Catalyzing Collective Action
to Decarbonize Healthcare
Roadmap for Health Systems
and MedTech Suppliers
May 2023
2
Table of Contents
About This Paper ..............................................................3
Executive Summary – Key Findings .............................4
The Imperative ..................................................................6
Health Sector Contribution to Climate Change ......8
Current State Landscape ................................................ 9
Competing Priorities ....................................................9
Sector Momentum .......................................................9
Growing Pressures and Opportunities .................10
Convening the Roundtable .......................................... 11
Opportunities for Successful Collective Action
Overview ........................................................................... 13
Renewable Energy ....................................................... 15
Collective Action:
Aggregate Power Purchase Agreements ................16
Product Innovation ...................................................... 18
Collective Action 1:
Takeback Programs ........................................................ 19
Collective Action 2:
Packaging Changes ..................................................... 21
Collective Action 3:
Product Composition Changes ................................22
Product Utilization - Clinical Engagement ..........24
Collective Action 1:
Identify Opportunities for Increased Product
Durability ..................................................................... 25
Collective Action 2:
Product Reprocessing Education and Pilots ........ 26
Collective Action 3:
Surgical Kit Reformulation .......................................27
Transportation and Logistics .................................. 29
Collective Action:
Implement Logistics Efciencies ...............................29
Impact and Effort Assessment Matrix ...................... 31
Opportunities for Collective Commitment ............32
Renewable Energy .......................................................33
Product Innovation ......................................................33
Product Utilization - Clinical Engagement .......... 33
Transportation and Logistics ...................................33
Enablers ............................................................................34
24 Month Roadmap .......................................................36
Renewable Energy .......................................................37
Product Innovation ......................................................37
Product Utilization - Clinical Engagement ..........37
Transportation and Logistics ...................................37
Moving Forward as a Collaborative ...........................38
Appendix A:
Industry Collaboratives ............................................... 40
Appendix B: Health System –
MedTech Roundtable Participants ............................. 41
Appendix C:
Findings from the April Roundtable ...........................42
Endnote References ......................................................44
Acknowledgements ...................................................... 49
About the Organizations ............................................. 51
3
About This Paper
In November 2022, Kaiser Permanente and Health Care Without Harm convened
a Roundtable of health system and their top suppliers, as well as group purchasing
organizations (GPOs), to discuss how they might work together to address
greenhouse gas emissions related to the healthcare value chain. The health systems
represented hundreds of hospitals from across the country and the suppliers
included medical device, equipment, service, and distribution (MedTech) companies,
representing over $1 trillion in annual revenue. The convening grew out of initial work
on supply chain decarbonization done by the U.S. Health Care Climate Council and
MedTech supplier partners.
While several existing health sector industry
collaboratives are working on decarbonization,
they are either broad sector collaborations
or primarily focused on decarbonizing the
pharmaceutical value chain; and MedTech
companies are not well represented. With medical
devices and supplies generating 7% of the
United States health sector footprint, Roundtable
participants agreed working together was critical
to reduce healthcare value chain emissions.
1
Kaiser Permanente and Health Care Without
Harm reconvened the participants for an April
2023 Roundtable, facilitated by Accenture, to
identify areas for collective action, dened as
initiatives done in collaborartion, to decarbonize
the healthcare MedTech value chain. This paper
demonstrates the need for collective action and
sets the foundation for a collaborative effort.
Health systems and their MedTech suppliers must
together address product composition, packaging,
distribution, utilization, and disposal in order to
decarbonize emissions from the supply chain.
Suppliers can focus on making products more
sustainable, but health systems ultimately make
decisions about procurement and use.
The recommendations in this paper come from
the outputs of the April Roundtable, subject matter
expert interviews, and secondary research. The
paper describes key decarbonization levers with
corresponding collective actions and collective
commitments (individual commitments made
by each company) that will accelerate emissions
reduction efforts. The identied collective actions
are assessed for impact and effort and mapped to a
24-month roadmap to illustrate an actionable path
forward. For this work to be successful, companies
would need to commit time and resources to a
formal collaborative. The paper concludes with best
practice recommendations for effective governance
and productive cooperation.
4
Executive Summary – Key Findings
To mobilize collective action and provide a roadmap for near-term efforts to
decarbonize the MedTech value chain, key collective actions have been selected
under four decarbonization levers:
The table below summarizes the lever and collective actions with further detail provided in the paper.
LEVER CATEGORY COLLECTIVE ACTION DESCRIPTION IMPACT EFFORT
Renewable
Energy
Aggregate Power
Purchase Agreements
Pursue aggregate Power Purchase Agreements to:
• Procure renewable electricity at a lower price by
aggregating demand
• Enable smaller companies to participate
• Bring new renewable capacity onto the grid
High Medium
Product
Innovation
(Composition,
Packaging, and
End-of-Life)
Takeback Programs Identify and pursue takeback programs for packaging
and products to reprocess or recycle component parts to
reduce and move towards a circular economy.
Medium Medium
Packaging Changes Identify and pursue opportunities to reduce packaging
where possible and substitute more sustainable materials
where packaging is needed.
Low-
Medium
Low-High
Product Composition
Changes
Identify and pursue product composition changes to
bring more sustainable products to market.
High High
Product
Utilization
– Clinical
Engagement
Increased Product
Durability
Set up a forum to evaluate opportunities to replace
single-use devices with reprocessed or durable options
while maintaining patient safety in different clinical
environments.
Medium Medium
Product Reprocessing
Education and Pilots
Educate clinicians on available reprocessed devices and
set up pilots for specic devices to increase adoption.
Medium Low-
Medium
Surgical Kit
Reformulation
Identify surgical kit items that routinely go unused during
procedures and remove them from surgical packs to
avoid the unnecessary purchase and disposal of those
supplies.
Medium Medium-
High
Transportation
and Logistics
Implement Logistics
Efciencies
Reduce transportation-related emissions through order
consolidation, packing efciency, optimized delivery
routes, decreased delivery frequency, and minimized
less-than-truckload, overnight, and last-mile deliveries.
Medium Medium-
High
For each action, the following
criteria are considered:
• Health system and
supplier roles and
value proposition
• Impact and effort
• Timeline
• Proposed metrics for
measuring progress
Renewable
Energy
Product
Innovation
Product
Utilization –
Clinical
Engagement
Transportation
and Logistics
5
Each collective action has been mapped to a 24-month timeline based on estimated ranges for execution.
Several initiatives can be accomplished within the rst 12-24 months while others will lay the foundation for
further decarbonization.
Achieving these collective efforts will require the following enablers:
6
months
9
months
12
months
15
months
18
months
21
months
24
months
Future
Renewable Energy
Product Innovation Product Utilization – Clinical Engagement Transportation & Logistics
3
months
Conrm and qualify interested collaborative members
Identify target markets with adequate vendors and electrical supply
Develop and sign a Consortium Governance Agreement
Duration: 12 - 18 months
Create health system and
supplier teams to choose
target products or product
categories
Duration: 3 months
Identify achievable
decarbonization
opportunities for the
product or product
category
Duration: 3 - 6 months
Deploying an effective pilot takeback program
Duration: 6 - 12 months
Product composition changes difcult due to regulations and development cycle
Duration: 24 - 84 months
Scale use of reprocessed device
Launch additional pilots
Duration: 12 months
Tertiatry packaging changes
Duration: 6 - 12 months
Issue RFP and choose project(s)
Duration: 6 months
COLLECTIVE ACTIONS
AGGREGATE
PPAS
TAKEBACK
PROGRAM
PRODUCT
REPROCESSING
EDUCATION &
PILOTS
Set up a forum to evaluate
a set of single-use devices
(SUDs)
Duration: 3 months
Identify opportunities for
SUD replacement with
reprocessed or durable
alternatives
Duration: 3 months
Educate and recruit
clinicians
Duration: 3 months
Choose product and implement pilot
Assess progress and KPIs
Share learnings with other collaborative members
Duration: 3 - 12 months
SURGICAL KIT
REFORMULATION
Perform Surgical Kit Reformulation on one
target pack
Duration: 3 - 6 months
TRANSPORTATION
& LOGISTICS
Implement logistics efciencies, e.g. order consolidation and minimization, reduce overnight deliveries with air shipping and less-than-truckload deliveries
Duration: 6 - 24 months
Scale Surgical Kit Reformulation across surgical pack types and
facilities
Duration: 12 months
Pilot and/or adopt new product(s)
Duration: 6 - 18 months
PRODUCT
DURABILITY
PACKAGING
CHANGES
PRODUCT
COMPOSITION
Primary & secondary changes
Duration: 12 - 24+ months
Scaling of pilot
Duration: 24 - 36 months
available for most medical supplies and
equipment. Many companies do not properly
understand their own emissions.
• Data Standardization: Procurement
professionals are currently not getting the
data they need to make sourcing decisions and
suppliers are getting inundated with a variety
of data requests.
There are already efforts underway to address data
challenges at the federal, cross-sectoral, and health
system-MedTech interface levels. The Roundtable
participants are focusing on collective actions
and commitments for decarbonization, while
supporting and aligning with existing data initiatives
as appropriate.
LEADERSHIP
Leadership support is critical for enterprise-wide
supply chain decarbonization initiatives. Leaders
must provide resources to operationalize efforts, as
well as the direction and incentives to ensure culture
change.
DATA ACCESS AND TRANSPARENCY
Both health systems and suppliers require access
to the right data at the right time to support
decarbonization. There are currently two signicant
areas of challenge:
• Accurate emissions accounting: Accurate,
product-level emissions are not currently
6
The Imperative
Climate change is a global health crisis, disrupting access to clean air, safe drinking
water, nutritious food supply, and safe shelter. The warming climate results in heat-
related illness and death, injuries and fatalities due to weather events, increases in
respiratory and cardiovascular disease, vector-borne illness, and mental health impacts;
we are already experiencing widespread adverse health impacts (Figure 1). The World
Health Organization projects there will be an additional 250,000 deaths per year
worldwide caused by climate change between 2030 and 2050, and direct damage
costs to health are estimated to be between USD $2–4 billion per year by 2030.
2
According to the Intergovernmental Panel on Climate Change, emissions must begin
to decrease by 2025 and be reduced by 43% by 2030 in order to limiting warming to
around 1.5°C (2.7°F) and avoid the most catastrophic impacts of climate change.
3
In the United States, populations are already facing
increasingly frequent and severe heat waves,
wildres, ooding, hurricanes, and droughts,
devastating communities across the country. In
2022, there were 18 weather and climate disaster
events with losses exceeding $1 billion each. These
events led to $165B in damages, and 474 deaths.
4
As temperatures continue to rise, United States
populations are faced with worsening chronic
conditions and heat-related deaths, with 1,300
people dying in U.S. cities from extreme heat every
year.
5
In one week of June 2021 alone, a heat wave
within the Pacic Northwest resulted in 600 heat-
related deaths in the states of Washington and
Oregon.
6
A 2021 study indicated that across the
Western United States, there were ~150,000 asthma
events resulting from wildres and these smoke-
induced asthma exacerbation cases contributed to
over $1.5 billion in excess healthcare costs.
7
Increased
ooding intensity and hurricanes have resulted in
fatalities, destruction, damage, and displacement;
Hurricane Ida in 2021 caused ten heat-related deaths
and millions of Louisiana residents to lose power.
8
Climate change disproportionately impacts
populations already suffering health inequities –
communities of color, low-income communities,
people with disabilities, children, the elderly, and
people with underlying health conditions. These
same populations are among the most exposed,
most sensitive, and have the least individual and
community resources to prepare for and respond
to health threats. As health systems and suppliers
try to address health equity, climate change must
be understood as a force multiplier for the other
determinants of health. For example, people with
underlying health conditions such as asthma are
more likely to have a serious problem in extreme
heat, and asthma is more prevalent in children and
communities of color.
9
The business of healthcare and access to healthcare
services and supplies are also vulnerable to the
effects of climate change. Health systems and
suppliers must prepare for changes in disease
prevalence and assess their facilities and supply
chains for climate vulnerability. Extreme weather
events put health systems at risk for patient
evacuations, suspended services, postponed
procedures, and closures. These situations can
lead to reduced revenues from decreased clinical
demand and lower reimbursement rates. After
Superstorm Sandy in 2012, NYU Langone Health
had to suspend surgery and inpatient admissions for
two months and close the Emergency Department
for 18 months, with 500 providers forced to seek
privileges elsewhere during the months of rebuilding.
Lost revenue during this time period was estimated
at $400 million.
10
Climate-related events also cause
supply chain disruptions, affecting access to critical
supplies. In 2017, Hurricane Maria damaged a vital
saline manufacturing plant in Puerto Rico, causing
a widespread shortage of small-volume saline bags
throughout the United States.
11
7
FIGURE 1 An overview of climate-sensitive health risks, their exposure pathways and vulnerability factors. Climate change
impacts health both directly and indirectly, and is strongly mediated by environmental, social, and public health determinants.
