IEEE PULSE presents

A Move Toward Sustainability in Health Care

Feature January/February 2022
Author: Pamela Reynolds

From eliminating some anesthetic gases to creating their own microgrids, more hospitals are looking for ways to cut carbon emissions.

Like any large health care system, Cleveland Clinic goes through a lot of disposable cups each year. To be exact, employees, patients, and visitors at the multispecialty academic center with locations in Ohio, Florida, Nevada, London, and Abu Dhabi, use about 12 million polystyrene cups a year, or an average of 180 cups for every caregiver. 

But in 2019, the health care provider decided that such a high level of waste was unacceptable. The clinic began to phase out polystyrene cups across all its facilities in favor of paper cups. In 2021, workers and visitors at Cleveland Clinic used zero polystyrene cups. 

“Trust me, this became an intensive, longer than I care to admit, study on cup options,” says Jon Utech, senior director of the Office for a Healthy Environment at Cleveland Clinic. “We looked at compostable. We looked at paper. … We looked at all different kinds of environmental life cycle studies on different options.”

The careful attention paid to the lowly disposable cup is just one example of a growing focus on sustainability in health care. As climate change becomes a daily reality rather than just a future possibility, dozens of hospitals and health care systems in the United States have announced plans to decarbonize, among them seven Boston-area teaching hospitals and clinical institutes as well as six medical centers affiliated with the University of California [1], [2]. Meanwhile, Columbia University Medical Center in New York and the Shands Cancer Hospital at the University of Florida, Gainesville, FL, USA, have received LEED certification from the U.S. Green Building Council for their healthy, efficient, and cost-saving green buildings. In 2021, Practice Greenhealth, a membership organization of health care organizations committed to sustainable practices, recognized more than 270 hospitals across the country for initiating “superior” programs in environmental sustainability.  

The push to become “green” comes in recognition that the health care industry is a significant driver of greenhouse gas emissions. According to The Commonwealth Fund, the health care system accounts for about 10% of the carbon dioxide emitted annually in the USA [3]. American hospitals produce approximately 6 million tons of waste each year and use approximately 7% of all water consumed in commercial and institutional settings [4], [5]. Health care facilities consume close to 10% of the total energy used in U.S. commercial buildings and spend more than US$8 billion on energy every year. Globally, the health care sector is responsible for about 4.6% of worldwide greenhouse gas emissions [6].

As health care organizations begin to confront the issue of climate change, they’ve recognized the need to clean up their act. Doing so not only helps the environment, but, also, they’ve found, their budget [7]. They are rethinking everything from the meals they serve in the cafeteria to the anesthetics they use in the surgical suite. 

As part of our continuing series looking at sustainability in health care, we’ve talked to three large health care systems taking aggressive action to lower their carbon footprint.  First up is Cleveland Clinic, which has pledged to become carbon neutral by 2027. 

Cleveland Clinic: Linking energy efficiency to patient health

Who they are: A nonprofit academic medical center consisting of 19 hospitals, including a 173-acre main campus near downtown Cleveland, and more than 220 outpatient facilities and locations in southeast Florida; Las Vegas, NV, USA; Toronto, ON, Canada; Abu Dhabi, United Arab Emirates; and London, U.K.

What they’re doing: “Major cost savings through a variety of sustainability strategies; support for community-based climate ambassadors; advocacy at state and national levels for climate/renewable energy and energy efficiency policies; building resilience into infrastructure in Florida hospital in the face of climate threats,” according to Gary Cohen, president and founder of Health Care Without Harm, a non-profit organization that seeks to reduce the environmental impacts of health care.

Climate goal: To become carbon neutral by 2027.

In some ways, Cleveland Clinic’s goal to become carbon neutral by 2027 is more measured than other large hospital systems. Jon Utech, senior director of the Office for a Healthy Environment at Cleveland Clinic, attributes this lag to geography, as some states incentivize renewable energy while others don’t.

But even without the incentives, Cleveland Clinic, an international system of 19 hospitals headquartered in Ohio, has managed to build a comprehensive strategy to address climate change. The hospital’s sustainability team, made up of seven people with expertise in energy, waste, water, climate, purchasing, community, sustainable food, green building, and healthy chemicals, has found myriad ways to improve the organization’s carbon footprint, from turning off lights when rooms aren’t in use, to “green” procurement of hospital supplies, to rethinking building design. Everything has been on the table, even a climate resiliency initiative to plant trees

“We’re a group run by doctors,” says Utech. “So, to get these energy programs, we have physician-champions who help us highlight the importance of this work because ultimately we relate this work to our patient care. When we use less energy, we create less pollution, which makes the patients and communities that we serve healthier. We link this energy efficiency work to patient health, and that helps get people on board with what we’re doing.”

Changing out the lightbulbs

A relatively simple climate-friendly change was to install LED lights in new construction and retrofit older buildings. Since lighting makes up one-sixth of Cleveland Clinic’s energy footprint organization-wide, it was a small adjustment with major impact. The group estimates that installing more than 500,000 new bulbs in hospitals, family health centers, and administrative spaces has resulted in a 4% reduction in the organization’s carbon footprint. 

