Climate Action:
A Playbook for Hospitals

Introduction

Climate change is a public health crisis – impacting our weather and environment, along with the quality of the air we breathe, the water we drink, and the food we eat. The most vulnerable members of our communities – children, people of color, the poor, people with disabilities or chronic diseases, and the elderly – are the ones who suffer the most. 

Health care is on the front lines of climate change bearing the costs of increased illnesses, changes in disease prevalence, and the health impacts of more frequent extreme weather events. At the same time, health care operations contribute significantly to climate change and the very diseases it is trying to treat. The health care sector is responsible for nearly 10% of U.S. greenhouse gas (GHG) emissions with hospitals generating one-third of those emissions. 

Hospitals have a distinct leadership opportunity to address climate change by following a three-pillar approach:

  • Mitigation: Reduce the carbon footprint from operations and implement low-carbon health care delivery

  • Resilience: Prepare its facilities for climate impacts and help build community health and climate resilience.

  • Leadership: Use the trusted voice and purchasing power of the sector to support the transition to climate-smart policies and a low-carbon economy.  

This playbook captures how hospitals are operationalizing climate solutions – inspiring and encouraging hospitals to engage further in climate action while providing a path forward to achieving measurable progress and outcomes. The time has never been more critical for hospitals and health care to take action.

For more information on the Health Care Climate Council, visit our website.

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Lean and clean energy

Due to their unique activities, more stringent code requirements, and 24/7 operations, hospitals are highly energy-intensive, using 2.5 times more energy per square foot than an office building. Health care organizations spend more than $6.5 billion on energy each year.

Consider the following:

  • Clean, renewable energy provides price predictability as well as competitive or cheaper prices than fossil fuels. Distributed renewable energy plus storage can also help hospitals remain operational during extreme weather events or periods of peak demand.

  • Based on CBEC’s data entered into Health Care Without Harm’s Energy and Health Impact Calculator, a 30% cut in health care electricity’s carbon pollution by 2030 would reduce GHG emissions– preventing an estimated 4,130 premature deaths, 85,000 asthma attacks, 4 million respiratory symptom events, 3,750 hospital visit incidents, and would save about $1.2 billion in medical costs. 

Over the last decade, wind energy prices have fallen 70% and solar photovoltaics have fallen 89% on average with the price of renewables falling below the cost of coal in 2018. The cost of renewables is predicted to considerably beat fossil fuels or decades to come.

Advocate Aurora Health set a 100% renewable electricity goal by 2030 across their health system. This goal builds off their extraordinary energy efficiency work throughout the health system, including a weather-normalized 23% energy utilization index reduction in their Illinois hospitals from 2008-2015, and ENERGY STAR certification for nine of their hospitals to date.

Ascension’s environmental stewardship program met the Department of Energy’s Better Buildings Challenge goal of 20% energy reduction by 2020 across its acute care hospital portfolio. From 2008 through 2018, Ascension reduced energy usage by 29.2%, saved $61.9 million in cost avoidance, and reduced over 1.5 million tons of carbon dioxide emission across 141 health care facilities. Ascension also deployed a data dashboard to report facility operations (energy, water, temperature, humidity, and air changes) on a real-time basis.

Over the past decade, Gundersen Health System has become 56% more energy-efficient and installed every form of renewable energy – solar, wind, geothermal, biomass, landfill gas, anaerobic digestion – supporting community health and growing the local economy. Gundersen first achieved energy independence in October 2014.  The health system saves $3 million annually from energy efficiency improvements. In 2019, Gundersen expanded its energy portfolio by installing a battery and microgrid at a new clinic.

In 2017, Rochester Regional Health became the first health system to publicly announce a 100% renewable electricity goal by 2025. They have built a 500-kW solar array at their system headquarters, completed building a 5.5 MW solar farm, and have invested heavily in being an anchor for community solar systems, allowing the community members they serve to receive local renewable power and save money on their electric costs.

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Healthier food

As health care takes a more holistic approach to improving health, food is a critical element, both in terms of what a patient consumes as well as what a hospital serves or wastes. Consider the following:

  • Project Drawdown estimates that if employed widely, regenerative agriculture could result in a total reduction of 23.2 gigatons of carbon dioxide and provide a $1.9 trillion financial return by 2050 on an investment of $57 billion.

