Sustainable healthcare: Cutting carbon, boosting care

When Northern Health set up the Victorian Virtual Emergency Department (VVED) during the COVID-19 pandemic, environmental benefits were not the key objective.

But five years on, the hospital in Melbourne’s northern suburbs estimates it has saved more than 2200 tonnes of carbon emissions by reducing patient transport and hospital occupancy.

The VVED, which triages and treats patients with non-life-threatening conditions and is available 24 hours a day, seven days a week, is now the largest virtual emergency department in the world, serving more than 700 patients a day and keeping 86% from having to attend hospital in person.

Northern Health is not alone in its innovative approach.

The model is part of a growing body of evidence that more sustainable healthcare models can improve patient care and reduce costs for providers.

Perhaps most importantly, sustainability appeals to the core ethical principle of healthcare: First, do no harm.

The paradox for health providers is that while they treat patients, they’re generating emissions that contribute to the climate crisis, which in turn has real and lasting consequences for human health.

A steady momentum is gathering from across Australia to address this challenge with innovative solutions, and they’re seeing wider benefits for patient care, the quality, safety and efficiency of healthcare, and reduced costs for patients and the system.

They’re now joining forces to bring others along on the urgent but challenging mission to overhaul the health system for a greener future.

Accelerating towards net zero

The Transitions to Sustainable Health Systems Consortium, convened by Monash University, is made up of 15 members, including federal and state government health departments, metropolitan and regional hospitals, private health providers, professional bodies, and peak bodies for Aboriginal-controlled community health organisations.

The diverse experience and expertise each member brings reflects both the momentum for change and the vast challenges of overhauling a system that encompasses a broad range of systems and settings.

Through a rapid review on the effectiveness of sustainable healthcare interventions and a series of participatory workshops, and 135 healthcare professionals from 54 healthcare organisations, the consortium brought together research and practice wisdom from across Australia.

The findings are detailed in Accelerating towards net zero: A guide for the Australian health system, which aims to help providers across the country implement sustainable improvements in their own organisations, and explains how they can be part of a movement to influence change across the health system and beyond.

These solutions will help build the enabling environment to effectively and efficiently decarbonise the Australian health system while contributing to other health system priorities.

The research identifies nine priorities for collaborative action to unlock emissions reduction:

1. Embed ambitious emissions reduction as a core responsibility of the health system.
2. Build the capabilities needed to accelerate action towards net zero.
3. Create spaces for collaboration, collective action and alignment of policy and practice.
4. Generate knowledge needed to make lower-emissions choices.
5. Reduce the burden on healthcare by investing more in prevention.
6. Develop and mainstream integrated, high-value and health-promoting models of clinical care.
7. Embed low-emissions and circular economy principles in health system purchasing.
8. Address the barriers to reducing single-use items and increasing the reuse of medical devices.
9. Ensure low-emissions, net-zero-ready and climate-resilient new builds and retrofits or renovations.

Where do healthcare emissions come from?

The Australian health system generates an estimated 23,522 kilotonnes of greenhouse gas annually, which accounts for 5.4% of total Australian emissions.

Some 68% of these emissions relate to products and services purchased by the health system, including disposal at end of life.

A further 20% come from purchased electricity, and 6% is from patient travel to and from healthcare services.

Another 6% of emissions is directly generated by healthcare organisations as part of operations, such as use of petrol in company vehicles, fossil gas for heating and sterilisation, refrigerants in cooling systems, and the use of anaesthetic gases.

A key challenge lies in addressing emissions sources unique to the health sector, including pharmaceuticals, anaesthetic gases and inhalers.

There are also operational challenges such as the need to maintain 24-hour services in hospitals.

Indeed, it’s been estimated that the majority of the health system’s emissions are attributable to care provided in hospitals (44%) and pharmaceutical use (19%).

With steadily-increasing demand and costs for healthcare, activity-related emissions can be expected to rise over time, unless action is not taken.

