The Healthcare Hub

Green Healthcare Supply Chains: Strategies To Reduce Environmental Impact

Friday, June 7, 2024

In today's environment of financial pressures and economic instability, determining where to invest limited resources is not a cut and dry decision. When it comes to the environmental impact of healthcare supply chains, organizations want to see a proven link between sustainable practices and other factors such as better health outcomes or financial sustainability.

Nevertheless, pressure on healthcare facilities to develop greener practices from regulators and health sector stakeholders (including clinicians, nurses and patients) is increasing. At the same time, new incentives are being introduced to financially benefit healthcare provider organizations that actively engage in sustainability projects.

 

 

Table of contents

  1. Environmental challenges in healthcare supply chains
  2. Key areas for environmental impact reduction
  3. Common challenges and how to overcome them
  4. Success stories in sustainable healthcare supply chains

 

 

Healthcare Supply Chains and the Environment

"An environmentally sustainable health system improves, maintains or restores health, while minimizing negative impacts on the environment and leveraging opportunities to restore and improve it, to the benefit of the health and well-being of current and future generations."

World Health Organization

 

Sources of Waste in Healthcare Operations

The healthcare industry has a large-scale impact on the environment and human health throughout the supply chain, from the sourcing of raw materials by manufacturers for medical/surgical supplies and medical equipment, to the disposal of these items. Factors that fuel healthcare supply chain's carbon footprint and environmental impact include:

  • Single-use supplies, excess supply packaging/waste and supplies that expire and must be discarded
  • Fossil fuels, including natural gas, used in transportation of supplies
  • Capital equipment energy use, including power used by medical imaging equipment and HVAC
  • Sterile medical devices and unused instruments prepared for procedures that must be reprocessed or discarded 
  • Anesthetic gases are greenhouse gases, which contribute to climate warming and ozone depletion

 

The Role of Healthcare Supply Chains in Global Emissions

The healthcare industry and climate change are tightly interwoven. The health sector is responsible for 8.5% of greenhouse gas emissions in U.S., largely from hospital care and from physician and clinical services.

Healthcare emissions are classified into three groups depending on how directly or indirectly they are influenced by industry actions and decisions according to the Department of Health and Human Services.

  • Scope 1: Direct emissions controlled or owned by the organization, including emissions from facilities and vehicles.
  • Scope 2: Indirect emissions from the generation of purchased energy, such as electricity, steam, heating, and cooling.
  • Scope 3: All other indirect emissions, including those within the supply chain, covering the production and transportation of goods and services.

Scope 3 emissions include indirect emissions related to supply chains, such as those generated by production and transportation of medical supplies and waste management. They constitute most of the healthcare sector’s emissions, estimated at approximately 80%.

 

 

Key Areas for Environmental Impact Reduction

Given the many different areas where the health sector contributes to carbon footprint, there are numerous opportunities for procurement professionals to reduce carbon emissions and engage in waste reduction initiatives.

 

Sustainable Sourcing and Procurement Practices

Look for suppliers that have prioritized waste reduction (including non-hazardous and hazardous waste) energy efficiency, limited use of fossil fuels, and lower carbon emissions. For healthcare providers and supply chain leaders looking to reduce their environmental, adjusting procurement policies to "prioritize suppliers based on verified environmental disclosures" is a good place to start, according to the U.S. Agency for Healthcare Research and Quality.

Many well-known suppliers have invested in sustainability and waste reduction initiatives to reduce their their environmental impact (more on that below). Another strategy is to purchase from smaller, local suppliers local to healthcare settings. This shortens the supply chain and, by doing so, reduces the fossil fuels required for goods to arrive at their destination.

 

Waste Management and Recycling Initiatives

Large quantities of plastics are used throughout care pathways in patient care delivery. While research has shown that 85% of plastics waste could be recycled, 91% of plastics still end up in landfills or in natural environments. Medical supply manufacturer, distributor and strategic partner Medline offers these tips for waste reduction and recycling of plastics used in healthcare facilities:

  1. Sustainable packaging: Replace traditional plastic packaging with sustainable packaging materials, such as bio-based or compostable alternatives.

  2. Optimized packaging: Optimize packaging design to use only what’s necessary.

  3. Reusability: Employ reusable containers to ship products instead of cardboard containers to reduce the amount of cardboard in the supply chain.

  4. Closed-loop recycling: Implement closed-loop recycling systems to "ensure that materials are recycled and repurposed within the industry itself."

  5. Effective and efficient sorting and separation: Deploy advanced sorting and separation technologies that can "improve recycling rates and ensure the proper disposal of waste."

