Table 2.

Examples of decarbonization efforts by healthcare organizations, scope, goals, and outcomes.

Initiative (or organization driving initiative)	Scopea addressed and example	Goal of initiative	Brief description of initiative	Achievements of initiative or lessons learned from initiative
Kaiser Permanente (Kaiser Richmond Medical Center—50-bed tertiary care facility; part of larger system of care in multiple states	Scope 1. On-site combustion	Carbon neutrality achieved in 2020 for Scope 1 and 2 emissions and Select 3 emissions	Solar microgrid, a 250-kilowatt solar panel installed atop the center's five-level parking garage, connects renewable energy and battery storage to a pre-existing, diesel-fueled backup power system.	Microgrid supplements the hospital's electrical demand with cleaner energy, augmenting energy loads at peak hours, offsetting the need for power from the major grid, and reducing consumption by at least 365 000 kilowatt-hours annually, the equivalent of removing nearly sixty cars from the road per year.35
Veterans’ Health Administration (large integrated healthcare system in the United States, serving 9 million enrolled veterans each year)	Scope 1. On-site combustion	Pursue mission of care, while achieving energy efficiency and resilience identified through quadrennial energy audits	Through combined capital investment and third-party financing, VA upgrades its facility infrastructure and equipment while installing renewable power where feasible.	Has successfully reduced its energy intensity (kilo-British thermal unit (kBtu)/gross square foot) by over 26% since 2003. Sixteen VA hospitals overall use 38% less energy per square foot than the national average for all hospitals (which is approximately 234.3 kBtu/gross square foot.37,41
NHS England	Scope 1. Facility-owned vehicles	In 2021 transition to a fully zero-emissions ambulance fleet, aligned with the national specification to decarbonize, while ensuring the highest standards of safety and patient care	Purchases of zero-emissions ambulance fleet.	Decarbonizing the ambulance fleet is estimated to reduce emissions by 87 kilotons of carbon dioxide equivalents (ktCO2e).27
The Department of Veterans Affairs (VA)	Scope 1. Facility-owned vehicles	VA plans to transition its roughly 23 000 vehicle fleet to ZEVs	VA audits its medical facilities to assess and plan for charging infrastructure, while also acquiring solar chargers to provide more immediate capacity. Simultaneously, VA is replacing its petroleum-fueled vehicles with ZEVs.	Since October 2021, VA has confirmed 507 ZEV orders, which make up 34% of its light-duty vehicle acquisitions this annual cycle.37
UCSF	Scope 1. Anesthetic gas	To reduce emissions related to excessive volatile anesthetic consumption by lowering FGFs	Implemented an electronic health record–based clinical decision support tool within the Epic Anesthesia Information Management System (AIMS) aimed at reducing FGFs and evaluate the effectiveness of this intervention in achieving sustained reductions in FGF rates and volatile anesthetic consumption and cost.	Demonstrated a decrease in mean FGFs by 0.6 L/min (95% CI, 0.6–0.6 L/min; P < .0001) for sevoflurane and 0.2 L/min (95% CI, 0.2–0.3 L/min; P < .0001) for desflurane immediately after implementation of the intervention, resulting in decreased rates and cost per MAC hour.33,34
Providence Health and Services (8 regional hospitals in Providence, Oregon, including quartenary medical center)	Scope 1. Anesthetic gas	To reduce emissions associated with inhaled anesthetics	Used iterative clinical quality-improvement program, including personalized clinical benchmark reports and education.	Reduced inhaled anesthetic emissions by 4550 tons CO2e per year (equivalent to 980 passenger vehicles per year), largely through avoiding use of desflurane; sustained a 94% annual reduction in GHG emissions.36
Providence St. Vincent Medical Center	Scope 1.	To decommission central piped nitrous oxide and substituted portable E cylinders after discovering high rates of infrastructure leaks	The overall facility leak rate was 1.89 liters per minute (L/min), resulting in clinical use efficiency of 5.4%.	The decommissioning of central nitrous oxide piping reduced losses by 958 tons CO2e (the equivalent of 206 gasoline-powered passenger vehicles off the road) in one year and saved $12 000 USD in procurement costs. Similar assessments at twenty-four other Providence hospitals found leak rates ranging from less than 0.1 to more than 3.5 L/min, with use efficiency of 0.9 25%–29%, suggesting additional opportunity across the health system.36
