Sustainability often begins with passionate employees. “Health care is full of passionate people. The place is teeming with individuals who want to do this work,” said Janet Howard, director of facility engagement at Practice Greenhealth (PGH), a non-profit membership organization. At the beginning of her career, when Howard was conducting hospital waste audits, she was struck by the fact that no matter which unit she was in or what care was being delivered, “Everybody, from waste handlers to food service people, nurses and surgeons — they all had opinions about what we could do to improve our environmental performance.”

In some cases, hospital executives are not even aware of these “green champions,” but, Howard said, “They’re out there, whether they have been identified or not, because they see the work as an extension of health and healthy communities and healthy people.” In fact, when administrators tell Howard that their institutions aren’t doing anything about sustainability, she generally hands them a self-assessment checklist developed by PGH. Once they start talking to employees, often the administrators quickly discover examples of sustainability they never knew existed — a cook who has started a community garden on the hospital grounds, for example, a doctor championing reusable plastic sharps containers, or a nurse who is collecting unopened suture packs that would normally be thrown out and sending them to Haiti.

Sometimes these individuals drive important changes on their own. Keith Sutter, director of medical device sustainability at Johnson & Johnson, tells the story of a packaging engineer who questioned the widely held belief that regulations prohibited the use of recycled material in medical device packaging. This one dedicated advocate had the commitment, perseverance and the knowledge needed to push changes all the way through the system, resulting in significantly greener packaging for an important surgical product.

Generally though, said Kathy Gerwig, vice president of employee safety, health andwellness at Kaiser Permanente, “The organizations that are successful in bringing environmental stewardship into their health care programs all have interdisciplinary teams that guide the work.”

Green Teams – Turning Passion into Action

“The magic comes in working together as a group,” said Gerwig. These “green teams” play two key roles. First they bring together people from different disciplines, each of whom can spot challenges others might miss or provide information that is essential to the work the team is doing.

“The organizations that are successful in bringing environmental stewardship into their health care programs all have interdisciplinary teams that guide the work.” –Kathy Gerwig

Green teams can also help overcome one of the bureaucratic hurdles that sustainability efforts commonly face. All too often, one business unit will be called upon to do work and incur expenses that benefit the P&L of a different unit. To deal with situations like this, “It’s important to get people talking to each other,” said Gerwig, so that they can reach an agreement that is in the best interests of the whole organization. Together, the members of a green team can discuss costs and benefits, regardless of whose budget they affect. “They can say that, as a hospital, yes that’s worth the investment.” The group as a whole gains a larger perspective than any one member’s and can see that it’s worth moving past parochial department budgets to achieve an outcome that benefits the entire hospital.

Most of the 1,000-plus hospitals that are part of PGH have green teams with members that are well equipped to deal with direct operational issues, such as waste, energy and water. But Gerwig stressed that teams often lack expertise in parts of the hospital that deal with higher-level activities upstream in the supply chain. To tackle such issues, teams need to bring in leaders from procurement and facilities. “If you want to change out the flooring from vinyl to something that doesn’t create dioxin pollution, for example, that’s a facilities move, and you need someone from that part of the operation to join the team. That’s why the most successful teams are the ones that not only have an interdisciplinary approach, but also include some folks from procurement and facilities.”

Early wins can lead to enduring change. For the contagious enthusiasm of green champions and green teams to spread throughout a hospital, it’s important to celebrate their successes and build on them. “You build a quiet little army,” said Howard, “and you gather your successes and you write them up and then, and only then, you sit down with leadership, and together as a team in a very coordinated fashion, you demonstrate the value that’s already been realized, and you make a formal pitch for a real program.”

Once those in the C-suite see the concrete value in sustainability, they can help promulgate it by setting ambitious but reachable goals and rewarding achievement either through financial rewards or personal recognition. Ultimately, the goal is for these incentives to wither away as sustainability takes root and becomes self-sustaining within an organization. This is what happened at Inova Health System. For some time, executives at Inova were rewarded for achieving sustainability goals. But eventually it became clear that the incentives had worked, that sustainability had become firmly embedded within the culture. Sustainability, said Seema Wadhwa, assistant vice president for sustainability and wellness at Inova, is now built into basic job responsibilities. As an example, she pointed out thatpeople in food services and environmental services now handle waste audits for their units as part of their everyday jobs, a task that used to fall to Wadhwa herself.

Now that sustainability is well established, Inova has shifted its use of incentives. For the first time this year, executives will be rewarded for reaching wellness, rather than sustainability, goals.

