National Support Program on “Climate Friendly Healthcare Facilities”

Technical Case Study

by Gesundheit Österreich GmbH | Competence Center Climate and Health

1. Why take action?

The healthcare system is responsible for 6.7 percent of Austria’s overall carbon footprint. As a climate-relevant sector, the healthcare sector therefore represents an area in urgent need of action. Research and experience show that those responsible for healthcare facilities are interested in and willing to implement measures to mitigate climate change and reduce GHG emissions. However, there is often a lack of information, practical assistance and support to introduce such measures.

This is why the Competence Center Climate and Health at the Austrian National Public Health Institute (Gesundheit Österreich GmbH, GÖG) developed the initiative “Climate Friendly Healthcare Facilities”, aiming at overcoming the obstacles described above and providing the best support possible for Austria’s healthcare facilities to reduce their GHG emissions. Due to the decentralized nature of Austria’s healthcare system, many independent stakeholders need to decarbonize their operations to significantly reduce the GHG emissions produced in the system. The initiative presented here pools efforts to access high quality information on how to successfully implement decarbonization strategies in healthcare facilities. This approach strengthens the facilities’ resilience and emergency preparedness; it also addresses health promoting aspects of climate action, for example in the fields of mobility, food systems and green spaces.

The core project “Consultation for Climate Friendly Healthcare Facilities” was developed as a comprehensive and practical service. It provides the foundations for a holistic integration of measures mitigating climate change in the participating healthcare facilities and covering all relevant fields of action. The aim of the project is to support individual healthcare facilities in the process of becoming climate friendly by providing them with the necessary expertise, relevant information and concrete support following a one stop shop principle. During this process, the individual facilities are accompanied by an expert in the field of environmental consulting.

The key goals of the consultation are to:

• identify measures already implemented and the potential for improvement
• obtain an overview of the healthcare facility’s GHG emissions
• create a climate action plan with specific targets and measures to reduce GHG emissions which also includes aspects of health promotion
• provide support in identifying funding opportunities as well as in contacting advisory and funding organizations

All of the results are made available in an individual report to the healthcare facility concerned as well as in a publicly available report containing anonymized and aggregated results.

The following healthcare facilities are the target groups of the project:

• hospitals and rehabilitation centres
• nursing homes
• outpatient clinics
• primary care units
• doctors’ practices
• pharmacies

The pilot project was launched in summer 2022. Due to the high response rate from the healthcare facilities addressed, the project was extended and relaunched at the beginning of 2023. As of October 2023, more than 300 Austrian healthcare facilities are taking part in the project. Of these facilities, 75 are hospitals, which means that 30% of Austrian hospitals are actively involved in the project.

In addition, the Competence Center Climate and Health is also running the training programme “Climate Managers in Healthcare Facilities” on the topics of climate change mitigation and adaptation measures as well as health promotion. The course provides basic knowledge that enables climate managers to take a leading role in supporting healthcare facilities on their way to becoming more climate friendly by saving resources and energy as well as reducing GHG emissions in connection with buildings, energy, sustainable procurement, mobility, resource and waste management, green spaces and food systems.

 

KEY MESSAGES

The benefits of the initiative are:

• reducing the healthcare facilities’ GHG emissions
• reducing costs through increased energy and resource efficiency
• promoting healthcare facilities as role models and multipliers on the path to a net zero health system
• creating a climate friendly, health promoting environment for patients and employees
• increasing the facilities’ resilience, emergency preparedness and supply chain security
• providing a sound basis for the holistic integration of climate action in the healthcare facilities concerned

The initiative can be transferred to other countries too in order to achieve significant reductions in GHG emissions within the healthcare sector on an international scale.

 

2. How to get started?

Austria’s government has committed to reaching net zero by 2040. Given the CO₂ contribution of the healthcare sector, which is 6.7 percent of the national carbon footprint, in 2021 the Competence Center Climate and Health was set up by the GÖG.

This section highlights the key areas that have been implemented by the Competence Center Climate and Health in the initiative “Climate Friendly Healthcare Facilities” and shows the key learnings which are relevant for other health services wishing to implement similar initiatives.

 

2.1. Supporting healthcare facilities in becoming climate friendly

The main approach of the project “Consultation for Climate Friendly Healthcare Facilities” is that each healthcare facility receives customized advice for all fields of action following a one stop shop principle, which minimizes the effort required by the facilities. Participation in the project does not incur any costs for the healthcare facility.

