As climate change continues to impact our world, more industries are looking for solutions to lower carbon emissions, and the healthcare system is no exception. In a new Sounding Board published in the New England Journal of Medicine, researchers at Baylor College of Medicine and other institutions propose strategies to advance the industry into a net-zero emissions future, beginning with mandatory emissions reporting from U.S. healthcare organizations.
"Excessive greenhouse gas emissions are causing preventable harm to our patients, the healthcare workforce and society," said Dr. Hardeep Singh, lead author of the report and professor of medicine at Baylor and the Michael E. DeBakey VA Medical Center. "Decarbonization should be an essential component of quality improvement efforts. We propose that all healthcare organizations should start measuring and reporting greenhouse gas emissions for transparency, accountability and improvement purposes."
"Voluntary initiatives are clearly not working. Healthcare organizations lag behind other industries in environmental performance reporting when they should be leading in matters pertaining to good corporate citizenry for healthier populations," said Dr. Jodi Sherman, senior author and associate professor of anesthesiology at Yale School of Medicine. "Mandatory standardized transparent reporting through trusted governmental entities is essential to prevent greenwashing, identify best practices and ensure rapid progress as called for by the scientific community."
Currently, healthcare organizations, with the exception of those operated by the federal government, are not required to report their carbon emissions output. Without this data, the environmental impact of non-federal healthcare systems cannot be accurately accounted for, making it difficult for this industry to meet the United Nations' Intergovernmental Panel on Climate Change goals of reducing overall carbon emissions around the world. Singh and colleagues propose that all healthcare organizations should now start reporting their greenhouse gas emissions.
"The implementation of standardized metrics for reporting healthcare greenhouse gas emissions is essential to quantify progress, identify best practices and ensure accountability," write Singh and colleagues. "Other countries have begun measuring, setting targets and implementing interventions to achieve healthcare decarbonization goals."
The team proposes use of international frameworks and standards already being used in other industries to help calculate total greenhouse gas emissions for healthcare organizations. This framework consists of three scopes: greenhouse gases emitted directly from healthcare facilities, those emitted indirectly through purchased energy, and all other indirect emissions, including emissions from purchased goods and services, employee commuting and waste management.
"U.S. healthcare contributes to 8.5% of U.S. emissions, the majority of which comes from purchased goods and services. Overconsumption of resources and inappropriate care comprise about 30% of all healthcare so there is an opportunity here to reduce unnecessary tests, treatments and procedures," Singh said.
Reporting on these metrics is only the first step in reducing the industry's carbon footprint. Authors believe healthcare organizations also will need to designate leadership responsible for decarbonization that is committed to implementing measurement activities and improving healthcare infrastructure, supply chain and delivery processes to reduce pollution while maintaining or improving quality of care. The authors acknowledge that all healthcare organizations are resource constrained and will need support and guidance on measurement and reporting. They add that healthcare policy changes should create these support mechanisms, including the development of a standardized and systematic reporting structure for performance tracking and external accountability.
"Healthcare pollution harms human health, similar in magnitude as harm due to medical errors. Healthcare pollution prevention requires its own accountability efforts, similar to those dedicated to preventing direct harm from medical errors, that can be incorporated into existing patient safety and quality infrastructure," Sherman said. "Actions proposed herein could accelerate the transition to a sustainable future."
Singh is supported by the Houston VA Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
Other authors of the Sounding Board are Dr. Matthew Eckelman with Northeastern University and Dr. Donald M. Berwick with the Institute for Healthcare Improvement.
