Organization Description
Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a community anchor for sustainability and leader in the global movement for environmental health and justice. Working closely with Health Care Without Harm, Practice Greenhealth is the leading sustainable health care organization, delivering environmental solutions to more than 1,700 hospitals and health systems in the United States and Canada.
Project Description
Health Care Without Harm is seeking proposals from qualified researchers to leverage our extensive dataset to identify and standardize the most impactful quality improvement metrics for measuring direct and indirect emissions reduction in hospitals.
Overarching Goals
American health care organizations have the opportunity to improve operational efficiency and reduce their environmental impact through lowering their direct and indirect greenhouse gas emissions. For example, electrifying mobile fleets reduces ground-level air pollution as well as emissions that contribute to the climate crisis, which itself drives morbidity and mortality through increasingly frequent and severe storms, heat waves, wildfire events, and other hazards. In addition to fleet vehicle electrification, key decarbonization actions include electrifying health care facilities and switching to low-emissions anaesthetic gases.
Quality improvement frameworks have systematically improved care across a number of key outcomes, including reducing patient safety incidents and maternal morbidity and mortality. Applying a quality improvement lens to health sector emissions reduction leverages proven models to address the most important health threat of the 21st century. However, the health sector does not currently use standard and comparable methods to measure emissions reduction. Another challenge is a lack of peer-reviewed literature validating the key steps toward decarbonization and structural elements that help decarbonization efforts succeed. The sector would benefit from identifying and building consensus around a small number of reliable, valid, and feasible quality improvement metrics for reducing direct and indirect emissions.
This research initiative aims to address this critical knowledge gap by identifying quality measures that are strong predictors of emissions reduction in hospitals. Health Care Without Harm and its membership organization Practice Greenhealth possess a unique longitudinal dataset, spanning 11 years of data and featuring over 900 hospitals, that will be made available to the selected researcher(s). This data is self-reported as part of Practice Greenhealth’s Environmental Excellence Awards and is not independently audited.
Requirements
Deliverables
Project deliverables include:
- Normalization for scope 1 and 2 measurement: Utilize our comprehensive dataset to test different normalizing factors for Scope 1 and 2 emissions so as not to penalize facilities for structural and operational characteristics (e.g. CMI, climate zone, facility size, patient population, urban/rural status). Comparing hospitals based on improvement (e.g., reduction in emissions from baseline) should also be considered. The goal of this process will be the creation of a measure of Scope 1 and 2 emissions that fairly assesses hospitals and compares like-with-like.
- Analysis of key drivers of emissions reduction: Analyze the programmatic and operational measures collected by Health Care Without Harm/Practice Greenhealth to identify key actions that lead to Scope 1 and 2 emissions reduction in hospitals. Such actions might include a reduction in gas-powered fleet vehicles, installing onsite renewable energy systems, electrifying building equipment, decommissioning central piped nitrous oxide, and eliminating desflurane use.
- Identification of key structural elements: Evaluate the leadership and strategy measures collected by Health Care Without Harm/Practice Greenhealth to identify key structural elements that are highly correlated with Scope 1 and 2 emissions reduction in hospitals. Such elements could include tying executive compensation to improved environmental performance, making an organizational commitment to emissions reduction and resilience, and formulating a sustainability program budget.
- Developing standardized measures: Considering the normalized measures of Scope 1 and 2 emissions as well as the key drivers and structural elements identified, propose one or more quality improvement measure(s) for direct and indirect emissions for hospitals. Measures should be designed to equitably and appropriately compare facilities. A composite structural measure with many elements would be acceptable, as would several distinct measures that could be part of a quality improvement program.
- Measure specifications: The measure(s) must each have a precise definition and calculation formula and, if it is a composite measure, a justification for the weighting of its components.
- Model Measures: In considering different measure approaches, researchers should consider innovative models from other areas of quality improvement. For example, the patient safety structural measure and maternal morbidity structural measure.
- Reporting burden: Any measure or measures suggested should strive to reduce reporting burden by considering opportunities to minimize additional data collection.
- Publication: Publish a peer-reviewed paper describing the proposed quality measure(s), including the measure specifications. This paper will educate the health sector and support the integration of the quality measure(s) into pilot programs and existing frameworks like federal or state quality improvement programs.