There is more than one way to engage employees in sustainability.One key lesson that Wadhwa said she learned from her work in sustainability is that people are motivated to confront global issues when those issues are brought home to them at a personal level. This realization is part of the reason for the shift at Inova from rewarding sustainability to rewarding wellness. With that focus, which encompasses preventive health care, Inova brings sustainability down to the personal level. Encouraging everyone “to see not just what effect we are having on the environment, but what effect the environment is having on us,” said Wadhwa, engages employees more deeply in both their own health and sustainability: “Why should I care about the environment? Because it impacts the air I breathe and the food I eat.”

Johnson & Johnson has engaged employees in sustainability through its innovative Earthwards program. Unable to find a single external standard that could be used to measure sustainability for all its diverse product lines, J&J consulted with other organizations to identify seven key categories — material and packaging selection, energy, water and waste reduction, innovation, and social impact — and key measures within each. To gain Earthwards recognition, a product, which has already satisfied regulatory compliance and met company standards, must also make significant improvements in at least three of the seven impact categories.

The Earthwards approach drives innovation internally by encouraging teams from different parts of the company to find improvements throughout a product’s lifecycle.“By requiring three significant improvements in different categories, we incentivize collaboration across functions.” said Sutter, director of medical device sustainability at Johnson & Johnson. The R&D team may have used green chemistry to improve the formulation of a product, but to secure Earthwards recognition, the packaging team, for example, may also have to get involved. And because the improvement in each category has to be at least 10%, teams that have not quite attained that level have to reach out and collaborate with others who can help put them over the top.

The work that goes into achieving Earthwards recognition is significant, and the reward is significant visibility within the company. The success of the program demonstrates just how powerful such recognition is. J&J’s corporate goal was to recognize 60 products. By the end of 2013, 55 products had been recognized, representing more than $8 billion in annualized sales, approximately 12% of total revenue. By the end of 2014, the company had surpassed its original goal with 73 different products having achieved Earthwards recognition.

“For something to be truly sustainable and to solve a social issue at scale, it’s important to find a way for the business to be successful.” –Susan Beverly

As with Inova and J&J, Abbott, the global health care company, has developed an approach to sustainability that it hopes will integrate such efforts into the work lives of employees throughout the company. While many in health care have discovered that driving sustainability also drives business, Abbott has formalized the relationship between the two by adopting the management concept of “shared value,” pioneered by Nestlé.

For many years, Abbott approached social issues through its philanthropic fund. But “business is at its best when it acts as a business and not as a charity,” noted Susan Beverly, director of global citizenship and policy. “For something to be truly sustainable and to solve a social issue at scale, it’s important to find a way for the business to be successful.”

As part of this shared value approach, senior executives throughout the company are encouraged to identify social issues, including sustainability, that are barriers to business success. Those employees who are eager to tackle a sustainability issue have to show it will serve a strategic business purpose and everyone who undertakes a business initiative must stop to consider if there are any relevant sustainability issues that might interfere with their efforts. Every employee becomes a potential green champion.

How will hospitals and businesses involved in health care know when they have succeeded in making sustainability an integral part of their culture? Green journalist Joel Makower once asked the environmental manager of a company with 9,000 employees how many people within his organization were working on the environment. Without hesitation, the manager responded: 9,000. “Perfect answer,” said Makower.

Makower was also a moderator at the fall 2014 Wharton conference, “Metrics that Matter; Messages that Motivate,” held in San Francisco and co-sponsored by Johnson &Johnson and Wharton’s Initiative for Global Environmental Leadership (IGEL).


How to encourage employee engagement

A few of the ways that University Hospitals of Northeast Ohio, engages its employees in sustainability:

  • Sustainability certification program: A novel training program on health care sustainability is customized for hospitals’frontline leaders.
  • “Eat real food” photo contest: Employees sent in photos that illustrated how they were incorporating real, unprocessed, locally grown food into their lives. Winners were recognized on National Food Day.
  • Earth Day celebrations: Various annual celebrations, including large employee fairs, are hosted across the system.
  • Sustainability pledge: Available to UH employees and non-UH community members, those who take the interactive and educational pledge show their commitment to becoming more environmentally, socially and economically responsible both at work and at home.
  • Green health heroes: Peer-nominated employees who take leadership roles in helping UH to advance environmental responsibility, promote health and wellness, and save money.
  • Zero-waste annual sustainability celebration: An annual, system-wide, year-end sustainability celebration commemorates employee accomplishments.
  • Sustainability vignettes: A series of short online video vignettes illustrates sustainability efforts taking place across the system.
  • Employee Intranet website: A Greening UH intranet site offers employee-specific information about all sustainability initiatives and current events, and includes useful resources.