A longer-term view on saving lives

Climate change is a public health crisis, and unfortunately the health care sector in the United States is actually disproportionately contributing to the damage. Hospitals are estimated to contribute 8% of greenhouse gas emissions in the United States.1 Getting more granular, a recent study linked the air pollution emissions produced directly by various health care provider activities as well as the indirect emissions from their suppliers given the integrated nature of the industry.2 These emissions contribute to a variety of environmental effects ranging from acid rain to carcinogenic chemical exposure, which according to the study translates to the equivalent of 44,000-98,000 deaths (in line with estimates of U.S. hospital deaths from preventable medical errors).

Hospitals require a tremendous amount of energy given the service they provide. Examples of what contributes to energy use in hospital provider settings include:

  • Always being available and functioning to treat patients
  • Having the ability to adjust to a variety of temperature needs given the differing functions of the rooms in the hospital (e.g., operating rooms tend to be kept very cool)
  • Using medical devices and other technology as an integral part of providing patient care
  • Providing patients with basic human needs such as food and laundry for bedding and hospital gowns

Like other organizations, hospitals necessarily prioritize short-term goals. This is especially important in the health care sector where direct patient care should not be compromised. The core mission of hospitals is to serve patients and this is most measurable by treating the patients that are coming into the hospital. Moreover, malpractice suits contribute to the overutilization of resources by health care providers and thus higher energy use. However, given the impact that the health care sector and especially hospitals are having on the environment, they are an important part of the solution. They will need to balance more efficient energy use with maintaining and hopefully improving the quality of patient care.

Leading hospitals have a responsibility to serve as benchmarks for what can be done. One such hospital is Cleveland Clinic. It is already one of the most renowned health care providers in the U.S. Other hospitals use their operating models as benchmarks for saving costs. Cleveland Clinic has considered the ways in which climate change would affect its operations, including higher demand from a sicker population, increased costs to mitigate against natural disasters or other public health threats, and quality risk of precious natural resources like water.3

One step that shows commitment to identifying meaningful changes and implementing them is that Cleveland Clinic set up an Office for a Healthy Environment. A few examples of the strategic areas they’ve made progress on include:

  • Designing and building more sustainable buildings – 13 projects certified thus far (e.g., they’ve substituted nearly all incandescent lightbulbs for LED)4
  • Building waste reduction into processes – proper waste management and reduced inventory5
  • Being mindful about their suppliers – communicated preference for environmentally-friendly product options with suppliers6 and using their purchasing power to collaborate with suppliers to be more environmentally friendly themselves7
  • Educating the community – encouraged community to conserving energy at home8

Finally, Cleveland Clinic also publishes an annual report on how it’s progressing along the goals it’s committed to as the first healthcare provider to in the U.S. to sign the United Nations Global Compact.9

While Cleveland Clinic is setting the standard for best practices in hospitals to address climate change issues,10 the real change will come from making this change realizable for hospitals that do not have the same level of funding and operational excellence. A barrier for many other hospitals are that they struggle with greater constraints on their budgets and short-term profitability targets. There are many hospitals that have not yet signed up for the 2020 challenge in the U.S.11 The website and press releases surrounding Cleveland Clinic demonstrate the effectiveness of its projects, but there is a large barrier to pushing these initiatives at many hospitals. Given Cleveland Clinic’s reputation and their mission to effect serious change, an additional step they can take is deploying a task force to sign on other health systems to the cause. They can present not only the cost savings to make the business case but also an implementation plan to make this more feasible for other hospitals act on. For example, they can share which suppliers provide low-cost, high quality, sustainable products and educate/convince physicians at other hospitals to switch to them. Having already done a lot of the leg work, Cleveland Clinic can help lead other hospitals to make progress faster by learning from any mistakes it may have made along the way. Finally, to make this more appealing, this can be bundled with teaching hospitals other best practices that hospitals already pay consultants to help them with.

