For hospitals and other healthcare providers, measuring scope 3 emissions (i.e., emissions from suppliers) has already been a hot topic for a few years. However, until recent months, government institutions and agencies have largely stayed out of it, leaving it to hospital administrators to voice their demands to manufacturers and distributors. No clear pathways were available to address those demands, and no accountability existed for the suppliers that contribute the largest share of hospital carbon emissions.
Being able to measure carbon emissions is a necessary starting point in creating healthcare climate change. Health Care Without Harm and Practice Greenhealth have played an important role in making tools available for this, including Practice Greenhealth’s Health Care Emissions Impact Calculator.
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However, measurement without accountability does not drive change. Carbon emissions measurements need to be accompanied by tools for leveraging said measurements in new initiatives and practices, and they need the involvement of institutions that can punish and reward carbon emissions behavior, directly or indirectly. The individual hospital—or hospital system—has very little power to affect the behaviors of the gigantic suppliers and distributors of the healthcare industry. Hospitals have increasingly sought to change the behaviors of their suppliers, specifically by asking for carbon emissions data and life cycle analyses (LCAs) of environmental impact. Some are even favoring suppliers that can demonstrate better climate responsibility than others. However, most hospital acquisition decisions are made under semi-monopolistic market conditions. After all, it’s not easy to switch from the supplier preferred by the doctors—or from the supplier that provides alluring volume discounts. As a consequence, real change is delayed.
Hospitals may now be getting some help. In recent months, we’ve seen several government institutions actively engaging this challenge—an encouraging step forward. However, these initiatives currently stop short of providing the teeth that our industry requires to ignite meaningful improvements.
The Joint Commission’s Sustainable Healthcare Certification
The Joint Commission launched its Sustainable Healthcare Certification. It describes the certification thusly: “Across the health care sector, hospitals and health systems are pursuing decarbonization efforts without a common framework for setting priorities, creating baselines, and measuring and documenting greenhouse gas (GHG) reductions across the industry. This certification provides a framework to help organizations expand or continue their decarbonization efforts and to receive public recognition of their commitment and achievements in contributing to environmental sustainability.”
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The certification guidelines tout five benefits associated with the certification: Environmental impact reduction, cost savings, improved health outcomes, enhanced reputation and community engagement, and regulatory compliance and risk mitigation. These are all important for hospitals, but the “reward” isn’t exactly tangible, nor does it focus on the overwhelming impact of scope 3 emissions. Demanding climate accountability from suppliers has a greater climate impact than stopping the use of plastic cups in the cafeteria or growing organic food on the hospital rooftop.
Further, there is really only one requirement for the certification: that the hospital can demonstrate improvement over 24 months on three identified greenhouse gas emission sources. The problem with this certification is right here: When you set the bar low, you get broader participation, but results will be unimpressive. Why would I strive for a certification that everyone has?
The National Academy of Medicine’s Sustainability Journey Map
Meanwhile, the National Academy of Medicine has launched its Sustainability Journey Map. The Academy states: “The Sustainability Journey Map & Resource Repository is an interactive visual that intends to support health care suppliers in initiating or accelerating their decarbonization and sustainability efforts.” The journey map outlines five stages of the sustainability journey: understanding and navigating the regulatory landscape; governance and organizational planning; tackling scope 1 and 2 emissions; tackling scope 3 emissions; and continuous improvement. Importantly, the journey map is aimed at healthcare suppliers, and is therefore much broader and potentially impactful in terms of hospital scope 3 emissions.
The map comes with resources, planning templates, and a bunch of other tools. Compared with Joint Commission’s certification, this is much more involved and will require more resources and more organizational commitment.
What’s in it for the hospital? Well, for the hospital that is 100 percent committed to carbon reduction, this will create real—and positive—change. However, the “Journey Map” suffers from the opposite problem of the Joint Commission certification: The engagement and resource commitment needed will leave precious few healthcare suppliers actually “taking the journey,” especially because there is no tangible punishment or reward involved.
SEC’s climate rules
Most recently, a third initiative came from a government agency, and this initiative is likely to be more impactful. I am talking about the proposed U.S. Securities and Exchange Commission (SEC) climate rules: Rules to Enhance and Standardize Climate-Related Disclosures for Investors. The proposed rules would “require companies that are publicly traded in the United States to report detailed information about risks to their businesses posed by climate change, including ways the businesses could be harmed by the escalating climate crisis and risks associated with their own contribution to climate change.”
In healthcare, the rules would only directly impact certain publicly traded for-profit entities, but this type of disclosure tends to trickle down even to organizations with no formal requirement, as these have an interest in emulating the practices of larger, more regulated institutions. In a best-case scenario, we would see publicly traded hospital systems creating standards for such reporting—and then smaller private hospitals adopting these standards (to gain competitive edge and respond to the growing demand for climate accountability). Hospitals, large and small, will have to demand parallel action from their suppliers; they simply will not be able to show favorable climate accounting without demanding change from the suppliers.
In combination, these initiatives are a good start in terms of addressing healthcare climate change accountability. Whoever “runs American healthcare” needs to start making demands. The problem is that nobody “runs American healthcare,” and successful change therefore depends on several actors taking initiatives to create climate accountability.
Hospitals and hospital systems need to make clearer and more consistent demands for climate accountability from their suppliers, and they need to follow through with preferred green vendor programs and the like. Meanwhile, suppliers should consider an aggressive, proactive engagement in these efforts—for example, using the NAM journey map. Suppliers that engage in real green transition today will have the competitive edge tomorrow.
Finally, government institutions need to get involved, and this is critical for the process as discussed above. Supply-demand mechanisms in healthcare are not going to effect the change needed. Elsewhere in the world, we have seen national healthcare authorities mandating climate accountability. While this might not happen in the U.S., we have institutions that can create a system of punishments and rewards.
Photo: Petmal, Getty Images
