The sustainable hospital
Report: Michael Krassnitzer
‘Sustainability’ is more than a buzz word. The original meaning – to limit the use of natural resources so they will be available for future generations – has been expanded to encompass an economic as well as a social dimension. Companies – including hospitals – are increasingly integrating the concept of sustainability in their corporate strategies.
‘It is our vision that hospitals ensure their own sustainability and at the same time contribute effectively to a sustainable social development,’ says psychiatrist Dr Karl Purzner, head of Organisational Development at Otto-Wagner-Spital in Vienna, who is also a hospital manager. At the hospital an interdisciplinary team of scientists and clinical staff have launched a pilot project called Sustainable Hospital. ‘We aim to establish sustainability as an important corporate principle,’ explained Dr Purzner, during a symposium in Vienna.
In the course of the project a so-called Sustainability Balanced Scorecard (SBSC) was developed based on the traditional Balanced Scorecard, an instrument designed to focus corporate management on specific agreed objectives. The idea is to improve the quality of the outcome with key criteria -- clinical care, health promotion, profitability, social indicators (stress levels of staff/patients) and ecology (consumption of materials and energy). ‘SBSC’, Purzner is convinced, ‘supports the development efforts in an organisation by focusing on the essentials. In addition it facilitates communication among professions and hierarchy levels.’
‘Key strategy when establishing a sustainable hospital is sustainable demand planning’, says Uli Weisz of the Institut für Soziale Ökologie, University Klagenfurt, who was a partner in the project. Incorrect assignment of hospital beds, he explains, are not necessarily a micro-economic problem in the hospital, but they do cause costs on the social – the macro-economic – level, because they do not deliver positive outcomes but contribute to staff stress and generate unnecessary consumption of resources and emissions.
At Otto-Wagner-Spital, the improvement and resource-saving potential of sustainable demand-based planning was tested in a weaning centre – a pneumonology centre where patients are ventilated according to individual needs in certain ‘step-down’ units. A survey at Otto-Wagner-Spital indicated that the length of stay of ventilated patients in the ICU could have been reduced by 13.5% if the patients had been moved to a Respiratory Care Unit (RCU). Even more: the length of stay in the RCU could have been reduced by 56% because many patients did not need intensive care at all. ‘At the pilot hospital, a three-step weaning centre could save 8% of the costs, which translates into €4.1 million and material savings of 352 tons’, Uli Weisz underlined.
‘We cannot afford to not invest in sustainable development,’ concluded Josef Aumayr, technical director at Otto-Wagner-Spital.
However, beware of the inflationary use of the term sustainability. ‘Unbalanced optimisation of the healthcare system, be it in favour of technical or medical feasibility, be it in favour of costs, undoubtedly will create boomerang effects,’ warned Willi Haas of the Institut für Soziale Ökologie, University Klagenfurt. A strong focus on technical and medical solutions opens up capacities that need to be used. Increased efficiency might initially reduce costs but it also leads to increased application and cost increases that can no longer be financed and will require healthcare services to be reduced based on entirely unforeseeable priorities. If that happens, Willi Haas fears ‘sustainable development will be considered a curse rather than an opportunity’.
07.07.2010
