Leaning towards sustainability


It’s now clear that in an effort to appear green, many organisations are trying to paint over poor business processes – a practice known as “green-washing”. This is a shame because it’s increasingly clear that true sustainability-oriented practices provide tangible long-term benefits for organisations as well as being good for the environment. To help give some dimensions to one aspect – let’s look firstly just at waste management in healthcare. A recent Victorian Government finding1 estimated that waste management costs in the Victorian healthcare setting are around $90M per annum. The report also stated that ”senior management levels at some sites were not aware of the high costs of general and clinical waste management and the financial savings that can be made from ensuring correct waste separation, increased recycling and waste reduction; environmental successes made by reducing waste and increasing recycling are not widely acknowledged and or promoted; and up to 40 different departments are responsible for waste management.” This conclusion is undoubtedly true of other jurisdictions.

In a healthcare setting there is also the potential benefit of improved health outcomes for people in an optimum environmental setting. Putting all these improved sustainability practices together can provide tangible benefits such as cost savings, improved well-being and reduced environmental impact. In the USA there is at least one index[2] attempting to measure hospitals by a Green Index of 12 criteria including physical site location, waste reduction, energy and air pollution, materials and resources.

But given that many of our healthcare practices and hospitals have been in place for many years, what benefits might realistically be achievable for the healthcare sector in Australia today? This was the question put to a forum of our consultants recently. In response, our consultants recommended that the improvement practices developed in other sectors including the corporate sector could be usefully applied to the health sector. A key approach that originated in the manufacturing sector is known as Lean/Six Sigma. Lean was developed by the car-maker Toyota in an effort to reduce waste in seven major categories. In more recent times, Lean has been combined with Six Sigma process improvement which concentrates on reducing process variance. Combined together, Lean/Six Sigma is becoming widely accepted as an effective process improvement and waste reduction management approach – well beyond the manufacturing sector where it began.

How can Lean/Six Sigma work to improve Sustainability Practices?

In fact, it is pleasing that the health sector has embraced the Lean/Six Sigma process improvement practices with a noteworthy degree of interest. This adoption of Lean/Six Sigma suggests that building upon this approach in a holistic manner to further incorporate improvements in waste and energy management in addition to the patient flow improvements that are a frequent target, could be helpful in building a sustainable healthcare approach. The use of Lean/Six Sigma might thereby help achieve the twin benefits of greener hospitals that also have reduced running costs and better health outcomes (e.g. through improved patient flow and lower error rates).

It is our belief that many organisations, and most particularly the health and human services sector would benefit from any sustainability initiatives being considered in the context of overall process improvement approaches. After all, the Lean approach considers process improvement from the point of view of waste elimination – primarily from the perspective of wasted time and effort to be sure – but it is not a large leap from that thinking to the more direct and tangible waste aspects associated with supply chains, and actual physical waste disposal processes and carbon and energy footprint reduction. Efforts to improve work processes that result in better business practices also have a resultant flow-through of reduced consumption of supplies and reduced waste.

Engage Green Technology to Assist

Some practical ideas that help in sustainability include the use of low-energy lighting (with proximity sensors), and better environmental management systems using advanced heating, cooling and air recirculation systems for buildings. However, consider enlisting the Information Technology department as well: they can also assist in the drive to improved sustainability. With manufacturers creating low energy servers and desktops, there is an emerging opportunity to change over some or all of your computers towards more energy efficient devices. There’s also a technology called virtualisation that is proving helpful: virtualisation is where today’s powerful hardware is enabled to run several instances of software so that its utilisation is increased and made considerably more efficient.

Virtualisation of servers also has the benefit of enabling easier migration of servers from one physical location to another. This is a key requirement in relocating an IT environment in the event of a physical issue (power failure, fire, flood, etc).

Computer processor manufacturers have recently made the task of virtualisation even more efficient by enabling the processors themselves to do some of this complex work thereby further improving the efficiency of this approach. While figures vary, medium-sized organisations are finding some energy savings and benefits through virtualisation approaches. We believe virtualisation will become mainstream in 2008 and beyond.

Going further than changing the desktop environment, some organisations are deploying approaches that enable whole departments or specifically nominated sets of desktops to be put to sleep or powered off by centralised commands. In this manner power can be saved. Some green sites are even advocating the use of software to change the default screen colour of older CRT monitors to black in order to reduce power consumption in monitors! While we are not fully convinced yet about some of these claims, we do know that paper printing is a major cost in all industries including healthcare, and that much printing is wasted or unnecessary. One partial solution is to employ a software application that acts as a final layer before a print is generated. Such software can show the user what the printed document will look like and also provide the option to eliminate unnecessary pages (for example that wasted column from a spreadsheet, or unwanted graphics from a print of web pages.) Try Googling the term “greenprint” to see one example of this approach that looks interesting although we haven’t yet seen it deployed in a healthcare setting.

Other efforts include eliminating duplicated information entry – so implementing efficient Patient Administration System, and finance systems can provide major benefits here – as can developing an overall information management plan to ensure that an efficient information flow is occurring in the service as a whole.

In more clinical areas, companies such as Intel and Microsoft with specific health practices are heavily investing in technologies that enable mobile healthcare at the point of care. These systems (built on replicable processes and practices) are often less affected by the interrupted workflows experienced by clinicians than contemporary approaches.

A key goal of sustainability efforts is to reduce car or air travel by both staff and patients, and in certain specialised cases of telemedicine (remote diagnosis, and even remote robotic surgery) has some potential travel savings benefits as well.

Now is also the time to start planning for how to take advantage of the eHealth initiatives (electronic referrals, electronic shared health records, electronic booking, electronic prescriptions etc). eHealth also has the potential to decrease unnecessary travel and increase efficiency. In fact, many trials are underway both here and overseas that demonstrate improvement to organisational efficiency and effectiveness, but it is also clear that electronic health records provide an additional benefit of data security (as seen during Hurricane Katrina where USA military patient records that were electronic were preserved where many paper records in public hospitals were lost).

Other useful technologies to consider include scanning software, advanced document management systems, and digital transcription/voice recognition systems to reduce the need for additional work effort.

Measuring the benefits to be achieved will require some up-front thinking from a Benefits Management approach which will help to identify the contribution expected from each of the identified benefits prior to the initiative being implemented. A Benefits Management approach relies on appropriate measures being regularly reviewed to ensure the expected benefits are achieved.

In the end, all savings in work-effort ultimately reduce environmental impact and thereby help achieve long-term sustainability goals.

Where can you start?

Our advice is:

  1. Begin from a Lean/Six Sigma process improvement perspective with one of the process areas required to identify how sustainability objectives might be included, and to put appropriate benefits measure in place.
  2. Make sure you have the needed buy-in from the executive team – ideally they should be the direct sponsors of the improvement program.
  3. Conduct a sustainability audit that will identify the most significant areas of waste and cost – and then target those areas in which Lean/Six Sigma process improvements might best be focussed
  4. Don’t forget your IT Department – apart from improving their own efficiency of operation, they may be the key to your overall organisation achieving some very significant efficiency, quality and sustainability objectives

In summary, to “go-green”, “think-lean”!


  1. Waste Minimisation in Health Care. Available at http://www.sustainability.vic.gov.au/www/html/2375-health-care.asp [Accessed on 18/02/2008].
  2. Kweller K. The Top 10 Green Hospitals in the US: 2006. Available at http://www.thegreenguide.com/doc/113/top10hospitals [Accessed on 18/02/2008].

Posted in Australian eHealth

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