 

2.1.1. Key learning: Quality control and a standardized approach

The project “Consultation for Climate Friendly Healthcare Facilities” is the first of its kind in Austria as well as internationally. For the first time ever, healthcare facilities in Austria are being provided with the expertise and support needed to identify their potential to undertake climate action in a standardized design.

To guarantee quality, the experts providing the consultations for the healthcare facilities were selected very carefully. To identify experts suited to the task, a call for tenders was launched in the preparatory phase to identify qualified organizations with appropriate expertise that can provide the comprehensive range of consultation services required and that also have experience with the specific needs of healthcare facilities.

In addition, the quality control element of the project entails a precise definition of the services provided by the expert. This is ensured by defining quality standards that need to be taken into account, e.g. with regard to nutrition in residential and care facilities. Standardized templates are used to collect GHG data, prepare the climate action plan and write the reports. Criteria are provided for the climate-relevant fields of action, including examples of measures with a health-promoting effect, such as promoting active forms of mobility (walking and cycling), reducing air pollution, increasing well-being and providing healthy and climate friendly nutrition, etc.

To ensure projects can be implemented successfully, all participating healthcare facilities have signed a binding agreement to cooperate actively as part of their declaration of participation. The task of individual healthcare facilities is to provide the consultants with the best possible support in developing the climate action plan and in its evaluation, specifically by:

• giving the consultants the information and documents required to carry out the project
• making project-related technical, environmental, climate and GHG data available which are required for implementing the project as well as, if necessary, cost data
• filling out the questionnaires sent by GÖG

Regular meetings with external experts in the fields of climate protection and sustainability or with government stakeholders (such as from the Ministry of Social Affairs, Health, Care and Consumer Protection (BMSGPK), the Ministry of Climate Action, Environment, Energy, Mobility, Innovation and Technology (BMK) or “klimaaktiv”, the Austrian climate protection initiative organized by the BMK) are held to exchange knowledge and provide room for debate. Information about the project is spread via the relevant stakeholders and interest groups such as public insurance providers, the Austrian Medical Chamber or the Chamber of Pharmacists.

 

2.1.2. Key learning: Determining the starting point and defining the direction

The design of the project “Consultation for Climate Friendly Healthcare Facilities” was set up to ensure the sustainability and impact of its results. The consultation process itself lasts about one year in all, which guarantees that the participating facility is not left alone at the beginning of implementation phase and is given advice about evaluating the chosen measures. Embedded in the climate action plans of the healthcare facilities, setting clear measures and goals will help them to ensure that all goals are sustainable and are actually maintained in the future. To ensure the sustainability and longevity of the project, but depending on budgetary capacity, it is planned to evaluate the data of the participating facilities on an annual basis.

In the course of the year the consultation is organized in three phases:

• In the first phase, following discussions, on-site inspections and data analyses, the consultant works with the healthcare facility to develop an individual climate action plan covering all relevant fields of action and defining specific targets and measures to achieve them, including health-promoting aspects. Information is also provided on special funding opportunities in the area of climate protection
• Immediately after the initial consultation, the second phase begins, in which short-term measures defined in the climate action plan are implemented by the healthcare facility. During this phase, which lasts about a year, the healthcare facilities are contacted and supported by their consultants at regular intervals
• In the third phase, the implementation of the climate action plan as well as conducive and hindering framework conditions are evaluated by the consultant and an updated climate action plan is developed. The results of the evaluation form the basis for further developments and recommendations

In this way the healthcare facilities are able to quantify their GHG emissions and develop a comprehensive strategy on how to reduce them.

The project design does not only benefit the healthcare facilities themselves. The approach also gives the Competence Center Climate and Health the opportunity to collect knowledge and data on GHG emissions as well as on the climate action plans of individual healthcare facilities. This knowledge will be used to generate benchmarks, learn about the general conditions that hinder and promote progress in climate action and identify best-practice examples and particularly effective measures.

2.1.3. Key learning: A holistic approach towards climate action

The project “Consultation for Climate Friendly Healthcare Facilities” is unique in its holistic approach, which is integrated by addressing all relevant fields of action:

• buildings
• energy
• mobility and transport
• resource and waste management
• sustainable procurement
• food systems
• green spaces
• awareness raising and communication
• overall integration in the organization

Including all relevant fields of action in the initiative reflects the healthcare facilities’ overall impact on reducing emissions.

Healthcare facilities are supported in becoming climate friendly by receiving the necessary information, assistance and support for all areas of climate change mitigation following a one stop shop principle.

