Is your hospital, health system, or organisation serious about tackling the climate crisis? A checklist

Talk is easy, action is hard. Strategies are easy to devise, but it’s the
implementation that matters. We are surrounded by organisations,
including hospitals and health systems, making commitments to reach carbon net-zero, but how can you tell if the commitment is more than empty words? Here’s a list of what an organisation needs to be serious about responding to climate change, and it needs all of them—but I fear that many organisations with grand promises lack most if not all of them.

The first thing is commitment from the top. The board must commit the organisation to net-zero, provide the means, and review progress at every meeting, just as all boards review finance. And just as all boards need at least one and preferably two non-executives with high financial competency, it also needs one and preferably two competent in sustainability and carbon accounting.

Chief executives must make getting to net-zero one of their top
commitments and review progress at least monthly. All organisations need chief sustainability officers, just as they have chief financial officers, leaders whose sole job is sustainability and are responsible for devising and implementing plans. Ideally hospitals and health systems would also have chief clinical sustainability officers because changing clinical pathways is likely to be hardest part of achieving sustainability. There will also have to be somebody in procurement who concentrates on sustainability, preferably as their full-time job.

There must be a plan, a detailed plan with measurable targets that are publicly reported and SMART (specific, measurable, achievable,
relevant, and time-bound) objectives. The plan must be regularly
reviewed, updated, and reported to the board.

A budget—with both capital and recurrent expenditure—is essential. No organisation can tackle climate change without funding. It was a
“lightbulb moment” for me some 35 years ago when I heard Sam Their, then chief executive of the Massachusetts General Hospital, say “If you want to understand an organisation look at its budget not it strategy.” The budget shows what an organisation really cares about, and a plan without a budget is worthless.

Staff are essential, and again preferably staff who work full-time on
sustainability and are trained and supported. The number of staff
depends obviously on the size of the organisation, but even with a small organisation there must be somebody who has time reserved for working on sustainability.

Progress (or the lack of it) should be reported annually with interpretable data. The beauty of a carbon footprint is that it’s a single measure, akin to profit. An organisation that is serious about reaching net-zero will report its carbon footprint annually, and an increasing number of organisations do, just as they report their financial performance annually. Financial data are audited, the carbon footprint should be audited. Over centuries standards have been devised and agreed for reporting financial data, and we need the same standards for accounting carbon footprints—and ideally environmental impact.

I know that if you measure your hospital or health system against this checklist it will fall short, probably woefully short. But these are the elements of what are needed to be serious about sustainability—and, I repeat, you need all of them.

Our Commitments

The UK Health Alliance on Climate Change has produced a set of ten actions for health organisations to take to demonstrate leadership and mitigate and adapt to climate change.