Source: Climate Change and Health, World Health Organization https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
8
12%
European Union
United States
China
5%
Japan
4%
Russia
2%
Brazil
2%
S. Korea
2%
India
2%
Canada
2%
Australia
27%
17%
All other nations
25%
Health Sector Contribution to Climate Change
The health sector, which must care for people during and after extreme weather
events and adapt to changing disease prevalence, has a key role to play in
decarbonization. The health sector is responsible for 4.4% of global emissions and
the U.S. is the largest healthcare emitter in absolute and per capita terms, making up
27% of healthcare’s global footprint (Figure 2).
12,13
In the U.S., the health sector accounts for 8.5% of
national emissions and 82% of those emissions are
generated by the supply chain.
14
Pharmaceuticals
and chemicals account for 18% and medical devices
and supplies account for 7% of U.S. health sector
emissions (Figure 3).
1
As the only industry with a healing mission, the
health sector has a unique responsibility to address
Other
100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Water and waste
Energy
Transport
Testing & research
SCOPE 1
SCOPE 2
SCOPE 3
GHG EMIS SIONS , 201 8
Food
Pharmaceuticals & chemicals
Medical devices
Medical supplies
Plastics, rubber, textiles, and paper
Information and computer technology, equipment, & services
Other manufacturing
CONSTRUCTION
Finance, insurance, adminstration, & public health
FIGURE 2 Top ten emitters plus all other nations and
percentage of global health care footprint
Source: Health Care’s Climate Footprint, Health Care Without Harm
and ARUP https://noharm-global.org/sites/default/les/documents-
les/5961/HealthCaresClimateFootprint_092319.pdf
FIGURE 3 U.S. national health care greenhouse gas (GHG)
emissions by GHG Protocol Scope, 2018
Source: Eckelman et. al., Health Care Pollution And Public Health
Damage In The United States: An Update https://www.healthaffairs.
org/doi/10.1377/hlthaff.2020.01247
its footprint. With the majority of emissions in
the value chain, it is essential that health systems,
distributors, group purchasing organizations),
pharmaceutical companies, and MedTech companies
individually set ambitious decarbonization goals
and also collaborate to accelerate decarbonization
efforts. The health sector has not historically been
a leader in climate action, but there is now growing
momentum within the sector.
9
Current State Landscape
Competing Priorities
The latest United Nations Global Compact-
Accenture CEO Study on Sustainability found that
CEOs are navigating unprecedented uncertainty.
Among the 2,600 CEOs across industries surveyed
for the study, 93% of CEOs said they are facing ten
or more simultaneous global challenges to their
business.
15
In addition to challenges from threats
to public health, ination and price volatility, and
talent scarcity, it has been a very difcult few years
nancially for health systems. Hospitals ended
2022 with higher expenses due to ongoing stafng
shortages and fewer patient discharges.
16
According
to a survey of more than 900 hospitals, November
2022 was the 11th straight month of negative
operating margins.
17
Recent healthcare CFO survey
data suggests that 60% of healthcare organizations
defaulted or were unable to meet terms on bond and
loan covenants, and 74% of CFOs cited supply chain
disruption as a threat to their business in 2023.
18
The good news is that despite these competing
priorities, CEOs understand that sustainability is not
only a climate imperative, but also the foundation
for security, growth, and resilience. In the UNGC-
Accenture CEO Study on Sustainability, 98% of
CEOs see it as part of their role to make their
business more sustainable, up from 83% in 2013.
Leading CEOs are already embedding sustainability
into their businesses by launching new products
and services for sustainability (63%), enhancing
sustainability data collection across their value chains
(55%) and investing in renewable energy sources
(49%). Nearly half (49%) are transitioning to circular
business models, and 40% are increasing R&D
funding for sustainable innovation.
19
Sector Momentum
According to a 2022 Accenture study of Global
2000 companies, the health and life sciences
sector companies combined have set the fewest
net zero targets of all industries; only 10% of health
companies and 33% of life sciences companies
had net zero goals in place. However, momentum
is beginning to grow. The proportion of companies
setting net zero targets began to increase from 2021
to 2022, with a 6% increase for health companies
and a 9% increase for life sciences companies.
20
In October of 2020, the National Health Service
of England (NHS) became the rst health system
to commit to net zero emissions, with a goal of
2040.
21
In April 2022, over 100 health organizations
committed to the White House and Department of
Health and Human Services (HHS) Health Sector
Climate Pledge, committing to reduce emissions by
50% by 2030 and achieve net zero by 2050, publicly
accounting for progress annually.
22
In addition to an increasing number of individual
net zero targets, there has been a considerable
increase in climate action in the health sector over
the last several years. Over 60 countries, including
the United States, committed to the 2021 COP26
Health Program, pledging to develop more climate-
resilient and low-carbon health systems. In 2022,
over 100 healthcare organizations committed to
the White House and Health and Human Services
Health Sector Climate Pledge, agreeing to 1) reduce
emissions by 50% by 2030, achieve net zero by 2050,
and to publicly report data on progress, 2) develop
an inventory of supply chain emissions (Scope
3), and 3) create action plans to develop climate
resilience. With federal health system commitments,
this Pledge includes 15% of all U.S. hospitals.
23
The
Joint Commission, the largest standards-setting and
accrediting body in healthcare, not only committed
to the White House pledge but also has targeted
climate change as a top strategic priority. Jonathan
B. Perlin, MD, PhD, The Joint Commission’s new
president and CEO, believes “Decarbonization
and sustainability are critical to a health agenda,
especially because climate change is having a direct
and inequitable impact on the health and well-
being of people globally”.
24
In March 2023, the Joint
Commission published for public comment a new
proposed Leadership Standard (LD.05.01.01) requiring
hospitals to address environmental sustainability,
including measuring and reducing their greenhouse
gas emissions.
25
After receiving negative industry
feedback, the Joint Commission announced they
were considering introducing the new standard as
optional rather than as a mandatory requirement.
26
10
Growing Pressures and
Opportunities
Increasing regulatory mandates and market forces
are compelling health sector companies to disclose
the business risks and opportunities related to
climate change and how those risks will be managed.
As multinational, publicly-listed corporations, many
MedTech companies are subject to new regulations
taking effect in Europe and the U.S.
The Corporate Sustainability Reporting Directive
(CSRD) went into effect in the EU January 2023 with
the goal of making corporate sustainability reporting
more common, consistent, and standardized,
like nancial accounting and reporting. The
CSRD applies to both EU companies and non-EU
companies with either a signicant presence in
Europe or those listed on a European exchange. To
comply, companies will need to publish detailed
sustainability reporting including strategy, targets,
and transition plans, as well as impacts on climate,
biodiversity, working conditions, diversity, human
rights, and human health across value chains. The
rst CSRD report for large companies will will be
due in early 2025 based on 2024 scal year data.
Small and medium companies will follow shortly
thereafter with reporting begining in 2026, following
streamlined guidelines.
27
The Securities and Exchange Commission proposed
a new rule in March 2022 to enhance and standardize
climate disclosures for investors. This rule would
require publicly-listed companies to include
disclosures regarding Scope 1, Scope 2, and Scope 3
greenhouse gas emissions; material climate-related
risks; and plans for addressing those risks as part of
their registration statements, periodic reports, and
audited nancial statements.
28
While the climate rule
has faced signicant opposition and has yet to go
into effect, it is expected to be nalized in the second
quarter of 2023.
29
Investors and credit rating agencies are also
increasingly considering the need for companies to
decarbonize and plan for climate impacts. According
to Bloomberg, Global ESG assets surpassed $35
trillion in 2020 and are projected to surpass $50
trillion by 2025, one-third of the projected total
assets under management globally.
30
The three big
credit rating agencies – Fitch, Moody’s, and Standard
& Poor’s – have all started to integrate ESG factors
into their rating methodologies. Recent research
on 700 companies showed that this data is not yet
impacting credit ratings, but it serves as an important
market signal and may begin to affect the cost of
capital in coming years.
31
In addition to mandates, legislation is creating
new opportunities for companies to implement
sustainability initiatives. In August 2022, the Ination
Reduction Act (IRA) was signed into law directing
$369 billion in federal funding to clean energy. This
investment is projected to reduce national emissions
43% by 2030.
32
The IRA will provide billions of
dollars in grants, loans, and expanded tax credits for
renewable energy, energy efciency, and electric
vehicles. The IRA also includes a “direct pay” option
so nonprot health systems with no tax liability will
be able to receive a payment equal to the amount
of the tax credit. This act provides incentives for
decarbonization across the health care supply
chain, addressing emissions as varied as medical
supply manufacturing and hospital construction
material.
33
Additionally, the IRA allocates funding to
the EPA to implement enhanced GHG emissions
reporting requirements. These product declarations
of GHG emissions should foster further supply chain
decarbonization.
34
HHS has elevated the IRA as a
vehicle for health sector decarbonization. On Earth
Day 2023, HHS issued the Quicknder for Leveraging
the Ination Reduction Act for the Health Sector to
help healthcare companies take advantage of the
IRA’s opportunities to advance decarbonization and
resilience.
35
11
SMI
Energize
PSCI
Manufacture 2030
Payors
GPOs
Healthcare
Consumer
& Patient
Pharma
MedTechDistributors
Academia
Healthcare
Providers
Govt.
Regulators
NGOs
NAM
< 25%
Make-up of Membership
25% – 75%
>75%
Convening the Roundtable
In response to growing pressure and the urgent need for action, health industry
companies have begun organizing collaboratives to address key climate issues at
scale, including these summarized below (See Appendix A for details):
Sustainable Markets
Initiative Health
Systems Task Force
Launched in 2021 and convened by AstraZeneca, this public-private partnership
focuses on the delivery of net zero, patient-centric health systems with three
working groups across Supply Chains (small molecule and biologics drugs),
Patient Care Pathways, and Clinical Trials.
National Academy
of Medicine’s Action
Collaborative on
Decarbonizing the
US Healthcare Sector
Launched in 2021, this public-private partnership has four working groups across
Health Supply Chain and Infrastructure, Health Professional Education and
Communication, Health Care Delivery, and Policy, Financing, and Metrics.
Energize
Launched in 2021 and convened by Schneider Electric, this collaboration between
17 pharmaceutical companies creates opportunities for their suppliers to
decarbonize through renewable electricity.
Manufacture
2030 Activate
Announced in 2022, this group is focused on accelerating decarbonization of
Active Pharmaceutical Ingredient suppliers via data collection, technology, and
operational and resource efciency opportunities.
Pharmaceutical Supply
Chain Initiative’s (PSCI)
Decarbonization Team
PSCI has focused on responsible pharmaceutical supply chains since 2006, but
in recent years formed a Decarbonization Team developing maturity models,
environmental surveys, and learning plans for member companies’ suppliers.
FIGURE 4 Health
sector stakeholder
presence within existing
decarbonization
collaboratives
Source: Accenture, presented
at Decarbonizing the
Healthcare Value Chain
Roundtable, April 3, 2023
12
While these collaboratives are important for value
chain decarbonization, they are focused on the broad
sector or on pharmaceutical companies; MedTech
companies are not well represented (See Figure 4).
This presents a signicant opportunity for health
systems and MedTech companies to work together
to decarbonize the supply chain.
1
Kaiser Permanente and Health Care Without Harm
recognized this need and hosted Roundtables
on Decarbonizing the Healthcare Value Chain in
November 2022 and April 2023 for health systems
and their top suppliers. The Roundtable participants
are generally industry sustainability leaders, but there
are differences between the health systems and the
MedTech suppliers. The health system participants
are nearly all nonprot organizations that have
not been subject to public reporting standards or
investor pressure to disclose climate risks including
emissions. In contrast, many of the suppliers are
publicly-listed, multinational companies that have
been tracking and reporting on their greenhouse gas
emissions for many years.
The participating health systems have been working
on sustainability efforts for decades, setting targets
and making progress in areas such as energy, water,
and waste, but many are not tracking and reporting
on total annual emissions. In fact, many health systems
have not yet completed a Scope 3 emissions inventory
baseline. Of the 15 participating health systems:
• The majority have committed to the White
House and HHS Health Sector Climate Pledge
(HHS Pledge)
• Four are participating in the UN’s Race to Zero.
The Race to Zero is a global campaign backed
by the United Nations that aims to build a
healthier, fairer zero-carbon world by rallying
non-state actors – including companies, cities,
regions, nancial, and educational institutions –
to halve global emissions by 2030 and reach net
zero emissions by 2050.
36
• Seven of the participating health systems
announced their net zero targets with their
commitment to the HHS Pledge. While the HHS
Pledge includes a net zero target, it does not
specify whether that includes emissions across
Scopes 1, 2, and 3, so the details for these health
systems’ targets are not clear.
• Nine have goals to be carbon neutral for Scopes
1 and 2 by or before 2030
• Seven committed to 100% renewable electricity
usage by 2030
The participating MedTech suppliers are ahead of
the Roundtable’s health systems in tracking and
reporting emissions, and are beginning to engage
their suppliers to address emissions upstream. Of the
16 MedTech supplier participants:
• A majority have approved or committed to
science-based near-term goals through the
Science-Based Targets Initiative (SBTi)
• Nine are participating in the UN’s Race to Zero
• Seven committed to carbon neutrality in their
operations (Scopes 1 & Scope 2 emissions) by
2030
• Seven have set targets to use 100% renewable
electricity by 2030
• Three have committed to the White House and
HHS Pledge
For a complete listing of health systems and suppliers
that have been involved in the Roundtables, please
see Appendix B.
