#greenHC part 6: Are LEAN hospitals green hospitals? – Measuring CO2e in health care

Healthy environments and people eytan  23

My presentation is today, and just one more section to go after this one. This post is about measurement.

The question in the title of the post came from ePatientDave (@ePatientDave). He asked me, “I wonder if hospitals that are well advanced with LEAN are any different in the behaviors you cited – because everything you said sounded like a LEAN post.”

The answer is, I don’t know for sure. In theory they should be, because LEAN is about respecting your customer and those who take care of them (it’s a mistake to think that LEAN is about efficiency, it’s about respect).

Imagine you could measure the impact of what you do in your own operations as well as society

This is the advantage of looking at CO2 equivalents (or CO2e). As part of this work I have had to get rapidly up to speed on the nomenclature, and you can do this too, here (on Wikipedia) and here (at the EPA, with handy conversions). The difference between measuring this versus something like “profit and loss” is that it can take into account societal impact for what an organization does. Apple, Inc., is a great example here. It states that 2% of its carbon footprint comes from manufacturing, the other 98% is from the use of its devices by consumers. England’s National Health Service is the same, it measures CO2e output comprehensively, including the travel that its patients incur ( The NHS is responsible for 5% of all journeys made in the UK ), as well as that from its supply chain (the bulk of its CO2 output comes from this).

Kaiser Permanente was the first health care organization to report its green house emissions to the California Climate Action Registry, in 2007. I watched how this work has progressed and it’s not easy. It started with understanding how much energy was consumed at individual facilities. This starts with the simple question, “who actually pays the electricity bill?” Next all types of facilities in one region were accounted for, and then in multiple regions.  Things are to the point now where Kaiser Permanente can state what its national carbon footprint is, and have it listed in a public registry, now known as The Climate Registry.

Even with all of this work, though, we are not as advanced in understanding our impact at the NHS is – we do not yet include the output from travel of members and staff, and procurement of supplies. The slide above shows a comparison of just energy use. The NHS’ estimates its total footprint at 21 Megatons of CO2e. Interestingly, when I compared the CO2e footprint of energy use between Kaiser Permanente and the NHS, the proportion, 17%, is equivalent to the proportion of people being cared for (9 million vs. 52 million, 17% also).

Regarding The Climate Registry, go, check it out, look up a few reports.

The Climate Registry: In good company, when will the rest of health care join us?

The good news is that many large private and public organizations are reporting their CO2 emissions in a single place. The bad news is that few health care organizations are. Here’s the list of health care organizations in the registry. Considering health care generates 8% of the United States’ CO2 load, shouldn’t we see more than 4 or 5  listed here?

Back to Dave’s question….

If you look on specific health care organizations’ web sites, you’ll see links to green health care efforts. For example, I found this page at one of Dave’s favorites, Beth Israel Deaconness (See: Going Green – BIDMC ). There are a lot of good things happening there. I don’t see numbers or targets, though. This doesn’t mean they don’t exist, it just means I can’t find them (and if I looked in the wrong place, please post in the comments!). Kaiser Permanente also has a Green Center, that links to its annual CO2 output analysis.

I am clearly just learning about this, and so is American health care. However, comparing us to other organizations nationally and internationally and to other industries helps health care establish that it is part of the community that it serves. Or as I have quoted on here previously, “Health care should not face the hospital, it should face the community.”

Thought provoking question: Does your organization report its CO2e footprint? Publicly? In a registry? How does it compare? How does it help you understand your respect for the people you serve, the community you and they live in, and the people you employ to take care of them?

These are the questions that make LEAN and Green a good match, and CO2e a measure to understand where you are at and where you want to be.

Next: The “Why?” for me.


@MarkGraban Dear Mark, Thanks for taking a look and for the EPA reference, you’re right, it is extensive! And good blog post, it tells me that these philosophies travel together. My next post in the series is about this – you and I are clearly drawn in by the similarities on what this means for the people we serve,


Ted Eytan, MD