UC Health system, including from UC's own electric company, UC Clean Power	Scope 2. Renewable electricity purchases	To obtain renewable energy from off-site sources, such as utility and establish UC's own self- provided electricity program (“UC Clean Power”)	UC Health is obtaining municipal retail tariff options and participating in UC's own electricity program.	Overall, 55% of UC's electricity use comes from renewable or carbon-free sources. UC Clean Power currently supplies approximately 40% of the University's purchased electricity, serving portions of nine campuses and five academic health centers that are eligible to participate. The program's portfolio includes power generated by two Fresno County solar projects under long-term contracts, as well as other renewable and carbon-free sources.39
NHS England	Scope 3. Pharmaceuticals and chemicals, inhalers	To reduce total GHG emissions from the NHS; and found that MDI prescriptions contribute approximately 3% of total GHG emissions from the NHS	In 2020, NHS England conducted a systemwide carbon footprint analysis that showed that the footprint of dry powder inhalers, for example, is approximately one-tenth that of MDIs, presenting a more sustainable alternative for prescriptions.	Reducing unnecessary prescriptions of MDIs is part of the NHS's strategy to achieve a net-zero carbon healthcare service.27
Providence Health and Services (8 regional hospital facilities, Oregon)	Scope 3. Pharmaceuticals and chemicals, inhalers	Reduce environmental costs, improve formulary decision making for inhaled medications	After performing a detailed formulary review of propellant-based GHG emissions for each inhaled medication formulation, Providence Oregon hospitals identified clinically equivalent MDI formulations of albuterol with 3-fold differences in emissions.	By prioritizing the lower emissions intensity inhalers, these emissions are projected to drop by 42%, or 298 tons of CO2e (the equivalent of 64 gasoline powered passenger vehicles driven) per year.
Sutter Health Valley Region (10 hospitals ranging in size from 40 to 523 beds; 1402 total beds)	Scope 3. Food procurement	To reduce wasted food	Northern California, USA. In 2020, Sutter Health implemented a food-donation pilot program in their Valley Region facilities to reduce wasted food. From January 2020 to February 2021, the 10 hospitals donated almost 65 000 pounds of food to more than 40 area nonprofits within 5 miles of each facility using a food-donation logistics company.	This program diverted food waste from the landfill, reducing carbon emissions by 142 metric tons CO2e (the equivalent of thirty-two gasoline-powered passenger vehicles driven for one year), and provided an estimated 55 000 meals to organizations addressing food insecurity in their communities. The pilot also led Sutter Health to expand the food donation program to six additional facilities within its health system.23,40
UCSF Health (3 hospitals with 1675 total beds)	Scope 3. Food procurement	Hospital sites that serve approximately 2.3 million meals annually, comprising 537 000 patient meals and 1.7 million retail transactions with faculty, staff, students, and visitors	UCSF Health joined the Cool Food Pledge aimed at achieving a collective target of reducing GHG emissions from food by 25% by 2030.	Between 2017 and 2020, UCSF Health's plant-forward efforts have reduced the climate impact of the food served by 12.5% overall, translating to an 8% reduction in GHG emissions per meal—equivalent to 455 gasoline-powered passenger cars off the road annually. This effort was driven by a reduction of beef procurement by 28%, an increase in legumes by 13%, and an increase of almost 70% in plant-based milk during this time period.42

Note: CI = confidence interval; FGF = fresh gas flow; GHG = greenhouse gas; MAC = minimum alveolar concentration; MDI = Metered dose inhalers; NHS = National Health System; UCSF = University of California, San Francisco; ZEV = zero emission vehicle.

^aScope 1 = direct emissions from owned or directly controlled sources, on site; Scope 2 = indirect emissions from the generation of purchased energy, mostly electricity; Scope 3 = all other direct emissions that occur in producing and transporting goods and services, including the full supply chain.