Making Strides in Sustainability: Health Leaders Share Lessons on Pathways to Climate Action, an interview with David Entwistle, Stanford Health Care President and CEO

Climate change is increasingly affecting the health and well-being of people across the United States, leading to worsening health outcomes that disproportionately impact communities that have been historically marginalized. Hospitals and health systems are committed to supporting the health and well-being of the communities they serve, and there is growing recognition across the health sector about the need to address its environmental impact and reduce carbon emissions. Through facility operations, purchased energy supply chain of goods and services, and investments, the health sector produces 8.5% of U.S. carbon emissions. Health care organizations are increasingly prioritizing sustainability initiatives that reduce this environmental impact and create a more sustainable and resilient health sector, while also having significant health, social, and economic benefits.

David Entwistle. Photo courtesy Stanford Health Care

The National Academy of Medicine spoke with hospital and health system leaders about the sustainability initiatives their organizations are championing and how others in the field can take action, including concrete actions that come with up-front and long-term benefits. In this interview, David Entwistle, president and CEO of Stanford Health Care, discusses collaborative efforts to achieve sustainability in the health sector and the critical importance of building organization-wide engagement to create successful sustainability initiatives.

Why is decarbonizing the health sector an issue that is important to you and your organization?

As one of the world’s foremost academic medical centers, at Stanford Medicine, we’re proud to deliver world-class patient care, generate ground-breaking research, and educate health care leaders of tomorrow. Broadly, our mission is to improve human health, both in our surrounding communities and around the globe. In recent decades, it’s become clear that succeeding in this mission depends on sustainability — that is, supporting the health of our planet, which has a significant bearing on our personal health.

Today, climate change is the greatest public health threat we face. In California alone, we’ve already seen significant flooding in 2023, while droughts, wildfires, and other natural disasters have become a recurring backdrop of life. However, the severity and frequency of these events are anything but normal. These extreme weather events harm our health, contributing to everything from respiratory disease to temperature-related deaths—with people in disadvantaged and underserved communities disproportionately bearing the brunt of these impacts.

We know that global warming from carbon dioxide in the atmosphere is a major driver of climate change, and we know that the health care industry is responsible for an outsized share of the world’s carbon emissions. It’s clear that climate change—and the associated harms to our health—will only worsen if the health care sector takes a “business as usual” stance. We believe it’s critical to act now, first by committing to lessening our environmental impact.

What are your organization’s specific goals around addressing the sector’s environmental impact and strengthening its sustainability and resilience?

Stanford Health Care has joined more than 100 health systems representing over 800 hospitals in signing a pledge from the Biden administration to decarbonize the health care sector. Through this pledge, we are committed to reducing climate-warming emissions by 50% by 2030 and achieving net-zero emissions by 2050. We have also committed to developing a climate resiliency plan which anticipates the needs of people in our surrounding communities that are disproportionally at risk from climate change. To guide our efforts at Stanford Health Care, we’ve established a Sustainability Program Office, overseen by our Chief Sustainability Officer.

Recognizing the urgent need for immediate action, Stanford Health Care has established five target areas of progress by 2025.

Carbon Neutral Transportation. We’re working to increase staff use of alternative transportation and convert our fleet to electric vehicles, while encouraging telehealth visits when medically appropriate.
Zero Waste Compliance. We’re seeking to reduce the waste we generate by evaluating what we dispose of and finding alternative solutions, such as increasing the number of reusable or re-processable items and educating our staff on accurate waste stream sorting.
Sustainable Purchasing Program. We’re in the process of evaluating the environmental impact of our purchasing decisions, known widely as Scope 3 emissions, and setting expectations for our suppliers to evaluate their environmental impact. We are in the process of adopting a sustainable purchasing policy to formalize our expectations of suppliers.
Sustainable Design. We want to continue improving the environmental impact and energy efficiency of our buildings. Reflecting this commitment, our new Stanford Hospital, which opened in November 2019, achieved LEED gold certification for sustainability from the U.S. Green Building Council, the most common green building standard in the world.
Energy, Emissions, and Water. We plan to decrease our reliance on natural gas, increase energy and water efficiency, and to leverage our greenhouse gas inventory to determine priorities for action in reducing emissions related to Nitrous Oxide.

What successes have you had within your organization related to decarbonization, and what do you attribute those successes to? How have these accomplishments helped your organization in unexpected ways?

