Health care systems account for about 10% of the carbon dioxide emitted annually in the USA. In fact, American hospitals produce approximately 6 million tons of waste each year and use approximately 7% of all water consumed in commercial and institutional settings. As climate change becomes a daily reality rather than just a future possibility, major hospital systems are actively pursuing ways to reduce their carbon footprint. In this series, IEEE Pulse explores what steps are being taken and what challenges remain in conversation with different health care systems. This feature focuses on the climate change goals of Providence Health and Services.
Providence Health and Services is one of the largest nonprofit health systems in the USA. And when it comes to reducing carbon emissions, it’s also one of the most ambitious.
• Who they are: A nonprofit, Catholic health care system with headquarters in Renton, WA, USA, that includes 52 hospitals and more than 1000 nonacute facilities, supportive housing and educational services in Alaska, Washington, Oregon, and California, as well as Montana, New Mexico, and Texas.
• What they’re doing: Most aggressive climate goal of any system in America according to Gary Cohen, founder of Health Care Without Harm; impressive process coordination across many departments internally; excellent example of changing out anesthetic gases through clinical leadership; integrating climate/equity work with social determinants of health.
• Climate goal: To become carbon negative by 2030.
By 2030, the Washington-based health care system intends to become carbon negative, eliminating not only direct carbon emissions from its own facilities but indirect emissions from any utilities it purchases as well as indirect emissions from companies that supply the group of 52 hospitals and 1000 nonacute facilities with equipment, services, and food. In climate parlance, that means Providence Health intends to meet scopes 1–3 of the International Greenhouse Gas Protocol. If it is successful, it will have cut 40,000 metric tons of carbon dioxide emissions by 2021 and more than 400,000 metric tons by 2030.
“That’s an enormous lift,” says Beth Schenk, executive director of Environmental Stewardship at Providence. “That’s really the whole range of our climate impacts.”
Knowing the challenges ahead, Providence created Schenk’s role of “environmental stewardship leader” and came up with the acronym WE ACT, a slogan to help motivate and inspire employees. WE ACT stands for waste reduction and segregation, energy and water efficiency, agriculture and food, chemical reduction, and transportation that is less polluting.
“The mnemonic is very important for us in our messaging because this is something that takes all of us to accomplish,” says Schenk. “This is not something that our small team can do, or one state can do, or one part of our health system.” The phrase was meant to galvanize Providence’s 120,000 employees into action. They are, after all, the people “making decisions about what to buy or about how to run a facility, the power plant, or how to dispose of different products in a very complex waste stream,” she adds. “All of those decisions add up to our carbon footprint.”
Providence’s sustainability strategies mirror those of other large systems like Cleveland Clinic and Kaiser Permanente. They are talking to vendors along the supply chain about reducing carbon footprint at each step, while seeking to cut their own waste. But if there is one area in which Providence stands out, it’s in its strict attention to the metrics, or what it calls its “WE ACT Scorecard.”
Knowing the numbers
Developed at Providence’s Global Center, India, where 400 employees build apps and work in the health system’s tech support, the WE ACT scorecard tabulates every detail—the amount of energy used, volume of water, tons of waste produced, the cost, and carbon emissions in each category in the WE ACT framework for all of Providence’s 52 hospitals. In 2022, the scorecard will roll out to the system’s 1000 nonacute facilities. “Any site can take a look at the cost, usage, and carbon footprint to date,” says Schenk. “I’ve been working in this field for a long time—20 years—and we have never had this clarity of data.”
According to Schenk, the system has been able to see dozens of normalized metrics at any acute site and compare this to other sites. Examples include the kilowatt hours of electricity used per square foot, or gallons of water per adjusted patient day, or CO2 emissions from anesthesia per number of anesthesia machines at a given site. “This is enormously helpful in getting a clearer picture of efficiency, cost, and carbon pollution,” she adds.
Attention to anesthetic gases
One advantage of knowing the numbers is that you can discover waste you never knew existed. Like many other hospital systems, Providence knew that the inhaled anesthetic gas desflurane is a greenhouse gas that is 2000 times more potent than carbon dioxide. It has encouraged physicians to reduce the use of the gas, with the help of Portland physician Brian Chesebro, a well-known proselytizer for less harmful gases like sevoflurane, which he uses in his own surgeries.
But they hadn’t focused on the issue of nitrous oxide—used in operating rooms, radiology centers, cardiac catheterization labs, dentist offices, and sometimes during labor and delivery—until they realized that something odd was happening at the St. Patrick Hospital, Missoula, MT, USA: nitrous oxide was disappearing. When the hospital switched from an in-wall delivery system to cylinders, purchase volumes plummeted. “For reasons that we’re still unpacking, a lot of the nitrous that we purchase appears not to be going to patients,” says Schenk. “What we found is there’s a lot of leakage.”
“We are now developing a playbook for best practices with nitrous oxide,” she adds. “This does involve anesthesia providers, but it also really involves the facility staff—the people running the buildings—because they manage the pipes, the valves, the manifolds, and all the other elements that are necessary to deliver medical gases safely. Nitrous oxide wastage is a sleeper issue across the nation. At this point, it’s a significantly bigger challenge for us and a bigger source of greenhouse gases than are our inhaled agents.”
In their effort to meet scope 3 of the International Greenhouse Gas Protocol, Providence is measuring and monitoring employee business travel, including flights, hotels, and rental cars. It is also monitoring the carbon emissions of caregivers who must drive during the course of a day to other hospitals or to deliver hospice care.
Thanks to the pandemic, Providence was able to cut back on business travel flights by 90% in 2020 compared to 2019. (The total reduction for all business travel, including hotels, rental cars, and reimbursed miles, was 67%.) In 2021 and beyond, the organization aims to keep business travel at 25% of what it was in 2019. Schenk says about 15% of caregivers now work remotely and will continue to. Providence also is encouraging employees to seek more sustainable commuting options by, for example, installing electric vehicle charging stations on hospital grounds.
“We want people to get where they need to go but we also need to be true to the fact that transportation is the biggest contributor to greenhouse gases, now bigger than buildings since 2018, according to the EPA,” says Schenk. “So, we need to address it.”
These steps are helping build a cleaner, and healthier, future for everyone.
For more information on sustainability in health care, see “Meeting the Green Health Challenge” in the September/October 2021 issue of IEEE Pulse, and “A Move Toward Sustainability in Health Care” in the January/February 2022 issue. Next in the series: Driving Markets Toward a Greener Future.