Redefining Sustainability: A Healthcare Case Study

Redefining Sustainability: A Healthcare Case Study

By Azeeza Rangunwala (GGHH) & Chandan Khanna (Healthcare Without Harm - HCWH)

In the last decade, the global economy has moved beyond traditional Corporate Social Responsibility (CSR) initiatives and has instead, redefined what it means to be socially responsible by placing significant emphasis on addressing the climate crisis, sustainability, and integrating environmental stewardship into their core business strategies.

ESG: environmental, social and governance is an integrative approach. it represents a framework that encourages organizations to focus on long-term sustainability and ethical practices while considering the ESG aspects of their operations. In the healthcare sector, where issues such as access to healthcare, healthcare quality, and resource constraints are prevalent, the ESG approach offers a promising path towards improved healthcare outcomes, better resource management, and sustainable growth.

One of the focal points of an ESG approach is environmental considerations, which may range from energy sources and packaging to the supply chain. It is also important to tie environmental considerations together with societal impact, which includes diversity and inclusion, while the governance component in ESG is important for ethics and transparency. The governance component is also important in building trust with the community served by the company, as it is cross-cutting and ensures the quality of healthcare service delivery in the community.

ESG initiatives also focus primarily on emissions reductions which result in an extensive cost reduction for the organization. Cost, however, is only measured in one manner. Emissions raise temperatures and reduce air quality and this cost to society is externalized. To avoid a ‘carbon tunnel’ vision; other considerations such as livable wages are also important for organizational success. It attracts and retains top talent, increases productivity, and brings positive association with the organization. The health sector, globally, struggles with staffing issues, so this is more than a ‘return on investment’. To surmise, ESG broadens the definition of ROI.

The United Nations’ sustainability development goals (SDGs) are a good starting point to build an ESG strategy and it is important to take the long view as well as the broad view as an organization aligns itself for the future. In learning and sharing insights from successful partner implementation of some ESG initiatives, this article considered the Apollo Hospital Group in India with the same climate and personnel issues as African countries.

The story of Apollo Hospital, India (“Apollo”)

The Apollo Hospital Group is amongst the largest hospital chains in India, with a network of 71 hospitals. In addition, the company operates pharmacies, primary care and diagnostic centers, telehealth clinics, and digital healthcare services through its subsidiaries.

As part of the Apollo Sustainability Action Plan (ASAP), the Group periodically tracks its energy consumption, total Green House Gas (GHG) emissions, water withdrawal, waste generation and commensurate GHG emissions for 40 of its largest facilities which account for 90% of the total energy consuming sites in efforts to set and measure improvement goals.

One of Apollo Group’s Hospitals in India

The issue:

A major challenge experienced by Apollo was the lack of standard data sets available for the company’s decarbonization campaign. While each of Apollo’s units was maintaining data on emissions, waste generation and water, there was no aggregated group data. Consequently, a robust IT-driven platform was developed to aggregate data sets from all Apollo’s hospitals. This data was meant to be a baseline to identify decarbonization action plans for the group.

Apollo’s goals were:

1.?????? Create a robust IT-backed platform to capture sustainability aspects of Apollo’s operations;

2.?????? Ensure data collection related, but not limited, to energy consumption, Scope 1 & 2 emissions, waste generation, water use and discharge, as well as Scope 3 data in subsequent years;

3.?????? Create a framework to ensure the participation of key stakeholders to ensure ownership by those who operate these facilities; and

  1. Creation of a dashboard that can visualise data per hospital to create targets and monitor progress.

Sustainability strategy implemented:

The Apollo sustainability team initiated a multi-dimensional team including - corporate leadership, operations leadership, chief information technology officer, chief finance officer, chief of group compliance & company secretarial affairs, and group lead for sustainability -? to review and provide the best approach for standardizing and aggregating sustainability data from all Apollo’s facilities, by assessing the merits and ?demerits of each possible strategy noted below:

  1. Enhancement of existing hospital information system (HIS) to enable measurement of sustainability metrics;
  2. Creation of an in-house IT tool;
  3. Use of off-line and static methodologies (like Excel sheets, cloud file sharing etc.) for data capture and consolidation; and
  4. Partnering with an external IT solutions provider to develop customized software.

?

Having evaluated all the options available, and partnering with an external IT solutions provider, a new platform was selected. Additionally, various vendors were evaluated and a partner was identified and on-boarded for this project.

Implementation process:

The approval of Apollo’s CFO’s contract was a key enabler for buy-in from internal stakeholders including the board of director’s committee overseeing sustainability (“Board Committee”).

The Group Sustainability Lead (“GSL”) and other stakeholders began the evaluation and modification of the software available through the partner firm. Specific inputs were given on the nature of the group’s operations, its scope and current methodologies of reporting environment-related data. Emissions intensity factors data available through published international repositories like that of Healthcare Without Harm, the United Nations’ GRI, SASB etc. emissions inventory calculation tools were used.

The partner company created the customized solution for implementation in April 2022. GSL then presented this solution to the Board Committee. In May 2022, after the approval by the Board Committee, a pilot phase was implemented at facilities in New Delhi and Ahmedabad. For the pilot, team formation, process SOPs, data templates, data submission deadlines, capacity building & training etc. was initiated with the hospitals.

The sustainability team conducted a detailed outreach to the relevant internal stakeholders including Apollo’s heads of hospitals (CEOs, heads of operations etc.), chief engineers & IT heads of each hospital, Apollo’s quality team & Apollo’s head of medical services.?

Through a series of workshops in all regions, relevant stakeholders were oriented to the platform. After this, each hospital was asked to identify a Single Point of Contact (SPOC) and oversight mechanism. A detailed tutorial video was created for the operating teams. To reduce the carbon footprint from travel for orientation, e-meeting tools, WhatsApp groups of all SPOCs, video calls, creation of virtual tutorials and written materials were employed.


Tracking progress:

In August 2022, the first data sets were made available, and the platform helped to visualize the data in a manner never previously achieved- which helped the team understand the issues in detail. It also helped in comparing data amongst Apollo’s hospitals and better appreciating intensity data over a time period (months, seasons etc.). These first visualizations helped garner great enthusiasm within the team and helped propel further embedding of this project within the team and hospitals.

Challenges and lessons learned:

A major challenge was getting a diverse group of users to use the platform simultaneously.? Factors that attributed to the success include:

  1. Commitment by the senior leadership and board of directors to the project;
  2. Adequate resources and infrastructure made available;
  3. A governance and oversight structure and mechanism;
  4. Identifying local level champions; creating buy-in from hospital leadership;
  5. Creating tools to increase platform uptake and improve implementation;
  6. Use of digital tools for troubleshooting and real-time problem-solving;
  7. A monitoring framework which included weekly reviews, between Apollo and the service provider;
  8. Knowledge sharing on best practices on implementation between team members;
  9. Adequate feedback to SPOCs; and
  10. Fostering a sense of purpose for this project as part of a larger ambition to decarbonize healthcare;

A major lesson learned was the need for greater awareness and capacity building amongst the workforce to ensure smoother implementation. Sustainability efforts should be viewed as an ongoing process. Apollo continues to regularly review and update its environmental goals and strategies, to adapt to changing circumstances and emerge with best practices.

An ESG approach holds immense promise for health organizations globally. By addressing ESG factors, these organizations can achieve better healthcare outcomes, enhance sustainability, and improve their resilience in the face of complex challenges. As healthcare systems continue to evolve, the adoption of ESG principles is not only a moral imperative, but also a strategic choice that will lead to better healthcare for all.

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