Addressing decarbonization requires a clear vision and defined goals. We have sustainability targets, for example, in our annual operations plan for all departments. However, progress also requires a strong culture of sustainability, which begins at the leadership level. At Stanford Health Care, our Board of Directors has publicly committed to our sustainability efforts and incorporated sustainability as a core organizational value, fostering a sense of accountability across our community.

Our Sustainability Program Office has been instrumental in guiding our decarbonization journey by assessing our health system’s current state and setting targets for improvement. As one example, they have expanded the scope of our annual greenhouse emissions inventories, which first began in 2008, and identified focus areas for improvement with specific goals for energy, transportation, and waste. Cross-functional workgroups have been formed to work towards these goals.

In 2022, we expanded the greenhouse gas inventory process to encompass our supply chain, which can account for 80% of a health care organization’s footprint. Consequently, Stanford Health Care has joined various industry-wide supply chain groups to develop new tools for decarbonizing the health care supply chain. We have also partnered with our group purchasing organization to ensure suppliers meet environmental, diversity, inclusion, and health equity goals through contractual agreements and product audits.

To reinforce a culture of sustainability, we have introduced several initiatives aimed at engaging employees throughout the organization. These initiatives include a seed grant program that offers financial support for clinicians and staff to undertake sustainability projects, as well as a Sustainability In Nursing fellowship, which provides a paid opportunity for front-line nurses to achieve professional development goals in sustainability. We are also expanding the creation of Green Teams, which inspire our Stanford Health Care community to closely analyze their specific domains for sustainability and devise innovative, grassroots solutions. For instance, our Anesthesia Green Team reduced the department’s greenhouse gas emissions by 1,200 tons by decreasing the use of desflurane, an anesthetic gas with a high global warming impact. Another example is our Technology & Digital Solutions Green Team, which has catalyzed our enterprise-wide IT operations to adopt eco-friendly IT equipment and purchasing practices.

What barriers did you face when you began your decarbonization journey? How did you overcome these?

While sustainability has matured in many industries, it is a relatively young discipline within health care. Doing things for the first time is always hard. Whether it’s buying more recyclable products, substituting medical devices for more eco-friendly options, or changing the way employees commute or use energy, changing the status quo is often met with resistance. Leading change in an organization, let alone an industry, takes continuous education, communication, and engagement.

Initiating the process, conducting measurements, setting targets, and gaining agreement on programs were all challenging—but critical—parts of the process. And at each step, a constant lesson was reinforced: promoting sustainability is a team sport, involving many departments and divisions, as well as external partners. For instance, to reduce supply chain emissions, an organization must modify internal procurement processes, collaborate with suppliers to receive accurate data for decision making and align with other health care systems. Every change is complex, and no single organization can succeed alone.

In addition, success hinges on establishing standards internally, as well as with partners, other entities, and health systems. By embracing a team-sport mindset in doing this work, Stanford Health Care has significantly increased participation in sustainability within our organization and from the industry, including the group purchasing organization mentioned earlier.

How can leaders within the health sector contribute to and lead sustainability efforts?

It’s worth restating that none of us can do this alone. Achieving sustainability within the health sector requires a sustained, collaborative effort spanning health systems, suppliers, vendors, and numerous stakeholder groups. By working together to share strategies and best practices, we can save precious time and resources and avoid unnecessary duplication of efforts. Organizations, such as Practice Greenhealth and the Institute for Healthcare Improvement, provide helpful tools to get started on this journey.

It goes without saying that we all have competing priorities and challenges in our work to improve patient health; but the urgency of supporting our planet’s health cannot be overstated. We must place an intentional focus on sustainability, and we must lead by example. Internally, leaders can do this by encouraging their organizations to adopt new approaches, investing in dedicated staff to address sustainability challenges, establishing achievable targets, and creating mechanisms for accountability.

Although the journey may be challenging, there has never been a more critical time to act, as our patients’ health depends on it. As care providers, we are united by this shared mission, and with determination and collaboration, we can make a difference.

David Entwistle is a co-author of a June 2023 article in Modern Health Care, “Embracing sustainability makes good business sense,” and portions of this interview informed the article.

More Resources from the National Academy of Medicine

Carbon Accounting 101. Learn more about the basics of carbon accounting through a recorded webinar series with related resources and real-world examples.

Key Actions to Reduce Greenhouse Gas Emissions. Read a shortlist of key actions for hospitals and health systems to reduce their greenhouse gas emissions.

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