Three stories above Boston Medical Center’s (BMC) power plant thrives a rooftop farm, helping them reach their 2030 vision of making Boston the healthiest urban population in the world. Along with harvesting close to 6,000 pounds per year, the farm is also used as an educational platform to create food resiliency in the city of Boston. The farm provides fresh, local produce to hospitalized patients and cafeterias, as well as the BMC teaching kitchen and therapeutic food pantry. The farm reduces the hospital's carbon footprint, increases sustainable space, and reduces energy use – including the energy required to transport food

Hackensack Meridian Health partnered with dining services providers Sodexo, Morrison, and its in-house dining services to commit to the Cool Food Pledge. Championed by the World Resources Institute, the Cool Food Pledge focuses on offering diners delicious food that is better for the planet with the goal of slashing food-related GHG emissions by 25% by 2030. Hackensack Meridian brings their food budget of an impressive $22 million (over $4 million for meat procurement) in purchasing power to the table, as well as a commitment to reduce food-related supply chain emissions.

University of Vermont Medical Center (UVMMC) procures over 59% of its food locally and sustainably – including food grown on their rooftop garden. Food waste is composted off-site, and then some of that compost is purchased back for use in the garden. UVMMC utilizes a room-service model for patients which helps to reduce food waste.

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Leadership

Visionary health systems understand that addressing climate change must be core to their mission of improving health, and many are using their trusted voice to lead by example. Consider the following:

  • More and more, prospective employees are seeking job opportunities in organizations that reflect and align with their values regarding environmental stewardship. In a 2019 survey of millennials, 40% said they have chosen a job because the company performed better on sustainability and 70% shared they would choose to work at a company with a strong environmental agenda.

Recognizing the threat that thermal coal poses to human health and the environment, Dignity Health adopted a policy to restrict investments in coal and identify new investments that mitigate climate change. Dignity Health’s advocacy leadership has been critical in galvanizing the global health sector and partnering with multiple partners and allies in support of the Paris Climate Agreement. Dignity Health, now part of CommonSpirit Health, has advanced the work of the Health Care Climate Council and was instrumental in launching health care climate alliances in California and Washington.

Hackensack Meridian Health (HMH) is a member of the Ceres policy network for federal policy advocacy. Their advocacy engagement has included lobby days on Capitol Hill, signing onto letters, offering quotes and comments for pending legislation, and educating the community around the health impacts of climate change, clean energy, and the electrification of the transportation sector.  HMH also participates in many state organizations that educate and advance climate and clean energy including the New Jersey Climate Alliance and the New Jersey Sustainable Business Council.

To educate patients and communities on the health impacts of climate change, Inova features climate and health information on their website and in brochures, explaining climate change impacts on vulnerable populations. Inova partnered with Virginia Clinicians for Climate Action (VCCA) to educate health professionals across the state through meetings, online communications, and one-on-one discussions. VCCA and its members have been instrumental in supporting sustainability initiatives within Inova including Styrofoam removal, green building adoption, and leader education.

Intermountain partners with the Salt Lake County Health Department to co-host an annual climate and health symposium to educate health care providers and community leaders about the health effects of climate change. Intermountain has also developed a Care Process Model to help health providers counsel patients about reducing their risks from air pollution, which includes fact sheets for vulnerable populations with specific actions individuals and families can take to reduce their risk.

Kaiser Permanente (KP) has publicly pledged to be carbon neutral by 2020 and carbon net positive by 2025. To achieve this goal, KP will maximize the energy efficiency of their facilities, produce 70 MW of solar energy at up to 100 sites, and purchase the output from 330 MW of off-site wind and solar projects in California. KP plans to purchase carbon offsets in order to reduce the direct emissions from its central utility plants, as well as take more carbon out of the air than the company produces.