During the April Roundtable, participants shared
decarbonization activities that worked well for them
in their individual organizations and then identied
activities that could be scaled or accelerated with
collective action. That input formed the basis for this
paper along with subject matter expert interviews
and secondary research.
For further details on the ndings from the
Roundtable discussion, see Appendix C.
That input formed the basis for this paper along
with subject matter expert interviews and secondary
research. For further details on the ndings from the
Roundtable discussion, see Appendix C.
13
Opportunities for Successful Collective Action
Overview
Collective action is the path to decarbonization at the pace and scale required
to address climate impacts. As reporting requirements expand to include Scope
3 emissions and more companies focus on decarbonizing their value chains,
collaboration throughout the supply chain becomes essential. Companies must
have access to emissions data from their vendors both upstream and downstream,
and encourage those vendors to address their own total emissions. Small and
medium-sized suppliers will likely need guidance from larger customers on reporting
requirements, data needs, and decarbonization efforts.
Research from the Harvard Business Review
identied more than 150 business climate
collaborations with activities as varied as common
carbon accounting frameworks, principles for
responsible investments, and shared net zero
objectives.
37
The UNGC-Accenture CEO Study
on Sustainability found that 78% of CEOs believe
industry consortiums are needed and valueable
for innovation, standards-setting, investment
efciencies, and effective policy advocacy.
38
Roundtable participants agreed they want to avoid
duplicating the efforts of existing health industry
collaboratives, but acknowledged the need for an
effort focused specically on decarbonizing the
MedTech value chain. They emphasized a desire for
quick, effective action with a 24-month roadmap
featuring specic, measurable, achievable, relevant,
and time-bound (SMART) initiatives.
To meet these criteria and provide a launchpad for
the work ahead, key collective actions have been
selected under four levers:
1. Renewable Energy
2. Product Innovation (Composition, Packaging,
and End-of-Life)
3. Product Utilization - Clinical Engagement
4. Transportation and Logistics.
Each action presented below includes the following
information:
• Description
• Health system and supplier roles and value
propositions
• Proposed metrics for measuring progress
• Impact and effort
• Timeline
Impact and effort were assessed and timelines
were estimated to inform the 24-month roadmap.
Impact was determined by the expected effect the
action would have on health systems’ and MedTech
suppliers’ carbon footprint, with particular focus on
how the collaborative action can accelerate impact.
Effort was based on existence of a precedent or
foundation for these actions (e.g. existing programs
or past successes), number of stakeholders
involved, and regulatory barriers that may be in
place. Both criteria were rated on a scale of “low,”
“medium,” and “high.”
Collective commitments are dened as agreed-
upon individual company commitments and can be
employed as companion strategies to scale impact.
They are reviewed following the consideration of
collective actions.
The 24-month timeline maps all collective action
initiatives indicating the progress that could be
made for each initiative during that time period.
14
LEVER CATEGORY COLLECTIVE ACTION DESCRIPTION
Renewable
Energy
Aggregate
Power Purchase
Agreements
Pursue aggregate Power Purchase Agreements to:
• Procure renewable electricity at a lower price through
aggregated demand
• Enable smaller companies to participate
• Bring new renewable capacity onto the grid.
Product
Innovation
(Composition,
Packaging, and
End-of-Life)
Takeback
Programs
Identify and pursue takeback programs for packaging and products
to reprocess or recycle component parts to reduce waste and
move towards a circular economy.
Packaging
Changes
Identify and pursue opportunities to reduce packaging where
possible and substitute more sustainable materials where
packaging is needed.
Product
Composition
Changes
Identify and pursue product composition changes to bring more
sustainable products to market.
Product
Utilization
– Clinical
Engagement
Identify
Opportunities for
Increased Product
Durability
Set up a forum to evaluate opportunities to replace single-use
devices with reprocessed or durable options while maintaining
patient safety in different clinical environments.
Product
Reprocessing
Education and
Pilots
Educate clinicians on available reprocessed devices and set up
pilots for specic devices to increase adoption.
Surgical Kit
Reformulation
Identify surgical kit items that routinely go unused during
procedures and remove them from surgical packs to avoid the
unnecessary purchase and disposal of those supplies.
Transportation
and Logistics
Implement
Logistics
Efciencies
Reduce transportation-related emissions through order
consolidation, packing efciency, optimized delivery routes,
decreased delivery frequency, and minimized less-than-truckload,
overnight, and last-mile deliveries.
15
Renewable Energy
Health systems spend over $8 billion each year on energy, accounting for
approximately 10% of the energy used by commercial buildings in the United
States.
39
Because they operate around the clock, hospitals use 2.5 times more energy
per square foot compared to ofce buildings.
40
Annual energy costs for health
systems is roughly $10,000 per patient bed, and these costs are expected to increase
in the future.
41
Considering these facts and the accessibility of credits from the
IRA, the value case for transitioning to renewable energy has become increasingly
strong. The costs of wind and solar have fallen by more than 13% compared to 2020,
continuing a trend that has persisted since 2010.
42,43
By focusing on energy efciency
and renewable energy, health systems can lower their GHG emissions, save on
energy expenditure, and improve the air quality of surrounding communities.
44
To drive renewable energy sourcing, health systems
and suppliers can pursue joint purchasing of
renewable electricity through offsite Power Purchase
Agreements (PPAs). PPAs are nancial agreements
where a solar developer designs, permits, and installs
a solar energy system, then sells the power generated
to a customer at a xed rate typically lower than the
local utility’s retail rate. PPA contracts typically last 10
to 25 years with the developer assuming responsibility
for operation and maintenance for the duration of
the contract. There are two common options for
offsite PPAs: a physical PPA or a virtual PPA (VPPA).
Here is a simple explanation of how they work:
• With a Physical PPA, a customer purchases
energy from a renewable energy project in
their electric grid and physically receives the
electricity. Physical PPAs are limited to states
where customers are allowed to buy power
competitively on the retail market, currently
including 26 states and Washington, D.C.
45
• With a Virtual PPA (VPPA), there is not a physical
delivery of energy from the vendor to the
customer. The energy is sold into the market
where the renewable development is located,
and the buyer commits to a xed price for
the electricity. VPPAs work as a “contract for
differences” meaning when the market price is
higher than the xed VPPA price, the developer
pays the positive difference to the buyer, and
if the market price is below the contract price,
the buyer pays the developer the difference.
Two or more buyers can work together to buy
renewable energy from a large-scale generation
facility, commonly a VPPA, to create an aggregate
PPA. Aggregate PPAs enable companies to
achieve economies of scale, thus allowing smaller
companies to participate. They also bring new
renewable capacity onto the grid. Although
valuable, aggregate PPAs are complex; the most
signicant challenge is that each buyer has unique
needs and requirements that can lead to drawn
out negotiations over terms and timeline of the
deal. However, these challenges can be overcome,
especially when the co-buyers align on priorities and
rules of engagement ahead of time.
In 2016, Boston Medical Center entered into a
partnership with the Massachusetts Institute
of Technology and the Post Ofce Square
Redevelopment Corporation to enable the
construction of Summit Farms, a 650-acre,
60-megawatt solar installation on farmland in
North Carolina. This was the largest renewable-
energy project ever built in the U.S. at the time,
and the solar energy purchased covers 100% of
BMC’s electrical consumption.
46
16
Collective Action: Aggregate Power
Purchase Agreements
IMPACT EFFORT TIME
High Medium 12-24 months
DESCRIPTION
Health systems and MedTech suppliers can
form a buying group for an aggregate VPPA.
The rst step will be to conrm interest from
collaborative members and qualify their
feasibility as co-offtakers (purchasers of the
electricity). Feasibility depends on three major
factors:
1. Electricity Load Location: Companies
must be in a geography where PPAs are
economically and legally viable.
2. Available Offtake: The amount of
renewable energy the companies
collectively want to buy must be 150,000
megawatt hours (MWh) or more annually,
with higher demand increasing the
possibility of a successful deal.
3. Internal Sustainability Sophistication
and Leadership Alignment: Participating
companies will require education on
the nancial, legal, treasury, and tax
implications of entering into a PPA.
Coordinated procurement can be
complicated; key individuals in each
company will need to have dedicated
time if a PPA is to be signed successfully.
To streamline the process, larger, better-
resourced, and more experienced
companies within the group can take
the lead, but all companies will need
to understand the mechanics and risks
of the deal. The rst PPA cohort of the
Energize collaborative described above
will go to market with two sponsoring
pharmaceutical companies as anchor
tenants joined by seven of their suppliers.
47
After the participating offtakers have
been qualied, target markets need to be
identied. These are locations where PPAs
are economically viable, vendors exist,
and there is adequate electrical supply to
support an aggregate PPA. Lastly, companies
engaged in the aggregate PPA must develop a
Consortium Governance Agreement to detail
the collaboration before beginning the go-to-
market RFP process.
HEALTH SYSTEM & MEDTECH SUPPLIER ROLES
AND VALUE PROPOSITION
The value proposition for pursuing aggregate
PPAs for both health systems and MedTech
suppliers lies in the opportunity to procure
renewable electricity at a lower price by
aggregating demand. As a collaborative,
organizations can pool their demand forming
an aggregate PPA, whereas organizations
individually may not generate sufcient demand
for their PPA. Advantages of a PPA include low
upfront capital costs, avoidance of the risks
and complexity of installing and maintaining
solar equipment, and an off-balance sheet
nancing solution in which regular payments
for electricity are treated as operating expenses.
PPAs also provide price stability, locking in a
price and providing a hedge against utility price
uctuations over time. Inceased participation
by more companies enhances the consortium’s
negotiating power and could potentially lower
pricing and result in shorter contract durations.
The price of electricity through PPAs is typically
less than the retail rate but an annual price
escalator may result in offtakers paying more
than market rate if the price of electricity
declines.
48
PROPOSED METRICS
• # of participating companies
• Megawatts (MW) renewable electricity
procured
• % increase in organizations’ renewable
electricity after PPA completed
• Estimated metric tons of carbon dioxide
equivalent (MTCO2e) reduced
17
IMPACT HIGH
Aggregate PPAs are a highly effective vehicle
for health systems and MedTech suppliers to
access signicant amounts of renewable energy.
This advances progress toward their own Scope
2 emissions reduction goals and supports the
transition to a clean energy economy.
EFFORT MEDIUM
Aggregate PPAs are complex to execute. The
regulations around the use of PPAs vary by state
and energy market. Participating companies
must agree on priorities and timelines, which
slows down the decision-making process. It
will be critical to work with an experienced
advisor and ensure alignment on agreements
representing the best interests of all buyers.
TIMELINE 1224 MONTHS
It will take 12-24 months to execute an aggregate
PPA with the support of a partner experiened
in renewable energy procurement and PPAs.
It typically takes 12-18 months to qualify the
participating companies, identify target markets,
ensure adequate load, and agree on how the
participating companies will work together (i.e.
develop a Consortium Governance Agreement).
The companies must then nd vendors and
projects in the marketplace, which can take 6
months. The timeline for companies to procure
electricity from a PPA is dependent on the type
of renewable energy project. For instance, if the
consortium chooses an existing installation or a
project that is underway, energy will be available
much sooner than if the group invests in a new
solar development project.
18
Product Innovation
The carbon footprint of healthcare products is determined by product composition,
packaging, and end-of-life. Embedded carbon in MedTech products contributes
substantially to both health systems’ and suppliers’ Scope 3 emissions. Suppliers
have been looking at ways to produce more sustainable products in response to
customer demand for environmentally preferable products and to meet their own
decarbonization goals. However, changing products can be particularly challenging
because design and manufacturing changes may require signicant upfront
investment, longer timelines, and regulatory considerations. Collaboration between
health systems and MedTech suppliers creates a signicant opportunity to focus on
specic subsets or categories of products and identify ways to decarbonize across
the product lifecycle. Opportunities for product composition, packaging, and end-
of-life are outlined here. Clinical use of medical products is addressed under Product
Utilization - Clinical Engagement below.
sustainability programs that are well-established
and resourced, but the majority of suppliers likely
have not yet started these types of analyses.
The rst step for the collaborative would be to
create groups of health systems and suppliers
to identify the products or product categories
of interest. One approach could be for each
supplier to identify one product or product line for
focused effort, taking advantage of the diversity
of suppliers. Health systems may be interested
in addressing products that are purchased at
hight cost or volume. In both approaches, known
information about product emissions hotspots
should be included.
The next step would be for the health system-
supplier team to to identify achievable
decarbonization opportunities for the chosen
product based on composition, packaging,
and end-of-life. Once identied, a plan can be
developed to move toward implementation.
