The U.S. National Academies, composed of the National Academy of Science (NAS), the National Academy of Engineering and the National Academy of Medicine (NAM), provide independent, objective advice to inform policy with evidence, spark progress and innovation, and confront challenging issues for the benefit of society. They also represent some of the best scientific thinking in the country. Recently, the academies have called on partners including the American Hospital Association (AHA) and its professional membership group the American Society for Health Care Engineering (ASHE) to join its efforts to fight climate change. 

NAS President Marcia McNutt stated that, “Building on lessons learned from the pandemic, our institution is developing a coordinated, cross-cutting effort to mobilize expertise across the sciences, engineering and medicine to address the climate crisis on multiple fronts. Our goal is provide decision-makers at all levels with the type of actional advice and information they need to respond.”  

NAM President Dr. Victor Dzau created an initiative called the Grand Challenge on Climate Change, Human Health & Equity to respond to the rapidly increasing health crisis posed by climate change. As part of that challenge, NAM launched an action collaborative, convening the leaders of important health care organizations in the country, including AHA President Rick Pollack. As the collaborative has developed, additional AHA staff have become part of the effort by supporting necessary actions to secure environmental health. Critically, their work is focused not on what is politically expedient, but on what scientific experts say is necessary to effectively confront the climate crisis.

“The collaborative is comprised of a steering committee and four workgroups: infrastructure and supply chain; health care delivery; health professional education and communication; and policy, financing and metrics,” says Kara Brooks, LEED AP BD+C, BS, MS, the ASHE’s senior associate director of sustainability. “Leaders from the AHA sit on the steering committee, co-lead the health care delivery workgroup, and sit on the policy, financing and metrics workgroup. Additionally, ASHE and AHRMM (Association for Health Care Resource & Materials Management) staff are represented on the infrastructure and supply chain working group. This work will lead to a series of recommendations on removing carbon from the health care sector.” ASHE is a professional membership group of the AHA.

The action collaborative is currently wrestling with a number of questions central to its mission. In an effort to include its members in this conversation, ASHE leadership convened a workshop at the 2022 International Summit & Exhibition on Planning Design & Construction (PDC Summit) in March. The workshop was led by Brooks and Walt Vernon, ASHE member and action collaborative steering committee member.

The workshop included a brief overview of the NAM effort and questions. Participants then worked collectively in brainstorming roundtables to help provide input to NAM from the ASHE member perspective.

Findings from the group

The right way to decarbonize will vary from organization to organization, Brooks says.

“We learned that each hospital’s needs and circumstances may dictate a different approach to this work,” she says. “For instance, older physical structures may not be able to undergo the same type of retrofitting of heating or cooling systems compared to a newer facility, and heating and cooling needs will vary based on the facility’s location.”

Furthermore, specific geographic locations require different approaches to remain resilient and sustainable.

“These differences from hospital to hospital indicate that there isn’t a ‘one-size-fits-all’ approach to decarbonization. Rather, the individualized circumstances of each hospital and health system guide their path forward,” she continues.

Thus, the groups offered a range of recommendations to help overcome these challenges.

Goals to reach toward

Don Berwick, founder and Chairman Emeritus of the Institute for Healthcare Improvement (IHI) and leader of the policy, metrics and finance committee of the action collaborative says that when IHI defined the six dimensions of health care quality, it left out embodied carbon. Today, however, he says it’s time to correct that oversight and include embodied carbon as an essential element of clinical quality. In his view, health care needs to measure preventable clinical carbon much like it already measures preventable medical errors.

The workshop consensus was that health care organizations should target a 50% reduction in Scope 1 and 2 emissions by 2030. In addition, participants identified a 30% reduction in Scope 3 emissions as the right target.

Setting the metrics

There is a strong need for a standardized and accurate way to measure and report Scope 3 emissions. The roundtables largely agreed that using total CO2 emissions was the correct metric for measuring Scope 1 and 2 emissions, with various normalizing factors (e.g., per square foot, Energy Star Score and per patient encounter) being useful for better comparative understanding. 

Exploring policy opportunities

The Centers for Medicare & Medicaid Services (CMS) is still enforcing old codes that do not permit newer solutions like fuel cells and microgrids. The PDC Summit roundtable participants recommend CMS become more nimble in its adoption of new codes, and suggested accrediting organizations such as The Joint Commission can aid in that process. National performance-based codes that allow access to emerging technologies can provide better opportunities compared to the current patchwork of often antiquated, static prescriptive sets of requirements.

Participants also identified a need for performance-based codes, and fewer prescriptive codes. Codes that focus on outcomes instead of strict prescriptive requirements can inspire innovation. Many health care organizations now serve communities in multiple states, and, if they can start to standardize with local climates as the only variables, they can more cost-effectively deliver needed results. Creating incentives for better performance will be highly effective, as it will help motivate the c-suite whose support is critical in combatting climate change. The group also recommended code-making organizations include carbon as an essential element of their thinking instead of distancing themselves from the issue.

States should continue to enact aggressive renewable portfolio standards (RPSs) to move toward more carbon-free electrical systems, the group recommended. States with higher RPSs tend to make it easier for health care organizations to decarbonize. States should allow, and even require movement toward all-electric building codes as rapidly as possible. However, unlike today’s one-size fits all regulations, ASHE members proposed that these regulations include provisions based on the unique needs of health facilities (i.e., emergency generators and steam).

Potential in infrastructure and supply chain

Participants focused first on the rapid decarbonization of transportation systems. Fleet vehicles are Scope 1 and 2 emissions and electrifying fleets will help toward the needed 50% by 2030 reductions. Having vendors electrify their fleets provide a substantial Scope 3 improvement opportunity.

Other suggestions had to do with low-carbon concrete, buying locally made products (which also enhances supply chain resilience) and maximizing the reuse of medical devices rather than using disposable products. Designers should focus on the best possible envelopes and facades, making maximum use of natural forces and shielding occupants from maximum harm from natural sources.

Helping organizations with few resources

Another key insight from the group was the need for trusted financial partners and structures. Rural and other small health care facilities often do not have the resources — neither human nor capital — to enact needed improvements. Many require a partner organization to help identify, fund and help actualize the decarbonization opportunities available to them. This could produce a dramatic difference in the health of these communities and organizations.

Next steps

Information and ideas offered during the session will be used to further inform the action collaborative members on decarbonization priorities and challenges.

“Ultimately, the decarbonization of the U.S. health care footprint will be an important and necessary step to addressing the carbon emissions and mitigating the effects of climate change,” Brooks says. “ASHE supports the decarbonization of health care and is dedicated to leading the field by providing tools and resources to both reduce the health care carbon footprint and to inform public policy.”

Vernon echoes those sentiments.

“Every day, the news continues to get worse,” he says. “Every day, the scientists are re-affirming the desperate importance of dealing with this issue to protect us and our children from the worst impacts of climate change. Every day, I am helping health care organizations dealing with drought, wildfires, power shut-offs, hurricanes, raising seas and intensifying heat.

“Yet, no amount of hardening will outrun the climate crisis; the only way to outrun it is to stop it,” Vernon continues. “As the people who plan, design, construct and operate health care facilities, we have the unique opportunity and therefore the responsibility to be the ones to do it. Health care is the most trusted part of society in an increasingly untrusting world. We must therefore rise to the occasion and lead the way towards a healthier future. And this meeting was an important step towards ASHE members being these leaders.”