North US State Hospitals towards sustainable healthcare:

Northern Arizona Healthcare (NAH), Arizona: Joined the US Health and Human Services Health Care Climate Pledge to continuously improve sustainability initiatives. They have taken steps to reduce carbon footprint under the project Nah’s Blue Wrap Project. Under this project surgical items are re-purposed into items that can be used by patients and NGO’s. NAH has saved up to $17,000 in waste disposal fees and has removed about 60,000 pounds of surgical waste from the landfills under this project. (NAH, 2022)

Metro Health Hospital, Wyoming, Michigan: A 208-bed, Leadership in Energy and Environmental Design (LEED) -certified hospital with longstanding green practices, including water conservation, recycling programs, and a green roof to minimize stormwater runoff. In 2000, the hospital's board of directors identified "integrating green development strategies" as a fundamental principle. Since then, the hospital has actively pursued this objective. For instance, by transitioning to a microfiber mop system, Metro Health Hospital reduced its water consumption by 43,000 gallons and slashed chemical usage by 90 percent. Moreover, the hospital implemented extensive recycling initiatives and installed a 48,500-square-foot green roof to mitigate stormwater runoff and regulate building temperatures. Consequently, Metro Health Hospital earned recognition as the first hospital in Michigan to be designated as a "Clean Corporate Citizen" by the Michigan Department of Environmental Quality. (BECKER'S, 2015)

New York-Presbyterian Hospital, New York City: As the largest single hospital in the New York metropolitan area, New York-Presbyterian Hospital acknowledges its substantial carbon footprint. Through its sustainability program, NYP green, the organization emphasizes the intrinsic connection between sustainable practices and ecological well- being. Guided by a sustainability council, New York-Presbyterian is committed to adopting environmentally responsible measures. Key initiatives include waste minimization efforts such as recycling metal, plastic, and paper, as well as ensuring the safe disposal of hazardous bio-waste. Additionally, the hospital participates in farmers markets and operates a hybrid vehicle project (BECKER'S, 2015) .New York-Presbyterian has been recognized with numerous accolades, including awards from the EPA's Energy Star program and Mayor Michael Bloomberg's PlaNYC Hospital Carbon Challenge, aims to reduce greenhouse gas emissions 40% by 2030. (New York, 2024)

Regulatory Reporting Mechanism in the US: The U.S. Environmental Protection Agency (EPA) mandates GHG emissions reporting under the Greenhouse Gas Reporting Program (GHGRP), introduced through the regulation 40 CFR part 98. This program covers a broad spectrum of GHG emitters, including healthcare facilities that emit 25,000 metric tons or more of CO2e annually. The GHGRP aims to gather comprehensive data on GHG emissions, facilitating policy development and reduction initiatives. Reporting entities must submit their emissions data annually via the EPA's e-GGRT platform, ensuring accurate, verifiable, and consistent information that adheres to stringent validation checks.


CANADA

Provincial and Federal Regulations: In Canada, the responsibility for environmental regulation, including GHG emissions reporting, is shared between federal and provincial/territorial governments. Regulations such as Ontario's Ontario Regulation 390/18 and Alberta's Specified Gas Emitters Regulation exemplify the localized approach to environmental management, setting specific thresholds for emissions reporting and verification. These frameworks necessitate that healthcare facilities, when their emissions exceed the stipulated thresholds, accurately report their GHG contributions to provincial bodies like the Ministry of the Environment, Conservation and Parks in Ontario or Alberta Environment and Parks.

Reporting Formats and Verification: The reporting process requires a detailed accounting of GHG emissions, typically involving the calculation of emissions from direct sources (Scope 1), indirect sources like purchased electricity (Scope 2), and all other indirect emissions (Scope 3). The format for these reports is dictated by the respective regulatory authority, demanding comprehensive data on emission types, sources, and quantities. Verification, often by a third party, is a critical step to ensure the reliability of the data reported, particularly for facilities with significant emission volumes. This step underscores the commitment to transparency and accuracy in environmental reporting.

Case Studies and Examples:

Emissions Inventories to Comply with Regulatory Requirements: Example 1: Massachusetts General Hospital (MGH) in Boston, USA, conducted a comprehensive emissions inventory to comply with state and federal regulations. They tracked emissions from energy consumption, transportation, waste management, and other sources over a specified reporting period. Successful Initiative: MGH successfully identified emission hotspots and implemented targeted reduction strategies, such as upgrading HVAC systems, optimizing transportation routes, and implementing waste reduction programs. Challenges and Lessons Learned: Challenges included data collection from diverse sources and establishing baseline emissions for accurate tracking. Lessons learned included the importance of stakeholder engagement, data transparency, and continuous monitoring for effective emissions management.

