It’s time to take action to make the healthcare sector more sustainable. In the second of two articles, Dr Robin Clark, medical director for Bupa Global, India and UK Insurance, shares five vital interventions that healthcare providers can implement to accelerate carbon reductions.
We partnered with The University of Manchester and The Tyndall Centre for Climate Change Research to produce a report, Transforming Healthcare for a Greener Tomorrow, which encapsulates the critical role the healthcare sector must play in driving global environmental sustainability and provides a comprehensive roadmap for transitioning to low-carbon operations that uphold patient care standards.
What we know
In the first part of this feature, we explored how the urgency for the healthcare sector to adopting sustainable practices is highlighted by the fact that healthcare is also uniquely vulnerable to climate change as the adverse effects on human health further increase pressure on service delivery [1].
Now I’m going to share the five vital interventions that healthcare providers can implement to accelerate carbon reductions now and in the next few years.
1. Greener buildings
Healthcare estates make up 18% of all healthcare provision emissions, so reducing emissions from buildings plays a central role in a provider’s net zero roadmap. Heating, cooling, ventilation systems, and energy-intensive healthcare equipment comprise a large part of a building’s greenhouse gas (GHG) footprint.
Monitoring and managing energy consumption so it can be reduced is vital for lowering emissions and can help reduce costs. Steps that can be taken include:
- Automated metering to gather the data that’s crucial for benchmarking different facilities, identifying opportunities, and building business cases to reduce usage.
- Use of energy efficient technologies, such LED lighting, occupancy and ambient lighting sensors, building management systems to optimise consumption based on usage, and smart sockets and appliances that switch off when not in use.
- Improved insulation and ventilation to reduce energy loss.
- Switching from fossil fuels to renewables, for example by investing in electrification, generating electricity on site where possible. Also switching to heat pumps, integrating solar heating into hot water tanks and boilers, choosing electric ovens and induction hobs.
2. Sustainable clinical practice
To lower the carbon impact of demand for and delivery of services, we must reassess clinical pathways to provide care that’s best for patients and the planet.
This includes optimising:
- Patient site visits
- Duration of stays
- Use of testing
- Diagnostics and drugs
Achieving this needs time, input from specialist practitioners, and resource allocation. Combining clinical practice with sustainability knowledge may also require collaboration with academic institutions.
Digital services: Digital services have an important role in reducing carbon emissions. For example, once consent concerns about use of patient data are overcome, new approaches to healthcare data management and analytical capability, including AI and machine learning, have the potential to reduce hospitalisations, unnecessary diagnostic testing, post-operative complications, and re-admittance rates [2].
Changing interaction with patients to reduce trips to healthcare facilities cuts carbon and saves travel time and costs. For example, some admittance checklists and follow-up consultations could be completed online or by phone.
Anaesthetics: The fluorocarbons and nitrous oxide in anaesthetic gases are potent GHGs. Some private hospitals, such as the Cromwell Hospital, are already stopping or phasing out desflurane as an anaesthetic gas.
Other efforts to reduce leakage of the gas across hospital estates and leakage of anaesthetic gases in theatres are increasing, for example using the SageTech Medical system to capture and reuse anaesthetic gases cutting emissions to near zero.
Streamlined care pathways: Sustainability hasn’t always been routinely embedded in care pathway decision-making, despite offering options to improve patient experience and outcomes, and lower costs.
The Sustainable Healthcare Coalition provides resources to assess GHG, waste, and water impact on care pathways, including a carbon calculator. The next step is bringing together professionals involved in the care pathway to determine alternative practices that could reduce the number of patient visits, hospital stays, and more.
While not focused on carbon saving, programmes such as NHS Getting it Right First Time (GIRFT) will have climate benefits where new practices (e.g. rapid testing and diagnostics, timings of surgical interventions) reduce ward admissions and length of stays [3]. A recent study of inpatient transurethral resection of bladder tumour surgeries that were moved to day cases through GIRFT showed a cut in carbon emissions [4].
3. Greener travel
Transport produces the largest share of emissions in high income countries. Fleet vehicles, such as ambulances, goods vehicles, and business travel, are within scope 1 and 2 emissions of organisations that report their carbon impacts.
Tackling fleet vehicle emissions requires optimising the distance and number of journeys and switching from diesel and petrol to electric, hydrogen, and biofuel. Subsidising public transport and working with local transport providers to ensure bus route access to healthcare facilities can make greener commutes more viable. And on site electric vehicle charging can contribute to the broader system transformation toward a low-carbon future.
4. Supply chain focus
Supply chain emissions account for the largest proportion of a healthcare organisation’s carbon impact [5], [6]. Making sustainability and carbon emissions part of procurement decision-making processes can often address healthcare’s scope 3 emissions – the most challenging emissions scope to address.
Individually, providers are unlikely to influence suppliers’ offers on packaging and low-carbon alternatives. However, aligning product standards across healthcare providers can send a signal to suppliers about minimum sustainability performance.
Applying sustainability terms to tenders that include KPIs related to carbon emissions can further drive new low carbon offers from the supply chain. For example, the NHS requires 10% of tender evaluations to be based on a supplier’s sustainability score.
Procurement that considers product lifetime and data on waste is an important first stage in minimising waste. Enhancing product lifetime by moving to reusable sharps and containers, drug trays, surgical gowns, and other items will reduce healthcare waste.
5. Engagement and advocacy
The importance of board, consultant, and staff buy-in to help drive down emissions is clear. Rapid buy-in requires high-quality governance, information, and engagement. It allows the relevant people to understand what is happening once changes are introduced, why change is necessary, and the role they can play. It also promotes effective collaboration between colleagues from different departments to achieve shared goals.
Decision-makers responsible for setting and delivering strategic priorities must be fully behind the need to decarbonise healthcare quickly, and this increasingly appears to be the case.
Assigning employees as sustainability champions has been recognised as an effective way to link organisation-wide goals with the daily activities that influence operational carbon emissions. In a sector with diverse and complex activities, bottom-up and top-down strategies should be implemented, and champions should be recognised and supported.
Conclusion
We cannot have healthy people without a healthy planet. Unless we make a co-ordinated and concerted global effort to reduce emissions, the climate will become increasingly hostile to the life and ecosystems it has sustained for millions of years. Across our sector, there is an appetite for change and to reach net zero. It will require collaboration between healthcare organisations, involving every stakeholder, from management to patients, to turn this intent into positive action now. But, by taking the necessary steps to transform healthcare today, we can believe in the possibility of a greener tomorrow.
References
[1] Charlesworth, K.E., M. Jamieson, and M. Jamieson, Healthcare in a carbon-constrained world. Australian Health Review, 2018. 43(3): p. 241-245.
[2] Ioannou, I., S.X. Li, and G. Serafeim, The Effect of Target Difficulty on Target Completion: The Case of Reducing Carbon Emissions. The Accounting Review, 2016. 91(5): p. 1467-1492.
[3] Romanello, M., et al. (2023). “The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms.” The Lancet 402(10419): 2346-2394.
[4] CIBSE, Energy Savings Opportunity Scheme. Chartered Institution of Building Services Engineers: https://www.cibse.org/media/iawbw2tr/esos_cibse-response.pdf.
[5] Romanello, M., et al., The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. The Lancet, 2022. 400(10363): p. 1619-1654.
[6] Pinho-Gomes, A. C., et al. (2022). “Values, principles, strategies, and frameworks underlying patient and public involvement in health technology assessment and guideline development: a scoping review.” Int J Technol Assess Health Care 38(1): e46.
