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Making Change is Hard- An Opportunity for Leadership

Healthcare Development & Architecture

Recently, the City of Chicago launched a program to help the city prepare for climate change, essentially crafting a plan for the next 50 years’ worth of impacts on city infrastructure (increased heat and extreme weather) and those on public health (the appearance of new diseases, heat-induced health problems).

“Cities adapt or they go away,” said Aaron N. Durnbaugh, deputy commissioner of Chicago’s Department of the Environment. “Climate change is happening in both real and dramatic ways, but also in slow, pervasive ways. We can handle it, but we do need to acknowledge it.”

“Going Green Doesn’t Cost a lot of Green”

Many hospitals and healthcare facilities are working hard doing many of the same things that the City of Chicago is doing—reducing waste, energy and water—some healthcare organizations are still reluctant to speak or act about the issue of climate change and its impacts on health.

The good news is that healthcare organizations are reaping the financial, environmental and public relations benefits of reducing energy, water and waste; whether they frame it as a climate change issue or not. They are overcoming the perceived barrier that these programs cost too much money because in fact, they have proven the overall cost effectiveness of saving energy, water and reducing waste.

Leaders at a Health Forum workshop in 2010 (Sustainability: Reducing Costs, Improving Patient and Employee Satisfaction), widely agreed that we have spent the 1st decade of this sustainability debate overcoming this notion “going green costs too much green” to “okay, we get it that these programs make sense and are consistent with our goals of excellence in quality, safety, satisfaction and financial stewardship.

Now our challenge is figuring how to change the culture to make sustainability part of our organization’s DNA.”

And yet many healthcare organizations are missing the opportunity to talk about climate change and how it relates to their stated missions of overall better public health. The fact is that climate change comes with very clear and direct health risks.

In the new book “Changing Planet, Changing Health,” Dr. Paul Epstein, associate director of the Center for Health and the Global Environment at Harvard Medical School, asserts that it’s time to connect the dots for communities about why we as a healthcare community should care—and act—about increasing greenhouse gas emissions.

“Physicians are getting more involved, and we are getting a clear message from health groups and from the Centers for Disease Control and Prevention that these are real issues we need to know about and plan for,” Epstein says.

With climate change, we as a society are balancing the imperatives of today with those of the future. While we know the climate is changing and the impact on public health is real, planning and motivating our organizations for something that seems so far away can be very, very difficult.

But today, we also know that healthcare organizations who are implementing integrated sustainability programs through innovative green building strategies that use less energy and water, resource management programs that prioritize purchasing environmentally preferable materials and generate less waste. These programs pay for themselves, sometimes immediately.

Working Together for Change

If the leaders of this country’s healthcare community would come together and set goals that all hospitals can realistically meet today, to save money, improve environmental quality and worker, patient and community satisfaction.

Imagine if the healthcare community staked out the moral high ground on the issue of climate change, recognizing the public health implications of their operations, and the need to align their operations with their fundamental mission of healing. Imagine acknowledging—and moving to address—the negative impacts of your own organization’s greenhouse gas emissions on the very communities that healthcare organizations serve.

In 2008, after an extensive study, the American Medical Association concluded: “Ongoing global climate change is now widely accepted by the majority of scientists, climatologists, and meteorologists, that human activity is accelerating this process.

The extent of climate change will depend on many factors; most notably changes in global greenhouse gas emissions. . . The potential exists for devastating events with serious health implications, including extreme heat and cold events, flooding and droughts, increases in vectors carrying infectious diseases, and increases in air pollution. The health effects from these events should be on concern to the medical community and require action.”

On April 17, 2009, the United States Environmental Protection Agency, after exhaustive study, concluded that “In both magnitude and probability, climate change is an enormous problem. The greenhouse gases that are responsible for it endanger public health and welfare within the meaning of the Clean Air Act.”

The evidence seems to be in; the world’s scientific and medical communities have concluded that climate change is real, and that it is poses serious threats to human health. Some organizations are now looking at climate change as part of their Disaster Preparedness strategic planning.

Looking at climate change from a preparedness perspective takes the issue out of the realm of sustainability, which may help your actions resonate more with your organization. The point is not why you do it, but that you do something.

Change is Hard

It’s not often clear how to motivate an organization to actually make change. Spending some time and resources thinking critically about what motivates your organization,and the drivers and barriers to action, will help you develop a better plan to make the necessary changes, and will make those changes stick.

Five-step plan for making lasting, ongoing change, even when that change is hard for your organization and staff:

  • Define the problem. What are we trying to solve? What are our motivators? Disaster preparedness, cost savings, environmental sustainability, the price of oil, energy independence, staff and community satisfaction?
  • Engage stakeholders. If you want the change to last, you have to make sure the right voices are at the table from the start. Thinking through the potential stakeholder groups is often more difficult than anticipated, so make sure you include this as a deliberate and strategic step. Remember too that your stakeholder group is likely to shift as you move from scoping to planning for implementation to actual implementation to operations and reporting and communicating.
  • Develop your plan. Craft a plan that is motivational, strategic and achievable. Look to bright spots for motivation, either externally by learning from other organizations that have had successes or to your own successes. The good news is you will rarely be breaking new ground, so it’s almost always possible to seek guidance from others that has been there before.
  • Institutionalize the change. Making change to part of the culture means that stakeholders themselves eventually embrace the change. Your plan must communicate the need for the change, design the required behavior changes to make them as easy as you can, and communicate these step-by-step changes to staff to ease the transition to doing things differently.
  • Analyze feedback, report, and keep improving. Keeping the change going is critical. Combine both qualitative and quantitative information, and use data to make the change real. Be honest about what you’ve achieved and what’s left to do. Last, don’t forget to celebrate the successes with the entire organization to tap into that happy feeling of improvement and doing things a new and better way.

Leading the Way

Providence St. Peter Hospital in Olympia, Washington has planned and implemented lasting change. They are a bright spot when it comes to water conservation. First, St. Peter’s developed a multi-year strategy, and started this process by analyzing the extent of their problem before developing their action plan.

By benchmarking and tracking their water consumption over an 11-year period, they were able to reduce their water consumption or avoid consumption by 59 percent (conserving over 31 million gallons). This incredible progress came at the same time the campus was growing by 17 percent and patient days increasing by 22 percent.

These water conservation measures are saving the hospital almost $140,000 per year, and over an 11-year period saved them well over $1.5 million.

Now is the Time for Change

The time has come for healthcare organizations to seize the day. Climate change is real. “Green” is here to stay because sustainability programs are smart, even during a recession. Any organization can craft a change model that works, but succeeding means making a case for the change and developing a strategic, phased-in program of improvements that will call for new technologies and methods that can solve the financial, safety and environmental crises our industry faces.

This does not mean embracing wild, mindless spending sprees on new technologies that have a high price tag, but means supporting a carefully thought-out, systematic, gradual but relentless improvement in our environmental performance.

What we can do is show the world that American healthcare leaders recognize that the challenge is indeed tough, but that we can address it. As our forebears did during so many other kinds of crises over the past 250 years, we can accept our responsibility to face this challenge and we can show that we are determined to do better. We can be the leaders that the public needs us to be.

About the Author

Laura Brannen is senior environmental performance consultant for Mazzetti Nash Lipsey Burch (M+NLB), mechanical, electrical, plumbing, technology engineering and environmental performance consulting and design firm. Laura is a national and international speaker in the field of healthcare waste and environmental programs management. She can be reached at The AHA’s implementation strategies:

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