Example 2: The Cleveland Clinic, located in Ohio, USA, conducted a comprehensive emissions inventory to comply with local environmental regulations. They tracked emissions from energy consumption, transportation, waste management, and other sources across their multiple facilities. Successful Initiative: By identifying emission sources and implementing targeted reduction strategies, such as energy-efficient upgrades and waste reduction programs, the Cleveland Clinic achieved significant reductions in greenhouse gas emissions while maintaining high-quality patient care. Challenges and Lessons Learned: Challenges included data collection from decentralized facilities and establishing consistent measurement protocols. Lessons learned included the importance of staff training, stakeholder engagement, and leveraging technology for streamlined data management.

Implementing Energy Efficiency Measures to Reduce Emissions:

Example 1: Vancouver General Hospital (VGH) in British Columbia, Canada, implemented energy efficiency measures to reduce its carbon footprint. This included retrofitting lighting systems, installing energy-efficient HVAC equipment, and implementing building automation systems for optimal energy management.

Successful Initiative: VGH significantly reduced its energy consumption and greenhouse gas emissions while maintaining high-quality patient care. The hospital achieved cost savings through reduced energy bills and received recognition for its sustainability efforts.

Challenges and Lessons Learned: Challenges included upfront investment costs, technical complexities of implementing energy-efficient technologies, and staff training. Lessons learned included the importance of leadership support, staff engagement, and long-term planning for sustainability initiatives.

Example 2: The Royal Jubilee Hospital in Victoria, British Columbia, Canada, implemented a series of energy efficiency measures to reduce its environmental footprint. This included upgrading lighting systems, optimizing HVAC controls, and retrofitting buildings for improved insulation.

Successful Initiative: The Royal Jubilee Hospital achieved substantial reductions in energy consumption and greenhouse gas emissions, resulting in cost savings and environmental benefits. The hospital's sustainability efforts were recognized with awards and accreditation from regional and national organizations.

Challenges and Lessons Learned: Challenges included securing funding for capital investments, overcoming technical barriers, and ensuring ongoing maintenance of energy-efficient systems. Lessons learned included the importance of leadership commitment, staff engagement, and continuous monitoring of energy performance (Green, P. et al., 2019).

Incorporating Sustainability Criteria into Procurement Decisions:
Example: University Health Network (UHN) in Toronto, Canada, integrated sustainability criteria into its procurement process for medical equipment and supplies. This involved evaluating suppliers based on their environmental performance, product lifecycle impacts, and adherence to sustainability standards.

Successful Initiative: UHN achieved significant reductions in waste generation and environmental impact by sourcing products from environmentally responsible suppliers. By prioritizing sustainable procurement, the hospital supported green innovation and contributed to a more sustainable healthcare supply chain.

Challenges and Lessons Learned: Challenges included balancing cost considerations with sustainability goals, supplier transparency, and navigating complex procurement regulations. Lessons learned included the importance of collaboration with suppliers, continuous improvement, and tracking performance metrics to assess the effectiveness of sustainability initiatives (Smith, A. et al., 2020).

Reference:
GSA, D. N. (08, 02 2023). Federal Acquisition Regulation: Sustainable Procurement. Retrieved from Federal Register ( The Daily Journal of United States Government): https://www.federalregister.gov/documents/2023/08/03/2023-16012/federal-acquisition- regulation-sustainable-procurement

U.S.DHHS. (2022). U.S Department of Health & Human Services 2022 Sustainability Plan. Retrieved from https://www.sustainability.gov/pdfs/hhs-2022-sustainability-plan.pdf

NAH. (2022). Northern Arizona Healthcare joins the US Health and Human Services health care climate pledge. Retrieved from North Arizona Healthcare : https://www.nahealth.com/news/northern-arizona-healthcare-joins-the-us-health-and- human-services-health-care-climate-pledge/

DHHS. (2022). FY 2022 Sustainability Scorecard. Retrieved from https://www.sustainability.gov/pdfs/hhs-scorecard-fy2022.pdf

BECKER'S. (2015, October 2). 50 of the Greenest Hospitals in America. Retrieved from BECKER'S Hospital Review: https://www.beckershospitalreview.com/lists/50-of-the- greenest-hospitals-in-america.html

New York, P. (2024). New York-Presbyterian NYP Green. Retrieved from https://www.nyp.org/about/nypgreen/energy#:~:text=The%20NewYork%2DPresbyterian %20Energy%20Management,gas%20emissions%2040%25%20by%202030.

CCGHC. (2024). Retrieved from The Canadian Coalition for Green Health Care: https://greenhealthcare.ca/hospitals/ HC. (2024). 2023 to 2027 Departmental Sustainable Development Strategy. Retrieved from Health Canada : https://www.canada.ca/content/dam/hc-sc/documents/corporate/about- health-canada/reports-publications/sustainable-development/2023-2027-departmental- sustainable-development-strategy/2023-2027-departmental-sustainable-development- strategy.pdf

NASA, G. (2023, 03 08). Federal Acquisition Regulation: Sustainable Procurement. Retrieved from Federal Register : https://www.federalregister.gov/documents/2023/08/03/2023-16012/federal-acquisition- regulation-sustainable-procurement ISO 14001 in Healthcare - Enhancing Environmental Sustainability in Hospitals. (n.d.).