Some leading suppliers have begun analyzing
product data and doing internal assessments
to identify hotspots or specic products to be
prioritized for design changes. Typically,Leading
suppliers have completed a small number of product
Life Cycle Analyses (LCAs), mostly for internal use,
with a few publishing the data. As examples:
• Siemens Healthineers publishes Environmental
Product Declarations (EPDs) for all its products,
which provide detailed information about the
environmental performance of a product over
its life cycle based on LCA data.
49
• Stryker utilizes additive manufacturing (3D
printing) technologies, which have lower
contributions to ozone depletion, global
warming, smog formation, and fossil fuel
depletion, compared to conventionally
manufactured counterparts
It’s important to recognize that the LCA process is
time-consuming, expensive, and includes numerous
assumptions. Leading suppliers have mature
19
Collective Action 1:
Takeback Programs
consumers pay a monthly fee for electronic
monitoring devices and the associated software.
The goal would be to ultimately move towards
a circular economy to foster a low-emission
future. In a circular economy, products go
through cycles of reuse, reprocessing, repair,
repurposing, and recycling with the overarching
goal of maximizing the original material and
minimizing waste.
Stryker’s Sustainability Solutions business
unit collects and reprocesses a portfolio of
thousands of medical device SKUs to prolong
the life of specic products. Over the past
ve years, they’ve reached 3,000 engaged
customers, savings of approximately $1 billion
attributable to customers, and 25 million
pounds of waste diverted from landlls in the
short-term.
50
The ultimate goal is to move towards a circular
economy that fosters a low-emissions future. In
a circular economy, products go through cycles
of reuse, reprocessing, repair, repurposing, and
recycling with the intention of maximizing the
life of original material and minimizing waste.
51
HEALTH SYSTEM ROLE AND VALUE PROPOSITION
Health systems will play a crucial role in takeback
programs by establishing internal systems
for collecting products and ensuring minimal
contamination. Working with suppliers or third
parties, they will need to arrange the logistics of
returning products for reprocessing or recycling,
potentially including consolidation and storage
of materials from several clinical sites between
pick-ups. Health system can also target a
designated percentage of products within
predened categories to be included in takeback
programs. The value proposition includes
decreased emissions and potenially lower costs.
Health systems will save on disposal expenses
(although the supplier’s cost of recycling
may be greater than the cost of disposal) and
reprocessed devices are typically priced lower
than original equipment. Health systems
would be able to track metrics that show the
percentage of materials or products that were
IMPACT EFFORT TIME
Medium Medium 6 – 12 months
(Pilot), 24 – 36
months (Scaled)
DESCRIPTION
Product and packaging takeback programs
allow MedTech suppliers to collect and
reprocess or recycle the component parts
of used products. Together, healthcare
systems and MedTech suppliers can optimize
the collection process to ensure maximum
reprocessing or recycling and divert as much
waste as possible from landlls. They can
also educate clinical end users about medical
products that are eligible for takeback so
that they are not accidentally or intentionally
discarded following use. Takeback networks
can be designed to streamline pick-up across
multiple locations. Across the country, there
are several examples of health systems
successfully using reprocessed devices and
recycling blue wrap, demonstrating the
viability of this approach.
Prior to initiating a takeback program, health
systems and suppliers should develop a shared
understanding of the procedures involved.
This dialogue would include site-specic
locations, pickup cadence, and measurement.
Devices can either be reprocessed or broken
down into components for reuse and/or
recycling. If reprocessed, medical devices can
be re-sold for patient care.
49
When health
systems upgrade large, expensive medical
equipment, existing equipment can be
refurbished and resold, not only extending
the life of the product, but also enabling
health systems with more limited resources to
access this equipment. Exploring innovative
business models where products are rented or
supplied as a service is also an option. In the
last few years, several companies have begun
offering Medical Device-as-a-Service allowing
20
involved in takeback programs and potentially
use internal benchmarking to identify best
practices in different facilities. There may also be
an opportunity to efciently recycle products for
new uses within the health system. For example,
University of Vermont Medical Center has its
recycled blue wrap, a plastic fabric used to wrap
surgical instruments, made into bed pans, wash
basins, urinals.
52
SUPPLIER ROLE AND VALUE PROPOSITION
Suppliers’ role would be to establish the
reprocessing or recycling for the product and
work with health systems on takeback logistics.
Suppliers would benet from the reduced
emissions, cost savings, and new business
opportunities. Suppliers could also benet from
a lower cost of goods sold due to a secondary
material supply being created or an alternative
source of raw materials for repurposing within
operations.
53
With a circular business model,
suppliers may break down their products
into components in order to sell the recycled
material, thus creating a net new revenue
stream for the company.
54
All of these factors
can improve cost effectivity as the cost of the
product is spread over multiple lifetimes and
offset by new revenue streams. This may be
passed onto the health system or re-invested
into further product innovation.
PROPOSED METRICS
• % of total product produced diverted into
takeback program
• % of original product recovered (through
reuse or recycling)
• Estimated MTCO2e reduced
IMPACT MEDIUM
Successful takeback programs can
signicantly reduce emissions, given that
less new product is needed to meet demand.
However, additional emissions from reverse
logistics, used product treatment, and
disassembly must also be considered when
exploring potential products for takeback
programs.
EFFORT MEDIUM
Takeback programs require new systems and
processes to be established for both health
systems and suppliers. With a number of
takeback pilots and reprocessing programs
already successfully deployed, challenges
to implementation are being identied and
addressed that can inform new, and scaled
takeback efforts. Health systems often have
limited space for collection and sorting so
new solutions for offsite storage and sorting
may need to be jointly explored. Clinical staff
buy-in and training is also critical, as there
will need to be signicant behavior change in
clinical settings to ensure used products are
diverted into takeback collection points.
TIMELINE 6 12 MONTHS Pilot, 24 36
MONTHS Scaled Program
There are a number of takeback programs
and pilots that have been deployed for
specic products, providing case studies
on best practices and challenges that can
be leveraged by the broader collaborative
for new initiatives. Scaled programs would
take longer to deploy, given the high level
of dependency on health systems to collect
used products.
21
IMPACT EFFORT TIME
Low-
Medium
Low-High 6-12 months (tertiary),
12-24 months
(secondary),
24+ months (primary)
DESCRIPTION
Health systems and MedTech suppliers can
work together to identify packaging materials
that can be reduced or made more sustainable.
Both sterile and non-sterile medical devices
have primary, secondary, and tertiary packaging.
Primary packaging, the packaging in direct
contact with the product itself, can be a non-
sterile barrier, single sterile barrier, double
sterile barrier, or a carton.
55
Secondary and
tertiary packaging serve to protect the product
during shipping and handling. Making changes
to primary packaging is difcult since those
materials may have specic qualities related to
the sterilization method for a product. So the
initial focus should be on secondary and tertiary
packaging where packaging design, material,
and quantities can all be considered. Reusable
container options for tertiary packaging may
be an option, and converting the required device
Instructions for Use (IFU) from paper to electronic
(eIFU) is an option for reducing paper use.
Merck KGaA, with its partners, developed
a more sustainable packaging design
for transportation of its Millistak+ Pod
Disposable Depth Filters. An LCA revealed
a 24% reduction in corrugated cardboard,
which translated to a 17% decrease in GHG
emissions. In 2020, approximately 12 metric
tons of corrugated cardboard were saved and
end users required 70% less time to open and
dispose of the packaging.
56
HEALTH SYSTEM ROLE AND VALUE PROPOSITION
Packaging reduction and material changes
would help health systems reduce their Scope 3
Collective Action 2:
Packaging Changes
footprint as it relates to emissions of purchased
goods and waste generated through operations.
The role of health systems would be to identify
opportunities for packaging changes and ensure
internal systems are able to manage proposed
changes. For instance, if there is an opportunity
to put more units into a box to reduce the
amount of secondary packaging used, health
systems need to ensure they can order larger
quantities and store the bigger boxes. If there
is an opportunity to switch to reusable totes for
tertiary packaging, health systems would need to
put processes in place to collect totes for return.
Health systems could also send clear signals
to all their vendors by including packaging
parameters in their procurement contracts.
Contracts could dictate an expected
percentage for packaging reduction and for
materials transitioned to those that are more
readily recyclable or compostable. Plastic
within packaging exists as one of the largest
opportunities, as hospital audits have shown
that 50% of total plastic waste by weight was
disposable packaging plastic.
57
Setting targets
within supplier contracts would help build the case
for suppliers to initiate changes in packaging.
SUPPLIER ROLE AND VALUE PROPOSITION
MedTech suppliers would also identify
opportunities for packaging changes and
assess suggestions for health systems. Suppliers
should focus specically on opportunities to
reduce and replace single-use plastics and
petroleum-based packaging. For example,
there may be opportunities to discontinue
the use of individual protective plastic bags
for certain products or components. Suppliers
should also consider replacing plastic
packaging with alternatives that are recyclable
or degradable. These supplier-specic actions
can be enhanced by sharing learnings and best
practices with other MedTech suppliers.
58
A new,
annual conference for healthcare packaging
professionals called the[PACK]outTM has
sustainability as one of its three pillars and could
potentially serve as a good forum for ideation
and innovation.
59
22
On the supplier side, reducing or reusing
packaging can substantially impact costs,
especially when scaled across millions of SKUs.
The transition to more sustainable materials may
initially be more expensive, but will likely result
in savings as Extended Producer Responsibility
(EPR) laws take effect in the U.S. and around the
world. These laws hold producers responsible for
the entire lifecycle of their products incentivizing
them to adopt sustainable practices. Globally,
EPR laws have focused on packaging, packaging
waste, electronic or electrical waste, and
batteries. In the U.S, California, Colorado, Maine,
Oregon, and Washington passed packaging-
focused EPR laws in 2021 and 2022.
60
PROPOSED METRICS
• Tons of packaging avoided
• % reduction in virgin plastic packaging
• % of recycled material used in packaging
• % of products with electronic instructions
for use (eIFUs)
• Estimated MTCO2e reduced
IMPACT LOWMEDIUM
Reducing packaging and replacing plastic with
lower-carbon alternatives would signicantly
reduce the carbon footprint for product
packaging. Plastics made up 3.4% of global
emissions in 2019 and are projected to double by
2060.
61
Lower-volume packaging could improve
shipping efciency, but plastic-alternatives run
the risk of being heavier or bulkier, which could
have an adverse impact on shipping emissions.
EFFORT LOW (Tertiary); HIGH (Sterile barrier)
As long as packing and assembly are adaptable,
MedTech suppliers can manage changes to
secondary and tertiary packaging on their own,
making this process more straightforward.
Additional stakeholders need to review and
approve sterile barrier packaging, including
clinical and regulatory stakeholders. Changes
in sterile barrier packaging may also require
clinical behavior change, which would need to
be addressed during implementation.
TIMELINE 6 12 MONTHS (Tertiary), 12 24
MONTHS (Secondary), 24+ MONTHS (Primary)
Packaging reduction can be a quick win
for health systems and MedTech suppliers,
particularly when considering tertiary packaging.
A packaging reduction review and development
of new guidelines for key products can be
developed in approximately six months. Sterile
barrier packaging would take longer to address
given additional regulatory controls.
Collective Action 3: Product
Composition Changes
IMPACT EFFORT TIME
High High 24-84 months
DESCRIPTION
Product composition changes would be the
most difcult category for quick collective
action. The process of product development can
take years and is subject to regulation. The Food
and Drug Administration’s Center for Devices
and Radiological Health (CDRH) is responsible
for regulating rms who manufacture,
repackage, relabel, and/or import medical
devices sold in the United States. Medical
devices are classied into Class I, II, and III with
progressively increasing regulatory control.
62
A
new device takes three to seven years to go from
concept through research, development and
testing, to approval.
63
For legacy products with
strong market share, it can be difcult to justify
making a change for the sake of sustainability.
Many companies are developing alternatives
23
able to share transparent, veriable data on
emissions and other environmental attributes,
such as the percentage of recycled materials.
As suppliers adopt recycled materials or
source raw materials from environmentally-
preferred vendors, Eco-labels on products
will be useful to help customers compare
products and make informed choices.
Suppliers will also be critical in providing
education about the safety and use cases for
these new products.
PROPOSED METRICS
• # of new products available with lower
carbon footprints versus legacy products
• Estimated MTCO2e reduced
IMPACT HIGH
Much of a product’s carbon footprint comes
from its raw materials and manufacturing, so
addressing this directly is likely to have a major
impact on emissions for both health systems
and MedTechs.
EFFORT HIGH
New product composition takes signicant
time and investment and some products
changes may be subject to regulatory
approval. According to suppliers, the timeline
to develop new, low-carbon MedTech
products is two to seven years. That extended
timeline may be preferable to the complex
process and additional stakeholders involved
in reformulating existing products.
TIMELINE 24 84 MONTHS
Product reformulation requires signicant
R&D support to ensure that new materials
meet product specications and is cost
effective.
to plastic products using biodegradable plant-
based materials, but it is still a nascent market.
64
HEALTH SYSTEM ROLE AND VALUE PROPOSITION
Health systems can support the development
of lower-carbon products in several ways. They
can make procurement commitments and
provide preferential purchasing for suppliers
who are cutting emissions in their operations
and products. They can also invest in product
development through an innovation fund. To
identify preferred suppliers, health systems
can add purchasing criteria into RFPs and
vendor scorecards giving preference to vendors
who have set science-based targets and can
share information related to their products’
environmental impacts. When choosing
new products, carbon footprint should be
considered along with other traditional criteria.
