Greening the Healthcare Sector: How Hospitals Can Reduce Emissions

In late 2015, nearly 200 governments worldwide signed a landmark action plan known as the Paris Agreement. After decades of blame-shifting, disorganization, and avoidance, there was finally a formal acknowledgment of the shared nature of climate change and a unified effort toward tackling the mounting crisis.

The primary goal of the agreement was to cut greenhouse gas emissions—specifically, to limit global temperature rise to 1.5 degrees Celsius (or less) above pre-industrial levels.

That threshold is no arbitrary number. According to a NASA-led study, if and when we reach a two-degree Celsius global temperature increase, natural disasters including extreme heat, flash floods, landslides, and wildfires will become much more common. And if we are to surpass this threshold by another two or three degrees, rising sea levels and significant water shortages are guaranteed to follow.

To hold nations accountable and measure their progress toward reducing emissions, Paris Agreement signees also agreed to participate in incremental “global stocktakes” to track their efforts, the first of which was released in October 2023. Unfortunately, the results were less than assuring.

Now, scientists say that at the current rate of emissions, the world will exceed its remaining “carbon budget” by 2030, which means that without immediate intervention, the grisly predictions outlined by scientists will come to fruition. In 2023, the temperatures were 1.48 degrees Celcius above the preindustrial average—and some predict we’ll surpass the 1.5-degree threshold this year.

The recent global stocktake should inspire a new wave of urgency among policymakers and influential private sector members. Zeroing in on the biggest offenders of carbon emissions will be critical in making a real impact.

Across industries, healthcare is one of the worst contributors to climate change. If it were a country, healthcare would be the fifth largest carbon emitter on the planet—with a footprint bigger than Brazil’s total carbon emissions.

Read on to learn about the different aspects of the healthcare industry’s carbon footprint, the biggest opportunities for greening in the healthcare sector, and why industry players should invest in sustainability.

Matthew Pietro, sustainability strategy manager at Practice Greenhealth, has years of experience in healthcare sustainability program development and green building advocacy. Pietro’s specialty is building system-wide sustainability programs within large organizations, which include communication strategies, green building, energy management, waste reduction, climate action, healthier food sourcing, and other procurement efforts centered on improving efficiencies and supporting human and environmental health.

Practice Greenhealth is the only organization collecting comprehensive sustainability data for the healthcare sector. It helps healthcare organizations like hospitals, manufacturers, and engineering firms take responsibility for their role in preventing climate change.

Climate change experts use a framework called the GHG Protocol to measure and report carbon emissions, which categorizes greenhouse gasses into three different types: scopes 1, 2, and 3. This helps organizations visualize their carbon footprint and develop plans that target their specific problem areas.

• Scope 1 emissions are “direct” greenhouse emissions from sources that are controlled by a company or organization, such as a hospital. This category describes the energy use, such as fuel for heating a building, that the organization owns directly. These emissions account for around 7 percent of health sector emissions overall.
• Scope 2 emissions are “indirect,” such as the purchase of electricity, which has been produced somewhere else, usually by a local utility provider. These emissions account for about 11 percent of healthcare-related emissions.
• Scope 3 emissions are the most important and the most elusive, making up over 80 percent of overall healthcare emissions.

“Scope 3 relates to basically the value chain or supply chain of a hospital or system,” says Pietro. Since supply chains are made up of a web of third parties that are linked together, an organization’s scope 3 emissions are often outside their direct control, which can make pinpointing and addressing problem areas incredibly complicated.

However, when members of a supply chain each do their part, a chain reaction of sustainable practices begins to flow throughout the supply chain.

Hospitals are the top emitters among healthcare organizations (36 percent) followed by physician and clinical services (12 percent) and prescription drugs (10 percent). This is because they are typically large facilities that stay open around the clock and engage in many energy-intensive activities (e.g., heating, cooling, use of ventilation systems, computing, refrigeration, laundry, and food service).

As major energy and resource consumers in the sector, hospitals are key actors in initiating change in the healthcare supply chain. “We support hospitals in a number of ways that can help them to improve their operations or impacts and goal setting in those areas,” says Pietro.

When organizations like Practice Greenhealth help hospitals and other healthcare organizations reduce their emissions, they look at 11 different impact areas:

• Operating Rooms (ORs)
• Food
• Buildings
• Chemicals
• Climate and Health
• Energy
• Leadership
• Procurement/Purchased Goods
• Transportation
• Waste
• Water

While all of these categories contribute to a hospital’s total footprint, some are more impactful than others. “The operating room is a big focus. It’s one of our major impact areas that we prioritize in supporting hospitals and their goal setting,” says Pietro. Although operating rooms take up a small amount of physical space within hospitals, “they are a hotspot in terms of emission contributions because they are so energy and resource intensive.”

“It’s important to prioritize being efficient and responsible within those [highly energy consuming] spaces because you can have a more significant positive impact on your greenhouse gas emissions,” says Pietro.

ORs have high requirements for air changes per hour, strict temperature parameters, and oftentimes, highly energy-intensive surgical lighting systems—especially older operating rooms with outdated technology. “We’re finding that with operating rooms that transition to more energy efficient LED surgical lighting systems … you can put less strain on your operating rooms and from the perspective of temperature and overall operational efficiency,” says Pietro.

