HCWH: Getting Ready for Scale

As part of this Scaling Snapshot, see also Health Care Without Harm’s Organizational Overview, Scaling Strategies, and Scaling Pearls of Wisdom. You can find the full snapshot PDF here.

Environmental health advocate Gary Cohen co-founded Health Care Without Harm in 1996, supporting a variety of health care and environmental organizations to work on a common agenda. HCWH partnered with the American Hospital Association and together received early funding from the U.S. Environmental Protection Agency to engage hospitals in eliminating mercury and reducing waste. Through this effort, HCWH created a network of U.S. hospitals interested in tackling environmental health issues; when the EPA funding ended, HCWH decided to keep the momentum going by continuing to lead the network in addition to building its own advocacy, research, and partnership roles.

Key success factors in positioning HCWH for scale included:

• Proving Demand and Credibility: Early, influential partners. Early on, HCWH began working with two large and influential U.S. health care systems: Kaiser Permanente and Catholic Healthcare West. Both systems were beginning to explore environmental sustainability, and their interests aligned with HCWH’s offer of support. The engagement of these two systems was critical in bringing attention to the work and establishing mainstream validation.
• Creating a Robust, Responsive Model: Flexible capital. HCWH was able to access flexible funding through a few key foundations (including the Jenifer Altman Foundation, the Oak Foundation, and, later, the Skoll Foundation) for its early efforts, which allowed it to invest in the organization as a whole and be responsive to learnings and market changes.
• Thinking Big: A long-term, scaffolding approach. At the outset, HCWH recognized that if one of the long-term goals was to move the health sector into an advocacy role on environmental health issues, there were many intermediate steps the sector needed to take, including to get their own house in order. Therefore, over the first decade or two, HCWH’s work would build up slowly from more easily addressed (and mainstream) issues, such as waste reduction, mercury elimination, and energy use reduction. From that foundation, HCWH could bring the institutions along with a broader systems approach, which would ultimately position them to influence market and policy changes.
• Understanding the Ecosystem: Creating responsive and supportive partnerships. Without judgement, HCWH has been attuned to the needs and constraints of its health system partners and has focused on clearing obstacles to engagement. To lessen the discomfort of its early hospital partners with HCWH’s strong advocacy work, HCWH bifurcated its technical assistance and advocacy work into two related entities in the U.S.: HCWH and a membership organization called Practice Greenhealth. To collaborate productively with hospitals, HCWH presented them with their environmental impact data in a non-blaming, non-threatening way — and then provided step-by-step support to early adopters to model and evaluate changes.

HCWH spent its first decade pursuing these strategies, ultimately preparing it to begin to scale significantly around the year 2006. Click here to read about the ways in which HCWH has scaled its impact, including the implications of these strategies for the organization.