Providence was instrumental in developing the Nurses Climate Challenge, a campaign to mobilize nurses to educate 50,000 health professionals on the impacts of climate change on human health. Providence was also a founding member of the California and Washington health care climate alliances, two state advocacy coalitions supporting climate-smart policies in their states. Providence signed onto We Are Still In and continues to support legislation that would require the U.S. to adhere to the Paris Climate Agreement

Virginia Mason has worked to educate Washington state policymakers and the public on the connections between climate and health.  Virginia Mason publicly supported a carbon pricing initiative and testified in support of a statewide clean buildings bill focused on increasing energy efficiency in large buildings.  Virginia Mason also co-founded Washington Business for Climate Action and newly launched Washington Health Care Climate Alliance, both of which are focused on climate and energy policy in the state.

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Greening the Operating Room

Given the demand for large amounts of energy to accommodate special ventilation, lighting, cooling, and the large amount of waste generated – operating rooms (ORs) generate a significant environmental footprint relative to other hospital departments. Consider the following:

Since 2017, Advocate Aurora Health reduced emissions from volatile anesthetic gases by 55%, saving the organization over $1 million and avoided the equivalent of 15,300,000 miles of driving.

Through its Greening the OR efforts, Cleveland Clinic’s main campus saved more than $4 million in 2019. By reducing air changes per hour during non-surgical periods as part of their OR Setback Plan, Cleveland Clinic saves 25 million kWh/year in energy use and $2.5 million annually.

By implementing a fluid management system, HealthPartners Regions Hospital significantly reduced regulated medical waste (RMW) as well as the potential for bloodborne pathogen exposure for their employees. The facility diverted 110 tons of RMW, resulting in over $120,000 in avoided RMW waste disposal fees and a savings of over $150,000 in supply since purchases of disposable suction canisters are no longer needed.

Providence St. Vincent Medical Center (PSVMC) reduced supply purchases and waste by reviewing surgical kits and evaluating surgeon preference cards. In total,106,558 card line items were reviewed with 39,506 products subsequently removed. By removing unnecessary products from the facility's surgical kits, PSVMC is saving an estimated $1.5 million in supply purchases and $270,000 on expired items annually. They also removed 9,411 instrument sets, decreasing sterile processing usage by 72,000 trays per year, saving 495,000 kWh of electricity and 1 million gallons of water annually with about $50,000 in cost savings.

After learning that desflurane had a global warming potential 20 times greater than other anesthetic gases, an anesthesiologist and anesthesia technician at Virginia Mason worked with their colleagues to reduce desflurane in favor of alternatives. In 2019, Virginia Mason Medical Center completely eliminated desflurane use, resulting in an estimated 60% annual decrease in its GHG emissions from anesthetic gases.

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Sustainable procurement

The health care sector buys enormous quantities of goods and services, with health care spending accounting for nearly 18% of the GDP in the U.S. Consider the following:

In the 2019 fiscal year, Ascension hospitals embarked on a goal to increase collection of pulse oximeter medical devices for reprocessing. The project involved collaboration between green teams, the purchasing department, environmental services, clinicians, facility managers, and the medical device reprocessing vendor with data issued monthly and reported at environment of care committee meetings. The project resulted in 664,000 pulse oximeters collected and 66.4 tons of landfill waste avoided. As a result of the project's success, the vendor will donate 3,000 trees through the National Forest Foundation.

Cleveland Clinic has replaced more than 450,000 bulbs through its enterprise LED retrofit program, saving more than $3 million annually. To make the business case for LED retrofits of surgical fixtures, which have a higher acquisition cost, Cleveland Clinic assessed the total cost of ownership in its calculations including energy use, labor, and disposal over a 10-year period. By factoring in additional lifecycle costs in the assessment, Cleveland Clinic found installing LED tubes cost 70% less than compact fluorescent lights despite the higher acquisition price.

In 2019, Dignity Health saved over $8 million and eliminated more than 596,000 pounds of medical waste by reprocessing single-use devices. Over the last four years, Dignity Health has saved more than $31 million and eliminated more than 1.4 million pounds of medical waste from landfills. To implement a successful reprocessing program, it is critical that all staff members, including surgeons. are educated about the benefits, science, safety, and technology of reprocessing.

Kaiser Permanente implemented its rigorous Environmentally Preferable Purchasing (EPP) Standard in 2017 mandating specific environmental criteria be met in purchasing decisions related to five priority areas – cleaner energy, safer chemicals, less waste, healthier and more sustainable food, and water conservation – and that current and prospective suppliers of products comply with the standard. The EPP program delivers over $63 million in cost savings for Kaiser Permanente. Since its inception, the EPP program has delivered environmental savings reaching approximately 2,400 tons of waste reduced and 87,000,000 kWh saved.