1
Procurement commitments for lower-carbon
products can help move the market and are
already being implemented. For example, in
2021, 12 health systems committed to spend
$1 billion with minority and women owned
businesses (MWBEs) by 2025, with integrated
commitments to sustainability, and community
wealth building.
65
SUPPLIER ROLE AND VALUE PROPOSITION
The value proposition for suppliers lies in
becoming a preferred supplier and market
leader providing sustainable solutions to health
systems and GPOs. Companies that are early
adopters of lower-carbon products will have a
competitive advantage as product disclosure
requirements, Extended Producer Responsibility
(EPR) laws, and carbon pricing come into force
around the world.
To seize this opportunity, it’s crucial for suppliers
to understand the carbon footprints of their
existing portfolios and design and test new,
lower-carbon products. They will need to be
24
Product Utilization - Clinical Engagement
Product utilization plays an important role in the emissions generated over the
course of a product’s lifecycle. To build sustainability across the supply chain,
the clinician-patient-product interface must be considered with an effort to
move toward more sustainable use of products. Clinicians and other clinical
staff are not only key decision makers on the types of products being procured,
but also determine where, when, how, and how much of products are being
used. To enable adoption of sustainable products and practices, clinical staff
need to be educated on the importance of using sustainable products, as well as
their availability, safety, and efcacy. For example, the Sustainable Healthcare
Coalition, a UK-based healthcare sector-led group that is focused on sustainable
practices in healthcare, has developed a care pathway carbon calculator to
support the transition to lower-carbon care.
66
can greatly reduce emissions. A recent study found
that implementing power-saving measures, such as
switching off MRIs when not in use, leads to a 25%-
33% decrease in energy use; enabling power-save
mode can provide an additional 22%-28% decrease.
69
Three collective actions focused on engaging
clinical staff to reduce product-related emissions are
detailed below.
“We cannot ultimately have
sustainability across the supply chain
unless we address the way in which
clinicians are interfacing with patients
and products.”
SONIA ROSCHNIK
Executive Director, Geneva Sustainability Centre,
International Hospital Federation
Health systems and suppliers can drive increased
use of sustainable products by advancing clinical
stakeholder education and engagement. Initiatives
can focus on reducing the amount of a product
used, or the way a device or piece of medical
equipment is employed.
Great Ormond Street Hospital, a children’s
hospital in the United Kingdom, successfully
reduced unnecessary plastic glove usage
through an educational campaign including
email communications, in-person trainings, and
posters. Staff were trained on when gloves were
necessary and when handwashing alone was
sufcient. Results were reported throughout
the organization to celebrate progress and
raise awareness during the campaign. This
culminated in a total reduction of 25 metric
tons of plastic gloves and a cost reduction of
$134,000 US dollars.
67
Radiology is notorious for its energy-intensive
equipment, particularly MRIs. A 2022 study
found average carbon emissions were 17.5 kg/
MRI scan.
68
But simple training for clinical staff
25
Collective Action 1: Identify
Opportunities for Increased
Product Durability
equip them to educate their colleagues. Clinical
champions are essential for leading any changes
that impact the delivery of care.
In addition to clinician input, health care systems
should establish procurement policies that
prioritize, or at the very least consider, product
reusability. The considerable purchasing power
of health systems and partner GPOs will inuence
the market, driving investments into resources to
transition to increased product durability.
SUPPLIER ROLE AND VALUE PROPOSITION
MedTech suppliers actively work to assess
customer needs and priorities to develop aligned
products. Through participating in a forum
focused on product durability, suppliers can both
gather insights from health system participants
and share potential design and manufacturing
challenges. Suppliers can use these forums to
bring forward alternate products and use the
insights to consider the opportunities for more
durable products.
PROPOSED METRICS
• # of single-use devices replaced with
reusable alternatives
• Increase in # of reprocessed devices
• Net waste diverted from landll with
product change (lbs)
• Cost savings
• Estimated MTCO2e reduced
IMPACT MEDIUM
A forum with interdisciplinary experts, including
clinicians, can have a meaningful impact on
the adoption of more sustainable products.
When changing from an SUD to a more durable
option, the emissions impacts of disinfection
and sterilization will also need to be considered.
EFFORT MEDIUM
Given the presence of interdisciplinary decision-
making bodies focused on product use, the
forum can leverage existing best practices as
a framework for action. The involvement of
IMPACT EFFORT TIME
Medium Medium 12-24 months
DESCRIPTION
Single-use devices (SUDs) have become
ubiquitous in healthcare. Research has shown
that SUDs produce greenhouse gas emissions
that are severalfold higher on a lifecycle basis
compared to more reusable equipment. Despite
higher acquisition costs, resuables have lower
costs over the product lifetime.
70
Clinicians are uniquely positioned to collaborate
with infection prevention and suppliers to
identify single-use products that could be
replaced with reprocessed or durable options
without an impact to patient safety or ease
of use. Health systems and suppliers can set
up a forum to evaluate a set of single-use
products chosen based on volume, spend,
or other agreed-upon criteria. They can then
determine which products can be substituted
in different clinical environments and health
systems can run pilots or begin transitioning to
the new product. For instance, single-use pulse
oximeters could be replaced by durable models
and disinfected between patient uses. Timelines
and decarbonization impact will vary based on
the product and the intervention; for example, it
would likely take longer to institute a change for
endoscopes than for pulse oximeters.
HEALTH SYSTEM ROLE AND VALUE PROPOSITION
Clinicians and clinical staff are end users of
these products and have valuable insights into
product use, patient experience, and process
efciencies. Inviting clinicians to participate
in identifying opportunities for more durable
product usage increases their understanding
and buy-in. Including infection prevention
professionals in those discussions ensures
clinicians feel condent that they are not
compromising patient safety and can better
26
clinician and infection-prevention professionals
is crucial to the adoptions of durable devices;
their input and and openness to changes will
play a pivotal role. This shift to durable devices
might require changes in policies and practice.
For cost considerations, an approach based on
the total cost of ownership should be utilized.
TIMELINE 12 24 MONTHS
Setting up a forum of cross-functional
stakeholders and aligning on products to
evaluate will likely take three months. Product
substitutions then need to be identied and
agreed upon. The process of making the actual
substitutions can be lengthy due to existing
inventory, contract terms, and changes needed
to clinical practice policies or protocols. Health
systems might opt for a pilot as part of the
process as well.
Collective Action 2: Product
Reprocessing Education and Pilots
single-use devices are safer than reusable
or reprocessed devices; however, there is no
compelling evidence that single-use devices
reduce infection risk.
74
Health systems and
suppliers can create opportunities to educate
clinicians and infection prevention professionals
on the safety and quality of available
reprocessed devices and set up pilots for specic
devices to increase adoption. A clinician cohort
could be created to pilot specic reprocessed
devices across a number of institutions at the
same time allowing for shared experiences and
feedback. Those clinicians involved in successful
pilots can become clinical champions to help
educate their colleagues nationally.
HEALTH SYSTEM ROLE AND VALUE PROPOSITION
Engaging clinicians in reprocessing pilots can
lead to increased adoption of reprocessed
devices, resulting in cost savings, waste
reduction, and the potential for improved access
to medical devices in resource-constrained
settings. Hospitals save approximately 50% for
every reprocessed device purchased and spend
less on disposal of waste.
75
SUPPLIER ROLE AND VALUE PROPOSITION
For MedTech suppliers, the value proposition
for engaging clinicians includes increased
opportunities to sell reprocessed devices
and receiving targeted feedback for existing
and future products. Feedback from a key
end-user sheds light on customer needs,
IMPACT EFFORT TIME
Medium Low-
Medium
12 months
DESCRIPTION
Product reprocessing of SUDs offers a key
opportunity for health systems and MedTech
suppliers to reduce waste, lower costs, and
address carbon emissions. Hospitals in the
United States generate 29 pounds of waste per
staffed bed per day.
71
There are over 300 types
of “single-use” devices that are available for
reprocessing. According to a recent analysis by
the Association of Medical Device Reprocessors
(AMDR), 8,622 hospitals and ambulatory surgical
centers reprocessed medical devices in 2019,
diverting over 18 million pounds of medical
waste and saving over $20 million in waste
disposal costs.
72
Recent research indicates that
pursuing a reprocessing program can save
between $600,000 and $1 million annually for
a 200-bed hospital and generate even greater
savings for larger health systems.
73
Clinicians may be reluctant to switch to
reprocessed devices due to concerns about
changes in device efcacy, performance,
or infection risk. There is a perception that
27
However, these products are already in use at
many leading health systems so this should be
a manageable challenge. One caveat is that
amidst increased clinician workload, burnout,
and lack of resources, sustainability may be
a secondary priority compared to emergent
patient care, making it more difcult to get
pilots launched.
TIMELINE 12 MONTHS
Gaining initial clinician buy-in can take time;
once mobilization is achieved, reprocessed
options can be prioritized for pilots. After
clinician pilots, it will take time to scale the
program based on contract terms, existing
inventory, collection processes, and logistics.
“There currently exists a mismatch
between what is in the market and
what is being procured.”
DANIEL ERIKSSON
Founder/CEO Nordic Center for Sustainable
Healthcare
priorities, and preferences which can accelerate
improved product development and increased
market share. The joint effort will also serve
to build relationships with key health system
stakeholders.
PROPOSED METRICS
• # of reprocessing pilots involving health
system clinicians
• Increase in unit sales of reprocessed
products / units of reprocessed devices
repurchased
• Estimated MTCO2e reduced
IMPACT MEDIUM
Clinician end user engagement in reprocessing
pilots can lead to increased adoption, extending
the lifespan of devices. This reduces emissions
associated with both producing and using new
devices and the associated waste.
EFFORT LOWMEDIUM
As described above, clinicians may be hesitant
to pursue and adopt new, sustainable products
for a variety of reasons including concerns
that reprocessed products may negatively
interfere with patient safety and quality of care.
Collective Action 3: Surgical Kit
Reformulation
IMPACT EFFORT TIME
Medium-
High
Medium 3-6 months (Pilot),
12 months (Scaled)
DESCRIPTION
Operating rooms (ORs) are one of the largest
revenue drivers in hospitals but also produce
up to 70% of the eight trillion tons of medical
waste generated annually by U.S. hospitals.
76
A considerable portion of OR waste is directly
linked to opened-but-unused supplies
and recyclable materials that were sorted
incorrectly.
77
From a series of audits, it has been
observed that ORs routinely discard supplies
in surgical kits that were never used over the
course of the operation.
78
Many health systems have instituted surgical kit
reformulation to identify items that routinely
go unused during procedures, and then remove
them from the preference card and pick list. This
avoids the unnecessary purchase and disposal of
those supplies, leading to both waste reduction
and cost savings.
28
Through a review of surgical kits and
evaluation of surgeon preference cards,
Providence St. Vincent Medical Center
(PSVMC) was able to remove approximately
40,000 unneccessary products. The net
results were annual savings of $1.5 million on
supply purchases and $270,000 on expired
items. Additionally, over 9,000 instrument
sets were kept out of circulation decreasing
sterile processing utilization by 72,000 trays,
resulting in annual savings of 495,000 kWh
of electricity, one million gallons of water, and
about $50,000 in direct costs.
40
Health systems create some of their own
surgical kits, packs, and trays and purchase other
standard and custom kits from suppliers, so
reformulating surgical kits can be a key area for
collaboration.
HEALTH SYSTEM ROLE AND VALUE PROPOSITION
Health systems can work to identify routinely
unused items in surgical kits created in-house
as well as kits purchased from suppliers. Health
systems can then begin reformulating kits,
packs, and trays, both on their own and with
their suppliers. For health systems, benets
include waste reduction and cost savings, as well
as insights related to best practice as required
instruments and supplies are reviewed with
surgeons.
SUPPLIER ROLE AND VALUE PROPOSITION
Suppliers that create surgical kits, packs, and
trays would work with their health system
customers on surgical kit reformulation. They
would receive data and feedback from health
systems on what supplies routinely go unused
and adjust their standard and custom products
to eliminate these supplies. This allows suppliers
to be valued partners for their health system
customers. Suppliers can also offer newly
reformulated kits to other health systems.
PROPOSED METRICS
• Reduction in waste (lbs)
• Avoided medical waste disposal costs
• Procurement cost savings
• Estimated MTCO2e reduced
IMPACT MEDIUMHIGH
Streamlining OR kits and standardizing the
type and number of items would improve
inventory and supply costs and reduce
waste. Given the potential scale and outsized
contribution ORs have on medical waste,
this collaborative action is estimated to have
medium-high impact.
EFFORT MEDIUM
OR kit reformulation has been successfully
implemented by many health systems
for years. Although the process seems
straightforward, OR kit reformulation
does requires working with a number of
stakeholders in the OR and supply chain. Clear
communication, surgeon engagement, and a
feedback mechanism are all key for success.