 

2.2. Key learning: Working with staff

The training programme “Climate Managers in Healthcare Facilities” is essential to raise awareness and educate key personnel from healthcare facilities already taking part in the project “Consultation for Climate Friendly Healthcare Facilities”.

The training programme is one of the first climate-related courses in a German-speaking country to examine climate change mitigation in the healthcare sector from various angles. It is necessary to maintain the competencies and know-how required in facilities to ensure that all mitigation measures and climate-related goals are sustained. At the same time, comprehensive climate management must be integrated in the day-to-day running of all healthcare facilities. Hence, the various groups of professionals in the healthcare sector were identified as key players in implementing the necessary measures to support the reduction of emissions within the healthcare sector. The training tailored specifically for professionals in the healthcare sector is key to broadening competencies in climate protection. The target group in 2023 was employees at healthcare facilities (hospitals, nursing homes homes and other healthcare facilities) participating in the Competence Centre’s project “Consultation for Climate Friendly Healthcare Facilities”. Training these professionals constitutes an important measure to ensure the sustainability of the initiative.

In 2023, 40 people are participating in the course. It lasts from September 2023 to December 2023 and consists of 10 modules on different topics (e.g. buildings, energy, sustainable procurement, mobility, resource and waste management, green spaces and food systems).

2.3. Key learning: Promoting good examples in the healthcare sector

To promote good examples of climate action in the healthcare sector, facilities implementing best practice measures were presented an award and publicly showcased. There are already many hospitals, medical practices and other healthcare facilities that have implemented initial innovative projects in the area of climate change mitigation. It is important to identify and make these pioneer projects visible.

The award aims to bring best-practice projects relating to climate change mitigation in the healthcare sector to the forefront. By identifying innovative pioneer projects, a knowledge base was created on the topic of climate change mitigation in the healthcare sector and knowledge transfer was stimulated between healthcare facilities. The award is intended to serve as an incentive for other healthcare facilities to implement measures to mitigate climate change. In the long term, the project will contribute to reducing GHG emissions in the healthcare sector and increasing resource and energy efficiency, including cost reductions, as well as to promoting health and increasing the resilience and security of supply chains in the healthcare system.

All Austrian healthcare facilities (hospitals, nursing homes, primary care units, pharmacies and doctors’ practices) were eligible to submit projects in the following climate-relevant categories:

• buildings / energy
• green spaces
• mobility
• communication and awareness raising
• nutrition / food systems
• resource and waste management / sustainable procurement

 

A commission of experts from the fields of climate and health was set up to evaluate the submissions and select three projects in each award category. Depending on the field of action addressed in the project, different specific evaluation criteria were used.

The overarching evaluation criteria for the projects were:

• a reduction in GHG emissions (in the form of quantitatively measurable results)
• the innovative character of the project and long-term impact of the measure(s) implemented
• their contribution to health promotion
• the reproducibility of the measure(s) and willingness to share knowledge with other institutions

The prizes were awarded at a ceremony attended by the Federal Minister for Social Affairs, Health, Care and Consumer Protection. The award-winning institutions and projects were subsequently presented to the public and will serve as a model for other healthcare institutions.

3. Tracking progress

Austria’s healthcare facilities have shown significant interest in the initiative “Climate Friendly Healthcare Facilities”: As of October 2023, more than 300 Austrian healthcare facilities are taking part in the consulting project. Of these facilities, 75 are hospitals, which means that 30% of Austrian hospitals are actively involved in the project. In addition, 58 nursing homes, 83 doctors’ practices, 80 pharmacies, 12 primary care centres and 10 outpatient facilities are taking part. In 2023, 40 representatives of hospitals and nursing homes are participating in the comprehensive training programme “Climate Managers in Healthcare Facilities”. Sixty-two projects were submitted for the “Best Practice Award Climate Friendly Healthcare Facilities”.

One already visible success of the project is the start of substantial national funding, which will be a driver for energy efficiency measures in larger healthcare facilities throughout Austria. Building on the first results of the project “Consultation for Climate Friendly Healthcare Facilities”, the Austrian Ministry of Climate Action, Environment, Energy, Mobility, Innovation and Technology launched two new funding schemes in 2023 together with the Austrian Ministry of Social Affairs, Health, Care and Consumer Protection and the Competence Center Climate and Health at the Austrian National Public Health Institute. The target groups are hospitals and rehabilitation clinics as well as nursing homes. Between 2023 and 2030 up to 350 million euros have been allocated to funding these schemes by the Ministry of Climate Action, Environment, Energy, Mobility, Innovation and Technology.