 

Energy Efficiency in Supply Chain Operations

According to a report from the International Hospital Federation, the healthcare supply chain–production, transport, use and disposal of goods and products– represents a large part of the industry's energy footprint. In a survey of global healthcare executives, "energy consumption was voted as number one feasible lever to improve hospitals’ environmental footprint." [16]

In addition to sourcing from suppliers that have taken steps to be energy independent, such as leveraging solar energy, healthcare provider organizations can address energy usage related to the equipment they purchase.

Procurement professionals can target areas where capital equipment requires high energy consumption, such as imaging, and push for equipment that consumes less energy. For example, imaging equipment with a "power down" capability, can save significant energy and reduce energy costs for healthcare facilities.

 

 

Challenges and How to Overcome Them

"Health care leaders are often surprised to learn that their operations contribute significantly to a warming climate," stated the authors of a New England Journal of Medicine (NEJM) Catalyst article. That's why it is critical to communicate the environmental impact of healthcare delivery and the benefits of green healthcare initiatives, including associated cost savings and potential for improving health of communities and patients.

 

Addressing Cost Concerns of Green Initiatives

Former Environmental Stewardship Officer at Kaiser Permanente Kathy Gerwig speaks of the "cost myth" that holds back healthcare settings from pursuing green initiatives such as installing on-site solar power, long-term purchases of new renewable energy generation, and waste reduction, noting how they can yield a positive return on investment while also reducing green house gas (GHG) emissions.

Case in point: Yale New Haven Health System saved approximately $1,200,000 across the health system in one year by switching from desflurane to sevoflurane. The largest hospital in the system alone eliminated 1,600 tons carbon dioxide equivalent (CO2e) emissions that year, which is equivalent to removing 360 gasoline-powered passenger vehicles from the roads.

 

Establishing Priorities and Setting Goals

In its Roadmap to Addressing Scope 3 Emissions for Healthcare Organizations, the HHS recommends assessing and estimating "which of the 15 emissions categories are most relevant to your organization, considering factors like data availability, size/magnitude of emissions, your influence over these emissions, associated risks, stakeholder concerns, outsourcing practices, and sector-specific guidance."

 

Upstream Scope 3 emissions categories

  • Purchased goods and services

  • Capital goods

  • Fuel- and energy-related activities

  • Upstream transportation and distribution

Downstream Scope 3 emissions categories

  • Downstream transportation and distribution

  • Processing of sold products

  • Use of sold products

  • End-of-life treatment of sold products

 

Overcoming Initial Implementation Hurdles

While a transition to solar power or the use of electric vehicles on a healthcare campus may change the environment for clinicians in some ways, a much greater impact comes from switching from existing to new greener supplies and equipment used in patient care.

Any change in clinical practice requires careful change management, including education and training. Perhaps most importantly, it requires buy-in from the clinicians themselves.

In its Reducing Healthcare Carbon Emissions, A Primer on Measures and Actions for Healthcare Organizations to Mitigate Climate Change, the AHRQ recommends the following:

  • Nominate executive leadership to take responsibility for sponsoring and supporting climate action

  • Institute education and training programs to promote climate literacy across the workforce

  • Embed sustainability in administrative and clinical roles and responsibilities

  • Promote a culture of sustainability and resource stewardship

 

Track Progress Toward Long-term Sustainability Goals and ROI

With healthcare leaders seeking ROI from green supply chain initiatives, it is critical to set a baseline and measure progress toward goals.

In the area of carbon emissions, the AHRQ suggests healthcare organizations use the Greenhouse Gas Protocol (GHGP) framework, a comprehensive, globally recognized standard for quantifying and reporting on emissions. With regards to setting targets and timelines, the AHRQ recommends:

  • Setting a net-zero emissions goal and associated timelines for decarbonization targets

  • Setting a baseline year to assess decarbonization performance improvement

  • Setting interim annual decarbonization targets

 

 

Case Studies: Sustainable Healthcare Supply Chains

Here are just a few examples of health systems and hospitals engaged in supply chain sustainable practices - including cost benefits derived from these efforts.

 

Hospitals Leading in Sustainability

Cleveland Clinic made perioperative services a target areas for reduced energy consumption and overall waste reduction. In addition, their overall energy efficiency improvements have saved the health system more than $100M since 2010.

  • Conserving through containment: Cleveland Clinic uses standardized instrument sets and reusable rigid sterilization containers to reduce the need for blue polypropylene plastic sterilization wrap, which "can persist in landfills for hundreds of years."

  • Opting for a greener anesthetic agent: In 2011, Cleveland Clinic discontinued the use of desflurane, the anesthetic agent with the highest global warming potential, and has " piloted new technology to capture and reuse waste anesthetic gases."

  • Reducing waste through reprocessing: Since 2011, Cleveland Clinic has collected single-use devices (e.g. blood pressure cuffs, surgical basins, light handle covers and laryngoscope blades) for reprocessing to prevent them from entering the waste stream. In 2021 alone, approximately 20 tons of single-use devices were collected for reprocessing.