Historically, vendors have had different levels
of interest in working with health systems
so a cooperative effort will help streamline
the process. There will likely be a lag time
before a supplier can distribute reformulated
packs since many make up the packs in bulk
volumes.
79
TIMELINE 3 6 MONTHS (Pilot), 12 MONTHS
(Scaled)
Practice Greenhealth guidance on OR Kit
Reformulation recommends starting with a
pilot of one pack selected for potential impact.
The process involves collaboration between
individuals across nursing, sustainability ,
procurement, sterile processing, and OR
leadership. Decisions about kit composition
require input from multiple surgeons, then
data collection and estimation of impacts can
begin. Final steps include coordinating with
procurement and vendors on reformulation
requests before scaling the approach to
additional packs.
79
29
Transportation and Logistics
According to the U.S. Environmental Protection Agency, the transportation sector
generates the largest share of the country’s GHG emissions, contributing 28%
of total emissions.
80
The health sector contributes to these emissions via the
transportation of patients, emplyees, and goods and services. Health systems and
MedTech suppliers can identify transportation and delivery strategies to decrease
emissions while simultaneously increasing efciency and customer satisfaction.
distributors, and health system. This will
involve considerations across the supply chain,
including advanced ordering and shipping,
route planning, receiving product, and optimal
storage conditions. For instance, supplies that
are shipped by ground, sea, or rail must be sent
further in advance than those shipped by air. If
supplies are shipped in advance, health systems
would have to be ready to receive the product;
otherwise, suppliers will have to bear the
effort and expense of storing their products in
facilities. Depending on the product, this could
mean nding a facility in which certain criteria,
like temperature, humidity, or an adequate
power supply, can be maintained to prevent
product damage.
While complex, carefully planned changes to
logistics can result in increased efciency and
decreased emissions.
In 2020, Baxter and NHS Oxford University
Hospitals partnered with Pedal and Post,
a local cycle courier company, to deliver
patient-specic, compounded chemotherapy,
antibiotics, and intravenous nutrition
products to hospital sites in Oxford, England.
In the rst 10 months of the project, cycle
couriers expedited delivery of 36,000
products cutting transport time in half.
Bicycle delivery also yieled sustainability
benets estimated at 10 tons of averted
carbon emissions annually.
81
Collective Action: Implement
Logistics Efciencies
IMPACT EFFORT TIME
Medium Medium-
High
6 – 24 Months
DESCRIPTION
Efcient and timely logistics and delivery are
vital for health systems to ensure availability
of supplies for patient care and operations.
However, the complexity of health system
logistics, especially for critical, time-sensitive,
or expensive products, frequently results in
last minute orders and inefcient delivery and
transportation, including less-than-truckload
(LTL) deliveries. These situations negatively
impact both health systems’ and suppliers’
carbon footprints and bottom lines. Health
systems and suppliers can work together
to optimize ordering, packing, and delivery
routes and frequency. They can also minimize
less-than-truckload, overnight, and last-mile
deliveries, while ensuring the availability of
critical supplies. These changes can apply to
supplies being delivered to medical facilities as
well as those going to patient homes.
Reducing the number and frequency of
deliveries may require challenging system
and process adjustments for suppliers,
30
HEALTH SYSTEM ROLE AND VALUE PROPOSITION
Health systems can increase logistical efciency
by using order management technologies
powered by optimization algorithms to
consolidate orders and minimize small, frequent
deliveries. These changes can have immediate
impacts on clinical services. In a recent
survey, 87% of nurses indicated that logistical
inefciency affected their work at a weekly
cadence; 71% indicated delivery errors or delays
affected their ability to care for patients at least
once monthly.
82
In order to manage this change,
health systems may need to consider adding
additional storage space.
Health systems and suppliers must collaborate
on order-to-delivery timelines so that delivery
can be optimized without affecting product
availability for patient care. With the growth
of home care, there is an opportunity to
consolidate the typically separate deliveries of
medical equipment, supplies and medications to
patients’ homes. To further enable optimization
on this front, health systems can share order
management data with suppliers to allow direct
fulllment, deliveries, and scheduling. Finally,
health systems and suppliers can streamline
delivery and unloading operations to reduce idle
time and corresponding carbon emissions.
Through these actions, health systems can
reduced emissions and progress toward their
sustainability goals. Supplier cost savings can
be passed on to health systems through lower
negotiated prices.
SUPPLIER ROLE AND VALUE PROPOSITION
MedTech suppliers can utilize a variety of
individual actions to drive value and reduce
cost and emissions. First, suppliers can
periodically optimize their networks to ensure
distribution centers are strategically located
and their delivery routes are minimizing miles
traveled. Suppliers can also adjust modes of
transportation depending upon expected and
actual orders. Earlier and more complete order
data can enable greater reductions in emissions
from delivery. For example, if a supplier can
forecast increased seasonal demand, they can
utilize cheaper, lower-carbon modes such as
rail or ocean freight. Data allows suppliers to
consolidate multiple orders, avoid overnight
delivery, manage their own inventory, and
identify patterns in demand. To aid in this,
suppliers can use transportation management
systems (TMS), technology that to identies
real-time opportunities for mode switches and
load pooling.
As with many of the collective actions in this
paper, the importance of communication,
cooperation and training for key actors (e.g.
logistics managers, nurses, purchasers, etc.)
cannot be overstated. Increasing collaboration
and awareness are crucial elements to
optimizing logistics between MedTech
suppliers and the health systems they serve.
PROPOSED METRICS
• % of overnight deliveries / shipments (of
total deliveries received)
• % of deliveries / shipments utilizing
lower-carbon transport modes
• % of Less-than-truckload (LTL) deliveries
• Number of consolidated orders versus
single orders
• Estimated MTCO2e reduced
IMPACT MEDIUM
Based on U.S. healthcare emissions numbers,
83
transportation is estimated to account for
approximately 5% of the national healthcare
footprint. Estimating the impact on individual
health systems and suppliers is difcult from
publicly available emissions data. For health
systems, upstream transportation emissions
may be embedded in the Purchased Goods
and Services category with a spend-based
emissions inventory. For suppliers, the
downstream emissions are coming from both
eet and third parties. Given this allocation,
optimizing logistics and deliveries is expected
to have a medium impact.
31
Lo w
Hig h
Hig hLo w
Impact
Effort
Renewable Energy
Product Innovation
Product Utilization – Clinical Engagement
Transportation & Logistics
Reprocessing Pilots
Product Durability
Opportunities
Takeback Programs
Packaging
Changes
Product Composition Changes
Surgical Kit
Reformulation
Aggregate Power
Purchase Agreements
Logistics Efficiencies
Tertiary Secondary Primary
Impact & Effort Assessment Matrix
Medium
Med iu m
EFFORT MEDIUMHIGH
Ease of implementation is highly dependent
on the nature of a supplier’s logistics network.
For example, if a supplier uses its own eet
to transport its product, network changes
and mode optimization may be more
straightforward. However, a majority of suppliers
work with distributors and third-party logistics
providers, adding additional complexity to
implementing changes.
TIMELINE 6 24 MONTHS (highly dependent
on MedTech suppliers’ logistics resources and
strategies)
Impact and Effort Assessment Matrix
The Impact and Effort Assessment Matrix below in Figure 5 plots collective actions by
lever categories based upon dened impact and effort described in further detail above.
FIGURE 5 Collective action opportunities mapped based on impact and effort
32
Opportunities for Collective Commitment
Collective commitments, dened as agreed-upon individual company commitments,
are also important for decarbonizing at the pace and scale needed to address climate
impacts. This approach has several benets including increased accountability and
investment in the success of the collaborative effort, knowledge sharing that can
accelerate innovation, and combined resources and inuence that can be leveraged
to drive more effective and efcient progress.
Proposed collective commitments are outlined under each of the four levers.
Collective Commitments
Renewable Energy
Produce or procure % of
electricity from renewable sources
Commit to RE100
Install EV charging stations
Product Innovation
(Composition, Packaging, and End-of-Life)
Appoint a medical director
of sustainability, and/or
Assign a clinician sustainability
representative to product committees
Product Utilization –
Clinical Engagement
Set company targets around waste
reduction and SUD reduction
Pursue My Green Lab certication
product committees
Transportation
and Logistics
Transition eet to electric or
hybrid-electric vehicles
Implement “no idling” policy
33
Renewable Energy
Companies can collectively commit to powering their operations with a certain
percentage of renewable electricity by a specic target year. Eligible companies could
also commit to RE100, a collaborative initiative bringing together the world’s most
inuential businesses committed to 100% renewable electricity. RE100 members must
have signicant annual electricity demand and are typically in the Global Fortune
500. Companies with smaller consumption may be considered if they are a key player
in their industry or in a priority region.
84
A collaborative could also develop company
commitments to install EV charging stations powered by renewable energy, or to
provide incentives to employees for EV or hybrid adoption.
Product Innovation
Companies can collectively commit to set targets for reductions in waste and single-
use devices that align with the collective actions described above. They can also pursue
My Green Lab certication to address sustainability through purchasing, recycling,
and reducing waste in their laboratories. The certication program supports laboratory
personnel to make changes in the lab and in interdisciplinary projects through
actionable initiatives across 15 key areas.
85
Product Utilization - Clinical Engagement
Companies can collectively commit to appoint a medical director of sustainability and/
or assign a clinician sustainability representative to serve as a change champion on
product committees. The individual would play an important role engaging clinicians in
supply chain conversations, advocating for the integration of sustainability criteria into
purchasing scorecards, and driving the organizational adoption of sustainable products.
Clinician leadership is essential for developing and implementing a sustainable clinical
care strategy, educating others about opportunity areas, and offering insights on
product development and use.
Transportation and Logistics
Companies can collectively commit to transitioning their eets to electric or hybrid-
electric vehicles. Electric vehicles create zero tailpipe emissions and can help reduce
the environmental impact of last-mile delivery.
86
Companies can also commit to
implementing a “no idling” policy to reduce air pollution during non-value add vehicle
usage. For health systems, this would include emergency and service vehicles; and for
MedTech suppliers, shipping vehicles.
34
Enablers
Roundtable participants discussed what would need to be true to for value chain
decarbonization initiatives to be successful. These enablers will need to be
considered in parallel with collective action and commitments.
Currently, health systems and suppliers are using
a spend-based method for calculating Scope 3
emissions. This method relies on emissions factors
from the EPA’s US Environmentally-Extended
Input-Output Database (USEEIO). While the spend-
based approach has its limitations, it does allow for
identication of key suppliers and emissions hotspots
that can be addressed by individual organizations
and collectively. The next step is for an organization
to calculate their Scope 3 emissions based on a
percentage of a supplier’s Scope 1 and 2 emissions.
• Accurate emissions accounting: Accurate,
product-level emissions are not available for
everything companies procure today. Health
systems have tens of thousands of suppliers and
the same can be true for many of their MedTech
suppliers. Many companies in the supply chain
do not properly understand their own Scope 1
and 2 emissions, let alone those of second-tier
suppliers and beyond. And even when estimates
are available, different companies use different
industry averages, factors, and assumptions that
makes apples-to-apples comparison of suppliers
extremely difcult.
Many health systems have over 100,000
individual suppliers and the time and effort
spent on data collection must be balanced
with pursuing opportunities for near-term
decarbonization. Many health systems are
prioritizing suppliers based on spend or other
known emissions hotspots. In 2021, the NHS
issued a Net Zero Supplier Roadmap that
outlines requirements for suppliers to align
with the NHS net zero ambition by 2030. The
roadmap requires suppliers with contracts above
£5 million to publish a carbon reduction plan
as of April 2023, and for all suppliers to publicly
report targets, emissions across all Scopes, and
a carbon reduction plan aligned with NHS’ net
zero target by April 2027.
87
Product-level emissions are not available for
most medical supplies and equipment. There
“What makes a big difference
is when leaders are interested in
the success; then everyone will
align behind it and will be held
accountable even if the solution isn’t
obvious – leadership in uncertainty
matters, especially if you don’t know
what the answer is.”
FIONA ADSHEAD
Chair, Sustainable Healthcare Coalition
DATA ACCESS AND TRANSPARENCY
Health systems and suppliers both need to have
access to data to be able to support decarbonization
across the supply chain. Data is required to 1) Embed
sustainability criteria in purchasing and product
decisions and set vendor guidelines; and 2) For use
in calculating and identifying hotspots in Scope 3
emissions with more granularity than using database
emissions factors. As vendor data is collected, suppliers
need feedback about how they are tracking toward
their goals, and highlighting potential opportunities.
Data challenges exist in terms of both accurate
emissions accounting and data standardization.
LEADERSHIP
Leadership support is a critical enabler. Supply chain
decarbonization initiatives are complicated and
involve individuals and departments across health
systems and vendor companies. Leaders must
provide the human and nancial resources needed
to operationalize efforts, as well as the directives and
incentives to ensure enterprise-wide cooperation.
Leaders need to develop standard business case
formats that include sustainability metrics as well as
nancial implications.
