MHA 560 Week 1 Sustainability in a Health Sector Context Example

What Should Outlast Me: A Retiring Hospital Chief Executive Defines Sustainability for Patients, the Planet, the Balance Sheet and the Neighborhood

[Student Name]

University of Phoenix

MHA/560: Creating a Sustainable Legacy: Healthy Communities

Week 1 Assignment

[Instructor Name]

[Date]

The hospital, its leader, emissions and financial figures are composites written for a model paper; national figures and research findings come from the sources cited.

At a dinner marking her ninth year as chief executive of a composite 300-bed nonprofit community hospital on Milwaukee's north side, the board chair asked a question that stayed with her: when you retire in three years, what do you want to leave behind? She answered that she wanted the hospital to be sustainable, then realized she could not say exactly what she meant. This paper is her attempt to define sustainability for a hospital and to set an agenda she could accomplish and hand on.

Why Define the Word

Sustainability is often used loosely, to mean financial success or recycling programs. A leader who wants to build something lasting needs a precise definition, because different meanings lead to different priorities. The chief executive settled on a definition with three dimensions: environmental, financial and social.

Environmental Sustainability

Environmental sustainability means reducing the harm the hospital's operations do to the air, water and climate on which health depends. For a hospital, this is not a side issue: its emissions contribute to the illnesses it treats.

Health Care's Footprint

The evidence is sobering. Researchers modeling the whole economy estimated that the carbon output of American health care grew by 6% over the eight years to 2018, when it stood at 1,692 kilograms for every resident, more than in any other wealthy country. The sector's climate and toxic air emissions that year were judged to have cost some 388,000 healthy life-years, and states whose systems emitted more did not deliver notably better care (Eckelman et al., 2020). A hospital that pollutes the air its patients breathe is working against its own mission.

Where Hospital Emissions Come From

Operating rooms are a major source. A carbon footprinting study of operating rooms in three health systems found that anesthetic gases and energy use were the largest sources of emissions, that operating rooms were three to six times more energy-intense than their hospitals as a whole, largely because of heating, ventilation and air conditioning, and that preferential use of the anesthetic gas desflurane produced a tenfold difference in anesthetic gas emissions between hospitals (MacNeill et al., 2017).

The Hospital's Own Picture

The hospital had never measured its footprint. A preliminary review found that its eight operating rooms ran full ventilation around the clock, even when empty overnight, and that desflurane accounted for a large share of anesthetic gas purchases. Its buildings, most from the 1960s and 1970s, were inefficient.

Financial Sustainability

Financial sustainability means the hospital can keep serving its community for decades, not only survive this year. The hospital's operating margin averaged 1.1% over five years, below what is needed to replace aging buildings and equipment. About 60% of its patients are covered by Medicaid or are uninsured.

Social Sustainability

Social sustainability means strengthening the health and resilience of the community the hospital serves, including through its roles as employer, purchaser and neighbor. The north side neighborhoods around the hospital have high rates of poverty, chronic disease and premature death.

What Nonprofits Give Back

Research on tax-exempt hospitals found that they devoted 7.5% of operating expenses to community benefits in 2009, but that the great majority of it paid for free or underpaid patient care, with a small share for community health improvement undertaken directly, and that spending varied widely without being explained by community need (Young et al., 2013). Social sustainability asks hospitals to do more for health outside their walls.

How the Dimensions Connect

The three dimensions reinforce one another. Reducing energy waste lowers costs and emissions. Local hiring and purchasing strengthen the community and the hospital's workforce. Healthier neighborhoods, with cleaner air and better access to care, reduce avoidable admissions that strain a thin margin. A leader who treats the dimensions separately misses these links.

Tensions Among the Dimensions

The dimensions also compete. Replacing an inefficient cooling plant would cut emissions and long-term costs but require capital the hospital lacks. Expanding community programs would strain a thin margin. The chief executive recognized that sustainability requires trade-offs, not only win-win choices.

Voices From the Neighborhood

The chief executive met with residents at two community centers near the hospital. They spoke about asthma among their children, the lack of good jobs nearby and a sense that the hospital was a place they went when sick but not a neighbor. One grandmother said the hospital could start by hiring people from the neighborhood for more than housekeeping jobs. These conversations made social sustainability concrete.

Staff Perspectives

Staff also cared about sustainability. An operating room nurse had tried for years to start a recycling program for clean packaging, and an anesthesiologist had asked about reducing desflurane use but received no response. Both became early members of a sustainability working group. The chief executive learned that the ideas already existed inside the hospital; they needed a leader's sponsorship.

Health Effects Close to Home

The environmental dimension is not abstract for the north side. Asthma rates in nearby neighborhoods are among the highest in the city, and the hospital's emergency department sees children with asthma attacks every week. Air pollution from all sources, including the energy the hospital uses, contributes to that burden.

Personal Legacy

For a leader, sustainability also means what outlasts her. A leader's legacy is less a building than the capacities she leaves: leaders she developed, systems that keep working and relationships that continue. The chief executive decided her legacy should be measured by what continued after she left.

A Legacy Agenda

She set three priorities for her final three years. Environmental: measure the hospital's footprint and cut operating room emissions, starting with anesthetic gases and ventilation. Financial and social together: shift a share of the hospital's purchasing and hiring to north side businesses and residents. Personal: develop two internal candidates capable of succeeding her and embed sustainability goals in the board's strategic plan so they do not depend on her.

How She Will Know

Each priority has measures: emissions from anesthetic gases and energy, local hiring and purchasing as a share of totals, the operating margin and a succession readiness assessment by the board.

Sponsorship From the Top

The chief executive asked the board to add a sustainability goal to her own performance objectives and to the hospital's strategic plan, so that the work would carry the weight of governance rather than depend on enthusiasm. The board agreed and asked for an annual sustainability report alongside the financial and quality reports.

Why Now

Three years is long enough to establish systems but short enough to require focus. Starting now gives her time to hand on work that is under way rather than plans on paper.

Conclusion

The board chair's question led to a definition. Sustainability for a hospital means reducing its environmental harm, remaining financially viable and strengthening its community, and for a leader it means leaving capacities that continue. Evidence on health care's emissions and operating room footprint, and on how nonprofits spend community benefit dollars, shaped a three-part agenda that ties the hospital's future to the health of the people and place it serves.

References

Eckelman, M. J., Huang, K., Lagasse, R., Senay, E., Dubrow, R., & Sherman, J. D. (2020). Health care pollution and public health damage in the United States: An update. Health Affairs, 39(12), 2071-2079. https://doi.org/10.1377/hlthaff.2020.01247

MacNeill, A. J., Lillywhite, R., & Brown, C. J. (2017). The impact of surgery on global climate: A carbon footprinting study of operating theatres in three health systems. The Lancet Planetary Health, 1(9), e381-e388. https://doi.org/10.1016/S2542-5196(17)30162-6

Young, G. J., Chou, C., Alexander, J., Lee, S. D., & Raver, E. (2013). Provision of community benefits by tax-exempt U.S. hospitals. New England Journal of Medicine, 368(16), 1519-1527. https://doi.org/10.1056/NEJMsa1210239