SMART SUSTAINABILITY

From energy savings to patient-centered processes

For Neil Jay Sehgal, sustainability’s future as part of a healthcare institution’s culture is pretty straightforward. In the students he teaches at the University of Washington, he sees a clear-eyed commitment to how sustainability is influencing infrastructure planning, technology adoption and workforce strategy. Today’s students increasingly view sustainability not as an optional initiative, but as an indicator of whether an organization understands the resource-constrained reality of modern healthcare.

Sehgal, Associate Professor, and Health Systems and Population Health Director in the Master of Health Administration Programs, believes these expectations will continue to influence how health systems approach infrastructure investment, technology adoption, and leadership development.

“Organizations that integrate sustainability into operational decision-making signal to the workforce that they are serious about stewardship, adaptability and long-term planning,” says Sehgal, who also is the Austin Ross Endowed Chair in Health Administration. “These qualities resonate strongly with early-career professionals navigating an increasingly complex healthcare environment. From an academic standpoint, this represents an important alignment between workforce preparation and organizational strategy.”

In today’s healthcare landscape, the most meaningful shift is that sustainability is increasingly being treated as a response to structural constraints rather than a discretionary value statement. In teaching and research, this is framed as a resource-allocation problem. “Hospitals are operating in an environment defined by capital scarcity, workforce shortages, aging infrastructure and tightening margins,” Sehgal says. “As a result, procurement and facilities decisions are becoming more disciplined and data-driven, with greater emphasis on lifecycle cost, asset durability, and operational efficiency.”

“The most credible organizations are translating long-term goals into near-term operational milestones. This includes setting interim targets and embedding sustainability metrics into capital approval processes.”

— Suzanne Boren, Ph.D., Professor and Master of Health Administration (MHA) Program Director, University of Missouri

There is no questioning that hospitals are changing behavior by embedding sustainability criteria into capital planning, vendor selection and facilities management, often because inefficient systems now represent unacceptable financial and operational risk. This reflects a broader maturation of the field, where sustainability is evaluated using the same analytical frameworks applied to quality, safety and financial stewardship.

“In both academic research and executive education, we emphasize that sustainability decisions are fundamentally about managing scarcity and risk under uncertainty,” Sehgal says. “Health systems are facing constrained capital budgets, volatile energy costs, and increasing regulatory and reimbursement pressure. Against that backdrop, leaders are applying more rigorous capital allocation frameworks that weigh upfront investment against long-term operating savings, system resilience and reliability, especially in critical care environments where failure is not an option.”

More importantly, sustainability investments are not only becoming more justified on environmental grounds, but as mechanisms to stabilize operating costs, reduce exposure to future price shocks and improve infrastructure reliability. “When evaluated over appropriate time horizons, efficiency and resilience often align, an insight that is now shaping how systems prioritize limited capital,” Sehgal says.

At a broader level, patients are becoming more aware of the financial and environmental pressures facing today’s healthcare systems. Organizations that demonstrate responsible stewardship of resources reinforce trust and credibility, signaling a commitment not only to individual patient care, but to long-term community health and system sustainability.

From both research and teaching perspectives, sustainability and patient-centered care are closely interconnected. “Healthier facilities characterized by better air quality, thermal comfort, and reduced noise are associated with improved patient experience and staff performance,” Sehgal says. “More efficient and resilient infrastructure also supports safety by reducing system disruptions, which are particularly consequential in high-acuity settings.”

Operationalizing Sustainability

For Suzanne Boren, the shift is no longer theoretical—it’s operational. Boren, Ph.D., Professor and Master of Health Administration (MHA) Program Director at the University of Missouri, says sustainability has moved decisively from messaging to mechanics. What once lived in mission statements now appears in capital models, procurement criteria and facilities standards.

“Organizations that integrate sustainability into operational decision making signal to the workforce that they are serious about stewardship, adaptability and long-term planning.”

— Neil Jay Sehgal, Associate Professor, Health Systems and Population Health Director, Master of Health Administration Programs, University of Washington

“There is a clear shift from sustainability as a branding exercise to sustainability as a decision criterion,” Dr. Boren says. “In procurement, this shows up in lifecycle-based purchasing rather than lowest-price selection, with organizations evaluating energy use, maintenance requirements, upgrade paths and end-of-life disposal alongside cost.”

This evolution is visible in the built environment itself. Facilities teams are prioritizing electrification, high-efficiency HVAC systems, LED lighting with smart controls and building automation systems that actively manage energy use in real time. These elements are increasingly embedded in capital planning and vendor contracts rather than treated as optional green add-ons.

Progress remains uneven. Large integrated systems often have the scale and capital to move quickly, while smaller or resource-constrained organizations may share the same strategic intent but face practical limitations in implementation.

When evaluating trade-offs between upfront investment, long-term savings and reliability, health systems are becoming more sophisticated in how they model both risk and return. “Rather than focusing solely on payback periods, they are evaluating total cost of ownership and operational resilience,” Dr. Boren says. “In critical care environments, reliability remains non-negotiable, so sustainability investments are often paired with redundancy and performance guarantees.”

In this framing, sustainability functions as a risk-management strategy. Lower energy volatility, fewer supply disruptions and more predictable operating costs strengthen operational stability, particularly in environments where system failure carries clinical consequences. Long-term commitments such as net-zero by 2050 are also being translated into concrete operational steps. The differentiator, Dr. Boren says, is whether organizations embed sustainability into near-term decision frameworks.

“The most credible organizations are translating long-term goals into near-term operational milestones,” Dr. Boren says. “This includes setting interim targets and embedding sustainability metrics into capital approval processes.”

Health systems are investing in data infrastructure, including energy dashboards, emissions tracking and reporting systems that allow leaders to manage sustainability with the same rigor applied to quality and finance. When sustainability metrics appear in capital approval criteria, procurement standards and performance evaluations, they shift from aspirational to accountable.

Workforce expectations are accelerating that accountability. Students and early-career professionals increasingly interpret sustainability as a signal of organizational values such as innovation, stewardship and long-term thinking. “This is influencing infrastructure planning through healthier building designs, improved indoor air quality and more transparent sustainability reporting,” Dr. Boren says. “Systems are also adopting technologies that support energy visibility and smarter resource use. From a workforce perspective, sustainability is increasingly integrated into leadership development, onboarding and professional identity.”

From a patient-centered perspective, the impact is tangible. “Sustainability and patient-centered care are more connected than many people realize,” Dr. Boren says. “Greener facilities often mean better lighting, improved air quality, quieter environments and more comfortable spaces. Smarter energy use supports reliability and resilience, which patients may never see but absolutely depend on. Waste reduction and responsible sourcing also reinforce trust, as patients increasingly expect healthcare organizations to protect both individual health and community well-being.”

In practice, sustainability is no longer an overlay to healthcare delivery. It is becoming part of the operational backbone—shaping procurement, infrastructure reliability, workforce culture and, ultimately, the patient experience itself.