35
is a new initiative by Association for Healthcare
Resource & Materials Management (AHRMM),
the leading membership group for health care
supply chain professionals that is part of the
American Hospital Association, to address this
challenge. Sustainable Healthcare Assessment
of Product Emissions (SHAPE) plans to design
and oversee a greenhouse gas emissions
database for healthcare products. The database
will be open source allowing suppliers, GPOS,
and hospitals access to independently validated
product emissions data based on the ISO 14067
standard. SHAPE is still in design phase working
with stakeholders and potential partners to
explore potential supplier concerns about
transparency and digital tools to help scale
these assessments to the millions of medical
products procured.
• Data standardization: A lack of data standards
has been acknowledged across industries as a
signicant problem. Procurement professionals
are not getting the data they need to make
sourcing decisions and suppliers are getting
inundated with a variety of data requests. There
are many efforts underway at a variety of levels to
address this issue both across sectors and in the
health sector specically. For example:
– At the federal level: The Biden
Administration’s proposed Federal Supplier
Climate Risks and Resilience Rule would
require major Federal contractors (contracts
of $7.5M or more in sales) to publicly disclose
their emissions and risks and set science-
based targets; and HHS and NHS England
announced a collaboration at COP27 to align
procurement requirements.
– At the cross-sectoral level: The Sustainable
Purchasing Leadership Council (SPLC)
recently launched a cross-sectoral
Procurement Climate Collaborative[i]
including a working group focused on
development of procurement-centered
measurement strategy.
88
With the
understanding that carbon accounting
is misaligned with the practical needs
of procurement, the goal is to dene
meaningful and actionable shared
measurement that will enable procurement
decisions supporting near-term operational
change by suppliers. The group has drafted
a map of data and measurement needs
at each stage of procurement and this
prototype solution will now be tested by the
full collaborative.
– At the industry collaborative level: In April
2021, the Pharmaceutical Supply Chain
Initiative (PSCI) released an Environmental
Survey to standardize data collection from
suppliers for their members. Members of the
SMI Health Systems Task Force have committed
to align on a set of common supplier standards
supporting emissions reduction.
– At the health system – MedTech interface:
» Group Purchasing Organizations
(GPOs) are working with their customers
to enable tracking and monitoring of
progress toward decarbonization goals.
With 96-98% of health systems using at
least one group purchasing organization
(GPO) contract for their purchasing
function,
89
both health systems and
suppliers felt that GPOs could play a key
role in the standardization of requests and
collection of data.
» The U.S. Healthcare Climate Council
developed a standard set of supplier
questions and recently released a Climate
Excellence Standard for Health Sector
to identify leading suppliers, address
supply chain opportunities, and accelerate
momentum. Suppliers will be qualied by
data gathered through publicly accessible
websites and results will be reported
through a dashboard.
With the multitude of efforts underway to address
data challenges, Roundtable participants will be
best served by focusing on collective actions and
commitments, while supporting existing data
initiatives individually or collectively, as appropriate.
“We can’t wait for the perfect
solutions, let’s start today with what
we can do today. As we learn more
we can do more”
VIBHAS DESHPANDE
Vice President, Sustainability Innovation and Strategic
Research, Siemens Healthineers
6
months
9
months
12
months
15
months
18
months
21
months
24
months
Future
Renewable Energy
Product Innovation Product Utilization – Clinical Engagement Transportation & Logistics
3
months
Conrm and qualify interested collaborative members
Identify target markets with adequate vendors and electrical supply
Develop and sign a Consortium Governance Agreement
Duration: 12 - 18 months
Create health system and
supplier teams to choose
target products or product
categories
Duration: 3 months
Identify achievable
decarbonization
opportunities for the
product or product
category
Duration: 3 - 6 months
Deploying an effective pilot takeback program
Duration: 6 - 12 months
Product composition changes difcult due to regulations and development cycle
Duration: 24 - 84 months
Scale use of reprocessed device
Launch additional pilots
Duration: 12 months
Tertiatry packaging changes
Duration: 6 - 12 months
Issue RFP and choose project(s)
Duration: 6 months
COLLECTIVE ACTIONS
AGGREGATE
PPAS
TAKEBACK
PROGRAM
PRODUCT
REPROCESSING
EDUCATION &
PILOTS
Set up a forum to evaluate
a set of single-use devices
(SUDs)
Duration: 3 months
Identify opportunities for
SUD replacement with
reprocessed or durable
alternatives
Duration: 3 months
Educate and recruit
clinicians
Duration: 3 months
Choose product and implement pilot
Assess progress and KPIs
Share learnings with other collaborative members
Duration: 3 - 12 months
SURGICAL KIT
REFORMULATION
Perform Surgical Kit Reformulation on one
target pack
Duration: 3 - 6 months
TRANSPORTATION
& LOGISTICS
Implement logistics efciencies, e.g. order consolidation and minimization, reduce overnight deliveries with air shipping and less-than-truckload deliveries
Duration: 6 - 24 months
Scale Surgical Kit Reformulation across surgical pack types and
facilities
Duration: 12 months
Pilot and/or adopt new product(s)
Duration: 6 - 18 months
PRODUCT
DURABILITY
PACKAGING
CHANGES
PRODUCT
COMPOSITION
Primary & secondary changes
Duration: 12 - 24+ months
Scaling of pilot
Duration: 24 - 36 months
24 Month Roadmap
Each collective action has been mapped to a 24-month timeline based on estimated ranges for execution. A
collaborative can accomplish several actions within the rst 12 – 24 months, developing the foundations for
further decarbonization.
36
37
Renewable Energy
COLLECTIVE ACTION AGGREGATE POWER PURCHASE AGREEMENTS (12 – 24 months)
For aggregate PPAs, it typically takes 12-18 months prior to initiating the go-to-market process.
Then an additional 6 months would be needed to put out an RFP and secure a project.
Product Innovation
COLLECTIVE ACTION 1 IMPLEMENT TAKEBACK PROGRAMS (24 – 36 months)
A takeback program pilot would be undertaken over the course of 6-12 months. Scaling the
pilot to other hospitals within the health system network would occur over 24-36 months.
COLLECTIVE ACTION 2 PACKAGING CHANGES (Tertiary: 6 – 12 months, Primary & Secondary: 12 –
24+ months)
Packaging changes could be implemented in a 6-12 month timeframe for tertiary packaging
and signicantly longer timelines for primary or sterile packaging, with a timeframe of 12-24
months or greater.
COLLECTIVE ACTION 3 PRODUCT COMPOSITION CHANGES (24 – 84 months)
With a timeline to implement of 24-84 months, this is the most challenging of all suggested
collective actions due to the multiyear development process for products, regulatory
guidelines, and the sourcing of materials.
Product Utilization - Clinical Engagement
COLLECTIVE ACTION 1 IDENTIFY OPPORTUNITIES FOR INCREASED PRODUCT DURABILITY (12 –
24 months)
Minimizing the need for SUDs and looking for alternatives that are reusable or more durable
would take 12-24 months based on gathering input from clinical end users and moving towards
implementation.
COLLECTIVE ACTION 2 CLINICIAN AND PHYSICIAN ENGAGEMENT IN PRODUCT
REPROCESSING PILOTS (3 – 15 months)
The rst 3 months will be focused on clinician outreach and education and then a product
reprocessing pilot can be started. After the initial pilot, if successful, the use of the reprocessed
device can be scaled and other pilots launched.
COLLECTIVE ACTION 3 SURGICAL KIT REFORMULATION (15 – 18 months)
Reformulated surgical kits would rst be pilot tested within a single surgical specialty over 3-6
months. Upon completion, this action could be scaled over one year or more to the remaining
surgical specialties and hospitals.
Transportation and Logistics
COLLECTIVE ACTION IMPLEMENT LOGISTICS EFFICIENCIES (6 – 24 months)
It would take approximately 6-24 months to implement efciencies directly related to the
transport of medical equipment and supplies.
38
Moving Forward as a Collaborative
The Roundtable participants agree collaboration is needed to decarbonize the
emissions from medical devices and supplies. This paper has identied collective
actions and commitments that can form the basis for this cooperative work. The
next step is to design and launch a formal collaborative to enable execution of the
24-month roadmap. Establishing clear goals and criteria for membership, including
leadership approval and a nancial investment, will provide the formal collaborative
with the commitment and resources needed to move forward.
against these desired outcomes is a necessary step to
ensure accountability and forward progress.
After obtaining consensus on objectives, subject
matter experts universally agree that a governance
structure must be put in place to enable efcient
operation. It is not useful for a large group of
stakeholders to become hyper-focused on a specic
action item; searching for consensus on nonessential
items can result in wasted time, diverting
resources from the collaboratives’ core aims.
90
It
is recommended that a representative executive
group be established as a decision-making body to
facilitate action and rapid decision-making. Forming
other smaller working groups within the collaborative
will help formulate the best shared solutions while
building a sense of ownership and accountability.
Interpersonal and inter-organizational differences
can also be a challenge. Interestingly, research
revealed that the higher the proportion of experts
within a team, the greater the likelihood of
nonproductive conicts or stalemates.
91
Companies
may also be less willing to share information if
they view this as a threat to their market position.
The success of some past efforts was diminished
when only some of the participating companies
were willing to share data. Establishing principles of
engagement or “rules of the road” for participant
behavior and member expectations as part of
the membership agreement can help create
accountability and avoid these issues. The Chatham
House Rule for collaborative meetings is also
recommended to create an environment of trust
as “participants are free to use the information
received, but neither the identity nor the afliation of
the speaker(s), nor that of any other participant, may
be revealed.
92
Benets of working collaboratively to achieve
decarbonization across the value chain include
enabling innovation, dening standards and
targets, producing efciencies in terms of needed
investment, aggregating purchasing power, and
increasing effectiveness in policy advocacy. As
discussed above, there are a number of other health
sector collaboratives focused on decarbonization;
it will be important for this health system-MedTech
supplier initiative to carve out its unique value
proposition and to ensure coordination with other
existing initiatives.
“The market will not be transformed
by a diverse set of asks; a collaborative’s
purpose is to bring together diverse
purchasers to align on common asks,
creating clear signals for market
transformation.”
SARAH O’BRIEN
CEO, Sustainable Purchasing Leadership Council
Despite the clear benets of collaboration, it is
not easy. There are a variety of challenges that can
be minimized by following best practices. It is rst
critical to agree on ambition, a shared purpose, and
a clear understanding of what and how members
are contributing. Objectives need to be established
that are quantiable, timebound, and actionable.
Successful efforts such as the 100,000 Lives
Campaign, set goals so ambitious they could only
be reached through collaboration.
90
Benchmarking
39
Some companies may also have concerns about
antitrust violations. According to a 2020 international
survey, fear of prosecution related to anti-trust
violations can discourage up to 60% of companies
from participating in climate coalitions.
37
In the
United States, there was an antitrust investigation
into voluntary agreements between automakers
and the state of California, and the Arizona attorney
general wrote an op-ed in March 2022 titled “ESG
May Be an Antitrust Violation.”
93
To address these
concerns, any agreements used by the collaborative
should be reviewed to ensure they are in compliance
with competition laws.
Collaborative members will have differing levels of
maturity along their decarbonization journeys; it
is important to both create a space for the mature
members to take leadership roles and ensure less
mature members have opportunities to participate
and feel heard and recognized. It is helpful to have
a menu of options with minimum requirements
so that members can choose activities in which to
participate. Having a few of members who pilot
solutions and share lessons learned can become a
virtuous cycle, making it easier for others follow suit.
In the coming months, a formal collective
established with these best practices can provide the
vehicle for Roundtable participants to implement
collective actions to decarbonize the healthcare
value chain.
40
Appendix A: Industry Collaboratives
Two key industry collaboratives launched in 2021 are public-private partnerships that
have broad scopes and cross-sector membership:
Other recently launched collaboratives or
new initiatives are primarily focused on the
pharmaceutical industry.
ENERGIZE
Schneider Electric’s Energize, launched in 2021,
supports pharmaceutical industry suppliers in
adopting renewable energy through an aggregated
approach to contracting for PPAs. Members include
17 pharmaceutical companies.
95
MANUFACTURE 2030 ACTIVATE
Announced in 2022, with an ofcial launch in
April 2023, Manufacture 2030 Activate aims to
decarbonize Active Pharmaceutical Ingredient
suppliers through measurement, tools, advice, and
green nancing. The collaborative currently has ve
pharmaceutical members.
PHARMACEUTICAL SUPPLY CHAIN INITIATIVE PSCI
DECARBONIZATION TEAM
The Pharmaceutical Supply Chain Initiative (PSCI)
was launched in 2006 to promote responsible
supply chain practices, human rights, environmental
sustainability, and ethical business. In recent years,
they formed a Decarbonization Team to support their
members and created a Decarbonization Maturity
Model and an Environmental Survey for members
to collect data from suppliers. They are currently
developing Suppler Learning Plans across several
decarbonization topics. PSCI has 75 members,
predominantly pharmaceutical companies.