 

Providence Health and Services has taken a two-prong approach to addressing the impact of anesthetic gases on the environment

  • Desflurane avoidance: Reduced inhaled anesthetic emissions by 4,550 tons CO2e per year (equivalent to 980 passenger vehicles per year), largely through avoiding use of desflurane, and sustained a 94 percent annual reduction in GHG emissions and 70 percent cost reduction.

  • Resource conservation: Providence St. Vincent Medical Center decommissioned leaky central nitrous oxide piping, reducing losses of the gas by 958 tons CO2e (the equivalent of 206 gasoline-powered passenger vehicles off the road) in 1 year and saved $12,000 in procurement costs.

 

Gundersen Health System saves more than $3 million annually from sustainability improvements.

  • Energy conservation: Gundersen's conservation efforts alone have resulted in a 54% improvement, with a cumulative financial savings of more than $28M in energy costs.

  • Recycling: In 2014, Gundersen began achieving a 45% recycling and reuse rate of the solid waste stream, saving the organization approximately $70,000.

  • Consolidated Services Center (CSC): Features solar, geothermal, and battery storage to make the facility more energy independent and resilient.

 

Suppliers Tackling Environmental Impact

Many large, global suppliers have not only expressed commitment to green practices but also acted on these statements by investing in initiatives, such as use of renewable energy sources and reduced waste to support a healthier environment and improved human health. Here are five examples:

  1. Medtronic: In 2023, the company took back 5.8M products, diverting 202 metric waste from landfill and reduced intensity of operational greenhouse gases by 35%.

  2. Johnson & Johnson (J&J): 84% of the company's energy is generated from renewable energy sources, including on-site and off-site renewable energy systems.

  3. Stryker: In 2023, Stryker's Sustainability Solutions helped its customers divert more than 5M pounds of waste from the landfill through its reprocessing programs, saving 3,250 customers approximately $238M.

  4. Boston Scientific: The company's 2023 carbon neutrality results include 82% renewable electricity and 46% renewable energy usage.

  5. Zimmer Biomet: The company reported that it diverted 73% of its waste from landfill in 2023.

 

Towards Greener Healthcare Supply Chains

While some health systems and hospitals have taken a lead on greening their supply chains - whether it's reduction of hazardous waste or deployment of solar panels for a CSC - others are just beginning their journeys.

There is hope that government incentives will prompt more organizations to act. For example, the Inflation Reduction Act allows nonprofits, including health systems and hospitals, that are working to reduce carbon emissions to take advantage of tax credits that had previously been available only to the private sector. [25]

On the other hand, some believe it will not be incentives but regulatory action that will force sustainable healthcare practices. As researchers stated in the New England Journal of Medicine (NEJM):

"Voluntary pledges and initiatives will not be adequate to reach net-zero health care goals. Implementation of standardized metrics for reporting health care greenhouse gases is essential to quantify progress, identify best practices, and ensure accountability."

For now, healthcare supply chain management leaders can learn from those that have successfully reduced wastes and costs, leveraging case studies to engage support for these initiatives in their own organizations.

 

FAQs about Sustainable SCM Strategies in Healthcare

Q. Why is it important to reduce the environmental impact of healthcare supply chains?

A. The healthcare industry consumes tremendous resources and contributes significantly to pollution, including carbon emissions and waste. Indirect emissions related to supply chains (Scope 3 emissions) constitute most of the healthcare sector’s emissions, estimated at approximately 80%.

Q. What are the first steps in making healthcare supply chains more sustainable?

A. Assess where your supply chain is having the biggest environmental impact, what initiatives are achievable, and where you can generate ROI from your conservation work.

Q. How can healthcare organizations measure the success of their sustainability efforts?

A. There are numerous industry resources available to track and measure success. For example, The Joint Commission resource center features "easy-to-use, robust, and valuable key strategies, tools, literature, videos and links to help healthcare organizations get started on sustainability."

Q. Can small healthcare providers make a significant impact on environmental sustainability?

A. Yes, even small providers can have a big impact on environmental sustainability. For example, the University of Vermont’s Burlington campus saved $431,083, including a total OR savings of $175,028, through participation in a medical device reprocessing program.

Q. What are the emerging trends in sustainable healthcare supply chain management?

A. Supply chain leaders are seeking data to help drive green initiatives, whether it is data from their own procurement operations or data from suppliers on their carbon footprints. Speaking to manufacturer data, Cleveland Clinic's Utech stated: "You pretty much couldn’t get this data five years ago. There’s a lot of data now.”

 

 

Sources

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Kara L. Nadeau

Healthcare Industry Contributor

Kara L. Nadeau has more than 20 years of experience as a writer for the healthcare industry, working for clients in fields including medical device/supply manufacturers and distributors; software, solution and service providers; hospitals and health systems; and industry associations.

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