriers, engage in intellectual exchange with peers, and more. One national health system based in Maryland includes five priorities system wide; including the priority of ‘greening’ the organization.

In addition to staff, residents and patients can contribute to the sustainability journey. For example, during the design of a replacement nursing home, the ‘green’ team was made up of four independent living residents that provided feedback to the administration.

The average age on the ‘green’ team was 80 years old and they contributed throughout the entire project; including pausing the construction process when transom windows were “value-engineered” out of the project and providing the research, design, funds, and integration of construction services to have skylights appropriately installed for daylight.

To reach hospital and health care visitors within the community, programs such as health fairs, earth day celebrations, and farmers markets are becoming commonplace amongst health care facilities. Creating opportunities for healthy messaging and screening can be tied to community events; promoting an overall sustainable life style.

Product and service providers who regularly visit a health care facility have an important and integral role in changing the culture to be more sustainable. Providers can participate in collaborative education and training efforts, offer more sustainable products and services in their portfolios, and offer services such as audits and case studies.

One Maryland non-profit is partnering with a Maryland hospital to create a program for new moms that provides information on integrated pest management which reduces the utilization of chemicals in the home and potential exposure to family members.


So how do we get there and what is available to support integrated team management and practice? The following are two of several tools that focus on person-centered environments that are available to assist with completing culture change and on-going benchmarking utilizing a collaborative approach for sustainability.

The Senior Living Sustainability Guide® (SLSG) is available for free download at The goal of this tool is to provide information on the different stages of project development.

  • A predevelopment analysis process for successful site selection and tools to define a senior living project.
  • Defining the social-cultural context in which a project takes place; including identifying resident and staff population type and background is a major first step in understanding the appropriate care model for an organization. This contextual information provides a framework for a proposed project. Once a project direction is determined, process information is provided to further develop the detail of a specific project through four key dimensions: Resident, Organization, Operations, and Physical Setting
  • Each dimension illustrates an overview description, identification of the principles of the core values and their application and implications and establishment of an integrated team. It also includes elements and drivers, desired experiences and outcomes, means for sustaining operational processes, and documentation and indicators. The dimensions are intended to build upon one another, but most importantly, the Physical Setting is intended to support the Resident, Organization, and Operations dimensions.
  • Sustainability is about benchmarking all of the outcomes, having a process for continual improvement, and scheduling and budgeting adjustments and changes based upon the results of the feedback obtained. There is an absolute need for creating a process for continual improvement through commissioning, post occupancy evaluation, LEAN processes, flow charting, and other means for establishing consistent methods for evaluation. Once baseline data is established a continual improvement plan can be established for feedback to be integrated into all four dimensions.

Another new tool on the marketplace that supports culture change from a physical building setting perspective is the Green Building Initiative’s new Green Globes® Continual Improvement for Existing Buildings (CIEB) for Healthcare; available at

This is a web-enabled interactive green building design tool that incorporates an integrated project management approach and is available for third-party certification. It was developed based upon 21 Pilot VA hospital assessments completed in 2009.

This assessment program is currently being used for existing VA hospitals across the country and is now also available for existing private sector hospitals and long term care settings. In completing assessments throughout the country utilizing this system, it is the collaboration of different team members within the hospital and the opportunities to discuss and work with different departments that provides the opportunities for creative ideas and solutions to meet sustainability goals.


Sustainability is a journey that has the destination of improving resident, patient, staff, and community outcomes. The ultimate goal of developing and implementing a sustainable culture is not about the physical setting or operations of a facility but is related to the positive outcomes of the populations served by the facility, and the ability to instill in all the populations (outlined above) a sustainability ethic that is used at home and in the community to create healthy and sustainable cultures community wide.

About the Authors

Jane Rohde is the principal/founder of JSR Associates, Inc., a healthcare and senior living consulting firm providing client focus groups for creative program and care model development, innovative master-planning strategies, and design services based on evidence based research, sustainable principles, and person-centered programming.

She sits on the Environmental Standards Council, a Center for Health Design committee, the 2014 revision committee for the Guidelines for Design and Construction of Health Care Facilities, and the ASHRAE 189.2 standards committee for high performance healthcare buildings. Jane chairs the Senior Living Sustainability Guide® committee and is an assessor and content provider for Green Building Initiative™ Green Globes® for CIEB and CIEB – Healthcare. She may be reached at

Joan Plisko
is the technical director of Maryland Hospitals for a Healthy Environment, a technical assistance, education, and networking initiative providing support to health care participants in developing, implementing, and assessing environmental sustainability programs.

Joan was the founding Chair of the Baltimore County Commission on Environmental Quality as well as the recipient of several awards including the Maryland Tawes Award for individual outstanding efforts to enhance Maryland’s environment and the U.S. EPA Region III environmental achievement award for making significant contributions to reduce pollution and/or protect public health and the environment in the Mid Atlantic region. She may be reach at

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