Weaving ESG initiatives into health care facilities

The Nakielski File

CV

• ESG and sustainability adviser.
• Vice president of sustainability at Advocate Aurora Health, Downers Grove, Ill.
• North American health care practice lead at Anthesis Group, Boulder, Colo.
• Director of sustainability and environmental health at Blue Cross Blue Shield of Massachusetts, Boston.

Accomplishments

• Healthy Building Network, current board chair.
• The Chemical Footprint project, current steering committee member.
• City of Boston, Zero Waste Advisory Committee.
• Farm to Institution New England, Network Advisory Council.
• Women in Sustainability Leadership Award recipient.

Education

• Bachelor of Science in medical microbiology and immunology at University of Wisconsin – Madison.
• Masters in business administration at Simmons College, Louisville, Ky.
• Executive education for sustainability leadership at Harvard T.H. Chan School of Public Health, Boston.

As the former vice president of sustainability at Advocate Aurora Health (AAH), Monica Nakielski has developed and led organizationwide environmental, social and governance (ESG) initiatives. She recently transitioned into independent consulting and this month discusses the growing adoption of ESG in health care.

How did your early experience influence your career journey? 

My mother is from Ecuador, and I was impacted by our travels to her home country. Early on, I witnessed economic instability and understood that those living downstream in marginalized communities were greatly impacted by our upstream decisions. Also, I grew up in an environmental justice community near a wastewater treatment facility, and when we moved across the city, it was next to a recycling center. My childhood was abundant with love, humor and community. Neighbors and a local network with deep connections cultivated a desire to create space in our future that is better than what we found.

My path is nonlinear. I have been fortunate to create a career that aligns with my personal purpose and values of creating sustainability. Within ESG and sustainability, we are at a pivotal stage where there is a level of energy, attention and commitment to do more. We can create value while also leveraging the power of business for impact.

What are some of the ESG initiatives you led at AAH before transitioning into independent consulting? 

My team was responsible for setting the strategy. In collaboration with our system’s executives and senior business leaders, vendors and manufacturers, and community partners, we implemented the strategy to create business, environmental and societal value.

In response to stakeholder inquiries and evolving ESG disclosure requirements, my team spearheaded a benchmarking process. Leadership sought insights on industry practices, performance comparisons, target setting and associated costs. This process revealed several gaps and opportunities, including the establishment of an ESG council. I took the lead in designing the council’s structure, governance and first-year deliverables to conduct a materiality assessment, produce an ESG report and create an ESG fact sheet. 

The assessment also revealed the need to conduct a carbon emissions inventory as a foundational step for future objectives. Once completed, I trained my team to utilize this data and build models to establish a baseline and perform financial assessments alongside carbon emissions. We used these findings in our communications with leadership as we sought approvals of the next-generation goals. 

Another initiative I am proud of was co-leading the creation of AAH’s Healthy Spaces Roadmap 2.0, completed in the spring of 2023. It serves as an internal accreditation process for their planning, design and construction team and integrates ESG principles and elements of LEED, WELL, Fitwel and net-zero building standards. 

While there are many more projects and initiatives to highlight, I’ll end with the co-creation of the first of its kind interprofessional climate and health continuing education series that was recently admitted into Advocate Health’s Midwest graduate medical education repository. A six-part series was developed using the American Public Health Association’s model on health impacts of climate change. The training, Get Climate Smart, is open for all to access.

What are the factors accelerating ESG adoption today?

In recent years, ESG has gained mainstream attention and has become a crucial consideration for businesses, investors and regulators. Several factors have contributed to the acceleration of ESG adoption and its evolution:

• Increased awareness and stakeholder demand. The last decade witnessed a significant increase in awareness and concern about environmental and social issues. Climate change, social inequality and corporate misconduct have gained widespread attention, leading stakeholders like customers, employees and communities to demand more sustainable and responsible business practices. 

• Financial performance and risk management. Research has shown a positive correlation between strong ESG performance and financial performance. Companies with robust ESG practices tend to exhibit lower-risk profiles, better operational efficiency and enhanced long-term sustainability.

• Regulatory interventions. Governments and regulatory bodies worldwide have taken steps to integrate ESG considerations into their frameworks. This includes introducing regulations that require companies to disclose ESG-related information, enforcing stricter environmental standards and promoting sustainable practices.

• Investor pressure and capital flows. Institutional investors have become key drivers of ESG adoption. They increasingly integrate ESG factors into their investment strategies, engaging with companies on ESG issues and allocating capital to sustainable investments. 

• Rise of sustainable finance. The last decade has witnessed a surge in sustainable finance initiatives. Sustainable investing, green bonds and other instruments have gained popularity. 

• Technology and data advancements. Advances in technology and data availability have facilitated the collection, analysis and reporting of ESG. Companies can now more accurately measure performance, set targets and track progress.

• Integration into business strategy. ESG considerations have shifted from being peripheral to integral to business strategy. Companies increasingly view sustainability as a source of competitive advantage and innovation. ESG factors are now incorporated into product and service development, supply chain management, employee engagement and stakeholder relations.

How can facilities prioritize ESG amid limited budgets and competing needs?

Health care executives face a range of unique challenges due to shifting regulations, reimbursement models, technological advancements, human capital shortages and emerging medical treatments, among other factors. 

I would recommend organizations first assess and prioritize projects and initiatives to advance those aligned with long-term goals. Next, create a business case by highlighting the cost savings, growth, efficiency gains, reputation enhancement and/or risk mitigation to gain support. Engage stakeholders and communicate transparently to involve colleagues, patients, investors and communities in the shared ESG goals and progress. Also, seek partnerships and collaborate with organizations sharing ESG goals to pool resources, share best practices and secure joint funding. Explore external funding like grants, loans, green bonds and the Inflation Reduction Act.

Start with low-cost, high-impact actions like conservation measures that save money to reinvest in other long-term initiatives. Be sure to integrate ESG into the process; for example, an ESG purchasing and decision-making process can support local purchases and economic development, reduce human rights violations in the supply chain, and implement healthier, safer products.

Any or a combination of these steps can support meaningful progress despite budget limitations. 

Jamie Morgan is editor of Health Facilities Management magazine.