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Greenhouse Gas Emissions in Healthcare: Reporting, Evaluation, and Reduction Planning

There is no question that it is difficult to operate a robust healthcare system in the current market environment. The healthcare sector continues to face unique challenges brought about by COVID-19: staff burnout, labor shortages, and fragile supply chains. Add existing obstacles such as difficult payor models and the ever-increasing bout of competition from insurance companies and pharmacies building out direct-care and direct-to-consumer healthcare solutions. Previously robust margins have been squeezed and the pressure to boost employment benefits to attract and retain top talent is ever-increasing. All of this opens a need for a new approach for healthcare organizations catering to their burnt-out staff and patients alike. 


One avenue that has been gaining traction for its benefits to patients and the community is an examination of a facility or organization’s greenhouse gas (GHG) emissions. Individual hospitals and healthcare organizations have embraced the social challenge of reducing emissions as the industry is one of the largest GHG emitters due to the size and scope of their operations. These buildings must operate 24/7 with high levels of ventilation, air movement/air changes, wellness-enhancing solutions, and filtration to combat infections and keep patients healthy and thriving while within these environments. To put in perspective the magnitude of emissions, if the global healthcare industry were a country, it would be the fifth largest emitter in the world based on a report in 2019 by Healthcare Without Harm. There is a compelling argument that it is the right thing to do in the spirit of preserving health and healing in communities where these health systems live. It’s part of the mission statement when evaluated through this lens, healing and protecting communities. 

For these reasons, SSR has seen an ever-increasing trend for both healthcare design projects and existing campus master planning efforts that include an intense focus on emissions reduction and how facility operations impact the global climate. Consultants, contractors, and suppliers must be nimble in how they can help these organizations understand, reduce, and eliminate their emissions over time. 


Where to Start

Reducing GHG emissions first starts with an understanding of where emissions are generated, benchmarking the current profile of emissions for a healthcare organization, and establishing boundaries for measuring emissions associated with operations. The boundary can take many forms (facility-only, campus-only, organization-wide, etc.) and has been defined and sorted into three primary levels of scope to categorize sources of emissions and the impact an organization has on those emissions. The WRI’s GHG Protocol outlines scopes as follows: 

Scope 1 Emissions:

Direct emissions generated by facility processes. This includes on-site combustion from heating systems, generators, cooking, and other fuel-burning processes. 

Scope 2 Emissions:

Indirect emissions associated with purchased electricity. Scope 2 considers the local electricity grid and the fuel sources used by it to generate power. It accounts for transmission losses and the required fuel inputs to support the power consumed by the facility (entering the established boundary). 

Scope 3 Emissions:

These emissions are broader and represent indirect emissions associated with the healthcare organizations’ influence. This may include supply chain inputs for purchasing, employee commuting and travel, waste disposal, and many other categories. Scope 3 emissions are generated by third parties but recognize the demand for those services placed by the organization’s operations. 

The GHG inventory sets a baseline understanding of areas for reduction in emissions. Most GHG reduction programs, initiatives, and targets include specific reductions in Scope 1 and Scope 2 emissions associated with organizational operations. For example, a large healthcare organization may operate multiple campuses across the country – each with different designs, loads (from climate or location), and utility providers. By focusing on the organization, emissions are aggregated for every building under operational control and can help provide clarity and prioritize locations with the greatest opportunity for reductions. Scope 1 and Scope 2 emissions can be tallied for each location and aggregated to create an organizational GHG emission profile. Scope 1 and 2 emissions reflect the most direct impact in emissions for operations versus upstream supply chain-related emissions often associated with Scope 3.  

While many organizations choose to evaluate Scope 3 emissions, the low-hanging fruit remains in Scope 1 and Scope 2 emissions. There is plenty of opportunity for reduction and this is most directly influenced by operations. This coincidentally encompasses the traditionally cost-effective sustainability solutions associated with energy analysis and reduction strategies and can include retro-commissioning of older facilities and reducing the energy burden associated with aging infrastructure and existing operations without much in capital expense. Energy efficiency measures and reductions in energy use result in utility cost savings and provide a lower hurdle to offset emissions with more capital-intensive requirements (such as solar PV, REC’s, and off-site carbon offsets). Often, this is the best place to start. 

Without any intervention, as facilities age and the climate warms the operational emissions can increase over timeThis results from systems that operate closer to their peak capacity and least efficient state (peak load, max fan power, max pumping power, maximum brightness for lighting, etc.) or aging equipment and controls that fall out of calibration or experience glitches in operation.   A layered approach can be implemented by facility management teams to work for continuous improvement to avoid the inevitability of increased emissions. 

The steps to improvement can be summarized as follows: 

 1. Complete a GHG Inventory Benchmark representative of a year for typical weather and operations.  This establishes a base year accounting of Scope 1 and Scope 2 emissions (Scope 3 can optionally be included ad hoc or completely).  

2. Once an Inventory is established, facility operating budgets should be reviewed for allocations to building improvements or maintenance.  Energy spend can typically be close to 50% of the total operating budget! 

3. A facility condition assessment should be completed by a qualified professional and include an accompanying equipment asset list to understand current equipment type, age, condition, and useful life. 

4. Model future emissions based on previous steps  

5. Evaluate, plan/set targets, and implement steps for reducing emissions  

    1. Energy audit 
    2. Retro-commissioning 
    3. Automatic Fault Detection Diagnostics 

6. Report annually and update stakeholders on progress towards established targets, evaluate results and update the plan 

Tackling net-zero or net-positive carbon emissions aspirations can feel like a daunting task but it doesn’t have to be.  What gets measured, gets managed and the first step is understanding how your health care organization uses energy, which results both directly and indirectly in GHG emissions.  Once this is clear, a plan can be implemented to cost-effectively begin to lower those emissions and strive for something greater. 

Contact SSR’s Building Optimization and Sustainability (BOS) team for more information to set up your own GHG Climate Action Plan today.