By Erin Cristales, Vizient
Residents of the small Midwestern suburb were concerned even before the first child was diagnosed with brain cancer. Then, little by little, the number kept rising.
Though never conclusively confirmed, the suspected culprit was radioactive waste that had seeped into the town's water. No one really wanted to stay once they learned of the leaks, and certainly not after word of the diagnoses spread. But for most, packing up and moving out was not an easy option.
At just 4 years old, Rebecca (Sauer) Hou already knew several of the afflicted. Her 7-year-old sister was one of them. Although the circumstances were difficult, the answer seemed simple enough: Her sister was sick. The hospital made her better.
But over the years, as the treatments continued, Hou began to take note of everything from energy-draining MRI machines to the bags upon bags of biohazardous waste. If ecological degradation was the presumed cause of her sister's cancer, she thought, what could be more important than reducing the environmental impacts of the very place tasked with saving her?
"The healthcare system is phenomenal and I'm so appreciative of it, but it's important to understand that there are issues from a sustainability perspective," said Hou, who now serves as a product advisor at Vizient. "So, how do we mitigate those effects? I thought, 'I need to find a way to help make that change.'"
After spending her graduate career researching healthcare's carbon footprint, Hou was drawn to Vizient's Environmentally Preferred Sourcing program— now more broadly known as Environmental Sustainability — and the vision outlined by Cristina Indiveri, associate vice president of strategic programs and contract services. From their very first meeting, it was clear Indiveri was interested in a whole lot more than "publishing pretty words that don't move the needle."
"She wants to move the needle, and she wants to move it yesterday," Hou said. "Cristina and her team are so action oriented and driven. I could sense Vizient's willingness to be bold and go places that the healthcare industry had historically shied away from."
That's even more true in 2023, as the Environmental Sustainability program — which is one of Vizient's five core tenets — unveils transformational markers to guide healthcare's journey toward an environmentally friendly future. New strategies include contracting language that encourages suppliers to commit to reducing scopes 1, 2 and/or 3 emissions; an Environmental Sustainability Roadmap that provides hospitals with information on current performance, peer benchmarking and actionable solutions for carbon emissions; Environmental Sustainability Managed Services, which provides a full suite of sustainability performance solutions; and EP Optimized Insights, a platform that enables providers to see the line-item detail necessary to purchase products that meet Vizient's environmentally preferred standards.
"To put it simply," Hou said, "it's about providers, suppliers and Vizient coming together to make sure that every patient has a chance at a healthy future before they enter the hospital, while they're there and long after they leave."
'We all have an obligation to work together'
Some might see the stats and fear the quest is quixotic.
According to Health Care Without Harm, the global healthcare climate footprint is equivalent to the annual greenhouse gas emissions from 514 coal-fired power plants. The United States, which is responsible for 8.5% of global healthcare greenhouse gas emissions, saw a 6% increase in emissions from 2010 to 2018 — of which the healthcare supply chain is responsible for 80%.
But as Indiveri and her team know all too well, this isn't tilting at windmills. Climate change is frighteningly real — and confronting such a formidable adversary requires a solid strategy and a broad array of allies to help hospitals move toward decarbonization.
"The greatest single threat to global human health is not RSV or COVID-19 — it's climate change," said Indiveri, who noted that more than 200 medical journals, including The Lancet and The New England Journal of Medicine, have emphasized the irreversible consequences of inaction. "That's why we are working so diligently to provide transparency into healthcare emissions."
There already was an impressive foundation on which to build. Over the past several years, Vizient has:
- Collaborated with its Environmental Advisory Council to identify and define 23 environmentally preferred product attributes to help create standardization across healthcare, with 98% of suppliers now submitting EP attributes
- Launched the industry's largest portfolio of environmentally preferred hospital furniture
- Implemented environmentally preferred language into virtually all of its medical/surgical contracts to encourage suppliers to eliminate chemicals of concern and reduce waste from their products
- And developed an Environmentally Preferred Purchasing dashboard that allows users to view specific environmentally preferred attributes — which includes everything from metals and natural rubber latex to recyclability and chemical inventory — and evaluate the amount of their organization's spend that contains products with harmful chemicals or other environmentally undesirable characteristics.
In 2022, Vizient was the first group purchasing organization to sign a pledge to reduce greenhouse gas emissions and increase its climate resilience as part of an initiative led by the Department of Health and Human Services (HHS) and the White House that challenges hospitals, suppliers, pharmaceutical companies and other industry stakeholders to build climate considerations into the future of healthcare.
"We embrace our responsibility to mitigate Vizient's impact on the climate," Vizient CEO Byron Jobe said during a celebration of the pledge in November. "Just as importantly, as a connection point between providers and suppliers, we make every effort to enable healthcare organizations to reduce their climate impact as well."
It's an increasingly important — and undeniably complex — goal, particularly in relation to scope 3 emissions. While health systems can exercise direct control over scopes 1 and 2, they can only influence scope 3, which is the largest source of greenhouse gas emissions produced by the healthcare sector.
As the Environmental Sustainability team crafted the new carbon emissions contracting language that rolled out in early spring, they scrapped a one-size-fits-all approach in favor of a sliding scale based on suppliers' sustainability maturity. For instance, a supplier who is just beginning to track science-based targets would commit to scopes 1 and 2, while a supplier with a more established track record would tackle scope 3 and submit a climate action plan to report their year-over-year improvement.
"With this language, we're signaling to suppliers, providers and the larger healthcare industry that in order to be responsible stewards of human and environmental health, data transparency is paramount," said Indiveri, who in the fall of 2022 discussed Vizient's vision for greater sustainability with industry leaders at a Modern Healthcare panel focused on environmental, social and governance (ESG). "No single healthcare organization can tackle climate change alone. Vizient is committed to advancing broad collaboration within the healthcare industry to swiftly scale decarbonization efforts."
