Healthcare sustainability metrics: building a safer, low-carbon health system

Martin Hensher, Associate Professor of Health Systems Financing and Organisation in the Institute for Health Transformation, and Forbes McGain, Intensive Care Specialist at Western Health argue that effective measurement and reporting are key elements in reducing environmental damage from the healthcare system – but we need to learn from the hard-won lessons of measuring healthcare improvement and performance.

Written by Associate Professor Martin Hensher and Forbes McGain

The Australian healthcare system is estimated to generate between 5% and 7% of total national greenhouse gas (GHG) emissions. As appreciation grows of the scale and urgency of the climate crisis – and of its grave consequences for human health – so too does understanding that healthcare systems themselves need to reduce their carbon footprints and stop being part of the problem. Well-designed measurement and reporting on healthcare sustainability and environmental impacts will be an essential component of efforts to reduce the environmental harms caused by health systems.

In a new special issue of US journal Health Affairs, we explore how best to measure improvement and performance for healthcare sustainability, drawing on the lessons of decades’ experience in healthcare measurement and reporting.  Time-limited free access to our original Health Affairs article is available here. We examine and contrast different approaches to measurement and reporting on healthcare sustainability, using examples from the USA, Australia and England. 

In the USA, most effort on healthcare sustainability measurement and reporting has been voluntary, and centred either on climate risk disclosure (as in many other corporate sectors), or as part of healthcare organisations’ wider corporate social responsibility efforts. By contrast, mandatory reporting of healthcare environmental impacts has been introduced in certain Australian states and territories, such as Victoria, providing a basis for standardised reporting by public health services.  In England, the National Health Service (NHS) now collects and reports environmental impact data on every NHS organisation as part of its Sustainable Health Dashboard.

The most important lesson for measuring sustainability to be drawn from healthcare’s long experience in reporting on quality and improvement is simple – measurement and reporting must align with and be driven by the strategic goals of the health system. Healthcare systems need a clear sustainability goal – like NHS England’s recent commitment to a Net Zero NHS – and measurement must support that strategic goal, instead of letting goals be dictated by ease of measurement. Measurement needs to be consistent and comparable – which requires developing and following national and international data standards and classifications.

New sources of data (like Building Management Systems, procurement and inventory systems) need to be integrated into data collections in just the same way as clinical and patient administration systems already have been. Perverse incentives and outcomes must be carefully avoided, as experience has shown that performance measurement can easily have unintended consequences. In the long term, fully integrating sustainability reporting with clinical quality and performance reporting offers profound opportunities to reduce waste, low quality care and harms to both human and planetary health.

Hensher, M. and McGain, F.  (2020) Healthcare Sustainability Metrics:  Building a Safer, Low-Carbon Health System.  Health Affairs 39(12);2080-2087.

Free full-text access to this article is available until 13 March 2021.

Access the Health Affairs special issue on Climate and Health here.