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Innovation: Driving the Green Culture in Healthcare

Porter-O'Grady, Tim DM, EdD, APRN, FAAN; Malloch, Kathy PhD, MBA, RN, FAAN

doi: 10.1097/NAQ.0b013e3181fb48d3

Going green is more than a fad, and it is a mindset and a set of behaviors, knowledge, and dedication to sustainability of our environment and resources. The role of the leader now requires more than traditional strategies to strategically and swiftly move to a green reality. In this article, the involvement of individuals, the work of innovation, an infrastructure for significant cultural change, and new decision-making models are presented as necessary components for transforming organizational cultures.

Tim Porter-O'Grady Associates, Inc, Atlanta, Georgia (Dr Porter-O'Grady); and Arizona State University CONHI (Drs Porter-O'Grady and Malloch) and API Healthcare, Inc (Dr Malloch), Phoenix Arizona.

Correspondence: Tim Porter-O'Grady, DM, EdD, APRN, FAAN, Tim Porter-O'Grady Associates, Inc, 195 Fourteenth St NE, Ste PH501, Atlanta, GA 30309 (

AS there is greater scientific recognition of the need to bring Earth-sustaining environmental balance, every social institution is challenged to address its part in this mission. Creating a so-called “green” culture requires more than just good intentions and well-meaning conversations. What now becomes essential to institutions and people is an effort that begins to transform personal and social experience in a way that more strongly reflects bringing balance between utility and ecology at every level of the human experience.1

The problem with creating a new awareness is that quite frequently efforts at awareness are nonsustainable.2 If a culture change is to become sustainable, it requires both new infrastructure and new ways of doing business. Because going green is clearly a creative and transformative process for people and institutions, the dynamics and processes associated with innovation as a lived experience become an essential leadership capacity.3 Just as “being green” must now become a way of life, innovation must become a way of doing business and the means to advance this transformation.

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The struggle with most institutions and people in the workplace relates predominantly to creating a culture in which the energy and effort along any particular trajectory and translation of existing work into green work are both maintained and sustained. The challenge for leaders is to recognize that a number of critical elements must be embedded in the leadership's way of doing business if both the historical contextual and content conditions of work are to be challenged and changed. Several considerations must be confronted directly:

  • A clear and shared understanding of the meaning of green as each individual or team often has differing perspectives and descriptions;
  • members of the work community must clearly recognize particular ownership for decisions and actions reflecting their own belief and attitudes toward green values and practices;
  • leaders must see the work of innovation and the models and processes used to undertake it as a vehicle necessary to transform the people and the organization to living and practicing within the context of a green culture;
  • an infrastructure of innovation requires that both board and senior executives see innovation, not as an incremental process but, instead, as an organizational culture and a way of doing business at every place in the system;
  • sustainable changes in culture and practice must be driven from the point of service and demonstrate how green has been incorporated into every choice, decision, and action undertaken within the clinical process in a way that represents the clinical professionals'understanding of the inherent relationship between being green and being healthy; and
  • the traditional “waste-based” decision models and structures that are insidiously ingrained in the American “throwaway” business construct now require new modes of thinking, strategizing, financing, and providing clinical service.

Leaders must see innovation as the vehicle for challenging contemporary practices in creating a new framework for green living in their healthcare organizations.4 As green practices become more common and the American culture shifts to live within the context of environmentally sensitive decisions and actions, almost every component of business and clinical practice will need to be challenged. Similar to quality and safety initiatives, the behaviors and norms associated with green living must necessarily become part of the fabric of each individual. In a sense, there is a genetic altering of our behaviors to now be conscious of and accountable to the environment and our resources.

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A strategic imperative

Both board and senior executives must reflect that the innovations necessary to create a culture of green are driven by a strategic imperative originating with the commitment at the governance and administrative level.5 Mission, purpose, and objectives need to reflect the organization's commitment to seeing itself as a socially responsible, environmentally conscious institution that reflects and articulates the greater human values of ecology and green centeredness. Every element of business and clinical practice must be subject to a strategic imperative of green living, from structural and architectural decision making and processes associated with institutional support systems, technology, clinical support, and clinical practices. Operational systems must now include green elements of decision making as a part of the criteria for choice at every level of the system.

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Assessment and green gap analysis

Once decisions are made with regard to green strategic obligations, senior leadership must become quickly aware of the distance between current circumstances and the desired conditions of living green. Here again, the analysis of the current situation within the context of desired goals at every level of the system provides the leadership with a real-time evaluation of the distance and degree of response necessary to the creation of the desired level of green living. Included in the analysis, of course, are the capital and financial considerations related to priority setting, as those priorities address the gaps between desired environmental goals and current patterns of behavior at the systems and clinical levels.

Analysis activity should include every stakeholder in the organization. Personal ownership must be demonstrated as a part of the process of engagement if either structure or behaviors are to be sustainably altered.6 Individuals must know that they are stakeholders in the institutional environmental journey and are contributing positively toward ecological balance or actively contributing to imbalance. A sense of “time is of the essence” and of the priority attached to this work as it is experienced at every level of the system should be verified by the leadership's own energy and commitment to undertaking this effort as a transformative priority.

