Examining opportunities for circular adoption in healthcare

Healthcare emissions in the U.S. account for 8.5 percent of the nation’s carbon footprint. When looking at this figure through rose-tinted glasses, objectively speaking one might not be too surprised by that percentage. This is an energy-intensive field – healthcare facilities consume close to 10% of the total energy used in U.S. commercial buildings and spend more than $8 billion on energy every year.? The sectors contributing the most to carbon emissions in the health care space are hospitals (36%), physician and clinical services (12%), and prescription drugs (10%). The Greenhouse Gas Protocol also shows that, not unlike other industry sectors, Scope 3 Emissions represent the biggest slice of that GHG emissions pie: US facilities produce more than 30 lbs of healthcare waste per patient, per day (that's almost 6 million tons of waste annually), and medical waste accounts for 25% of US healthcare spending – more than $760 billion per year.

But, for healthcare organizations, progress in reducing their environmental problem isn't straightforward. Healthcare institutions have the responsibility to provide the utmost care and improve people’s health and well-being. Beyond the loss of trust and reputation, risks of noncompliance for patient care and safety can result in loss of accreditations, fines, and legal battles. Exemplary patient care and performance are how hospitals compete. Competition is usually in the form of perceived quality – highly trained staff, better technology, and a greater variety of services.

Climate change won’t wait to test our healthcare institutions

It’s no secret that as our planet warms, climate change is contributing to air pollution, extreme temperatures, severe weather, and other events that will put healthcare institutions' patient safety responsibility to the utmost test.?

According to the World Economic Global Risks Report 2024 , over the next 10 years, the top 5 human health risks are all climate-related: extreme weather events, critical changes to Earth systems, biodiversity and ecosystem loss, and natural resource shortages. This reality is exacerbated in marginalized communities heavily impacted by climate-related events. Today, climate-related illnesses are on the rise in communities most impacted by our warming planet, including respiratory and heart diseases, pest-related diseases like Lyme disease and West Nile Virus, water- and food-related illnesses. In addition, climate change has been linked to increases in violent crime and overall poor mental health.

If the U.S. healthcare system fails to take action to decarbonize its facilities and operations, it is not just a failure to enhance the sector’s ability to withstand and adapt to climate-related challenges. It is a failure of their primary responsibility: protecting the health of people. The U.S. healthcare system can’t aim to get people better, and as a byproduct, unintentionally drive worse environmental and health conditions for the communities they serve and reside in.

Where to start? Let’s go back to the AHA definition of sustainability

Something unusual happened just outside of my home in Chicago at the start of 2024. The Joint Commission, the nation's oldest and largest standards-setting and accrediting body in health care (located in Oakbrook Terrace, IL) was approached by enough healthcare professionals asking for a new certification focused on improving environmental outcomes , that it actually happened. The President and CEO, Dr. Jonathan Perlin, had this to say:

“It's rare that the Joint Commission gets asked for more standards.”

The Joint Commission’s sustainability certification program, launched in January, is designed to help hospitals in a number of ways and offer a roadmap for hospitals and health systems that have new or modest sustainability initiatives. While these standards are a clear indication that there is a rising awareness and concern regarding environmental damage in the medical industry, voluntary standards aren’t going to move the needle enough to meet the IPCC goal of halving emissions in every sector (including healthcare). Instead, we have to implement a system that is easily adaptable to how healthcare services and products are delivered, putting systems in place that are not only sustainable but also more cost-effective and efficient. This transition involves rethinking the lifecycle of medical devices, supplies and waste byproducts. So let’s reference what sustainability means in the context of healthcare. Sustainability according to the American Health Association refers to the “integration of environmental stewardship, social equity and fiduciary responsibility to support healthy, equitable and resilient environments and communities over time.” Digging deeper into the AHA definition, sustainability in health care is really based on one single principle: Everything that humans need for their survival and well-being depends, either directly or indirectly, on the natural environment.

For those in my network working towards circular economy solutions initiatives, does this sound familiar? Activating a circular economy requires methodologies that (1) Design out waste and pollution (2) Keep products and materials in and (3) regenerate natural systems. For our healthcare systems, it’s about turning to solutions that mimic and model our natural systems.

Opportunities for circular adoption in healthcare

Some of the most significant challenges towards adopting a circular economy model in the industry is (1) a lack of governmental legislation on CE healthcare policies and (2) a lack of a realistic CE business model. Healthcare also has among the most stringent standards for safety, hygiene, and waste management, creating risk aversion when it comes to practicing reuse and circularity.

The good news is the healthcare sector doesn't need to choose between safety and circularity (actually in most cases, circularity is the best safety protocol), nor does it need special legislation or sweeping business model changes to at least get started with an impactful circular strategy.?

One strategy for building circular adoption is to focus on circularity of one single product category before coming up with a system-wide solution. When waste generated by healthcare facilities is disposed of through incineration, pollutants enter the environment, contributing to the incidence of chronic illness. Many pollutants disposed of in this fashion come from furnishings that contain formaldehyde, perfluorinated compounds, polyvinyl chloride (PVC), antimicrobials and flame retardants.? By avoiding unnecessary disposal of furnishings through reuse, or prioritizing the tracking and purchasing of sustainable furnishings that won’t emit VOCs, we can create a circular ecosystem for one category of waste that isn’t as heavily regulated.

Recently, RUSH University Medical Center took leftover furniture on Rheaply in the Kidston building into other fully furnished spaces across the campus (and in some cases across Rheaply’s ecosystem). Through surveying and cataloging items that remained, the RUSH team identified more than 27 tons of furniture in the building worth nearly $200k that could be reused internally versus buying net new.

Similarly, Allina Health, a health care system with 12 hospitals and more than 90 clinics across Minnesota and Wisconsin looked at their sterile processing department and saw a massive opportunity for reuse. Using an ecosystem-based approach for internal sharing between clinicians, surgical departments and their instrumentation warehouse, over $193k of valuable items like surgical instruments, exam room tables and sterile processing equipment were recaptured.

What other high-priority product categories have high potential for exposures and thus need to be monitored, tracked and reused?

Here’s a short list from Practice Greenhealth:

• Enteral nutrition products
• Enteral tubes
• Breast pumps and accessories
• General urological supplies
• Gloves
• Parenteral infusion devices and sets
• Respiratory therapy products

Where can your institution easily get started with a circular action plan for one product?

Let’s continue the conversation at CleanMed

CleanMed will bring Rheaply to Salt Lake City to connect, share, and build upon this foundation for circularity in health care. If you’re attending and want to reach out and discuss the topics above, let me know in the comments below.