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Community resilience

Climate impacts are threat multipliers for the social determinants of health, affecting the availability of safe and affordable housing, compromising food and water security, and harming community health and safety. As anchor institutions, hospitals can leverage their purchasing power and social capital to protect health, advance equity and justice, and improve the long-term resilience of the communities they serve. Consider the following:

  • Hospitals and health systems are among the largest employers in the U.S., according to a "24/7 Wall Street" analysis.

  • More than 40 million Americans are food insecure; food insecurity costs the health sector an additional $53 billion a year. 

  • Communities of color and low-income neighborhoods will have the greatest exposure to climate impacts and extreme weather events.

Cleveland Clinic hosted a resilience summit in 2017 to bring together hospitals, state, county and city policymakers, community organizations, and neighborhood climate ambassadors to catalyze action and partnerships for a more resilient and healthy Cleveland.  As a founding member of the Cleveland Climate Action Fund, Cleveland Clinic has invested in sustainability projects that meet neighborhood needs such as improved stormwater management, increased clean energy, local food production, and active transportation.

As an Anchors in Resilient Communities project, Kaiser Permanente is investing in the local food economy to build resilience in underserved communities. Located in Union City, CA, the East Food Bay Production Center will provide 200-300 union jobs, prioritize local and sustainable sourcing from producers and processors of color for institutional meal preparation, and help stimulate growth of community-owned businesses around the center. The 56,000 square foot facility will also feature environmentally sustainable building technologies, including a state-of-the-art CO2 refrigeration system, and 270 kW of on-site solar power.

Seattle Children’s offsets 10% of its Scope 1 and 2 GHG emissions through tree planting. Working with a local carbon capture program, Seattle Children’s helps plant native conifer trees in local parks, natural areas, transportation corridors, public spaces and private lands. This partnership works well because tree planting happens in the region the hospital serves, including in under-resourced neighborhoods that lack tree canopy.  Seattle Children’s also hosts an annual demonstration tree planting with staff.

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Infrastructure resilience

Hospitals must be prepared to continue to give care even in the face of extreme weather. Designing hospitals and critical health care settings for preparedness, energy independence, projected sea-level rise, and extreme weather need to become the norm in building design and construction. Consider the following:

When a hospital does not invest in resiliency and an extreme weather event hits, the facility is damaged, loses power, and has to shut down key services. When hospital leadership invests in resiliency, the hospital incurs only minor damages and remains operational to serve its community.

Boston Medical Center secured a state grant and utility incentive to build a natural gas fired combined heat and power plant (CHP). The plant provides an efficient source of power for the hospital as well as “black-start” and “islanding” capability, which means that if the grid goes down, the CHP can still start and provide power for months at a time for critical hospital services. The plant also provides back-up for the City of Boston emergency communications.

Kaiser Permanente implemented the first hospital-based, solar-powered microgrid with battery storage in California in 2016. Kaiser Permanente installed 250 kW of solar and 1 MWh of battery storage at its Richmond Medical Center, reducing utility energy usage by over 350,000 kWh per year and decreasing peak site demand by 100kW. The on-site solar generation and battery storage allow the hospital to power its critical services if both the grid and backup generators fail.

Mass General Brigham’s (formerly Partners HealthCare) Spaulding Rehabilitation Hospital, located on a former brownfield site on the Boston harbor, was built with climate-resilient design features that make it one of the most sustainable and resilient hospitals in the country, and a model for how to use nature as part of a healing facility. Mass General Brigham completed a strategic resiliency plan to prioritize capital investments that address infrastructure and operational vulnerabilities, and shared the customizable RFP they used to execute the study.

After Superstorm Sandy, NYU Langone Health overhauled its power systems infrastructure with a focus on climate resiliency. Key changes included installing an 11 MW combined heat and power plant, new flood protection measures, and emergency boilers to ensure operations can continue during extreme weather events. NYU Langone’s main campus is the first in the world to achieve both PEER and LEED Platinum certifications for power system efficiency, resiliency, and reliability and sustainable building design.