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From gap to action

Once healthcare leadership is clear about current realities in the distance that must be traveled to achieve the desired level of green living, priority moves from assessment and goal-setting to the innovation-action phase. Here the innovation dynamic becomes ascendant. First comes the learning phase followed closely by the creative stage leading, ultimately, to action and transformation.7 Because healthcare facilities are complex adaptive systems, a part of the learning process requires that individuals at all levels perceive the intersection between environment and institution. Participants must also reflect the relationship and impact between decisions and actions made in one part of the system and those undertaken in another, as well as relationships and interactions between departments and people affecting subsequent choices and actions within services and units.8 Team members must acknowledge and address unknown yet inherent connections between components of the business, service, and clinical systems resulting in a set of choices, actions, impact that directly affect environmental (green) conditions and circumstances.

The smallest units of service and staff groups need to be commissioned and empowered to begin responding to small, sometimes individuated, choices and actions occurring at the point of practice and decision making that reflect nongreen behavior. Systems innovation requires that small incremental changes at the point of service drive response as a part of incorporating and embedding sustainable systems change in the decisions and actions of everyday work.9 Every individual should feel chartered and empowered to make decisions and take actions that represent green behaviors in their own practices. In the larger-agenda items involving multiple teams, units, departments, service lines, and interdisciplinary innovation, teams made up predominantly of stakeholders must be empowered with the capacity to decide and act in ways that represent green strategic priorities and act consistently within the financial frame resourcing green decision making.

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Once the goals for governance, strategic, operational, business, and clinical components of going green are clearly enumerated and established and the culture of engagement is created, the real work of environmental innovation begins. Because innovation is predominantly a dynamic, the tools and techniques of accessing the most creative and inventive potentials in the minds of people accelerate in importance. As indicated, small, localized, diverse teams of individuals using inventive techniques and processes can produce hugely effective outcomes even in unusually constraining circumstances.10

To be effective, these innovation teams must be well constructed, particularly diverse (related specifically to the issue at hand), and well facilitated. As a part of innovation becoming a way of life in the organization, development of the tools, techniques, and skill sets necessary to facilitate and discipline idea formation, generation, translation, application, and evaluation are critical to obtaining effective and viable outcomes.11 It is here, in the facilitation of local collectives of innovation, where the biggest transformative “buy for the buck” can be best obtained.

From the administrative perspective, leaders must approach green innovation with a firm commitment to investing in and responding to local innovation teams and their recommendations related to effective environmental transformation. While all deliberation and decision making must remain firmly within the boundaries of the strategic and financial constructs for them, the possibility of unplanned, nonconceived, transformative recommendations must be operationally acceptable. Further these recommendations must be actively implemented to maintain and advance the interest and investment of stakeholders. Leaders must recognize that all innovation is disruptive. It requires that they be constantly reminded in their own discourse and counsel together the likelihood of and need for leadership support. Their leadership must affirm the “noisier” more creative and transformative decisions that alter the very nature of the organization as it seeks to become truly green.12 Of greatest importance with the creation of the innovation infrastructure for going green is the role modeling behaviors of the administrative teams, specifically toward practices of trash management, paper conservation, and use of technology to minimize travel and labor efficiency.

The innovation of going green will require from leaders firm commitment to green outcomes. There must be willingness within the capacity of leadership to embrace the emergent truth of the conflict between current practice and unfolding appropriate change.13 Changing culture is sometimes brutal work in its requisite for frankness, honesty, openness, and availability to changing long-cherished structures, decisions, and practices. Building a green culture means creating a culture of innovation. The culture of innovation demands transparency, availability, mutuality, and acceptance of decisions and appropriate actions, regardless of where they emerge outside of the formal traditional authority hierarchy.14 Innovation further demands encouragement and support of the work of staff and leaders at various points of service in the organization as they grapple with the creative processes and act as agents of change in an environment that may be reticent to actually shift its rituals and routines toward more environmentally responsible practices.

In an evidence-driven world, data rule supreme. It is important for the leader of green innovation to recognize that this factor influences decisions that are made regarding particular practice or structural changes necessary to support a green way of life. Green practices need not be more expensive. Sometimes they are simple transitions in behaviors and use of equipment or supplies. Data related to such simple changes must have as much impact as broad sweeping cultural, social, and structural transformations necessary to create the vehicle or context for a green way of life. As much as possible, choices regarding green practices should reflect the evidence of impact and outcome. Practices themselves need necessarily to be subject to the discipline of data and the truth it reveals about that which is relevant to a green way of life and that which is not. With as much hype related to green thinking and being as exists in society, it becomes more imperative for leadership to be good stewards of both the data and resources ensuring that there is sufficient goodness of fit between them to take an appropriately legitimate action.

Innovations in green applications need not represent an unbridled or undisciplined enthusiasm in a way that outstrips reality. Becoming green is a journey. Thinking way outside of the box may be a wonderful exercise for vision creating; it is less valid in the translation of that vision to the limited resources available for implementing it. This means that green processes often must be disciplined, even constrained, reflecting staging and careful crafting in a way that best represents and uses available resources. Obviously, getting the best bang for the buck becomes a tactical template for making choices and taking action in the effort to progressively become more green. Organizations are cautioned to initiate those processes most affordable and easiest to implement in the early stages and to plan more strategically those green dynamics requiring greater resource commitment over the longer term. There is simply no value to any organization destroying its short-term economic viability over the long-term objective of environmental compatibility. In the end, such precipitous decision making fails to serve well either the life of the organization or environmental balance.

As the work of healthcare transformation continually challenges leaders to rethink current practices, move firmly entrenched cultures to new realities, and sustain some degree of personal balance, it is always energizing to remember that innovation never occurs in isolation. Teams of committed individuals can make greater strides together, using the tools and emerging science of the leadership of innovation to truly make a better future.

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green environment; innovation; leadership

© 2010 Lippincott Williams & Wilkins, Inc.