Although they are steadily gaining ground, hospitals appear to be inching rather than rocketing down the road to environmental sustainability. The reasons are varied, ranging from funding and staffing challenges to uncertainty by hospital leaders about how to wrap their arms around such a complicated, multilayered issue. Still, the vast majority of hospital leaders in a recent survey said that the green movement is truly important for the planet, patients, staff, the community and their own bottom line.

"Hospitals are dealing with many important issues and there are competing priorities," says Dale Woodin, executive director of the American Society for Healthcare Engineering. "Environmental issues don't always come out No. 1."

Hospitals are making the biggest strides in less cost-intensive areas such as upgraded lighting, which was cited as the single greatest success in a sustainable operations project followed by replacing building automation systems in the 2013 Sustainable Operations Survey, conducted by H&HN's sister publication, Health Facilities Management, ASHE and the Association for the Healthcare Environment, both divisions of the American Hospital Association. Recycling of pharmaceutical/regulated medical waste as well as green cleaning continued to gain momentum in 2013.

The survey also was revealing in terms of what hospitals are not doing on a wide scale, such as tracking performance metrics. Only 38 percent include performance metrics — such as the Environmental Protection Agency Energy Star rating, total waste generation or a recycling rate — in their senior management dashboards and the percentage of those that track energy overall stayed fairly static from 2010 to 2013. For example, less than half (45 percent) of responding hospitals conducted energy audits in 2013 — a drop of roughly 5 percent from 2010, the first time the survey was conducted.

Considering the close link between metrics and cost-cutting, experts say those numbers need to turn the other direction — quickly.

"Those numbers are shocking," says Janet Brown, director of facility engagement at Practice Greenhealth. "Environmentalism aside, this is also a financial issue, and these metrics let cash-strapped hospitals know where they have opportunities to save money, where they don't and where to prioritize."

Others take more of a glass-half-full view of the data. "The EPA would love to see that number grow, but we're happy that so many hospitals have come a long way in a relatively short period of time and are saving tremendous amounts of energy — and money," says Clark Reed, who heads the health care facilities division of the Energy Star program. "Compared with where hospitals were even 10 years ago, this is real progress."