While scientists have long documented the impacts of climate change, the
summer of
2023
made it clear that our world is literally changing. The western United
States has dealt with drought and wildfires for decades but unexpectedly
experienced its first hurricane in
generations.
The increasing frequency and severity of weather events in the southeast
have led to markets where consumers struggle to afford property insurance,
while insurers are
challenged
to adequately spread the risk associated with annual hurricane losses. The
Midwest and Northeast found their communities shrouded in smoke from
record-breaking Canadian wildfires; and Maui burned to the
ground.
Everywhere in between, the United States and the world experienced the
hottest summer on record — with numerous communities feeling the impact of
extreme heat for extended durations.
Perhaps this will be the tipping point where we collectively decide to make
sustainability a permanent part of our mindset, lifestyle and business
model. As pillars of their local communities, healthcare organizations have
long been committed to “first, do no harm” and are now being asked to
embrace sustainability as a social determinant of
health.
The pressure is coming from all directions — associates, patients, community
leaders, external investors and the federal government.
It's no secret that hospitals are high-acuity buildings with many different
technologies consuming significant amounts of energy in the provision of
care. Most healthcare facilities have established energy-efficiency programs
over the last two decades to reduce consumption (and operating expenses).
However, every facility will eventually reach the point of diminishing
returns for new investments, where they begin to approach the minimum amount
of energy required to operate the physical environment.
This is why many leading organizations have already made the transition from
an energy-efficiency approach to a carbon-management program. A hospital’s
carbon footprint encompasses more than infrastructure optimization and
lighting retrofits. While fossil fuel consumption is still a primary driver,
it also requires organizations to consider potent greenhouse gas (GHG)
emissions — from refrigerants, anesthetic gases and methane
emissions
from organic waste sent to landfills. It also extends the focus beyond
infrastructure such as boilers, chillers and backup generators to renewable
energy
procurement,
fleet vehicles and vendor emissions. It is an exciting new frontier that
requires innovation and collaboration to minimize emissions without
impacting the quality of patient-care environments.
Getting started is easy
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The first step on this journey is collecting data and identifying gaps where
data availability or quality could be improved. Calculating an
organization’s carbon footprint is critical to understanding where there is
the most opportunity for improvement. There are several free tools available
to make these calculations; it’s a matter of committing time and effort to
collect the data, implement the tools and analyze the results.
This information can further identify short-term opportunities, long-term
gaps and the financial implications of carbon-reduction efforts. For
example, natural gas is an efficient and relatively inexpensive heating
option that is frequently part of an organization’s scope 1 footprint.
Ultimately, these carbon emissions will need to be eliminated or offset; but
options such as
hydrogen
or direct carbon
capture
are not yet cost-effective and scalable. This would indicate that the
facility needs to place this item in the latter half of its long-term plan
while it tracks technology advancements and advocates for external support
in this area.
Data allow healthcare sustainability teams to accurately examine and
prioritize short-term options so the environmental impact can be made in the
most organized, cost-effective way. This is especially vital as healthcare
systems are currently under a great deal of financial
pressure.
Being able to analyze where a system is, where it wants to be, and how to
bridge the gap in a thoughtful way will be key to presenting new initiatives
and securing funding for their execution.
How to move the needle
There is strong support for sustainability initiatives from the federal
government’s Infrastructure Act and
Inflation Reduction
Act,
which are allowing many healthcare facilities to take advantage of grants
and direct pay incentives to improve their return on investment. On-site
renewable energy installations (such as solar panels), electric-vehicle
purchases or retro-commissioning investments are an excellent option for
most healthcare facilities, and could be eligible for subsidies. The US
Department of Health and Human Services’ Office of Climate Change and
Health Equity has even published a “Quickfinder for Leveraging the IRA for
the Health Sector” to help facilitate the process.
Organic waste is a substantial emitter of GHGs. Practice Greenhealth
estimates
that 10-15 percent of the waste an average hospital creates is food waste —
a total of more than 288,400 tons of waste sent to landfills annually.
Installing equipment such as food-waste
digesters
— that capture organic matter before they reach landfills, where they slowly
break down and release potent methane gas — actively counters this issue.
This is a relatively low-cost implementation that has some financial benefit
from reduced waste-hauling expense and could potentially minimize the risk
of associated injuries, depending on current environmental-services disposal
processes.
The three most common halogenated, inhalational anesthetics used for surgery
— isoflurane, sevoflurane and desflurane — are recognized greenhouse
gases; and the
healthcare industry is also working with clinical partners to reduce
emissions. This includes reducing consumption, taking into account the
associated leakage that comes with their delivery; and transitioning to
anesthetics that emit less potent GHGs. These initiatives have documented
benefits that not only reduce carbon emissions but also support high-quality
patient care and reduction of operating expenses.
Healthcare facilities are extremely complex physical environments. As such,
sustainability initiatives will require more planning, research and pilots
to ensure organizations are safely implementing initiatives without directly
impacting the provision of patient care. These measured decisions then
foster collaboration among healthcare institutions. The more positive
outcomes an organization has, the more it shares externally and encourages
other institutions to adopt successful programs themselves. Collaboration
helps accelerate implementation timelines. It provides evidence that
programs work in similar environments and develops a network of peers who
are committed to sustainability efforts and patient care. Whether you’re
just getting started in sustainability or have been at the forefront of the
industry, there is much to learn from one another to make healthcare that
much more sustainable.
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Dan Scher currently serves as the VP of Strategic Planning and Sustainability for Medxcel — leading master planning, infrastructure renewal and the sustainability program. He brings deep experience in strategy and facilities with a focus on healthcare and utility industries. Dan has served on the steering committee for the United States Department of Energy’s Hospital Energy Alliance and Health Care Without Harm’s Climate Council, and as member of the Health Care Supply Chain and Infrastructure Working Group for the National Academy of Medicine’s Climate Collaborative.
Published Oct 20, 2023 8am EDT / 5am PDT / 1pm BST / 2pm CEST