Clinical Sustainability Series
Article 1: Why Every Hospital Needs a Clinical Sustainability Program
SION60 has worked with 20+ hospitals and ASCs to reduce energy costs, supply waste, and pollution. We identified $100,000 to $1M+ in annual savings each time. Just as the last generation of leaders learned quality initiatives reduce the cost of care, sustainability projects also improve margins and engage the workforce. The rising generation of executive and clinical leaders are very much in tune with this principle- just ask them.
This summer we are proud to share a 4-part clinical series from our work with outstanding clinicians across the U.S. This article focuses on clinical sustainability and governance. Subsequent articles will dive deep into supply waste then OR and ICUs- the highest margin and most resource intensive services in the hospital.
Sustainability is an Operational Strategy. . . and improves your community’s health
For decades, hospitals pursued margin improvement through labor productivity, supply chain optimization, and clinical quality initiatives. Yet one of the largest untapped opportunities to improve operating margins now lies at the intersection of these disciplines: clinical sustainability. Often mistaken for an environmental initiative, clinical sustainability is fundamentally an operational strategy. It reduces the unnecessary “inputs of the care process at a DRG level”, lowers operating, energy, and supply costs, engages nurses and physicians in a positive way, and improves quality. For CMOs and CFOs facing margin pressure, workforce shortages, and rising energy and supply costs, sustainability should be viewed not as an add-on, but as a data driven system to improve hospital performance.
The timing is perfect. Hospitals are struggling with margin stability from ACA volume reductions and Medicaid work requirements in 2027 will increase days in AR and bad debt! Additionally, the U.S. health sector is responsible for an ~9% of the nation’s greenhouse gas polluton creating unprecedented heat, cold, rain and fires. Yale data suggest roughly 66% of Americans- your physicians and employees- are worried about climate change. The same activities that generate pollution also represent significant operating expense: energy consumption, disposable supplies, plastics, regulated medical waste, and inefficient procurement. Nearly every ton of carbon eliminated reflects a reduction in purchased goods, energy use, or waste disposal — in other words, real operating expense. The financial opportunity, therefore, is not driven by environmental objectives; it is driven by eliminating operational waste while improving patient outcomes. You may think your departments are each doing their part, but you may be surprised when we show up how many department leaders don’t know each other. Let alone how to focus their work, articulate ROI and meet state and local regulations.
From Grassroots Projects to Enterprise Performance Management
Over 100 health systems recognize this connection. Rather than organizing sustainability as a facilities or community-relations initiative, they are embedding it into enterprise performance management alongside quality, patient safety, infection prevention, and operational excellence. The most successful organizations understand that sustainability initiatives succeed when they are clinically led, data driven, and operationally integrated. They establish governance structures that connect physicians, nursing leadership, supply chain, facilities, finance, environmental services, and infection prevention around a common objective: delivering better care with fewer resources.
Many hospitals begin with enthusiastic grassroots projects led by passionate clinicians or environmental champions. These initiatives often produce localized wins but rarely achieve system-wide impact because they lack executive sponsorship, a plan, measurement, and someone to do the work. We do not advocate adding FTEs, it’s yesterday’s luxury, instead we will help you assess your spend data, build a plan, educate staff, set targets and drive projects to completion.
Governance Comes First
Sustainability work involves many departments- finance, facilities, energy, waste, supply chain, nursing, medical staff, HR, OR, ICU and local regulations. Some hospitals are doing this with “spreadsheets and interns.” That’s cute, not strategic and now with AI, yesterday’s ineffective model. Here is the formula for success: get an up-and-coming CXO to sponsor, identify a critical thinker from the departments above, gather data and meet monthly for 30 minutes. In our work hospitals and ASCs the organizational accountability created with governance is the critical success factor. (Ugh, you may be saying, that sounds like an expensive consultant gig to nowhere. Nope, for $8k we will do a 1-day assessment, gather data, find low hanging fruit and give you a plan with ROI and metrics).
Hospitals should resist the temptation to launch dozens of unrelated sustainability projects simultaneously. Instead, prioritize departments with the clearest return: operating rooms, intensive care units, sterile processing, anesthesia services, and supply chain consistently represent the largest opportunities because they combine high supply utilization, significant energy consumption, and large volumes of regulated waste. Early successes in these departments build financial credibility and organizational momentum for broader implementation, as demonstrated by health systems including Providence Health, Southcoast Health, LMH Health, Vail Health, and AdventHealth.
Measurement Turns Intentions into a Management System
Measurement is what elevates a program from a collection of good intentions into a management system. Hospitals manage infection rates, patient experience, readmissions, and operating margin with executive dashboards. Sustainability requires a data-driven approach to engage clinical staff and leadership by connecting environmental stewardship directly to operational performance and cost reduction
To succeed, organizations need data aggregated from many different sources: water, electricity, natural gas, vehicle fleet fuels, top supplies by service, top vendors, surgical and ICU kit costs, retrofit projects, anesthesia, pharmacy and waste contracts to translate resource utilization into metrics clinicians and executives can improve. Some hospitals even look at property insurance rates and mitigation strategies- another over-looked cost savings opportunity! The clinical sustainability scorecard should emphasize business outcomes that resonate across the C-suite like: building energy efficiency index, waste stream costs per day, operating room supply cost per case, ICU supply cost per patient day, cumulative project savings, vehicle fleet costs, nurse and physician engagement. Environmental metrics such as water and greenhouse gas reductions complement these financial measures. Finally, many states and cities have their own regulatory requirements and penalties. One 400 bed hospital we work with faces $10M penalties if they fail to comply and guess what . . . no one owned that problem or the plan to solve it!
Clinicians Find the Value Facilities Departments Miss
One of the most important lessons from early adopters is that clinicians- not facilities departments- often identify the highest-value opportunities. A report several years ago suggested 20% of pollution comes from plant operations, while 80% comes from procurement, care process and endowment investments. Physicians, nurses, respiratory therapists, pharmacists, and sterile processing professionals understand where supplies are routinely discarded unused, where custom procedure packs contain unnecessary items, where disposable products could safely become reusable, and where workflows generate unnecessary waste. Sustainability therefore becomes another form of clinical process improvement, driven by the same frontline engagement that has transformed patient safety over the past two decades. Our work similarly suggests that successful sustainability initiatives are most effectively led by those providing direct patient care, with infection prevention and operational stakeholders engaged early to remove barriers rather than create them. From our work at a large West Coast AMC, the infection prevention department required a great deal of patience, persistence and data to change just one policy! Without governance or follow-up, the opportunity for sustainability, quality and cost savings dies. Another lesson was you don’t want to waste the time of high performing clinicians and leaders to fight the bureaucracy- you need outourced help with industry contacts to provide convincing data.
SION60 helps you aggregate data and get organized to act now at a low-cost
Instead of sending another email announcing a new cost-cutting project, launch a sustainability strategy that generates repeatable, frontline-driven savings. High-performing hospitals have a sustainability program led with executive governance, rigorous measurement, and clinically led continuous improvement. Approached this way, sustainability becomes a consistent approach for reducing cost, improving efficiency, strengthening resilience, and delivering greater value to patients and your community.
