Proven practices for sustainability governance in health care: Structure & staffing

By Sarah Irwin, Practice Greenhealth sustainability strategy manager

To unlock sustainability’s full impact, leaders must design their organizational structure, processes, and governance in a way that is integrated into and compatible with the rest of the organization. 

Health care organizations are increasingly setting sustainability and climate action as a strategic organizational priority and paying attention to the environmental, social, and governance (ESG) disclosures process. With this growth, there is a need to consider how organizations are embedding sustainability – both from a structural perspective and a staffing one – to ensure longevity.  

The Inflation Reduction Act (IRA), signed into law last year, is the strongest U.S. climate action ever. Its incentives can be used directly by health systems to reduce their greenhouse gas emissions through investments in renewable electricity, electrifying vehicle fleets, installing electric vehicle charging stations, increasing building energy efficiency, and additional clean energy project financing opportunities. 

Funding opportunities such as the IRA, coupled with federal sustainability and climate targets, are increasing pressure for health care organizations to take a closer look at their sustainability efforts. 

The impact the health care sector can have on the environment and related social determinants of health depends on the strength and foundation of its sustainability governance structure.

Proven practices from our network

Practice Greenhealth is actively gathering new models and proven practices in sustainability governance from our network beyond current models captured in the sustainability program fundamentals. 

This summary provides a snapshot of practices we are uncovering and witnessing across our network on how health care organizations are approaching sustainability governance and structuring themselves to prepare for the future.

An increasing number of hospitals and health systems are prioritizing sustainability and leveraging quality, process improvement, or project management departments to bring additional capacity to manage the change. Additionally, organizations are hiring more dedicated staff focused on sustainability, assigning clearer responsibility and accountability to stakeholders, and establishing strong sustainability reporting processes. 

Most leading Practice Greenhealth partners report to their board of directors/trustees, and several are beginning to work through their boards to include sustainability in their organizational plans. We recommend that at least one board member has competence in climate-related issues, that the board form a committee to address climate/sustainability/ESG, and that this work is included in the organization’s strategic planning process.

Consider these proven practices we have gathered from across our network:

Structure

• Stanford Health Care has a Sustainability Program Office and an associated organizational chart that includes both full-time Stanford employees and part-time contractors.
• Providence’s sustainability team structure, focused on environmental stewardship, has a strong emphasis on sponsors, “caregivers,” and “partners” to advance sustainability. 
• Ascension’s commitment to reducing its environmental footprint and achieving sustainability is rooted in its mission, which calls for the system to be an advocate for a compassionate and just society in its actions and words. This is implemented through its various governance working groups. 
• First formed in 2003 by the University of California Office of the President’s (UCOP) senior vice president for business and finance, the Sustainability Steering Committee (SSC) engages decision-makers from all ten campuses in developing and implementing a successful, system-wide sustainability policy. The SSC forms one part of UCOP’s overall sustainability organizational structure. UC Health is represented as its own working group under the SSC and also participates in other subject-specific working groups. This allows UC Health to focus on its own sustainability challenges but also coordinate with campus sustainability efforts.
• OhioHealth has a set of board goals that focus on sustainability. These goals and the associated programs are implemented by and through a sustainability governance framework involving various teams across the system and associated hospitals.
• Allina Health highlights their environmental sustainability program’s sustainability structure in their climate action plan, which is available for download on their new sustainability website.
• Bon Secours Mercy Health ESG initiatives are overseen by the board’s Executive and Governance Committee along with the executive leadership team. Day-to-day responsibility is managed by a cross-functional ESG Steering Council supported by various internal teams such as the Sustainability Council, Socially Responsible Investing Workgroup, and Clinical Leadership Council. (Source: BSMH ESG 2022 Progress Report Page 6).
• Cleveland Clinic’s senior director of sustainability has been responsible for managing the health system’s annual sustainability and global citizen report and oversight of the Office for a Health Environment and Sustainability Committee formed in 2007 to measure and manage environmental impacts, develop and advance its sustainability strategy, and collaborate with and empower fellow caregivers to take action at work, at home, and in their communities to make a positive impact on human and environmental health. Cleveland Clinic also has 28 enterprise green teams and three committees that champion sustainability efforts at their facilities or in their functional areas. 

89% of partners reported through the 2023 Environmental Excellence Awards application that they are part of a health system that has hired or appointed a sustainability leader to provide support to its affiliates.

Staffing

• Mason Health- Mason General Hospital, a 25-bed critical access hospital, takes a team approach to their sustainability work. The “Green Team” is led by the chief development and communications officer, who reports to Mason Health's CEO and Superintendent, and Board of Hospital Commissioners on sustainability at quarterly meetings.
• Children's Minnesota has a full-time environmental sustainability program manager, who co-chairs the hospital's Sustainability Steering Committee. This committee, and the green team more broadly is supported by their vice president, operations, and chief executive officer. 
• CommonSpirit Health has a system vice president of environmental sustainability and a group of EcoChampions who are focused on aligning work with system-level goals. These groups are working on deeper engagement at all facilities within the CHI Franciscan Health/Dignity Health/Virginia Mason Franciscan Health merger. 
• Stony Brook University Hospital has formally embedded sustainability-related job responsibilities for a specified role. For example, the chief nursing officer or chief regulatory officer includes sustainability responsibilities and expectations. 
• The University of Michigan - Michigan Medicine has a senior vice president and chief ESG officer, who reports directly to the University of Michigan Health president. More details can be found in the job description.

Medical directors of sustainability

Practice Greenhealth is aware of more than 15 physicians who serve as the medical director of sustainability (MDS) or equivalent title in their hospital and health system, and one nurse who serves as a clinical director of sustainability (CDS). The individuals in these positions lead efforts to engage and educate clinicians and reduce the climate and environmental impact of clinical care. 

Individuals currently in MDS and CDS roles have 0.075-0.6 FTEs, with one having 0.8 FTE of administrative time, which includes sustainability efforts. Almost all MDS roles report to a vice president or chief officer, and physician specialties have included anesthesiology, internal medicine, emergency medicine, pathology, infectious diseases, physical medicine/rehabilitation, and gastroenterology. View our sample MDS job description for more information.

Sarah Irwin is a sustainability strategy manager with over a decade of strategic program and project management experience across many sectors including health care. As a change management practitioner and trained coach, she previously worked closely with health care leadership to build sustainability governance structures across Vancouver Coastal Health.