Another high-impact area within hospitals is purchased goods, which is “typically a major focus when a hospital is inventorying their scope 3 emissions,” says Pietro. This category can include medical supplies, equipment, hospital gowns, bed sheets, janitorial supplies, and food.

According to Practice Greenhealth, 10 to 15 percent of hospitals’ solid waste is food. This is a vital area to address since landfilling food generates methane—an even more potent greenhouse gas than carbon dioxide. Hospitals can reduce food-related waste in several ways, such as meal planning, deliberate purchasing, avoiding excess food preparation, using imperfect or “ugly” produce for soups and sauces rather than throwing it out, and food donation.

These are just a couple of examples of the key areas in which healthcare organizations can improve efficiency and reduce emissions.

There are myriad solutions proposed by organizations like Practice Greenhealth for many of the wasteful and energy-inefficient practices at hospitals. However, technology’s potential to shrink the sector’s footprint depends on participation from industry players.

In some cases, leadership may be resistant to implementing new sustainability practices. For example, hospitals may be hesitant to participate in food donation programs, which distribute uneaten food that would otherwise be wasted to those in need, out of fear that the donated food could later cause harm to recipients and result in a lawsuit. This is despite the fact that there are legal protections for organizations (including hospitals) protecting them from such litigation, reflecting a need for further education.

While Pietro says he typically ends up working with open-minded hospital leadership members about sustainability practices, “There are justified questions that are asked whenever something new is proposed,” he says. “We’re working with large anchor institutions that have been operating within their communities for decades upon decades. Organizational change is challenging, and it’s a process that requires education.”

Today, more than one in every four hospitals—or about 1,700 hospitals and health systems in the U.S. and Canada—are part of Practice Greenhealth’s network, “and that number is increasing, so there’s increasing enthusiasm [from] hospitals wanting to understand and improve their sustainability efforts,” says Pietro.

Going green is not only an ethical responsibility; investing in sustainability can significantly benefit healthcare organizations, too.

“Sustainability can basically be good business practice because it helps a hospital or system to lower their operational costs over time,” says Pietro. “And through those lowered operational costs, they can direct more resources to patient care.” There are countless examples of healthcare organizations saving money from sustainability efforts. To name a few:

• In 2020, Beth Israel Deaconess Medical Center in Boston saved $200,000 in one year thanks to waste prevention and recycling activities.
• In 2019, the Atlanta Veterans Affairs Medical Center saved nearly $1 million through facilitating ridesharing and offering teleworking options to employees.
• Between 2018 and 2020, the University of California, San Francisco Medical Center saved $300,000, mainly from reducing the use of desflurane gas within the hospital.

But there are other perks of investing in sustainability outside of financial incentives, says Pietro. “The fact that [healthcare organizations] have environmental sustainability efforts can also reflect positively on the organization and potentially lead to higher satisfaction among employees,” says Pietro.

Research supports this claim. For example, a 2022 study in Australia found that green practices within organizations promote a feeling of hope among employees and make them feel that they align with their organization’s values, which positively affects employee retention.

“Sustainability is something to consider very seriously if you [as a healthcare leader] haven’t already,” says Pietro. “From a healthcare perspective, we are facing monumental climate challenges, and we have issues of environmental justice and equity that sustainability programs can positively impact.”

Pursuing sustainability is a win-win for healthcare organizations. However, there is still much work to be done in the sector to make the goals laid out in the Paris Agreement possible.

The Biden Administration has attempted to make up for years of regressive environmental policy under Trump—setting an ambitious goal of net zero greenhouse gas emissions economy-wide by 2050, in line with targets set by the Paris Agreement.

Additionally, in April of 2022, the Administration launched the White House-HHS Health Sector Climate Pledge to single out the healthcare sector, specifically. It asks signees to make several promises, including developing climate resilience plans, keeping inventories of their scope 3 emissions, and publicly reporting on their progress.

All of this is underlined by a goal to reduce healthcare organizations’ emissions by 50 percent by 2030. To date, over 100 U.S. health sector companies have joined the pledge.

The climate pledge also suggests that industry organizations should designate an executive to facilitate sustainability goals. According to Pietro, this has become a common practice in recent years. “Oftentimes, I’m working with a sustainability leader in a dedicated sustainability role [at a hospital], whether that’s a manager, a director, or a VP,” he says. “And I’m seeing increasingly more positions that are defined with sustainability as part of the… performance indicators within their job description.”

According to Practice Greenhealth, almost 90 percent of the top-performing institutions in its sustainability benchmark reports have an executive-level leader at the top of their reporting structure.

For burgeoning health administrators, pursuing a career that is specifically dedicated to achieving sustainability is now a realistic goal.

“We have an opportunity to lead in supporting and enabling climate mitigation strategies as well as community resilience strategies in the space of climate change as we’re all observing,” says Pietro.

It’s easy to become overwhelmed by frightening climate change statistics and the slow reaction of world leaders to drive change, but organizations like Practice Greenhealth show that there are real ways for private industry members of any industry to make an impact. As the UN purports, every action counts.

“The healthcare sector really is at the front line of climate change; we bear financial costs and human health burden from a number of the negative effects of climate change,” says Pietro.