The health care sector is a major contributor to climate change. Reducing emissions isn't just good for the environment, it's also good for business; there's a high degree of correlation between environmental sustainability and cost reduction. For example, Sussex Community NHS Foundation Trust in the UK recently announced that cutting their carbon emissions over the last ten years saved the hospital £10m.

But because national policies to limit health care emissions are generally lagging, individual organizations must step in to take the lead on environmental sustainability. This means providers must come up with their own sustainability targets and detailed plans for how they are going to reach them. 

The first step to get right is creating a roadmap that is specific to the system or organization. Sustainability roadmaps (or 'action plans') offer an array of benefits: they provide a stepwise plan to achieve ambitious emissions targets, they offer time-bound promises to the public, and they foster collaboration between partners or departments across a system, especially when they are co-owned or co-produced by different partners.

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National roadmaps are good reference points, but insufficient at the local level

For health care organizations that don't know where to begin or what to include in their roadmap, they should start by first looking at broad policies. The most ambitious national plan is that of England's National Health Service's (NHS) 'Delivering a 'Net Zero' National health Service'. The NHS, in its commitment to becoming "carbon net zero" by 2040, lays out plans to reduce emissions in three areas:

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1. Functions of the NHS that can be directly addressed to reduce footprint (e.g. fossil fuel use, facility footprint, anesthetics use, and combined footprint of the NHS vehicle fleet);
2. Emissions that are produced from the generation and use of electricity by the NHS; and
3. All other indirect emissions, including those from the NHS' entire supply chain, produced to transport and provide services across the NHS.

National roadmaps such as that of England are certainly bold, but for hospitals, they can be lofty and too far removed from what can be done locally as they often don't deal with the 'practicalities' of improving regional sustainability.

The NHS's plan, for example, suggests potential interventions to reduce emissions from transportation, but those interventions are broad and are designed to apply to the entire NHS fleet and transport service.

Other than encouraging cycling or walking instead of driving, their plan doesn't provide details or guidance into how individual organizations can implement changes to their transport systems to hit the bold targets the NHS sets out.

And above all, these national plans often don't acknowledge that climate change is as much a behavioral problem as it is a system one. Humans are responsible for climate change, but humans are also very resistant to making changes in their own lives.

Fortunately, for those looking to build or flesh out their roadmaps with more specific and tangible aspects, we can draw lessons from what several local systems from around the world have included in theirs.

Denmark's Region Midtjylland prioritizes stakeholder support as the foundation of its sustainability pursuit

Region Midtjylland is the public health service for Denmark's Central Region, one of five regions in the country that each have full administrative and planning responsibilities for their area's health care. In their Sustainability Strategy 2030, they place an overarching emphasis on creating a localized circular economy through increased recycling and reduction of waste and resource consumption.

While this is notable, it's the three other elements involving stakeholder engagement and involvement that makes their plan stand out:

1. The Region encourages social responsibility toward sustainability across their network.

A common thread running through the Region's roadmap is acknowledging that any changes to make daily operations more sustainable require behavioral shifts and collaboration between stakeholders, namely staff.

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The Region leans on the diverse knowledge and skillsets of their workforce to both instill changes and educate their peers. As such, in 2019 the Region set up a network for sustainable hospitals to foster and promote knowledge and information exchange on sustainability between staff and management. After all, a successful transformation strategy hinges on the actions of individuals to make and support change.

2. The roadmap's clarity helps convey the message to stakeholders.

The Region's plan is well-presented, clear, and highlights every step they have taken so far. Following a roadmap will only work if all stakeholders know where the system was, where it is, and where it is heading. Effective communication informs stakeholders of potential changes and targets and provides a source of real-time feedback.

3. The Region focused first on the low-hanging fruit.

Instead of starting off by focusing solely on the big wins, they focused on making small changes within their hospitals, such as swapping out their cleaning chemicals to environmentally friendly ones or replacing their single-use bed covers with (cheaper) recyclable alternatives. You are more likely to gain early stakeholder support if changes are not too disruptive too quickly. Over time, these changes can often generate outsized results.

Region Midtjylland reminds us that sustainability relies on human behavior and that elevating the role stakeholders play in making positive change requires leadership to consider those stakeholders at every step. Every commitment should be grounded in what the change means for each key stakeholder group, what is in it for them, and the specific habits they will need to form to help the system succeed.

Ontario's University Health Network elevates climate-focused staff members to keep the system on track

Health systems and hospitals are big, complicated places. And identifying all of the structural and operational elements that can be made more sustainable can be a thankless task. But incorporating as many of these elements into your roadmap as possible is a must if you are to reach—or exceed—your emissions targets quickly.

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University Health Network (UHN) in Canada saw this and positioned their roadmap as an Energy Management Plan. In it, they outline specific actions and steps for their 12 focus areas, which include building automation systems, fans and pumps, commissioning, and maintenance.

Overly operational plans like these can be tough to manage. To keep them on track, UHN installed energy teams at every site within their network. These teams meet monthly to identify new ways to save energy and oversee implementation of any changes.

Not only this, but the system recruited over 750 "Green Team members" to represent different departments, act as sustainability champions, and oversee implementation of energy saving initiatives within their departments.

Having sustainability ambassadors at the ground level means that UHN can galvanize support for any operational sustainability initiatives they wish to make as well as delegate the work of keeping the entire system's workforce accountable.

Sydney North Health Network celebrates success stories to incentivize partners and generate buzz

Sydney North Health Network, one of 31 primary health care networks in Australia, published their Climate and Health Strategy 2020 to incentivize sustainability, support the community to mitigate the risk of climate change on health, and strengthen the resilience of the system to adapt to climate change disasters.

Vitally, they share case studies of local success stories. These are essentially teaching points centered around positive changes that can be translated across the network at any partner.

One example the network provides is from Kooweerup Regional Health Service (KRHS) who use a variety of methods to engage different stakeholder groups throughout their system and encourage positive sustainable behavior changes:

• Staff: All staff are expected to complete an environmental sustainability induction and can choose to pledge their support to sustainability in all aspects of their lives;
• Patients: All long-term residents have access to workshops that focus on environmental sustainability; and
• Community: A dedicated Health Promotion Communication Officer regularly communicates climate change initiatives and health promoting behaviors through traditional and social media formats. Local schools and community groups regularly visit KRHS' Eco-house facility to learn about solutions to climate change.

Climate change is, after-all, a universal human behavior problem that requires all hands-on deck—especially across health systems. The examples above are the tip of the iceberg for what health systems are already doing to plan for a sustainable sector, but it's heartening to see organizations taking steps to get there. And what we can see from these examples is that, right now, systems are better off looking to their peers than to the government for inspiration.