Making Strides in Sustainability: Health Leaders Share Lessons on Pathways to Climate Action, an interview with Dr. Cam Patterson, Chancellor of the University of Arkansas for Medical Sciences and CEO of UAMS Health

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 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 own 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.

Cam Patterson. Photo courtesy University of Arkansas for Medical Sciences (UAMS) and UAMS Health

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, Dr. Cam Patterson, Chancellor of the University of Arkansas for Medical Sciences (UAMS) and CEO of UAMS Health, discusses opportunities for health care organizations to prioritize sustainability in their facilities and operations, helping to mitigate pollution and producing cost savings in the long run.

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

Based on the most recent Commercial Buildings Energy Consumption Survey (CBECS), inpatient hospitals are the second most energy intensive building type in the United States. We also know that hospitals, and in particular operating rooms, are significant contributors to the waste stream. While UAMS is already significantly below the CBECS average for our building type, as an academic medical center, we believe UAMS plays a critical role in ensuring that the next generation of doctors, nurses, therapists, pharmacists, researchers, administrators, public health officials, etc. are educated on the larger impact the health care sector has on patients, their communities, and our global home. Understanding the full life-cycle impact of single-use devices, the impact of air pollution from burning fossil fuels, the potential for medicinal plants, and the potential financial risks of carbon emissions from waste anesthetic gases are just a few of the questions students going through UAMS’ educational programs will be asked to answer in the coming years. It is critical that UAMS and all other academic medical centers be leaders not only in educating our students but also in implementation of best practices.

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

UAMS signed the U.S. Department of Health and Human Services Health Sector Climate Pledge and joined the National Academy of Medicine Climate Collaborative as a Network Organization, and has already achieved a 39% reduction in Scope 1 and 2 emissions through implementation of energy efficiency measures across our 5 million square-foot Little Rock campus. We are on track to reach 50% reduction prior to 2030. The good news is that these reductions have been achieved without changes in occupant behavior or the capital costs of renovation/replacement of a large portion of our campus buildings. For this reason, significant opportunities remain, ranging from major equipment/system replacement and occupancy behaviors like turning the light off when you leave your office. We have utilized heat pump chiller technology in our central energy plants since 2008 and continue assessing ways to reduce onsite natural gas combustion, renewable energy sources, and paths for procurement of emission credits as well as possible monetization of our emission reductions. We are early in the process of completing our Scope 3 emissions survey, and it will be based on our Fiscal Year 2024 data. In accordance with the pledges, this will be completed by end of calendar year 2024.

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?

UAMS became the site of the first large scale (1000 tons of cooling) heat pump heater chiller in the United States in 2008, and we quickly added a second 1800-ton unit because of the tremendous reduction in natural gas consumption and cost. The success of these efforts provided the proof of concept of large-scale energy-based projects and eventually resulted in support for a $150 million performance contract that expanded energy efficiency efforts through an LED retrofit, a building controls upgrade and retro-commission, and replacement of aging and inefficient infrastructure. One critical component of the program is our measurement and verification process. Without a rigorous commitment to proactive performance monitoring, fault detection , and resolution of issues—an out of calibration sensor, a failed valve, etc.—our systems will not maintain performance, and costs that can and should be avoided will be incurred (approximately 4% year over year, based on the October 2020 Berkley Lab report “Proving the Business Case for Building Analytics.”)

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

The first step is for leaders at all levels of health care organizations to begin asking questions. Do we know how much energy we consume or waste we produce or plastic bottles we recycled last year? What are the year-over-year trends? Where are we along the expected life of our MRI or CT, as well as the expected life of our HVAC systems? If we are improving, why, is it an intentional process, and how can we do more of it? Everyone in the United States is concerned about rising costs in health care. Being a responsible health care provider must include an assessment of how we operate our facilities. This assessment must extend beyond the number of patients a nurse can cover to include the impact of utility, operating, and capital renewal costs. In many cases, health care as an organization is focused on acute problems, much like a firefighter. Just as health care providers know that exercise and a healthy diet prevent many acute problems, leaders need to extend the same approach to the physical environments and operating practices where we provide health care.

How do you inspire other health care organizations to become motivated if they aren’t involved in addressing decarbonization already?

One of the best ways is to highlight case studies where the investments in decarbonization actions have a positive return on investment and are significant contributors to the organization’s bottom line—and the net impact on the cost of delivering health care. The UAMS energy savings performance contract will return $5.6 million of annual energy cost savings plus $3.2 million in annual operational cost savings. The Inflation Reduction Act contains some great incentives for decarbonization efforts, especially for not-for-profit entities that are not eligible for direct payments.

Why should other health care organizations join this movement to mitigate fossil fuel pollution and the effects of climate change?

The big-picture goal of health care is to improve the health of the people in our communities. We can do that by treating only their acute issues, or we can implement practices which attack the underlying causes, the systemic causes, and risk factors that result in acute issues. By reducing the amount of natural gas burned on campus and waste gases emitted, we can positively impact the air quality in neighborhoods adjacent to our campuses. By reducing medical waste and improving the reuse/recycling of medical products, we can reduce run-off and potential hazards from waste dumps and the need for extraction of additional raw materials. We live in a circular world, and just as medical professionals create, then implement, then check, and adjust a treatment plan, we must begin applying that process in the broader context of decarbonization.

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.

Share the Health Leaders Interview Series

Tweet this! The health sector is making strides in sustainability. Hear from health leaders in new @theNAMedicine Climate Collaborative interview series covering lessons on pathways to climate action: nam.edu/ClimateCollaborative #ClimateActionforHealth