Table 3.

Case studies on reducing emissions in hospitals

Country	Provider	Description
Canada	Centre Hospitalier Universitaire de Montréal (CHUM)	• Installed new anesthetic stations to minimize gas leaks, as well as modules that capture gasses before they escape through the hospital’s chimney [55]. With these changes, the anesthesia department expects to reduce its greenhouse gas emissions from 3,500 tons in 2017 to 150 tons by 2023 • The bill is already lighter than it was previously: anesthetic gas costs for the CHUM dropped from $532,000 in 2017 to $106,000 in 2022
Chile	Valdivia Public Health Network	• Shut down their incinerator • Hired environmental managers for each facility, creating an environmental leadership committee • Staff was trained to use the Health Care Without Harm carbon emission footprint tool to calculate their hospital’s emissions. This led to them finding out that in seven out of the eight facilities that calculated their carbon footprint, scope 1 emissions (those produced on site) represented more than half of total emissions, mainly caused by boilers, cooling and anesthetic gasses. Energy audits have since then been carried out to monitor and optimize energy efficiency (i.e. switching from fuel boilers to gas) • Built onsite orchards to educate staff, patients and the broader community on sustainable agricultural practices and providing nutritious, low-carbon and chemical-free food for the facilities [56]
France	Centre Hospitalier de Niort	• Current waste policies encourage the sorting and recycling of waste (cardboard, toxic waste from laboratories, computer waste, batteries etc.) to minimize the quantities of materials going to landfill or incineration [57] • Awareness campaigns and staff education to encourage these recycling behaviors have been implemented
New Zealand	Hawke’s Bay District Health Board – Go Well Initiative	• In 2014/15 the facilities management team developed a Go Well Travel Plan to (1) improve access for low-income families and whānau, (2) promote exercise, (3) reduce the carbon footprint of the hospital and (4) increase the availability of car parks [58] • Introduced measures to encourage visitors, staff and patients to use public transport (free bus fares for patients) and car pools • Since the implementation of the Go Well Travel plan, use of buses has increased by 100% among patients and 4% by staff, the proportion of staff driving cars has reduced by 10% and the proportion of cycling to work has increased by 3%
New Zealand	Forté Hospital	• First hospital in Australasia to achieve a four-star green certification through the New Zealand Green Building Council [59] • Initiatives they have implemented include: (1) Better segregation of waste resulting in a 47% reduction in the amount of medical hazardous waste requiring emission-producing heat treatment (2016 – 2021); (2) Reducing waste to landfill by 1.6 tons from 2019 to 2020; (3) Reducing electricity usage by 12% from 2019 to 2021; (4) Recycling staff uniforms into bags for patient belongings or donating them to Pacific Island hospitals, thanks to a partnership with Rotary Worldwide; (5) Installation of a new VIE liquid oxygen tank resulting in an approximately 99% reduction in CO2 emissions from truck deliveries; (6) Removed single-use food packaging for patient meals, saving around 1,200 single-use containers going to landfill each year and (7) Replaced medicine trays with compostable alternatives • Future sustainability goals include to further reduce its carbon dioxide equivalent emissions by 10% over the next five years • Carbon offsetting projects involving planting trees at Spray Point Station in South Marlborough, at Puhi Peaks Station and Nature Reserve in Kaikōura and at the Hinewai Reserve, Banks Peninsula
Norway	NA	• Used drone technology in 2021 to transport biological samples between cities as far as 120 km apart. [20] • Drones can potentially be faster, competitive on price and emit 95% less CO2 than cars and be available at any time
Singapore	Changi General Hospital	• Deployed solar panels back in 2017, which has helped generate about 50MWh of energy a year [60] • Current solar energy accounts for around 1% of the hospital’s annual energy use, covering non-critical systems such as roof lighting and fans. The hospital aims to ramp up to 5% solar generated energy through expansion to new rooftop spaces, which could see carbon emissions reduced by up to 4,000 tons over 25 years • Introduced a heat recovery system for hot water since 2002, using waste heat from the air-conditioning system to heat water for showers and sterilization processes. Replacing water heated by the hospital’s gas-fired heaters has saved $300,000 a year