Corporate Sustainability and Responsibility in a Hospital with emphasis on a Medical Imaging Department.

The community used to have an important level of common trust in health care and its hospital organisations and physicians as such.

But nowadays, this trust has to be earned by hospital organisations, their employees and last but not least by their physicians. Hospitals have to work harder than other industries to win, re-win and retain that trust while coping with many operational challenges.

In health care, the growing and aging population and their need for professional care and well being drive the demand for corporate sustainability and responsibility. Awareness of health issues is imbedded in our modern society.

Due to the competition in the hospital sector, patients do have the opportunity and the right, as an intelligent customer, to choose the most valuable and best-quality -ranked hospital and medical department or physician for their personal care.

While searching for corporate sustainability and responsibility papers and literature dedicated, published and communicated by hospitals, only a handful of dedicated reports are revealed, and this mainly from hospitals overseas. Considering the level of trust that most people have in hospitals, it is unfortunate to see so few reports coming out from hospitals.

Giving this, its seems obvious, because there is almost no guidance on implementing sustainability and responsibility in hospitals organisations.

But times are changing. The last years, several accreditation and certification programs are available for hospital operations like the

International Organisation for Standardization (ISO) and more healthcare related like the Dutch Institute for Accreditation in Care (NIAZ), HKZ (Certificate for Quality in Care) and the Joint Commission International (JCI).

These programs aim for quality control and improvement in the organisation. It evaluates the best practices in quality and dedicated patient care, security and communication. The goal is to improve performance and outcomes and to achieve peak performance in patient care through education, publication, consultation, and evaluation services.

The Belgian government and the ministry of health already took the first steps to qualify medical departments and hospitals for their medical achievements and expertise. These certification reports are free available. Moreover, based upon these rankings, departments and hospitals will receive the 'exclusive' rights and financing for organising specific certified care programs.

In all these previous mentioned standards and requirements for hospital centres, sustainability and responsibility is of great importance.

The healthcare industry, on the other hand, picked up the need for sustainability and responsibility much earlier and implemented it already in their organisation and communication.

Transparency in hospital performance will for sure result in better sector understanding of public and patients and improve the hospital image.

Why Corporate Sustainability and Responsibility (C.S.R.) in a Hospital?

There is a great range of key benefits of implementing C.S.R. (corporate sustainability and responsibility) in a hospital environment.

Patient trust and loyalty for a specific hospital and aligned physicians and their recommendation is valuable in the growth and performance of a hospital.

Recruitment policies for attracting high quality and loyal

employees and dedicated highly trained physicians with morale and ethics embedded in a hospital organisation will benefit the realisation of the mission statement and optimal care.

Welfare of employees and empowering people through education and information creates a dedicated human capital to ensure the main central task of caring of our patients.

Application of sustainable procurement is mandatory because procurement is responsible for a large proportion of the budget in healthcare.

There is an economic, social and environmental acceptance of stakeholders (managers, board of directors, physicians and employees) for functioning in a 'profitable' and sustainable manner.

Reputational risk by losing patients has an important impact on the hospital and secondary on the health care industry.

Improving efficiency in the use of energy, natural resources, medical devices, investments, and other users' material will result in substantial cost savings.

Sound waste management will reduce the amount of waste and even more important is its safe disposal.

Using less costly and socially responsible and ethically sound healthcare solutions, a hospital will take advantage and will set the norm for other hospitals being more sustainable and competitive.

Not only financial health, but also even environmental issues will definitively attract investors by credibility and trust to fund hospital expansion.

Government will embrace hospitals implementing sustainability and responsibility programs to engage best practices in their national health care system.

Philanthropic commitment and community benefit enhance the social and caring image of the hospital and the use of its earnings in non- profitable projects.

Public reporting and transparency of hospitals corporate mission statement and strategy ensures a positive, open and community incorporated climate.

Implementing Corporate Sustainability and Responsibility in our Hospital based Medical Imaging Department.