That commitment to broad collaboration meant reaching out to suppliers who are themselves industry leaders in environmental and corporate responsibility. Anila Prabhu, vice president of sustainability and inclusion champion at 3M, initiates and executes sustainability strategy across multiple divisions within the company's healthcare business. In the past several years, 3M has achieved and adopted some sizable sustainability goals, including reducing scopes 1 and 2 greenhouse gas emissions by 72% with a goal to achieve carbon neutrality by 2050; approaching a goal of 50% renewable electricity at all global sites by 2025 and 100% by 2050; investing $1 billion over 20 years to accelerate air and water stewardship; and reducing the dependence on virgin fossil-based plastic by 125 million pounds by 2025.
Prabhu was one of several sustainability champions who weighed in on Vizient's carbon emissions contracting language and how it can best bolster suppliers' environmental commitments. No industry, she says, can achieve success in a silo — collaboration and partnership of multisectoral players in the healthcare supply chain is essential to address emissions.
"We may have different roles, but we all have an obligation to work together to solve this bigger issue of climate change," Prabhu said. "Sustainability is about meeting the needs of the present without compromising the needs of future generations. The work that Vizient is doing — and the objectives we can all meet in collaboration with each other — is absolutely the right direction."
'You can't manage what you can't measure'
In 2016, a northwest-based health system measured that its annual greenhouse gas emissions, largely due to a frequently used anesthetic gas, was 5,000 metric tons.
It wasn't an unusual number, and perhaps not even a particularly startling one in those rather abstract terms. But let's put it another way: 5,000 metric tons is roughly the emissions released by a large SUV driving 5.6 million miles.
It was a big problem – but one with a surprisingly simple solution. The system switched to an alternate gas and by 2020, had reduced its emissions by 95%, all while sustaining workflow efficiency and reducing anesthetic costs by 80%.
It's the kind of success story that, ideally, would be not so much extraordinary as commonplace. And the Environmental Sustainability team is ready to harness that aspiration with tools like Vizient's new Environmental Sustainability Roadmap. Set to launch later this year, the resource will provide clear, actionable scopes 1, 2 and 3 carbon calculations, identify "hospitals like me" for comparison and benchmarking, and recommend carbon-sensitive alternatives for performance improvement based on supplier data.
"Currently, there is no common tool in healthcare to showcase carbon emissions down to the product category segment, and that's because it's complicated and the data is sporadic," said Mellissa Nguyen, Vizient senior program services manager. "But no other consulting firm has the data we have, nor do they have as strong a foothold in the healthcare industry. So, we're working to align the industry on carbon-related reporting and expand our definition of sustainability so that providers can see not just sustainable procurement variables but also climate action. That way, they can make more informed decisions about the products that are safest for patients, reduce costs and measure their performance against their peers."
The Environmental Sustainability Roadmap was piloted last year with several provider participants, including The Ohio State University Wexner Medical Center. The roadmap provides data and insights that most health systems simply do not have the capacity to mine, said Aparna Dial, senior director of facilities management and sustainability at Ohio State, and quantitatively supports initiatives such as the reduction of hospitals' waste streams and carbon footprints. That's been particularly important for Ohio State, which in less than a decade saw its waste diversion rate increase from 5.9% to 37.4%, a 4% year over year energy reduction across facilities, and 99% of its Vizient purchased items include at least one environmentally preferred attribute.
"You can't manage what you can't measure," said Dial, who also serves on Vizient's Environmental Advisory Council, which is comprised of experts in sustainability, value analysis and supply chain who educate providers on the importance of incorporating environmental responsibility into their mission. "Typically, supply chain departments are focused and measured against delivering cost savings. By integrating sustainability ambitions with the data-driven world of cost analysis, the roadmap moves the perception of sustainability as a 'nice to have' and creates a mechanism for success."
Another new tool designed to help providers solve for today's toughest challenges is Vizient's Environmental Sustainability Managed Services, which will be offered this year as the most comprehensive and cost-effective extension of a provider's sustainability operation. ES Managed Services will offer expertise — including general sustainability strategies and specific technical support — by working with providers who don't have an internal sustainability department and bolstering the efforts of those with in-house teams.
"This was created in response to growing calls from providers who want support on their sustainability journeys," said Trey McDonald, Vizient senior sustainability consultant. "Providers are interested in our help to assess their current status, develop strategic plans to achieve their sustainability goals and identify possible funding mechanisms for their plans."
Similarly, Vizient's recently launched EP Optimized Insights enables deeper visibility into environmentally preferred spend. The tool showcases conversion scenarios to standard EP products, provides partner-led insights and highlights line-item level detail of products.
But no matter the resource, the goal is the same.
"We're showcasing the immense need for more data and more visibility into carbon emissions," Indiveri said. "That's why it's so important for us to connect providers and suppliers to set the industry standard so this becomes just another part of doing business and mitigating risk."
Making healthcare more sustainable – together
It's been a year now since Hou joined Vizient, and she's continued to make strides toward a goal that originated nearly two decades ago. Her sister is in remission, but her occasional oncology checkups are a reminder of where Hou's journey started. After all, the wellbeing of her sister — and everyone else — rests on ensuring healthcare itself becomes more sustainable in every sense of the word.
It may be a tough path, but it's not one she's traversing alone.
"Healthcare has been an integral part of my daily life since I was a kid — it means so much to me and all I've ever wanted is to play a role in helping to reduce its carbon footprint," Hou said. "It's exciting for me to be part of an organization that is putting in the work to minimize those environmental impacts."
Learn more about Vizient's Environmental Sustainability program and access more insights to support an environmentally sustainable supply chain.