How partnerships are accelerating health care’s sustainability progress

This is the fourth in a six-part series examining sustainability and decarbonization practices in the health care industry. Previous articles in this series detail the value of integrating sustainability and ESG principles into health care operations, innovations in sustainability, and climate-resilient strategies.

Health care organizations strive for a better world by following an evolving framework of aims. In 2007, the Institute for Healthcare Improvement established the triple aim to enhance outcomes, improve patient experience and reduce costs. This expanded to the quadruple aim in 2014 by adding better care team and physician experiences. In 2021, in response to the COVID-19 pandemic and the recognition of systemic racism, health equity became the fifth aim in the industry framework.

Addressing environmental sustainability and climate is critical for enhancing population and public health. In fact, the goals of environmental sustainability and climate action are inherently aligned with the quintuple aim. They also share a common path to success through intentional partnerships. In this article, we’ll explore three of the five aims that directly align with sustainability goals and how partnerships can realize the promise of sustainability.

Better patient outcomes 

Better patient outcomes refer to better health metrics after treatment from a clinical perspective. While diseases can have a genetic predisposition or accidental source, many are the result of chronic environmental or lifestyle factors. A healthier environment creates long-term benefits for patients, reducing comorbidities and overall disease levels. A healthier planet with less air, water, soil and light pollution is a preventive boon that can improve all outcomes, including more effective recoveries after acute disease treatments and less reliance on medications and hospital stays. A climate-related health example from a clinical perspective is the direct impact of improved air quality on respiratory health. 

Partnerships between health care organizations and policymakers, air resource boards and federal- and state-level participation in mitigation are key to improving patient outcomes through climate action. From a mandatory and regulatory standpoint, it is essential for every health care organization to perform the data gathering and preparation to comply with Securities and Exchange Commission (SEC) mandatory climate reporting rules, which establish a common framework for assessing and reporting carbon impact. California’s SB 253 and SB 261, which require carbon reporting and mandatory disclosure on climate risk and opportunities, serve as templates for future regulations in other states. Working with local governments can streamline compliance with state regulations such as SB 253 and SB 261, while partnering with universities can support research and development of sustainable health care practices. 

Meanwhile, in January the Joint Commission and the Centers for Medicare and Medicaid Services (CMS)  introduced voluntary climate reporting standards and certifications. The model is set to launch in 2026. These certifications provide health care organizations with a valuable template to follow, assess gaps, perform internal audits and develop strategic actions without reinventing the wheel. Each reporting standard and certification has direct and indirect provisions in combination with partnerships that address how to improve patient experience — specifically and holistically.

Health care as a business is not necessarily structured around the preventive ethos, but rather treating the illness and disease. However, there are incentives from the health insurance industry to focus on keeping the environment we live in as healthy as possible to minimize illness. The partnerships that shine here center on disease prevention, nutritional health education, community outreach and education. All of these examples highlight health insurers that are leading efforts at the intersection of climate and health. Blue Cross Blue Shield of Massachusetts pioneered this movement by appointing the first sustainability leader in the industry in 2011. Blue Shield of California and Cigna have also made significant strides. Cigna, in particular, as a for-profit entity, has responded to its financial stakeholders by adopting environmental, social and governance (ESG) frameworks. Insurers in the United States, which doesn’t have universal health care, have a particularly strong incentive to invest in preventive care since they foot the bill for many costly treatments.

Lower cost of care

Health care organizations benefit significantly from aligning with sustainability values, as this approach aims to reduce the total cost of care. Sustainability focuses on cost-effectiveness through improved resource management, both in the short and long term. 

Sustainability practices that lower overhead costs include energy efficiency measures, waste minimization/zero waste initiatives and renewable electricity sourcing. These practices can be executed via internal or external partnerships. Internal partnerships are those happening within health care organizations that involve collaboration between departments like operations, facilities, supply chain, waste management, environmental health and safety, and other internal stakeholders. External partnerships refer to those between health care organizations and entities such as universities and research institutions. These external partnerships can help explore new technologies, sustainable materials and best practices in energy efficiency and waste reduction, providing health care facilities with the latest advancements and strategies. 

Health care sustainability networks such as the American Society for Health Care Engineering (ASHE) share knowledge, access resources and participate in collective initiatives aimed at reducing energy consumption and waste. Lastly, engaging with local governments and community organizations can facilitate access to incentives, grants and support programs for energy efficiency and waste management projects. These partnerships can also help align health care sustainability efforts with broader community goals and regulations.  

Renewable energy partnerships between health care systems and third-party providers are increasingly common for large-scale services. These collaborations help health care organizations source healthier, safer electricity. Community solar programs have proven to be cost-effective for certain health care institutions, while also reducing renewable energy expenses for local residents. One innovative approach is Boston Medical Center’s Clean Power Prescription program, a pilot program that allows BMC providers to use renewable energy and reduce the utility bills of certain patients.

Partnerships play a significant role in simultaneously addressing the cost and sustainability challenges within the health care industry. By pooling resources, expertise and innovative ideas, these collaborations enable stakeholders to implement cost-effective solutions that enhance operational efficiency and reduce environmental impact. 

Health equity 

The newest addition to the quintuple aim is health equity, attained when everyone can achieve their full potential for health and well-being. Environmental sustainability and health equity align thematically and programmatically because health inequity and environmental pollution are two manifestations of the same imbalance in the world today. Addressing environmental stewardship contributes to health equity since marginalized communities often bear the brunt of environmental health issues. Both areas seek to minimize disparities and promote well-being for current and future generations.

Health equity requires every organization to understand the sources of structural inequity and pair up remedies one at a time for solutions that are deep and effective. That approach requires more than alignment statements of diversity, equity and inclusion (DEI). A pragmatic approach maximizes access for segments of the population that require flexible, local treatment options. For hospitals, this means ensuring equitable care to all patients. For medical device companies, this means ensuring all patients have access to the same technology. For training facilities, this means educating medical students of all backgrounds and addressing disparities in medicine due to curricula gaps and implicit bias in medical education and practice.

Deep partnerships with internal and external organizations will help drive the success of these health equity initiatives. Internally, health care-focused organizations need to partner with DEI teams, human resources, supply chain (for global human rights standards) and ESG functions. Externally, having ties with international research organizations, universities, other health care systems and particularly the United Nations subsidiaries are essential to ensure that any health equity work — small or large — is rooted in authenticity and trend data. 

Promoting health equity also means ensuring equal access to services such as breast cancer screenings, regardless of socioeconomic status, race or ethnicity. Social justice advocates call for equal opportunities for early detection and treatment, while environmental justice and sustainability proponents highlight risk factors and advocate for policies that minimize exposure to carcinogens. For example, women of color are disproportionately exposed to endocrine-disrupting chemicals. Therefore, successful breast cancer screening initiatives require leadership from justice, equity, diversity and inclusion (JEDI) functions as well as environmental stewardship. They also require working with other stakeholders, including those in community health, population health, government affairs and non-governmental organizations (NGOs).

Partnership of purpose 

Often partnerships are an afterthought of an organization’s sustainability and climate action design and strategy. The quintuple aim ethos, which is embedded in all health care organizations’ mission statement, makes partnerships a deliberate part of the sustainability value design with metrics, outcomes and deliverables. Doing so means the organization can thrive long term in a health care system that is constantly evolving to better itself.

The views expressed in this article are those of the authors and not those of their current or former employers.