Blue versus Green Hospital: Economical in all departments

Interview with M.Eng. Johannes Dehm, VDE, the German Association for Electrical, Electronic & Information Technologies


Hospitals seldom operate economically and sustainably - old building structures and the intricate logistics operations involving expensive patient care are costly. To get out of the red, hospitals need to become more efficient in all areas. One way to achieve this goal leads through the Blue Hospital Concept.
Image: Man with white hair, black glasses, tie and suite; Copyright: private

Johannes Dehm; ©private

Three years after its introduction, spoke with Johannes Dehm about different sustainability concepts for hospitals, their benefits and how they can be implemented.

Mr. Dehm, the Green Hospital, Green+ Hospital and Blue Hospital concepts that focus on sustainability in hospitals have firmly established themselves. What is their purpose and how do they differ?

Johannes Dehm: Green Hospital stands for environmental protection. The primary goal here is to save energy. Hospitals with this logo implement sustainability measures through green building technology such as a combined heat and power unit or energy-saving LED lighting for instance. They translate certain defined standards into ecological vision. Green+ adds to these requirements with business processes, modern information and communications technologies and medical technology that are all meant to produce further savings in energy and material consumption.

The quest for more economic operations encompasses all areas of a Blue Hospital. This gives hospitals a chance to achieve a significant increase in efficiency and quality and strengthen their competitive advantage. Aside from traditional energy saving concepts and modern technologies, there is also an emphasis on the responsible handling of available resources, on improving operating procedures and capacity utilization all the way to medical device interoperability. Yet this also requires workplace management and placing the right employees at the right place at the right time.

Image: Blue Stethoscope next to a blue glass globe on a blue keyboard; Copyright:

In the blue hospital concept, the hospital and its processes are evaluated holistically to design its operations in a more sustainable way; © Neirfys

How does it benefit a hospital to complete the Blue Hospital certification?

Dehm: The three pillars of the concept that puts patients at the center is the improvement of ecology, economy, and efficiency. In doing so, hospitals achieve significantly higher levels of quality performance, patient comfort and cost effectiveness.

One major advantage comes from monitoring all of the relevant hospital processes. A current state assessment is conducted at a specific time. The checklist that represents the basis for the certification shows improvement measures that can be completed. Based on subsequent regular audits, further advancements in the various processes at the hospital can be monitored and actively created.

The VDE introduced the Blue Hospital concept in 2013. What have you learned from practical experience since them?

Dehm: Since 2013, experts from all affected sectors in Germany, Europe and countries throughout the world have joined together to continue putting the "Blue Hospital" position paper, which illustrates the sustainable process, into practice. Having said that, over the past few years, we have come to realize that key data on the individual sectors of the hospital are missing. We are now addressing these issues so that the concept can be based on a standardized approach. This way, hospital operations can also be studied in terms of logistics services and organizational processes ranging all the way to employee qualifications. This process will presumably take another three years until the distinctions of the individual countries turn into a uniform approach worldwide.

Image: Man with short dark hair and jacket; Copyright: Siemens Healthcare

Jens Schneider; ©Siemens Healthcare

Mr. Schneider, what technical or organizational solutions assist in becoming a sustainable hospital?

Jens Schneider: For starters, a hospital and its management need to have a vision that states that this is their actual goal. This vision needs to result in sustainable objectives that are discussed with the stakeholders, in particular, the guarantors or financiers.

A sustainable strategy can prove successful for hospital CEOs for several reasons. On the one hand, costs - of energy for example - can be saved, while garnering investment appropriations, which are especially scant in Germany since several federal states promote sustainable investments. What's more, a hospital is able to set itself apart from the competition both in the battle for patients as well as the battle for good, qualified employees.

When vision, strategy and the plan to become a sustainable hospital are in place, it results in two fundamental implementation projects. The first project relates to investments in buildings, building technology, lighting, energy supply, information and communication technology and medical technology. The second project pertains to the hospital processes and procedures and primarily the actions of people.

How important is the "people factor" in a sustainable hospital, meaning what role do employees play?

Schneider: A lot depends on the actions of people, for instance when and how equipment or lighting and ventilation are used unnecessarily, and whether people recycle. These are all examples we know from everyday life and that play a major role in hospitals. After all, hospitals often have thousands of employees and operate 24 hours a day. The type of building management determines whether hospitals save more than 100,000 Euros per year in energy costs. These cost savings can easily add up to more than 10,000 Euros per year per medical device. This is where manufacturers differ greatly from each other.

A lot of waste of valuable working hours and money occurs due to wrong processes, waiting times or underutilized resources. For instance, hospitals are able to reduce unnecessary walking distances for nurses by at least 20 percent by implementing a good workflow. This benefits both the staff and the patients. After all, doctors and nurses should treat and take care of patients, and not have to walk along corridors or wait around.

Early and accurate diagnostics is also important since it ensures the right therapy for patients. This also includes intelligent imaging software and system integration of all subsystems, for instance for laboratory results, radiology, referring physicians, and electronic health records. In addition, the associates need to be well trained in using all the new technologies.

There are sustainable concepts available for tackling critical success factors such as recruiting and retaining employees, fostering relationships with referring physicians as well as the surrounding community. The core business of any hospital, however, is to provide great treatment, to measure it and to continuously improve.

Can a hospital be fully sustainable?

Schneider: Thanks to continuous innovations that also include technical advances, the infrastructure, processes and ultimately people are constantly changing. That's why in theory, an optimal hospital can only exist for a short amount of time. What counts is to continuously improve and to enjoy doing it. Hospitals and industry partners need to share this kind of mindset. In addition to the successful Green+ Hospital Initiative, Siemens Healthineers has now launched the Executive Alliance Initiative to assist with this. It systematically investigated the weak points of hospital management and staff members in various countries. We will soon publish the results and provide a collection of good practices for hospitals as a next step to make it easier to succeed with continuous improvement processes.

Image: Man with glasses and beard - Timo Roth; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Timo Roth and translated from German by Elena O'Meara.