Better outcomes for people and planet

The transition to a sustainable health system must enable providers to continue delivering high-value care while minimising emissions.

Fortunately, there’s a close alignment between environmentally-sustainable healthcare and a focus on keeping people well and providing high-value care.

About 40% of healthcare in high-income countries is considered low value, or even harmful.

This includes care such as unnecessary or duplicated tests that provide little or no benefit to patients, or provides marginal benefit for disproportionately high costs.

Estimates show harmful and low-value care in Australia pumps about 11,447 kilotonnes of avoidable emissions into the atmosphere each year.

This is more than the combined emissions from domestic aviation and shipping in Australia during the financial year 2022-23.

Addressing care before it becomes necessary would also have better outcomes for people and the planet, with more than a third of Australia’s disease burden considered preventable.

The costs of managing a disease are sometimes double that of preventing the disease in the first place, so there are potential financial and emissions savings to be found in disease prevention.

Reinvesting savings in what matters most

Examples from across Australia illustrate that many emissions-reduction initiatives free up funds to reallocate to other priorities, including patient care.

The Accelerating towards net zero: A guide for the Australian health system program shows that taking a holistic view of reducing waste and equipping staff across an organisation to take on and lead the challenge can generate savings on multiple fronts.

The program commenced in 2018 and has since trained more than 400 staff to implement resource waste reduction programs.

Outcomes have been diverse and impactful.

A nurse-led program to train staff to recognise early signs of sepsis helped prevent progression to more severe disease, halving the number of admissions to the intensive care unit (ICU), halving the length of time people were in ICU and dramatically reducing deaths.

Changing the model of care regarding iron infusions in heart failure reduced nursing time and costs, improved the quality of nurse observations and reduced patient readmissions.

This approach has become a key part of the organisation’s efforts to mitigate healthcare-associated emissions, and has ultimately given the organisation more resources to invest in patient care-related priorities.

Leadership for change

Health system policymakers, boards and executives play an important role in integrating sustainability and action on climate change across governance, strategy and operations.

They’re also critical in creating environments where staff can integrate sustainability into their day-to-day practice and be able to innovate and lead change.

But to do this, the sector needs support to lift knowledge, build capabilities, and share information and learning.

Leaders who support their staff to innovate and scale successful solutions will be critical to navigating the challenge of transitioning to net zero.

The sector can also influence significant change beyond the health system through channels such as purchasing requirements and supply chains.

The consortium has looked to England’s National Health Service (NHS) net zero supplier roadmap, which will require suppliers to demonstrate progress toward net zero.

From 2030, suppliers will only be able to qualify for NHS contracts if they can demonstrate their progress through published progress reports and continued carbon emissions reporting.

England is also working with other countries, including Norway and Ireland, on aligned approaches.

The NHS approach demonstrates the potential for nations to leverage their health systems to support decarbonisation beyond the emissions they control directly.

Translating momentum into commitment

Change takes time and effort, and can involve capital costs before savings are realised over time.

With so many competing and urgent priorities, the health system needs clear signals and support to prioritise sustainability

Governments, healthcare organisations, professional, advocacy groups and local champions are all stepping up to lead change.

In addition to the National Health and Climate Strategy, several states and territories have developed climate and health strategies, with emission reduction targets aligned with government commitments.

Harmonising policy across jurisdictions in key areas such as procurement and contracting, reporting and measurement, and product standards sends a clear signal to both the health sector and the wider market.

The challenge now is translating this momentum and commitment into further tangible, coordinated, efficient and sustainable action.

The guide brings together the collective knowledge and wisdom from many health practitioners from across the health system, but it is by no means the last word in this rapidly-moving agenda.

We hope many in the health sector, as well as leaders and decision-makers, can use the guide to learn from others, reflect on what the actions mean for them and their organisations, and use it to strengthen their work to reduce emissions.

We can all drive change. Be it big or small, it all makes a difference.

By taking action now, we’re helping safeguard our health services and the health of future generations.