As the project only started in September 2022, the first evaluation results are not to be expected until 2024. To measure the impact of the climate action as defined in the climate action plans, the GHG emissions of the participating facilities are monitored at the beginning of the project and one year after implementing the climate action plans. Relevant data on energy consumption (in kWh, incl. costs and relative key figures) as well as other relevant emission data (e.g. refrigerants, anaesthetic gases and waste) are collected. During the evaluation of the climate action plans in phase 3, the analyses of whether targets were achieved and measure implemented will be provided for the individual healthcare facilities but also in an anonymized and aggregated way for all participating facilities.

To ensure the sustainability and longevity of the project, but depending on budgetary capacity, it is planned to evaluate the data of the participating facilities on an annual basis. This will also be the basis for benchmarks specific to the healthcare sector in the long term.

 

4. In practice

Since the beginning of the initiative and with each launch of a new call, information about the initiative is spread as broadly as possible via the relevant stakeholders and interest groups such as public insurance providers, the Austrian Medical Chamber or the Chamber of Pharmacists. Healthcare facilities are also contacted directly. Immediately after the initial consultation, the measures defined in the climate action plan are implemented by the individual healthcare facilities. During this phase, which lasts around a year, the healthcare facilities are contacted by their consultants at regular intervals and supported as required. The healthcare facilities participating in the initiative are valuable and essential multipliers.

Through the training programme “Climate Managers in Healthcare Facilities” (mentioned in section 1.2), employees from healthcare facilities are targeted directly to help them implement needed measures into their routines and daily work life. By training the participants on different kind of topics related to climate change, climate change mitigation and adaptation as well as health promotion, a comprehensive climate management can be integrated into everyday healthcare facility life. The participants are gaining knowledge that enables them to take a leading role in supporting healthcare facilities on the way to climate neutrality, saving resources and energy, reducing GHG emissions in the areas of buildings, energy, sustainable procurement, mobility, resource and waste management, green spaces and food systems.

 

5. Key resources

• Project “Consultation for Climate Friendly Healthcare Facilities”: https://agenda-gesundheitsfoerderung.at/kokug/beratung_klimafreundliche_ge
• Training programme “Climate Managers in Healthcare Facilities”: https://agenda-gesundheitsfoerderung.at/kokug/klimamanagerinnen
• Best Practice Award: https://agenda-gesundheitsfoerderung.at/kokug/award_klimafreundliche_ge

More information
For more information, please contact: Ruperta Lichtenecker
(klimaneutrales.gesundheitswesen@goeg.at, ruperta.lichtenecker@goeg.at)

 

6. References

• Mezger, N.C.S., Thöne, M., Wellstein, I., Schneider, F., Litke, N., Führer, A.G., Clar, C., Kantelhardt, E.J. (2021), Klimaschutz in der Praxis – Status quo, Bereitschaft und Herausforderungen in der ambulanten Versorgung, Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, Vol. 166, pp. 44-54 
• Steininger, Karl W.; Bednar-Friedl, Birgit; Knittel, Nina; Kirchengast, Gottfried; Nabernegg, Stefan; Williges, Keith; Mestel, Roland; Hutter, Hans-Peter; Kenner, Lukas (2020): Klimapolitik in Österreich: Innovationschance Coronakrise und die Kosten des Nicht-Handelns. Wegener Center Research Briefs. Klima- und Energiefonds, Wien
• Steininger, Karl W.; Bednar-Friedl, Birgit; Knittel, Nina; Kirchengast, Gottfried; Nabernegg, Stefan; Williges, Keith; Mestel, Roland; Hutter, Hans-Peter; Kenner, Lukas (2020): Klimapolitik in Österreich: Innovationschance Coronakrise und die Kosten des Nicht-Handelns. Wegener Center Research Briefs. Klima- und Energiefonds, Wien
• Weisz, Ulli; Pichler, Peter-Paul; Jaccard, Ingram S.; Haas, Willi; Matej, Sarah; Nowak, Peter; Bachner, Florian; Lepuschütz, Lena; Windsperger, Andreas; Windsperger, Bernhard; Weisz, Helga (2019): Der Carbon Fußabdruck des österreichischen Gesundheitssektors. Endbericht. Klima- und Energiefonds, Austrian Climate Research Programme, Wien