Across the campuses, temperatures were reset and building equipment optimized. Such changes saved the organization US$362,000 a year in utility bills while reducing annual energy consumption by more than 1.5 million kilowatt hours—the greenhouse gas equivalent of removing 236 passenger vehicles from the road for one year. 

“We’re down 26% in carbon emissions total and down 33% when you track that on a per square foot basis, which is the amount of carbon per square footage of buildings that we operate,” says Utech.

Greener operating rooms

A big energy hog in any hospital is the operating room (OR). According to Practice Greenhealth, ORs consume between three to six times more energy per square foot than elsewhere in a hospital, thanks to energy-intensive surgical lighting systems and a high number of required air changes per hour. Strict temperature and humidity regulations also require energy-intensive air systems. (In addition to using lots of energy, ORs also produce more than 30% of a facility’s waste, says Practice Greenhealth). 

With 215 operating rooms across the Cleveland Clinic health system (there are 86 operating rooms just on the main campus alone), it was obvious that big OR-specific changes were needed. Cleveland Clinic dropped the number of hourly air changes in its ORs from 35 an hour whether the OR was in use or not, to 20 when the OR is in use and just 6 when the room is unoccupied. This one simple change resulted in U.S. $2 million in energy savings annually. 

Cleveland Clinic also installed high efficiency and low-flow faucets, toilets, and showers in new construction and retrofitted older buildings with updated efficient fixtures. In new construction meeting LEED standards, the organization also captures rainwater, installed high-efficiency sprinkler systems with moisture sensors, and planted drought-tolerant plants. In 2015, the clinic set a goal to reduce its water consumption by 10% by 2027. By 2019, it had already reduced water use intensity by nearly 3%. 

Attention to the supply chain and a Green Revolving Fund

Cleveland Clinic has hired a project manager whose job it is to evaluate all products it purchases and suppliers it uses through an environmental lens. The manager keeps track of each vendor’s sustainable supply chain rating, advocates for sustainable products and integrates sustainability criteria into supplier agreements. Any products they buy should be made with materials that minimize resource use and waste generation, have minimal packaging, and a small transportation footprint. They should also not be made of polyvinyl chloride (PVC) or di-2-ethylhexyl phthalate (DEHP), should be recyclable, renewable, and made in a way to reduce hazardous waste.

Like other systems, Cleveland Clinic has a goal to divert 100% of nonhazardous waste from landfills by 2027 and like other systems, it is working toward buying more local and sustainable foods for patients and employees. But where it differs is that it’s created a US$7.5 million Green Revolving Fund (GRF) to support ongoing green projects, like upgrading building systems and equipment. Any savings resulting from energy efficiency are plowed right back into the fund.

Redesigning the medical school curriculum

One of its most significant changes has been a redesign of its medical curriculum to incorporate the reality of climate change.

“We’ve actually changed the entire curriculum of medical school to incorporate that into our education, which is a longer-term strategy, but a really important one,” says Utech. “One of things that is true of physicians, nurses and other health care professionals my age is they didn’t learn about climate change in med school. A lot of them learned about it because they’re interested. But now they need to start asking questions and changing the way they practice accounting for these climate change health impacts that are happening today.”

Next: Providence Health and Services Has Ambitious Goals by the Numbers.

References

  1. Harvard, “Decarbonizing health care,” Dec. 19, 2018. [Online]. Available: https://hms.harvard.edu/news/decarbonizing-health-care
  2. University of California, “All University of California academic health centers receive environmental sustainability awards,” Jun. 16, 2020. Accessed: Nov. 19, 2021. [Online]. Available: https://www.universityofcalifornia.edu/press-room/all-university-california-academic-health-centers-receive-environmental-sustainability
  3. Commonwealth Fund, “To be high performing, the U.S. health system will need to adapt to climate change,” Apr. 18, 2018. [Online]. Available: https://www.commonwealthfund.org/blog/2018/be-high-performing-us-health-system-will-need-adapt-climate-change
  4. Research Nester, “U.S. medical waste management market to attain USD 5.25 billion by 2027;
    grim effects of clinical waste on nature and
    human safety to create opportunities for market growth throughout 2020–2027,” Nov. 19, 2020.
    [Online]. Available: https://www.globenewswire.com/en/news-release/2020/11/19/2130017/0/en/U-S-Medical-Waste-Management-Market-to-Attain-
    USD-5-25-Billion-by-2027-Grim-Effects-of-
    Clinical-Waste-on-Nature-and-Human-Safety-to-Create-Opportunities-for-Market-Growth-Throughou.html
  5. Practice Greenhealth. Water. [Online]. Available: https://practicegreenhealth.org/topics/water/water
  6. M. J. Eckelman et al., “Health care pollution and public health damage in the United States: An update: Study examines health care pollution and public health damage in the United States,” Health Affairs, vol. 39, no. 12, pp. 2071–2079, 2020.
  7. C. Thiel and T. Whelan, “If hospitals made efforts to go green, health care costs would go down,”  Fortune, Sep. 2019. [Online]. Available: https://fortune.com/2019/09/05/health-care-costs-sustainability/ 

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