Addressing the carbon footprint of health organisations: eight lessons for implementation

Transitioning to sustainable, climate-resilient healthcare: insights from a health service staff survey in Australia

BACKGROUND

More than 80 countries, including Australia, have made commitments to deliver climate-resilient and low carbon healthcare. Understanding how healthcare workers view their own and their organization's efforts to achieve sustainable and climate-resilient healthcare practice is vital to inform strategies to accelerate that transition.

METHODS

We conducted an online staff survey in a large state government hospital-and-health-service organisation in Queensland, Australia, to ascertain attitudes and practices towards environmentally sustainable, climate-resilient healthcare, and views about the organizational support necessary to achieve these goals in their workplace.

RESULTS

From 301 participants showed staff strongly support implementing sustainable and climate-resilient healthcare but require significantly more organizational support. Participants identified three categories of organizational support as necessary for the transition to environmentally sustainable and climate-resilient health services and systems: (1) practical support to make sustainability easier in the workplace (e.g. waste, energy, water, procurement, food, transport etc.); (2) training and education to equip them for 21st century planetary health challenges; and (3) embedding sustainability as 'business as usual' in healthcare culture and systems.

CONCLUSIONS

The research provides new insight into health workforce views on how organizations should support them to realize climate and sustainability goals. This research has implications for those planning, managing, implementing, and educating for, the transition to environmentally sustainable and climate-resilient health services and systems in Queensland, Australia, and in similar health systems internationally.

Environmental Sustainability in the Cardiac Catheter Laboratory

The health care sector contributes to nearly 5% of global carbon emissions with the exponential growth of medical waste posing a significant challenge to environmental sustainability. As the impact of climate change on individuals and population health becomes increasingly more apparent, the health care system's significant impact on the environment is also raising concerns. Hospitals contribute disproportionately to health care waste with the majority arising from resource intensive areas such as operating theatres and cardiac catheter labs (CCLs). Despite the growing volume of cardiac procedures worldwide, initiatives to reduce waste from CCLs have received limited attention, overlooking opportunities for significant reduction in operational costs and carbon footprint. We aim to raise awareness of the current landscape of waste management in CCLs. We identify areas of resource optimisation and highlight practical strategies and frameworks employed elsewhere in health care to reduce waste. Importantly, we hope to empower health care workers in CCLs to make a meaningful change to their practice and contribute towards a more sustainable future.

Climate adaptive hospital: A systematic review of determinants and actions

Introduction

Climate change is among the most renowned concerns of the current century, endangering the lives of millions of people worldwide. To comply with the United Nations Climate Change Conference (COP21), hospitals should be on track to reduce greenhouse gas emissions. Although hospitals contribute to climate change by emitting greenhouse gases, they are also affected by the health consequences of climate change. Despite all the guidance provided, hospitals need more radical measures to confront climate change. The current study was carried out to examine the components of hospitals' adaptation to climate change and to review measures to confront climate change in hospitals.

Method

This systematic review was designed and carried out in 2020. The required information was collected from international electronic databases including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar. Moreover, Iranian datasets such as Scientific Database (SID), Irandoc, Magiran, and IranMedex were reviewed. No restriction was considered in the methodology of the study. For the relevant thesis, the ProQuest database was also explored. The related sources were examined and the Snowball method was applied to find additional related studies. The research team also reviewed other accessible electronic resources, such as international guidelines and academic websites. The checklist of the Joanna Briggs Institute (JBI, 2017) was employed in order to evaluate the quality of the included papers. The studies published until June1, 2020, were included in the study.

Results

Of 11,680 published documents in the initial search, the full-texts of 140 were read after evaluating the titles and abstracts, of which 114 were excluded due to lack of sufficient information related to countermeasures in hospitals. Finally, the full-texts of 26 studies were reviewed to extract the required components. Two strategies were found, including climate change mitigation and climate change adaptation, with 13 components including water, wastewater, energy, waste, green buildings, food, transportation, green purchasing policy, medicines, chemicals and toxins, technology, sustainable care models, and leadership in hospitals were identified as affecting these measures and strategies.

Conclusion

Considering the significance of climate change and strategies to confront it as one of the current challenges and priorities in the world, it is necessary to develop a framework and model to reduce the effects of climate change and adapt to climate changes in hospitals and other health centers. The identification and classification of the measures and components, influencing hospital adaptability and solutions for reducing the climate change impacts could be the first stage in developing this strategy. This is because it is impossible to create this framework without identifying these factors and their mutual impacts at the first. In the present study, through a systematic review using a comprehensive approach, the related components were explored and divided into two categories, including measures to reduce the effects and measures to adapt to climate change. The results of this study can be useful in developing a comprehensive action model to reduce greenhouse gas emissions and adapt hospitals to climate change.