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Transportation

Transportation wields a big footprint for a hospital when you think about the amount of energy going into workforce commuting, patient and family travel, and the transport of patients, goods, and services to and from the hospital. Consider the following:

Mass General Brigham (formerly Partners HealthCare) has a comprehensive transportation program working to minimize the number of single-occupancy vehicles. Over 50% of staff use public transportation and employees are provided monthly MBTA pass subsidies of 35-50%. Mass General Brigham is also exploring the electrification of fleet vehicles, installing electric charging stations, allowing a “connected work program” where 22% of 4,200 employees at Assembly Row work remotely, and sponsoring Boston's Bike Share.

Seattle Children’s Hospital has been leading sustainable transportation efforts by reducing the drive-alone commute trips made by their workforce from 73% in 1995 to 32.5% in 2017. They achieved this by charging daily parking rates, offering generous subsidies and incentives to use lower-impact options, working with the city and county on bike, pedestrian, and transit improvements, and providing personalized commute planning to every new employee.

University of California Health (UCSF) offers its staff, faculty, and students a variety of alternative transportation options and commuter benefits to reduce emissions, traffic, and parking congestion. They have reduced their single-occupancy vehicle (SOV) rate to 26.2% in 2018, and 20% of their commuter population drive hybrid or all-electric vehicles. UCSF operates 15 electric buses, improved the electric fleet vehicles percentage to 24%, installed 38 electric vehicle charging stations, and its bike parking and shower facilities are used by nearly 900 people.

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Less Waste

Given that waste management represents 1 to 5% of U.S. GHG emissions and hospitals produce an average of 30 pounds of waste per patient per day, waste reduction offers a big opportunity for hospitals. Consider the following:

  • Landfilled waste produces methane, a potent greenhouse gas with 28 to 36 times the global warming potential of carbon dioxide over a hundred year period.

  • Incinerators are some communities' largest emitters of mercury, formaldehyde, nitrogen oxide, sulfur dioxide, and other pollutants linked to harmful health impacts including asthma, cardiovascular and respiratory illness, preterm births, and even cancer. Communities with incinerators are also likely to house a disproportionate number of other polluting facilities..

HealthPartners has a comprehensive waste reduction program that delivers significant financial savings. In 2019, 223.69 tons of food waste was diverted from the trash through organics recycling, animal food, and food donation programs. Additionally, 1,712 tons of material were recycled, saving an estimated $336,000, along with 903,820 pounds diverted from hospital and surgery centers’ operating rooms, for a total savings of $2.1 million. Since 2014, the program has also achieved a 9% reduction in paper with an indirect savings of over $1 million.

Moving to a modified room service model, UC San Diego Medical Center at Hillcrest saw a decrease in plate waste from 33% to 9%, resulting in nearly $290,000 savings. The medical center also diverts pre-consumer kitchen and post-consumer patient food waste, collecting over 114,000 pounds of food waste to be composted, diverting over 162,000 pounds of food waste. They have also donated 13,000 pounds of food to local organizations, including the student pantry on campus.

University of Vermont Medical Center (UVMMC) was the first hospital in the country to recycle blue wrap, and they collected 7.5 tons of the material in 2019. UVMMC has continued its leadership in this area, becoming the first hospital in the country to purchase items made from its own blue wrap waste. UVMMC’s blue wrap gets recycled into patient care items and the medical center buys about 38,000 washbasins and 7,500 bedpans of these products annually.

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About the Health Care Climate Council

The Health Care Climate Council is a leadership body of health systems committed to protecting their patients and employees from the health impacts of climate change and becoming anchors for resilient communities. Health Care Climate Council members implement innovative climate solutions, inspire and support others to act, and use their trusted voice and purchasing power to move policy and markets to drive the transformation to climate-smart health care. 

The Council’s mission is to amplify public and private responses to climate change by:

  • accelerating investment in renewable energy and energy efficiency;
  • scaling the health sector’s adoption of climate change mitigation and resiliency programs; and
  • advocating for local, state and national policies that ensure a sustainable and healthy future consistent with our collective vision for healthy individuals and communities. 

Published in October 2017. Revised in July 2020.