Climate change is here, now, in our backyard – but there is much we can do about it. The pollution generated by our healthcare practices, specifically the hospital system generated pollution is killing Americans. Greenhouse gas emissions associated with healthcare are an alarmingly large slice of the pie – 4.6% of total emissions worldwide, and a whopping 8.5% of all greenhouse gas emissions in the U.S are emitted by healthcare systems. Today, particulate pollution alone causes over 350,000 deaths in the United States and over 9 million deaths globally.2 That is, 16% of deaths globally are caused by pollution and now many additional deaths by climate change. For perspective that is three times more deaths than AIDS, Tuberculosis, and malaria combined.2
Providers and physician leaders are driven by an inherent desire to serve by furthering community health goals in times of prosperity and particularly in times of crisis – such as the most recent COVID-19 pandemic. The “First Virtue” to do no harm extends provider responsibility to transform health system operations to adopt a population-level view of the impacts on their patients and communities of their organizational operations. The top five things that providers can do to lead on climate change are:
1. Lead with courage and discipline
The first step in creating change, is for providers in every discipline to admit that we are part of the problem and we have the power to change our ecosystem. Providers and physician leaders in particular to lead and to serve improving the health and wellbeing of their communities
The negative effects of the healthcare delivery system are best innovated by providers that understand the complex regulatory and technological advances that exist in their environment. Albert Einstein once said that “Problems cannot be solved at the same level of thinking that they were created”. Providers, and not regulators or industry “outsiders” are best placed to drive healthcare and planetary wellness ahead of the curve by employing sustainability-levers.
2. Take on organizational leadership roles and lead with discipline and durability
Making progress on ‘north-star’ goals is a strategic, mission-driven intention that will result in some difficult conversations, decisions and detractors voicing lack of support. The discipline in this cascading, long-term and ever-evolving success story is the phased approach in which values-based leadership is driving change. Intentional investments in pilots can result in successes that provided capital for further investment into transformative projects that ultimately result in creating an agile organization.
What we tolerate, we support. So, once we have had the courage to acknowledge our failings, and discipline to carry our message forward, we will need durability to adapt and re-engineer when our initiatives are met with obstacles. At Gundersen, initially, all sustainability initiatives had to be approved by the board. Now, while all team-members are aware that any infrastructure related project may face delays, shortages or require re-evaluation before launch, the healthcare leaders in particular, have a level of durability in the face of any transition.
3. Embed sustainability in organizational strategy and in the mission statement of your department
The first step in designing a sustainable operating model is to learn how to recognize when the right thing is being done wrong. Recognition is critical. Healthcare organizations will need to embed sustainability into their strategic plans going forward, and should begin the early work of crafting a vision for the future and understanding their current state gaps.
Whether the scope of embedding innovation is in a provider service lines or at an enterprise level, sustainability is a strategic pillar for:
- Cost-avoidance- avoiding rising energy expense and in the handling of biohazardous waste and worker safety
- Cost reduction particularly as it relates to waste prevention strategies in energy, pharma, tech
- Reimbursement and value based contracting opportunities – particularly if population health benefits can be tied to reduction or elimination of hazardous substances from the community.
- Compliance considerations as The Joint Commission and CMS are committed to requiring sustainability metrics in the future
4. Invest in innovation
Today, healthcare workers should be leading the “War on Climate Change” by reducing greenhouse gas emissions caused by the health sector, particularly those caused by hospital supply chains that drive the majority of emissions that cause climate change. There are a number of opportunities for providers to create drop-in replacement changes and wide-spread transformations that will embed sustainable practice conditions. Wherever possible, providers can explore innovation opportunities to:
- Create sustainable operating rooms
- Prescribe or use reprocessed medical devices that reduce the total cost of care
- Consider switching to the use of green anesthetic gasses
- Prevent waste through re-use of surgical masks, gowns, and surgical materials where possible
- Address biomedical waste that now ends up in groundwater or in the form of air pollution
- Work with labs and others outside of healthcare to research and develop sustainable solutions for waste prevention: Consider the effect of formaldehyde-waste handling alone- a chemical that meets its end of life in landfills and is a complex chemical to safely dispose of, since dilution and other strategies for waste disposal do not work
- Prescribe greener alternatives: Hydrofluorocarbon (HFC) propellants used today in pressurized metered-dose inhalers (pMDIs) prescribed for patients with asthma have many times the global warming potential than that of carbon dioxide. This is an opportunity to switch patients to dry powder inhalers (DPIs)
5. Create partnerships!
Partnerships deepen collaborative relationships and allows organizations or departments to scale innovative solutions. Particularly for sustainability, Harald Tepper, Sr. Director of Sustainable Development at Royal Philips NV recommends creating partnerships with external stakeholders- even competitors and firms outside the healthcare space. This will help optimize nascent health system capabilities but more importantly, they can help address industry level barriers.
For Gundersen Health, their initial partnerships included local small businesses that served as co-investors and strategic communicators for the organization’s mission. Since then, the partnership ecosystem for the health system has steadily deepened –we encourage all leaders to think strategically about such collaborations:
- Academic partnerships: Collaborations with medical schools or departments are valuable in investigating key environmental and health issues that could be impacting the local population. In addition, such collaborations further innovation and provide a platform for promising solutions to be identified through start-up competitions, invested in and absorbed into the care delivery pathway.
- Pharmaceutical collaborations can improve access to care, medication and improve the supply chain
- Association collaborations: Associations such as Practice Green Health and Healthcare Without Harm provide a platform for health systems around the country collaborate on broad, industry wide issues that affect players across the care delivery ecosystem. Achieving energy independence, addressing electronic waste, and markedly improving ESG outcomes are the broader global issues that can only be solved through cross-industry collaboration
Dr. Jeff Thompson is the former CEO of Gundersen Health System, pediatrician, and author of Lead True: Live Your Values, Build Your People, Inspire Your Community. Gundersen was nationally recognized for higher quality, lower costs and dropping its greenhouse gases by 95%. Dr Thompson spoke at the Paris climate talks and was honored by the Whitehouse as a champion for change. He has served as the board chair of Healthcare Without Harm.
Dr. Urvashi Bhatnagar is a healthcare executive, physical therapist and author of “The Sustainability Scorecard: How Firms can Implement and Profit from Unexpected Solutions.”
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