We can't mitigate what we don't monitor: using informatics to measure and improve healthcare systems' climate impact and environmental footprint

Climate change, human health, and healthcare systems are inextricably linked. As the climate warms due to greenhouse gas (GHG) emissions, extreme weather events, such as floods, fires, and heatwaves, will drive up demand for healthcare. Delivering healthcare also contributes to climate change, accounting for ∼5% of the global carbon emissions. To rein in healthcare's carbon footprint, clinicians and health policy makers must be able to measure the GHG contributions of healthcare systems and clinical practices. Herein, we scope potential informatics solutions to monitor the carbon footprint of healthcare systems and to support climate-change decision-making for clinicians, and healthcare policy makers. We discuss the importance of methods and tools that can link environmental, economic, and healthcare data, and outline challenges to the sustainability of monitoring efforts. A greater understanding of these connections will only be possible through further development and usage of models and tools that integrate diverse data sources.

Carbon footprint reduction associated with a surgical outreach clinic

BACKGROUND

Healthcare systems generate substantial carbon footprints that may be targeted to decrease greenhouse gas emissions. Outreach clinics may represent tools to assist in this reduction by optimizing patient related travel. Therefore, we sought to estimate the carbon footprint savings associated with a head and neck surgery outreach clinic.

METHODS

This study was a cross-sectional survey of patient travel patterns to a surgical outreach clinic compared to a regional cancer treatment centre from December 2019 to February 2020. Participants completed a self-administered survey of 12 items eliciting travel distance, vehicle details, and ability to combine medical appointments. Canadian datasets of manufacturer provided vehicular efficiency were used to estimate carbon emissions for each participant. Geographic information systems were used for analyses.

RESULTS

One hundred thirteen patients were included for analysis. The majority of patients (85.8%) used their own personal vehicle to travel to the outreach clinic. The median distance to the clinic and regional centre were 29.0 km (IQR 6.0-51.9) and 327.0 km (IQR 309.0-337.0) respectively. The mean carbon emission reduction per person was therefore 117,495.4 g (SD: 29,040.0) to 143,570.9 g (SD: 40,236.0). This represents up to 2.5% of an average individual's yearly carbon footprint. Fewer than 10% of patients indicated they were able to carpool or group their appointments.

CONCLUSION

Surgical outreach clinics decrease carbon footprints associated with patient travel compared to continued care at a regional centre. Further research is needed to determine possible interventions to further reduce carbon emissions associated with the surgical care of patients.

Determined Action to Tackle Health Determinants: A Collaborative Response to the Challenge of Climate Change Mitigation in Practice Settings

The physical environment has long been understood as a major determinant of health and well-being. In recent years, the relationship between health and the environment has become particularly pronounced, with the impacts of climate change identified as having the potential to reverse the last 50 years of public health advancement (Watts et al., 2015). Increasingly, professional bodies within health care are called upon to frame climate change as a health issue. Despite this, studies have found that nurses report feeling ill-equipped to respond to environmental changes and the resulting health impacts (Anåker, Nilsson, Holmner, & Elf, 2015; Lewis, 2018; Polivka, Chaudry, & Mac Crawford, 2011). This article recognizes some of the barriers facing concerned health-care professionals who wish to introduce climate mitigation activities within their sphere of professional operation. The Australian Nursing and Midwifery Federation (Victorian Branch) was approached by nurses, midwives, and carers, to become more involved in policy debates surrounding climate change and to provide stronger support to members in responding to environmental issues. The result is top-down and bottom-up responses working in synergy for climate change mitigation, by empowering nurses to make changes to their professional practice.

How Local Health Districts can prepare for the effects of climate change: an adaptation model applied to metropolitan Sydney

Climate change adaptation can be defined as a form of risk management (i.e. assessing climate change-related risks and responding appropriately so that the risks can be pre-emptively minimised and managed as they arise). Adapting to climate change by hospital and community health services will entail responding to changing health needs of the local population, and to the likely effects of climate change on health service resources, workforce and infrastructure. In this paper we apply a model that health services can use to predict and respond to climate change risks and illustrate this with reference to Sydney's Local Health Districts (LHDs). We outline the climate change predictions for the Sydney metropolitan area, discuss the resulting vulnerabilities for LHDs and consider the potential of LHDs to respond. Three 'core business' categories are examined: (1) ambulance, emergency and acute health care; (2) routine health care; and (3) population and preventative health services. We consider the key climate change risks and vulnerabilities of the LHDs' workforce, facilities and finances, and some important transboundary issues. Many Australian health services have existing robust disaster plans and management networks. These could be expanded to incorporate local climate and health adaptation plans.