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  1. http://www.triplepundit.com/2014/10/hospitals-stepping-challenge-climate-change/
  2. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157014
  3. http://my.clevelandclinic.org/about-cleveland-clinic/office-for-healthy-environment/about
  4. http://my.clevelandclinic.org/about-cleveland-clinic/office-for-healthy-environment/our-buildings
  5. http://my.clevelandclinic.org/about-cleveland-clinic/office-for-healthy-environment/our-operations/waste-detail
  6. http://my.clevelandclinic.org/about-cleveland-clinic/office-for-healthy-environment/our-operations/waste-detail
  7. http://my.clevelandclinic.org/about-cleveland-clinic/office-for-healthy-environment/our-operations/waste-detail
  8. http://my.clevelandclinic.org/about-cleveland-clinic/office-for-healthy-environment/our-operations/energy-detail.aspx
  9. http://portals.clevelandclinic.org/ungc2016/Reporting/tabid/9623/Default.aspx
  10. http://www.modernhealthcare.com/article/20160510/NEWS/160519998
  11. http://www.greenhospitals.net/2020-participants/


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Student comments on A longer-term view on saving lives

  1. I really like your recommendation that Cleveland Clinic should serve as not only a model, but also as a resource to other hospitals. Hospitals are necessarily focused on other pressing issues, and don’t have the financial or human resources to track their impact on an issue as long-term as climate change.

  2. I believe the health care system is impacted in many ways by climate change, and one of them is through their practice directly. Hospitals not only have to put significant effort in reducing their emissions and energy consumption, but they must also adjust their care to the growing demand for climate change related treatment. Evidence suggests that climate change contributes to longer allergy seasons, increased respiratory disorders, etc. (see source). The health care system needs to put some effort in improving its footprint but also needs to be equipped to react to the changing needs of its customers due to climate change as well.


  3. Glad you decided to write on a hospital system. I hadn’t realized that hospitals contributed that much to greenhouse gas emissions. The comparison of 44,000-98,000 deaths due to carcinogenic chemical exposure to preventable medical errors is shocking. This same comparison could be used as the hook for an article about how hospitals can improve their processes to reduce these deaths.

    Of the ways hospitals consumer energy, I would imagine that a lot of this has to do with the sheer scale of the operations. It would be interesting to see how the energy consumptions/capita is in hospital compared to other large consumer volume industries like hotels. Alternatively, I wonder what this metric may be when comparing across different types of hospitals – academic, community, clinics, etc…

    I agree that hospitals are caught in a tough position of having to prioritize short-term goals. I find it hard to find which one of the services that you had listed above could be reduced without affecting the quality of care provided for patients. Instead of reducing the operating times and services of a hospital, it makes sense that hospitals could try pressuring their suppliers to be energy-efficient. There surely can be cost-saving lessons shared among hospital systems – I’m sure many industries would like to spend less money on consultants.

  4. Such an interesting article, highlighting the tension between being prepared for the needs of patients, while using unnecessary energy resources at the same time. I agree with Phillip above in the question about how this would compare to other large buildings like hotels. These are clearly enormous costs for hospitals, so I would think they would be incentivized to utilize more energy efficient practices. For example – similar to a hotel, an empty room should have the energy completely shut off – no machines need to be actively running until a patient is in the room.

  5. Like many who commented, I had no idea the scale of impact from hospitals. Given how much other aspects of hospital operations are regulated nationally in the US, is there a space for regulation here? Are there solutions to some of these issues already, or will suppliers / operations need to be completely revamped?

    Like Philip, I wonder how much room there is to move on some of these, but I also would be that some of the ways hospitals can cut down are actually great for operational efficiency overall (e.g., moving to a model we’ve seen in FRC with more efficient use of operating rooms).

    Finally, does Cleveland Clinic have an incentive to help other hopsitals? If this would help other hospitals have better PR and reduce costs, might the Clinic hope to keep some of their efforts more secret to keep the benefits for themselves? Again, I wonder if there is a role for a third party (government or otherwise) to help incentivize the dissemination of information.

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