96
SUSTAINABLE MARKETS INITIATIVE HEALTH SYSTEMS
TASK FORCE
The Sustainable Markets Initiative (SMI), launched
at Davos in January 2020, is a network of global
CEOs across industries working together to build
prosperous and sustainable economies that
generate long-term value through the balanced
integration of natural, social, human, and nancial
capital. The Health Systems Task Force, launched
in 2021 and convened by AstraZeneca is a public-
private partnership to accelerate the delivery
of net zero, patient-centric health systems that
improve individual, societal, and planetary health.
The initiative has three working groups to address
emissions across Supply Chains, with a focus on
small molecule drugs and biologics, Patient Care
Pathways, and Clinical Trials. Members include
seven European-based pharmaceutical companies,
National Health Service (NHS) England, Karolinska
Institute, the Sustainable Healthcare Coalition,
UNICEF, the University of Pavia, and the World
Health Organization (WHO).
NATIONAL ACADEMY OF MEDICINE’S ACTION
COLLABORATIVE ON DECARBONIZING THE U.S.
HEALTHCARE SECTOR
The National Academy of Medicine’s (NAM) Action
Collaborative on Decarbonizing the U.S. Healthcare
Sector is a public-private collaborative, launched
in 2021 that provides a neutral platform to align
collective decarbonization goals and actions based
on evidence, shared solutions, and commitment to
health equity promotion.
94
The Action Collaborative
has four working groups: Health Care Supply Chain
and Infrastructure, Health Professional Education
and Communication, Health Care Delivery, and
Policy, Financing, and Metrics. Members of the
Action Collaborative represent health and hospital
systems, clinicians, private payers, biopharmaceutical
and medical device companies, health care services,
health professional education, academia, nonprots,
and the federal government.
41
Appendix B: Health System – MedTech
Roundtable Participants
MEDTECH SUPPLIERS / DISTRIBUTORS
AmerisourceBergen (soon-to-be Cencora)
Baxter
BD
Boston Scientic
Cardinal Health
GE Healthcare
Genentech
Henry Schein
Intuitive Surgical
Johnson & Johnson
McKesson
Medline Industries
Össur
Roche Molecular Systems
Siemens Healthineers
Stryker
GPOS
Premier
Vizient
INDUSTRY PARTNERS
Health Care Without Harm
Institute for Healthcare Improvement
National Academy of Medicine
Sustainable Purchasing Leadership Council
HEALTH SYSTEMS
Advocate Health
Boston Medical Center
Cleveland Clinic
CommonSpirit Health
Hackensack Meridian Health Network
HealthPartners
Kaiser Permanente
Mass General Brigham
Northwell Health
NYU Langone Health
Providence
Seattle Children’s Hospital
Stanford Healthcare
The Ohio State University and Wexner Medical Center
The University of Vermont Medical Center
42
Appendix C: Findings from the April Roundtable
At the April Roundtable, participants identied decarbonization activities that
worked well for them in their individual organizations under ve levers: 1) Energy
Efciency and Renewable Energy, 2) Physician and Clinical End User Engagement,
3) Product Composition, Packaging, and End-of-Life, 4) Product Utilization, 5)
Transportation and Logistics. The group was then asked to identify which of these
could be scaled or accelerated with collective action.
looking at ways to produce more sustainable
products, not only to drive decarbonization but also
to meet customer EPP goals, through changes in
design, materials, and packaging. By meeting such
targets, suppliers can gain a competitive advantage
in the market as health system customers may
prioritize preference for environmentally responsible
products. Product energy use was also elevated as
an important consideration both in how a product
is initially designed and then used in the eld. Other
efforts discussed included utilizing assets more
efciently and extending the useful life of products.
A key issue raised was for buyers to be able to
understand and trust the sustainability attributes of
products and the need for an independently veried
“ecolabel” like those used for food and consumer
goods products. Greenhealth Exchange recently
launched Greenhealth Approved to address this gap.
Products are reviewed against a set of sustainability
criteria established for its category and if a product
both meets sustainability criteria and functions in
clinical settings, it receives a Greenhealth Approved
seal. There are currently limited categories being
reviewed and a small number of products that have
been reviewed but provides a way for suppliers to
differentiate their products and help health care
providers make purchasing decisions.
A more complicated collective action opportunity
would be to look to circular economy solutions
to reduce waste and the need to source virgin
material. Ideas for takeback programs included both
packaging and products. A number of health systems
have worked with suppliers to shift to reusable totes
for deliver. Takeback is, of course, complicated,
requiring changes by both suppliers and health
systems. Products would need to be designed for
reuse, refurbishment, or recycling and systems in
place to do so. Health systems would need to put
systems in place to collect and store products that
are being sent back to the manufacturer. There
Energy Efciency and Renewable Energy – Most
of the Roundtable participants have successfully
implemented energy efciency initiatives at their
sites and many have installed onsite renewables
and/or procured renewable energy through Power
Purchase Agreements (PPAs) or their utilities.
Aggregate PPAs or Virtual Power Purchase
Agreements (VPPAs) were identied as a key
opportunity for collective action. There was a
suggestion to talk continue the conversation with
leading industry experts in the eld.
CLINICAL END USER ENGAGEMENT
Clinical advisory teams were identied as key to
building engagement across the supply chain and
with clinical stakeholders. Gathering input from this
advisory team about new products and processes
ahead of time has led to more favorable adoption
outcomes. Another widely recommended approach
was to ensure sustainability criteria are routinely
considered by value analysis committees (VACs) that
evaluate new product purchases for hospitals and
clinics. This approach leads to increased buy-in from
physicians and clinical end users who are concerned
about patient safety and the functionality and
quality of products. For instance, clinical end user
engagement is critical for reprocessing initiatives.
Having physician-led initiatives increases the
willingness to adopt new processes and products. It
was also suggested that training sessions or videos
during orientation, annual trainings for target areas
like operating rooms, and continuing education helps
raise awareness at the broader organization level. A
novel strategy that was successfully implemented
was having patient care advocates serve the dual role
of decarbonization advocates.
PRODUCT INNOVATION
Suppliers with decarbonization goals have been
43
are successes in place in health systems across the
country who are using reprocessed devices and
recycling blue wrap recycling that demonstrate the
viability of this approach.
PRODUCT UTILIZATION
In addition to changes in product composition,
packaging, and end-of-life considerations, how and
how much a product is being used must also be
considered. Many health systems have instituted
surgical kit reformulation to identify items that
routinely go unused during procedures, and then
removing them from the preference card and
pick list to avoid the unnecessary purchase and
disposal of those supplies. Great Ormond Street
Hospital, a children’s hospital in the United Kingdom,
provides a success story of reducing unnecessary
plastic glove use that was initiated by their infection
prevention department. Through an educational
campaign including email communications, in-
person trainings, and posters, staff were trained
on when gloves were and were not necessary, and
when handwashing alone was sufcient. Metrics
were reported throughout the organization to show
progress and raise awareness during the campaign.
This culminated in a total reduction of 25 metric tons
of plastic gloves and a cost reduction of $134,000 US
dollars.
TRANSPORTATION AND LOGISTICS
Transportation and logistics have been a key
area of focus for many companies. Participants
shared efforts related to packing efciency,
route optimization, and minimization of less-
than-truckload and last-mile deliveries. Order
optimization, consolidating separate smaller orders
into larger deliveries to reduce delivery frequency, is
also being utilized. Looking to other sectors, many
retailers like Amazon and Walmart are prompting
consumers to consolidate orders for delivery.
Relatedly, participants discussed efforts to minimize
overnight and rush shipping since emissions
related to air travel are signicantly higher. Health
systems participants identied opportunities to
consolidate sending supplies to patient homes across
departments versus having multiple deliveries going
independently.
Successes were also shared related to electrication
of eets, charging station construction, and
incentives to employees to encourage car-sharing,
hybrid, and electric vehicles.
44
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Acknowledgements
AUTHORS & CONTRIBUTORS
Kaiser Permanente
Seema Wadhwa
Executive Director, Environmental Stewardship, Kaiser
Permanente
Ije-Enu Udeze Nwosu
Vice President, Performance & Impact, Kaiser Permanente
Priscilla Ng
Program Manager, Sustainability, Kaiser Permanente
Health Care Without Harm
Kathy Gerwig
Senior Advisor, Health Care Without Harm
Keith Edgerton
U.S. Associate Director of Climate Solutions, Health Care
Without Harm
Accenture
Jessica Wolff, MBA, MSN
Principal Director, Health Sustainability Lead
Strategy and Consulting, Accenture NA
Siqi Ngan
Senior Manager, NA Life Sciences Sustainability
Strategy and Consulting, Accenture NA
Research team – Tara Baumgarten, Soa Guerriero,
Bushra Islam, and Chris Magas
With support from
Margaret Chen
Managing Director, Health Enterprise Portfolio Lead,
Accenture NA
GL Zunker
Senior Management Director, Global Health Account Lead,
Accenture NA
SUPPLIER ADVISORS
BD
Sarah L. Hill
Director, Sustainability, BD
Johnson & Johnson MedTech
Cal St. Denis
Global Director, Sustainability Johnson & Johnson Medtech
Stryker
Erol Odabasi
Director, Corporate Sustainability, Stryker
50
ADDITIONAL ACKNOWLEDGEMENTS
Members of the Health System-MedTech
Roundtable Advisory Group:
• Advocate Health – Adrienne Ainsworth, Vice
President, Strategic Sourcing; Monica Nakielski,
Vice President, Sustainability
• AmerisourceBergen – Jackie Prazenica Bridge,
Sustainability Manager
• Cleveland Clinic – Jon Utech, Senior Director,
Ofce for a Healthy Environment; Andy Pettit,
Project Manager, Sustainable Procurement
• CommonSpirit Health – Kelly Paul, Director,
Training, Education & Communications;
Supplier Diversity & Sustainability Leader;
Mary Ellen Leciejewski, System Vice President
Environmental Sustainability
• Kaiser Permanente – Kelly Kelso, Environmental
Stewardship Project Manager Lead; Elizabeth A
Eldridge, Director of Sustainable Sourcing
• Brigham and Women’s Hospital – Gregg Furie,
Medical Director for Climate and Sustainability
• Mass General Brigham – Todd Turner, Senior
Director, Supply Chain Strategic Sourcing
• National Academy of Medicine – Jessica Marx,
Program Ofcer
• Premier, Inc. – Deborah Williams Sr. Director,
Supplier Diversity
• Providence – Elizabeth Schenk, Executive
Director of Environmental Stewardship;
Jennie Kim, Director, Contract and Supplier
Management; Oriana Turley, Environmental
Stewardship Data Analyst and Program
Coordinator, Providence
• Vizient – Cristina Indiveri, Associate Vice
President, Core Tenets; Molly Zmuda, Vice
President, Spend Management Services and
Delivery
Special thanks to all the subject matter experts who
participated in interviews to help us develop this
paper, including:
• Fiona Adshead, Chair, Sustainable Healthcare
Coalition
• Steven Chyung, Chief Supply Chain &
Procurement Ofcer, Kaiser Permanente
• Vibhas Deshpande, Vice President of
Sustainability and Strategic Research, Siemens
Healthineers
• Daniel Eriksson, Founder/CEO, Nordic Center
for Sustainable Healthcare
• Joe McCannon, Senior Advisor on Climate,
Health and Equity, Ofce of the Director,
Agency for Healthcare Research and Quality,
U.S. Department of Health and Human Services
• Sarah O’Brien, CEO, Sustainable Purchasing
Leadership Council
• Sonia Roschnik, Executive Director, Geneva
Sustainability Centre, International Hospital
Federation
• Christina Vernon Sanborn, Senior
Decarbonization Specialist, Mazzetti
51
About the Organizations
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of
America’s leading health care providers and not-for-prot health plans. Founded in 1945, Kaiser Permanente
has a mission to provide high-quality, affordable health care services and to improve the health of our
members and the communities we serve. We currently serve 12.7 million members in 8 states and the
District of Columbia. Care for members and patients is focused on their total health and guided by their
personal Permanente Medical Group physicians, specialists, and team of caregivers. Our expert and caring
medical teams are empowered and supported by industry-leading technology advances and tools for health
promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management.
Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of
community health. For more information, visit about.kp.org.
About Health Care Without Harm
Health Care Without Harm seeks to transform the health care sector worldwide so that it reduces its
environmental impact, becomes a community anchor for sustainability, and a leader in the global movement
for environmental health and justice. For more than 25 years, the organization has worked in partnership with
the health care sector to reduce its use of toxic chemicals and generation of waste, decarbonize its operations,
transform its supply chain and foster broader climate action. With regional teams in the United States, Europe,
Southeast Asia, and Latin America; and strategic partnerships with organizations in Australia, Brazil, China,
India, Nepal, and South Africa; Health Care Without Harm is a leader in mobilizing the health care sector to
realize this vision. For more information, visit noharm.org.
About Accenture
Accenture is a global professional services company with leading capabilities in digital, cloud, sustainability,
and security. Combining unmatched experience and specialized skills across more than 40 industries, we
offer Strategy and Consulting, Technology and Operations services and Accenture Song — all powered
by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 738,000
people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120
countries. We embrace the power of change to create 3600 value and shared success for our clients, people,
shareholders, partners and communities. For more information, visit accenture.com.
May 2023
