How Health Systems are Advancing Decarbonization and Sustainability Efforts

Key takeaways:

• Representing 18 percent of the U.S. economy and 10 percent of the global economy, healthcare has the power to drive sustainability and transform health at patient, community and global levels.
• Today, health systems are using scopes taxonomy to account for and report on emissions, based on accounting guidelines and standards from the Greenhouse Gas Protocol and other organizations.
• Premier is committed to supporting its members’ diverse sustainability and decarbonization objectives.

For more on this topic:

• Check out Premier’s 2021 Sustainability report.
• Read our blog to learn more about three key ways to drive sustainability via the supply chain.
• See how Premier was recognized as one of the World’s Most Ethical Companies by Ethisphere for the 15th consecutive year in a row.

The scientific consensus is clear. Human-caused climate change is real and will have significant consequences for the health and wellbeing of Earth’s inhabitants. The 2020s have been called a ‘critical’ and ‘decisive’ decade where action will be vital if we are to avoid the worst consequences of a changing climate. Maintaining the Earth’s average temperature at, ideally, 1.5^oC and certainly no more than 2^oC above pre-industrial levels is vital.

For its part, the healthcare sector is responsible for almost 10 percent of U.S. greenhouse gas (GHG) emissions. Healthcare-related pollution also includes particulate matter (soot) and sulfur dioxide amongst others ─ and worldwide, pollution from all sources contributes to approximately 7 million deaths per year.

Fortunately, over the last 20 years a new language and system for addressing GHGs has evolved. GHGs include various volatile gases, principally carbon dioxide (CO₂) and methane (natural gas), as well as nitrous oxide (N₂O) and more exotic pollutants such as hydrofluorocarbons (HFCs) and sulfur hexafluoride (SF₆). Organizations account for their production of these gases using “scopes,” and these break down as follows:

• Scope 1: Emissions produced directly at controlled or owned facilities. For hospitals, this would primarily be CO₂ from boilers and incinerators, as well as emissions from owned vehicles. In addition, anesthetic gases (primarily desflurane) and those lost from refrigerant systems are considered scope 1.
• Scope 2: Emissions attributable to purchased electricity, steam, heating and cooling. GHGs emitted by an electric utility as they produce an organization’s purchased power are accounted for in scope 2 emissions.
• Scope 3: All other indirect emissions attributable to an entity. These include emissions from business travel, employee commuting, waste disposal and investments. Critically, scope 3 emissions also include those associated with purchased goods and services, and capital goods.

In response to climate change, many healthcare organizations, including Premier members, are using the above taxonomy to account for global warming impact. Guidelines issued by organizations such as the Greenhouse Gas Protocol and the Taskforce on Climate-Related Financial Disclosures (TCFD) provide a roadmap. Publication of this accounting, either in the form of an annual report or via an independent body such as CDP ─ a global disclosure system to manage environmental impacts ─ is the next step. This is followed by setting goals for emissions reduction and eventual elimination (also known as a net-zero target, where any residual emissions are offset by GHG removal elsewhere).

Each organization may set their own targets, but a one-size-fits-all approach may not work. Flexibility is key as a GHG reductions approach leveraged in other industries may not apply in healthcare due to the complexities in its unique needs and operations. The gold standard is to set a “science-based target,” where a reduction plan has been verified by the Science Based Targets Initiative (SBTi) to align with keeping temperatures well below the 2^oC threshold. An important note is that while many non-profit organizations, including many of Premier’s members, can and should set science-based targets, they are currently not yet verified by the SBTi.

A Look into Decarbonization Efforts

Premier aids healthcare decarbonization efforts across all three scopes. For scopes 1 and 2, our contracted suppliers help members save energy in various ways. For example:

• HVAC services suppliers can support with everything from system tune-ups to entire retrofits and replacements;
• Building services suppliers can design and implement upgrades such as LED lighting retrofits; and
• Energy services firms can assist members in a wide variety of capacities, including in the purchase of renewable energy.

Scope 3 emissions are an emerging and challenging area ─ and Premier is collaborating with our members to understand their primary challenges and co-develop solutions. For instance, Premier works with suppliers to ensure sustainability information is available before purchasing decisions are made.

Our requests for information (RFIs) include questions on environmentally preferable policies and practices, and are guided by Premier’s Environmentally Preferred Purchasing (EPP) Advisory Council. Comprised of sustainability specialists from a cross-section of member health systems, EPP Advisory Council input is vital to ensuring that our efforts reflect their goals, and that supplier documentation is fit for purpose. With guidance from the Council as well as Practice Greenhealth and the Healthcare Climate Council, we’re also updating RFIs to include specific questions on our suppliers’ GHG accounting ─ what they are measuring, how they are reporting and whether they have set emissions reduction targets.

Member health systems are beginning to consider deadlines by which suppliers will be required to have GHG reduction targets in place, so now is the time to act.

On this front, the establishment of the Office of Climate Change and Health Equity within the U.S. Department of Health and Human Services (HHS) and the publication of SEC’s proposed guidance requiring listed companies to report their GHG emissions are notable recent developments. Premier’s team in Washington, D.C. is actively involved ─ monitoring and engaging with the Administration and Congress to support our members’ efforts.

Going Green in Healthcare

Decarbonization efforts are just one component of a broader sustainability initiative.

Building on a long heritage of engagement on this issue, Premier is committed to supporting its members’ diverse sustainability objectives:

• Premier RFIs contain detailed product-level questions on a swathe of environmental traits, including the presence of chemicals of concern, product reuse and recyclability and packaging.
• Health systems are now leveraging technology and analytics to easily identify sustainable suppliers and products designed to reduce environmental impact, pinpoint gaps and opportunities, and benchmark against their goals. Premier technology contains EPP information for more than 200,000 products and nearly 400 suppliers ─ and we expect this number to grow. As a use case, Premier members are leveraging RFI information and supply chain data to support programs aimed at the reduction and elimination of certain anesthetic gases that have significant global warming potential such as desflurane.
• Premier offers reprocessing under contract for many items so that they may be used again safely and with environmental stewardship in mind. As an example, one Premier-contracted supplier offers a fluid cart with proprietary cleaners and a closed-system process that reduces operating room (OR) red bag waste by up to 70 percent with its reusable reservoirs ─ eliminating the OR’s need for plastic containers. Member health systems are also re-evaluating their foodservice operations with an eye to using more environmentally friendly products and reducing their output of plastic waste.

Through specific contracted suppliers, advanced analytics, and industry collaboration and advocacy, Premier continues to drive sustainability and decarbonization throughout the complex healthcare supply chain.

New challenges call for new thinking, and Premier, together with its members, will continue to innovate in the sustainability space in the months and years to come.