The benefits of C.S.R. in a medical imaging department are mostly related to the advanced technology and innovation. Applying new technologies means accordingly training and educating our staff (employees and physicians). This is to ensure to use the best available imaging modalities for adequate diagnosis and care.

Since the scientific concern and the community awareness of the potential risks of radiation a well-documented protocol is written as a firm guideline for appropriate use of radiation in health care. Applying the 'ALARA' principle (as low as reasonable achievable) is the key in applying radiation in our department and others. Quality of care and patient safety are the most important values.

Another field in risk management is the standardized use of relevant contrast agents, drugs and medication. Interview with the patient with relevant questions, choosing the right contrast media and/or drugs and guidelines for an interventional approach will reduce the risk of allergic and life threatening complications.

Reducing or banning common hospital related infections, by acting accordingly to the guidelines (like hand hygiene and sterile platforms), is part of the spectrum of patient's safety.

Given the different imaging modalities available (x-ray, ultrasound, computed tomography, nuclear magnetic resonance), we carefully have to choose the best available modality for each diagnostic problem giving the patient and the financial impact.

Reducing the financial cost and stopping the financial waste our health care system is for many years a hot topic in political, managerial and community discussions. As a hospital, as a medical department and as a physician, we have the ethical obligation to ensure the controlled

and well-balanced use of the available financial means in an environment of shrinking budgets.

Guidelines from the Belgian Society of Radiology give an excellent example to reach for a sustainable future for payable quality radiology.

Based upon these well-documented guidelines, the use of dedicated imaging technologies is mandated with alignment of the ALARA principle, the scientific based health care rules and the available financial budgets. Diagnostic related groups (DRG) management guide the decision makers (hospitals, physicians) is using financially approved means for providing the best of quality care.

Several hospitals and medical departments are now on the highway to implement lean methods to improve operational efficiency. In our department we recently started a process analysis at the MRI (magnetic resonance imaging) facilities. Attention to patient service improvement, reducing waiting lists, providing smooth patient flow (in- and out hospital), achieving uninterrupted diagnostic equipment occupation are the main goals to operate efficiently.

In our supply chain we track down our available and used materials, reusable items, disposables and we have a clear overview of our inventory. Given the lifetime of sterile material and drugs it is obviously an important safety issue. Interaction and collaboration with our suppliers in this setting is needed for instant delivery and inventory control.

An environment-friendly medical imaging department is one of our targets. We are reducing our waste production using more reusable items, using only disposables when necessary and preferring recyclable materials. Recently we changed the textiles clothes by paper-based shirts for our patients during their exam. Given the high cleaning costs and the environment unfriendly chemical cleaning of the textiles, we changed.

Handling waste safety are some of our priorities to create a safe working environment for all our employees and our patients. Special boxes for medical and contaminated waste and needle deposits are available.

Medical suppliers with an environmental label get a positive rate in our investment choice. As an example, the diagnostic reading screens

we use can be refurbished and recycled. Moreover, toxic products are banned out of the production and energy savings are implemented.

We see, more and more, that the health care industry takes the C.S.R serious. Supplier awareness and engagement in safety and environmental issues are becoming more crucial in the relationship between health care customer-user-supplier.

We introduce a paperless and filmless environment in our department. Using speech technology and an electronic medical patient file (electronic health care records), we now provide protocols and images on web-based soft copy. The PACS (picture achieve and communication system) provides us with a system to distribute medical images and protocols web fast and efficient to our referrals. Our environmental footprint of using paper (wood) and films (silver) is near zero.

Energy savings and implementing green energy in a modern age are obligatory. High performing low energy reading screens and automated shut down computer systems and imaging modalities are standard in our department. Computer controlled air and temperature conditions and smart lighting complete the spectrum of energy awareness in the organisation. Our hospital uses green energy like solar panels, biomass energy systems and heat exchanger well fields.

As an open hospital and a medical imaging department in a high demanding society, we provide full access to our health care system for each and everyone. We provide service for the whole community, by offering state-of-the-art health care and organising free available screenings in breast cancer, prostate cancer, cervical cancer and since last year colon cancer.

