Health care has massive potential to tackle climate change!

By Dr. Myles Sergeant

Many of us worry about the negative impacts of climate change and wonder what, if anything, we might do about it in our daily lives. We may make changes such as recycling at home and biking instead of taking the car, but we don’t realize the magnitude of impact we as healthcare leaders can have at work by promoting and supporting a culture of sustainability. As it turns out, the health care sector contributes approximately five percent of the total carbon footprint of our country. This is more than the airline industry! Healthcare is a high emission business and there are massive opportunities to lessen our carbon footprint and put us on the road to sustainability.

Together with other healthcare leaders, PEACH Health Ontario (https://www.peachhealthontario. com) helps to educate hospital leaders, and their employees, on the numerous ways a healthcare organization can get to ‘carbon zero.’ In an effort to help senior leaders, PEACH, in collaboration with the Canadian Coalition for Green Health Care, created a simple guidebook titled “Environmental Stewardship: An implementation Guide for boards, executive leaders, and clinical staff: Meeting hospital standards and beyond.” It provides an overview of some of the key steps and actions that senior leaders can initiate and support for their hospital to move towards a climate-resilient, carbon net-zero, and environmentally sustainable health system.

The rationale behind the guidebook was to create a learning tool which was easy to read, provided a roadmap for leaders, and contained a section which showed the largest greenhouse gas (GHG) saving items to pursue. A checklist in the guidebook illustrates that in order to effectively manage GHG emissions, one needs environmental leaders from many different hospital departments involved in the effort!

Action Items

Leadership

Implementation of a Sustainability Strategy

Appoint a leadership person for sustainability

Divest foundation funds from fossil fuels to low-carbon funds

Education

The Choosing Wisely Canada (CWC) program was developed to educate clinicians on minimizing unnecessary tests and investigations. Hospitals can be recognized for their efforts.

Recognized by CWC as a "Using Blood Wisely Hospital"

Recognized by CWC as a "Using Labs Wisely Hospital"

Recognized by CWC as a "CWC Hospital"

Supply Chain

Facility uses reusable gowns and linens

Hospital has a reusable sharps container program, or equivalent financial and environmental savings.

Operating room (OR) reduces waste by having pick lists for each surgeon

Meant to optimize OR efficiency, operative pick lists, or surgeon’s preference cards, indicate which surgical instruments need to be opened for a given procedure. Studies show that up to 87% of opened items are not used; thus, streamlining lists reduces waste of instruments and instrument wrapping material, reduces emissions required to reprocess and transport instruments, and leads to overall cost reductions.

Drugs And Devices

Pharmacy has a sustainable prescribing strategy

Sustainable prescribing is done to decrease unnecessary medications, errors, interactions, and side effects. It is also important because pharmaceutical production and disposal release a significant amount of GHGs.

We studied the GHG equivalents of 40 of the most common initiatives which hospitals consider to decrease emissions. All of the items were standardized to the same hospital size over the course of a year, and we calculated what the corresponding GHG savings would be. We also considered the cost of the various initiatives. This resulted in the 22 action items listed in the diagram. We found that some of the usual suspects, like replacing boilers and taking active transport to work, did end up on the checklist of high impact items. There were some cost-neutral items which had a major GHG impact, such as increasing plant-rich menu options and adopting sustainable procurement practices. And the items which can actually save money for the organization include such actions as de-prescribing medications and reducing the ventilation rates of operating rooms at night. Most of the items either save money, or cost relatively little.

Desflurane is minimized to less than 5% of OR gases

Anesthetic gases are released directly into the atmosphere following their use, and exert considerable greenhouse effects (higher than CO2). From these, desflurane has the worst GHG burden in comparison to other gases (2200 times more than CO2).

Buildings And Energy

Heating, Ventilation and Air Conditioning (HVAC) Systems are energy efficient

Older generation boilers and chillers produce most of a facility's GHGs. Upgrading to energy-efficient HVAC systems, using ground, air or water sources heat pumps, using wind or solar to generate electricity can further reduce GHGs.

Over 90% of the facility has been converted to LED lighting

Replacing old light fixtures with modern energy-efficient LED fixtures can significantly reduce energy expenditures.

OR ventilation is set back to 8 to 10 cycles per hour, or lower, overnight

Other countries (such as the UK) do not run their OR ventilation at full settings during off-hours, whereas in Canada hospitals may not ‘set-back’ their ventilation settings because of safety concerns regarding infectious diseases. However, there is no evidence that this is an unsafe practice.

Facility, or proposed new build, is LEED Gold standard or higher

New builds operate with minimal GHG emissions.

Facility has a dedicated energy manager or equivalent consultation service

A dedicated energy manager is hired to oversee and optimize all aspects of a hospital’s energy use, and coordinate programs through the hospital.

Food

Plant-based food options to patients are increased by 25%

GHG reductions are associated with providing a more plant-based diet and decreasing the quantity of meat products offered to patients.

Hospital uses a composter for food waste

An aerating composter, whether on-site or as part of municipal waste management system, decreases the amount of GHGs released by food waste.

Transportation

Facility has a secure area to store bikes, or other accommodations that encourage bike riding

Installment of bike stations (ranging in size and cost) can encourage employees to bike to work by providing a safe location to store bikes.

Min. 2% of parking spaces at the facilit y are dedicated to carpooling or EV charging

Car travel by staff, patients and visitors is a significant contributor to GHG emissions within health care. Therefore, encouraging carpooling can decrease environmental impact.

NATURE-BASED SOLUTIONS

The facility has 25% green cover including green roof, food gardens, tree canopy, pollinator gardens and natural grass (except lawns)

Plants absorb CO2 and reduce heat island effect. They provide beauty and evidence suggests plants lead to improved patient outcomes.

While the list of potential actions may seem daunting, it is important to break it down into manageable elements while taking advantage of the growing list of resources available to assist. We are seeing an increasing number of hospital organizations developing sustainability strategies and taking on the challenges of reducing their GHGs and ecological footprint. Most senior-level decision-makers are in positions to oversee drastic reductions in their organization’s GHG emissions.

By way of additional examples, an anesthetist stopping the use of the anesthetic gas desflurane can have a significant impact on an organisation’s overall GHG emissions. A food service or nutrition manager switching to a more plant-rich diet or decreasing food waste can also do their part for a healthier planet.

Finally, consider the impact of a hospital financial lead divesting their foundation’s investments of fossil fuel stocks! For those who want to do a deeper dive, and truly want to wow the people from Accreditation Canada, which has recently introduced new sustainability standards, the Coalition for Green Health Care offers the Green Hospital Scorecard. Started in 2016, the Scorecard allows you to go into a detailed look at various departments, and provides a data-driven outcomes score highlighting your successes and where you have room for growth. Participating hospitals are automatically part of the yearly awards process. In short, once your baseline is created, you are scored in successive years and compared to your own score and that of your peers. https://greenhealthcare. ca/ghs/ Climate change is a significant societal problem, but fortunately it is a problem we can mitigate. As health care leaders we are in positions of influence, and can step forward, empower our colleagues, and make great change happen! Visit www.greenhealthcare. ca to learn more. n H

Health Ontario – myles@greenhealthcare.ca

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