Rethinking the Triple Aim

CHW Logo“Better care for patients, better health for the population, lower cost”: this is the Triple Aim of health care.  Last week at the Institute for Healthcare Improvement Annual National Forum, there was a riveting panel discussion on “Environmental Sustainability and the Triple Aim.”  Don Berwick opened with a reflection on the huge environmental impact of healthcare, especially hospitals.  A few examples:

  • Hospitals have 2.5 times the energy intensity and carbon dioxide emissions of other commercial buildings; they account for 8% of the nation’s energy use.
  • Hospitals generate a daily average of 26 pounds of waste per staffed bed – 5.2 billion (yes, billion) tons of waste annually.

You get the idea.  Berwick posed the question, how can we create better health when we are creating an unhealthy environment?  How can we drive cost down with so much waste?  He suggested that paying attention to environmental sustainability was essential to driving the Triple Aim.

Four panelists highlighted some of the successes in promoting environmentally sustainable healthcare.  Jeff Thompson, CEO of Gundersen Lutheran Health System in LaCrosse, talked about their successes in their goal of becoming the first carbon neutral hospital in the US.  Although some of that has been through innovations in using alternative energy sources such as geothermal and methane from biodigesters, Thompson noted “conservation should always be your first fuel.”  He cited a $2 million dollar investment in energy conservation and waste reduction that has yielded $1.3 million in savings every year.  That’s a pretty spectacular ROI.  Another speaker discussed the Healthier Hospitals Initiative, which currently includes over 700 facilities and aims to increase that to 2000 in the next few years.  The model is that of the improvement collaborative, with hospitals helping each other figure out how to improve their sustainability in several areas, including energy, food, chemicals, and waste.

The final speaker was an architect who discussed the progress of thinking from “green buildings,” which have a less harmful impact on the environment, to “living buildings,” which have zero impact, to “restorative buildings,” which actually provide a net benefit to the environment.  That sort of thinking is somewhat visionary and aspirational; getting there can seem daunting.  But if a journey of a thousand miles begins with a single step, think about what we could do easily that would get us started.  I came in to the office last weekend, and was startled at how many computers were running, monitors ablaze.  Why? Think of how many disposable cups we use, how many documents we print (with multiple copies for people who already have one, or aren’t even coming to the meeting), how many supplies we simply throw away unused.

The panelists were asked how, at a time when we all feel overwhelmed by what we are expected to do with shrinking resources, can a hospital possibly hope to add yet one more thing to the list of “blue chips.”  This is a fair question.  The canned, and somewhat disingenuous, responses were that this is different – it’s really, really important – and that it’s “easy” to piggyback this with other priorities.  But let’s face it, there does come a point where you truly can’t fit even one more sock into the suitcase – it just won’t close (or the zipper breaks).  The fascinating response came from a panelist who talked about their recycling initiative.  They were looking for a group to lead it, and over 50% of the employees volunteered, including many who had never stepped forward into a leadership opportunity before.  His conclusion is that there is a hunger for this sort of effort within our organizations, it’s something people recognize as a shortcoming in how health care operates, and that those people will come out of the woodwork to participate.  By inspiring action, it actually increases the pool of resources available.  Imagine not trying to cram that last sock in, but getting an additional suitcase.

This is a season that, at least in the US, is a virtual celebration of excess and waste.  Then January comes and we all resolve to do better.  When you are making your resolutions, maybe you can include some that will move us closer to environmental sustainability and the Triple Aim.  The kids in Wisconsin can’t be the healthiest in the country if at the same time we are making Wisconsin itself less healthy.

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