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Technical Case Study

from the Norwegian Directorate of Health

Key takeaways:

  • Measuring environmental performance in the health sector is important to raise awareness of current challenges and to achieve improvements in our sector
  • We developed an online, interactive dashboard enabling users to track CO2 emissions and achievement of environmental goals in Norwegian specialist healthcare services. The dashboard shows data for individual hospitals and for regional and national levels. Data include scope 1 and scope 2 emissions (scope 3 from 2024), updated annually. The dashboard is based on Power BI
  • Regional health authorities in Norway use the dashboard to monitor progress in follow-up of nationally agreed targets in the hospital sector. A core goal is to reduce CO2e emissions for scope 1 and scope 2 by 40% by end of 2030

1. Why take action?

The specialist healthcare service manages significant resources and has a duty to society to manage these resources sustainably. The healthcare sector is responsible for significant greenhouse gas emissions and needs to take action to mitigate its impact on the environment. Measuring environmental performance in the health sector is important to raise awareness of current challenges and to achieve improvements.

In 2021, the executive boards of the four Regional Health Authorities defined common climate and environmental goals for Specialist Health Care Services in Norway. A core goal is to reduce CO2e emissions for scope 1 and scope 2 by 40% by end of 2030 (Figure 1).

 

KEY MESSAGES

  • Measuring environmental performance in the health sector is important to raise awareness of current challenges and to achieve improvements.
  • An interactive online dashboard allows to:
    • Assess the effects of interventions across the health system and track progress.
    • Comparing performance between facilities to enable targeted sharing of experiences and practices between high and low performing facilities.
    • Aid dissemination of results.
    • Raise awareness among staff.

 

2. Getting started: development of the online dashboard

KEY MESSAGES

  • The dashboard prototype was developed by trainee students, supervised in a collaborative effort, and taking advantage of already available datasets.
  • Key competence to develop the dashboard include competence in analysis, accounting, climate, and environment. The dashboard is made in Power BI.

To monitor progress towards the new national goals, there was a need for compiling results from all hospitals in the country and to present these data in an informative and accessible manner. This would then be used in the established governance structure in the Norwegian hospital sector.

 

2.1. Key learning: Using a collaborative approach

Development of a dashboard was proposed by the Norwegian Directorate of Health. A prototype was developed by three trainee students provided free-of-charge by Deloitte, supervised in the summer of 2022, in a collaborative effort including the Specialist Health care sector, Health Region South East. The dashboard was then further developed and launched by Health region South East in 2023. Key competence to develop the dashboard include competence in analysis, accounting, climate, and environment.

 

2.2. Key learning: Enabling comparison and exchange between facilities

The dashboard is an interactive tool which enables up-to-date comparisons of status in a given hospital over time, or between different hospitals. The aim of the dashboard is to enable decision makers and others to track status towards reaching set targets and to help assess effects of relevant interventions. Results are shown in relation to the national goals. Variation in progress towards these goals aids individual decision makers in identifying priority areas for action and promotes overall goal achievement.

 

2.3. Key learning: Building on existing datasets and tools

The dashboard is publicly available online and is thus accessible to hospital leaders, employees, and other stakeholders. It is updated annually with results by hospital and helps disseminate information about the goals. The dashboard currently has datasets showing emissions from scope 1 and 2. From early 2024, scope 3 will also be included.

The dashboard is made using the software Power BI, which allows connecting and visualising data and can be used to create reports and dashboards from large datasets.

 

3. Using the online dashboard in practice

3.1. Key learning: Communicating climate and environmental goals for leaders and employees

The dashboard is an important tool for the Regional Health Authority to request results from hospitals. Once a year, CEOs of hospitals present the status of common climate and environmental goals to the management team in the Regional Health Authority. The dashboard makes a large dataset accessible, giving management easy insight into hospital performance. Hospitals with lower progress can then be requested to take action.

 

Total emissions have been broadly stable during 2019-2022. Emissions were lower in 2020, chiefly due to reduced staff travel (related to the covid-19 pandemic) and lower heating costs (due to higher temperatures that year).

In 2022, emissions decreased if purchases of recycled energy are included. Further interventions are needed to reach the target of 40% reduction in emissions by 2030.