We offer training and education with the highest standards for our medical employees (technicians, nurses). As a university aligned certified training centre for physicians and radiologist-in-training and fellows we provide full time internships. To ensure high quality and up- to-date training we intensely collaborate with national and international universities. This is to ensure high quality medicine and professionally trained physicians for the future.

For our department employees, medical trainees and fellows- physicians we provide a fair financial pay with financial securities. Correct remuneration and work load with recuperation after being on

standing duty is mandatory. Concerning the non-financial advantages, we take care of the growth in the department with recognition, informal moments, team and personal coaching and by giving challenges to our co-workers.

To improve access to health care in our medical imaging department we create and implement an intelligent appointment- scheduling tool to reduce waiting times. Offering modern and cosy waiting room facilities, imaging modalities with ergonomic standards, with central patient care, we try to create overall patient satisfaction.

We engage our stakeholder's management by building a good and solid relationship. We frequently plan communication, consultation and dialogue with our different stakeholders: interaction during our weekly board of staff meetings with our colleagues-physicians and fellows, conference meetings with the board of directors and the medical board, monthly feedback to and from our health care co-workers, gatherings with patient organisations and influencers, video-conferences with a network of universities and chairing and organizing international conventions.

Philanthropic initiatives are based in profound financially and structurally helping a Central Africa based regional hospital.

Mainstreaming corporate sustainability and responsibility in our medical imaging department is not fully implemented yet. In the future we have to address more attention to reporting ad communicating our quality of care, our performance, our environmental achievements and our social management.

Conclusion

In the progress of corporate sustainability and responsibility, in first our hospital and medical imaging department environment stands for good citizenship. In second, our value chain and innovation is already well implemented. The use of different management programs and processes will lead us to a higher stage in providing quality care. We have to create a patient- and client- centred approach in a sustainable and responsible manner.

Dedicated health care access management, safety management, drugs management, waste management, energy management, supply chain management, financial and operational management,

stakeholders management and others will lead us to competency. Public sharing of our improvements and transparent communicating our sustainability and responsibility reports will improve the overall understanding of the sector and the complete trust.

In the sustainability reality score we can still evolve and make progression, on the other hand, we believe we score high in the perception of sustainability. Our hospital and department tries to evolve consequently as a promoter in the sector.

The main target in the future is the alignment of all the medical departments in hospitals throughout to whole health care system and related industry to implement sustainability and responsibility with feasible commitments for high quality, safe and accessible health care.

Bibliography

Corporate sustainability and responsibility. Baeten X. EMBA Course. Vlerick Business School. 2014-2015.

Quality Initiatives. Lean Approach to improving performance and efficiency in a radiology department. Kruskal JB. Radiographcs. 2012; 32

Radiology Improved processes. SBTI. Columbus Regional Hospital. Managing Waiting Times in DMI. Nuti S. BMJ Open. 2012; 2

Leadership and management in quality radiology. Lau LS. Biomed Imaging Interv J. 2007; 3

Streamlining the workflow for high volume MRI department. Document of Philips Healthcare.

An Operations Management Approach for Radiology Services. Falsini D. Proceedings of the Conference on "Sustainable Development: Industrial Practice, Education & Research. Bari (Italy), September 2010

Corporate social responsibility in hospitals focusing on sustainable procurement. ZonMw. June 2011

Time management. A realistic approach. Jackson VP. JACR. Vol 6, Issue 6, 434-436

Social Responsibility: A New Paradigm of Hospital Governance? Brando C. Health Care Anal. 2013; 21(4): 390-402

Road map for implementing value driven health care. Centres for Medicare and Medicaid services. Dept. of Health and Human Services, USA

Magazine for health care leaders. Vol. 30, Number 1. American College of Health Care Executives

Joint Commission International (JCI), Standards for Hospitals. 5th Edition. Joint Commission Resources, Inc.