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How hospitals can improve their sustainability, and why they should get moving


Health systems are facing growing pressure to address climate change. A panel at the American Hospital Association Leadership Summit outlined strategies to move forward.

Health leaders discuss sustainability at the American Hospital Association Leadership Summit in San Diego on July 19. From left, Simrit Sandhu, Vizient executive vice president; Shelly L. Schlenker, CommonSpirit, executive vice president and chief advocacy officer; Mark Howell, AHA's associate director, policy and patient safety; and Nancy Foster, AHA, vice president for quality and patient safety policy.

Health leaders discuss sustainability at the American Hospital Association Leadership Summit in San Diego on July 19. From left, Simrit Sandhu, Vizient executive vice president; Shelly L. Schlenker, CommonSpirit, executive vice president and chief advocacy officer; Mark Howell, AHA's associate director, policy and patient safety; and Nancy Foster, AHA, vice president for quality and patient safety policy.

Hospitals and health systems are facing more demands to reduce their environmental impact, and the pressure is coming from several areas.

The federal government is taking a greater interest in seeing hospitals reduce their emissions. The healthcare industry is responsible for 8.5% of America’s carbon emissions, federal officials say.

House Ways and Means Committee Chairman Richard Neal, D-Mass., sent a letter to hospital systems asking them what they are doing to reduce emissions. In addition, health system boards, employees, environmental advocates, and bond rating agencies want to know what hospitals are doing to address sustainability.

Health leaders addressed sustainability during a panel discussion at the American Hospital Association Leadership Summit last month.

The health ecosystem must be built around making the right decisions from an environmental and sustainability perspective, said Simrit Sandhu, Vizient’s executive vice president for strategic transformation and clinical supply solutions.

“This cannot be an initiative,” Sandhu said. “This has to be the new normal.” (Shelly Schlenker of CommonSpirit Health spoke to Chief Healthcare Executive at the AHA Leadership Summit. The story continues after the video.)

‘The business case’

Shelly L. Schlenker, CommonSpirit Health’s executive vice president and chief advocacy officer, stressed the importance of getting health leaders to see the financial benefits of sustainability efforts.

“In every instance, you can make the business case,” she said.

By reducing energy costs, Schlenker said, “That’s money in your pocket.”

She pointed to Dignity Health switching to LED lighting. The bulbs are more expensive, but they use much less energy and the system saves substantially in the long run. By investing a couple million dollars in LED bulbs, the system saved $10 million, Schlenker said.

Health system boards are increasingly interested in tackling sustainability, but they need to see the savings, panel members said.

The board “is going to want to see that financial benefit,” Sandhu said.

The supply chain

Perhaps the most complex challenge facing hospitals in improving their sustainability involves dealing with the scores of vendors in their supply chains, health system leaders said.

The supply chain may be the most difficult to mitigate because it is the most challenging to measure for environmental impacts, said Mark Howell, the AHA’s senior associate director of policy and patient safety.

Hospitals have dealt with a host of supply challenges throughout the pandemic, from personal protective equipment to the contrast dye used in imaging. The pandemic has shown the need to look for more sustainable supply solutions, including developing more supply sources domestically or at least closer to America, Howell said.

The shortage of contrast dye in the spring largely stemmed from the lack of production from a plant in Shanghai, which was on lockdown for weeks.

“COVID has forced our hand on revamping the supply chain,” Howell said, adding, “I’m not sure we have another chance than right now to take those steps.”

Health systems can work gradually with vendors to move toward more sustainable products, first by educating them and then eventually putting it in contract language, Schlenker said.

Form a green team

Health systems looking to improve sustainability should form a green team.

Rather than relying on the CEO, systems should embed a green team in the organization to lead sustainability efforts.

“The younger workforce is passionate about climate work,” Howell said. “If they are engaged and involved in a team, it’s a win-win.”

CommonSpirit has green teams at its hospitals, Schlenker said. Members volunteer to serve on green teams that meet monthly, and the system offers time on their regular shift for meetings.

Start small

Many hospitals say they don’t have the resources to design green buildings, Howell said, but health systems can start with manageable remedies.

Health systems can go with one easy fix by making sure workers power down their computers before they go home. Moving to LED bulbs is another step that pays off from a business perspective, he said.

Health systems can start by using anesthesia that’s less harmful to the environment. “It’s not only better for the patient’s health but it’s less expensive,” Schlenker said.

The American Society for Health Care Engineering’s “Energy to Care” program helps health systems track their electricity spending, emissions and offers mitigation strategies, even for limited budgets.

After building some initial steps to make progress and build confidence, Howell said, then it’s possible to “have the conversation about the bigger investments.”

Investors are watching

Investors are more commonly associated with a different kind of green, but they are interested in how hospitals are tackling sustainability.

“If your CFO hasn’t spoken to you about this, they will,” Sandhu said.

Investors are increasingly worried about the business impact of climate change, she said.

“This is a business risk, so the conversation’s changing,” Sandhu said.

“You’re seeing the investment community speak up, you’re seeing the bond rating community speak up,” she added. “That’s going to be a major driver.”

Bond rating agencies, Schlenker said, “are looking at what we’re doing.”

Improving patient care

Health systems need to understand clean air and water are social determinants of health, and pollutants have a direct impact on health outcomes, Sandhu said.

“Our argument is this is about patient safety,” she said.

Rachel Levine, the assistant U.S. secretary for health, hammered that point home in a speech delivered for the AHA Leadership Summit. Speaking via video, Levine said some sustainability measures will save money.

“The more money you’re going to save and the better you’re going to be able to take care of patients and communities,” Levine said.

Health leaders have focused on the tie between reducing environmental impacts and improving health equity. As panelists noted at the AHA summit, members of minority groups and those in less affluent areas suffer greater impacts of emissions and pollutants.

“It is the poor and the vulnerable that suffer,” Sandhu said.

Move before mandates

President Biden’s administration has been focused on the healthcare industry and climate change. Biden established an Office of Climate Change and Health Equity within the U.S. Department of Health and Human Services, although Congress has yet to provide funding, The Washington Post reported.

The Centers for Medicare & Medicaid Services has been reaching out to healthcare groups to determine the challenges and barriers for hospitals in addressing climate change, Howell said.

The American Hospital Association would have concerns about the government tying federal aid to sustainability initiatives, Howell said. Hospitals need “helpful information and support,” he said.

Members of Congress are interested in what health systems are doing on sustainability, but Howell said it’s unclear if any legislation will emerge. “There’s a lot of potential for something to happen on the Hill. It’s unclear if something will yet,” Howell said.

Schlenker said health systems should voluntarily decide on ways to measure progress in sustainability and work to reduce environmental impacts, before government mandates are imposed.

“If we don’t do it together, the government is going to do it to us,” Schlenker said.

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