 

KEY MESSAGE

  • In Norway, the dashboard contributes to goal achievement and communication of progress towards climate and environmental goals.

 

3.2. Key learning: Comparing performance between facilities enables sharing of experiences and practices between high and low performing facilities

In Norway the Specialist Health Care Services have defined a goal linked to Sustainable Development Goal 6, Clean water and sanitation, as follows: "The share of products without substances that can harm humans or the natural environment should reach 75 percent."

Purchased volumes of desflurane, an anaesthetic gas which is a highly potent greenhouse gas, is one of the areas monitored to inform progress towards this goal (see Figure 3).

Overall, desflurane consumption in Norwegian hospitals dropped by more than 60% during 2019-2022. Consumption varies across hospital, e.g. Sørlandet Sykehus HF had a higher consumption of desflurane in 2022 than comparable hospitals (Oslo Universitetssykehus is Norway’s largest hospital and cannot be directly compared with Sørlandet Sykehus HF).

In 2022, the management team in the South-Eastern Norway Regional Health Authority asked the management of Sørlandet sykehus HF to exchange experiences with other hospitals that have achieved a better reduction of desflurane. This is now being followed up locally and Sørlandet Sykehus HF expects to use less desflurane in 2023.

In Norway the reduction in the use of desflurane has been driven by clinicians, helped by academia, authorities and decision-makers. Medical periodicals have published articles on sustainable practice. In 2021, the Norwegian Directorate of Health proposed a session on sustainable anaesthesiology to the Norwegian Anaesthesiologist Association annual meeting, where a national survey was presented.1 In 2023, Regional Medical Directors of the four hospital regions declared that greenhouse gas emissions from inhalation anesthetics should be minimised. Several hospitals have set goals to reduce desflurane use, e.g. Oslo University Hospital has reduced use by 60-70% (current goal: 80% reduction), and in October 2023 the Hospital in Vestfold stopped using desflurane altogether.

 

KEY MESSAGES

  • The example of desflurane shows how the dashboard contributes to
    • Monitoring facilities' performance and progress towards low carbon sustainability goals
    • Identifying facilities and actions to prioritise to enhance performance
    • Enabling peer support and exchanges to stimulate progress
  • The reduction in the use of desflurane in Norway has been driven primarily by clinicians, helped by academia, authorities and decision-makers.

 

4. Key resources

Dashboard English version: Microsoft Power BI (pages 1, 3, and 5)

More information 
For more information, please contact: 
Health Region South East: Ms Signe Hveem, signe.hveem@helse-sorost.no  
Norwegian Directorate of Health: Dr Erlend Aasheim, erlend.tuseth.aasheim@helsedir.no 

 

5. Reference

  1. Lindholm E, Hegde IJ, Saltnes C, Leonardsen AC, Aasheim ET. Climate change, sustainability and anesthesiology practice: A national survey among anesthesiologists and nurse anesthetists in Norway. Journal of Climate Change and Health 2023. https://www.sciencedirect.com/science/article/pii/S2667278223000597

About the Norwegian specialist health care service

 

Philosophy:

  • Equal and free access for all to high quality health care services

 

Financing:

  • Mostly publicly financed and tax based
  • Total public spending on healthcare around NOK 357 billion (Statistics Norway, 2021)

 

Responsible authority:

  • Split between state (4 regional health authorities) and municipalities (356)
    • Primary care: Municipalities
    • Secondary (specialist) care: State (health regions)

Health regions are 100% state owned trusts with full legal and financial responsibilities, their own board and their own CEO/management.

 

Regions have a twofold responsibility:

  • Ownership
  • Ensure people in their region have adequate supply of specialist care services

(either through their own hospitals, private hospitals or hospitals in other regions)

 

Regions have between 0,5 million and 3,1 million inhabitants, total population 5.4 million.

 

South-Eastern Norway Regional Health Authority (Helse Sør-Øst RHF) is one out of four regional health authorities. The four regional health authorities have responsibility for the specialist health care services in their respective regions. They have ownership responsibility for the health trusts in their respective regions. The health trusts are independent legal entities with governing bodies at regional and local levels.

 

South-Eastern Norway Regional Health Authority is responsible for the dashboard and coordinates development and data collection with the other three health regions.

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