Lessons from patient safety to accelerate healthcare decarbonization

Unofficial AI-generated summary based on the public title and abstract. Not an official translation.

🔬研究者:Provides a framework for applying patient safety principles to healthcare decarbonization, highlighting the need for verified data and transparency.

🏢実務担当者:Offers guidance for healthcare organizations to build credible sustainability programs by adopting transparency and accountability measures.

🏛政策担当者:Suggests regulatory and payment reforms to mandate public reporting of healthcare emissions, drawing parallels to patient safety regulations.

Climate change and environmental degradation are increasingly impacting human health, with more frequent heatwaves, wildfires, extreme weather events, emerging infectious diseases, increased respiratory, cardiovascular, and mental health conditions, and food and water insecurity.1 Current projections of global greenhouse gas (GHG) emissions suggest it will be harder to limit warming below the critical threshold of 2°C to avoid the worst predicted harms unless deep and immediate reductions in GHGs occur in all sectors of society. The healthcare sector contributes approximately 4.6% of total global GHGs and 4 million disability-adjusted life years lost from air pollution annually.1 Health care must do its part to mitigate environmental degradation and pollution and avoid excessive resource consumption.2, 3 One-fifth of global healthcare GHG contributions come from the US healthcare sector despite the United States comprising only 4% of the global population. A number of motivated US healthcare delivery organizations (HCOs) have begun to implement decarbonization initiatives, and these efforts should be applauded.4, 5 However, many of these initiatives are not grounded in rigorous measurement and data transparency, making it difficult to judge the veracity of claims or progress consistent with science-based targets.6 The nascent state of healthcare sustainability is reminiscent of the early days of the patient safety movement and is experiencing similar growing pains. In 1999, the report “To Err is Human” raised the alarm about patient safety, but demonstrable improvement was slow going and hampered by, among other things, a lack of data and transparency required for guiding and tracking evidence-based performance improvement.7 Progress has been made since then primarily through regulatory and payment reforms, and in 2025, the US Centers for Medicare & Medicaid Services (CMS) is expected to implement a Patient Safety Structural Measure that further embeds measurement, accountability, and transparency in assessing how hospitals ensure patient safety.8 However, the urgency of the climate crisis and healthcare's significant contribution to it leaves no room for decades-long delays. To ensure progress in the absence of regulation and payment levers, HCOs should apply the principles guiding the patient safety movement to ensure that data transparency and verification are the centerpiece of the transformation to evidenced-based, environmentally sustainable health care. Previous research has quantified the harmful effects of US healthcare pollution at nearly 400,000 disability-adjusted life years (DALYs) lost in 2018.9 Creating effective systems to protect patients, the public, and the planet from harm requires adherence to basic principles of transformational change that include transparency, accountability, standard operating procedures, regulations, commitment to continuous improvement, publicly shared data, and quality ratings. Many of these principles underpin the performance of high-reliability organizations aiming to prevent catastrophic safety lapses. Data verification and transparency ensure accountability and build stakeholder trust. These principles have guided advances in patient safety since the Affordable Care Act-mandated expansion of reporting and accountability in 2010.10 This led CMS to require public reporting of patient safety measures and implement payment penalties for poor performers, ensuring the availability of credible, consistent, and uniform information about hospital performance. These efforts also served as the basis for an “A” through “F” safety grading system through The Leapfrog Group.10 Data from the Medicare Patient Safety Monitoring System (MPSMS), which tracks adverse events among hospital inpatients, showed a significant decline between 2010 and 2019, coinciding with major patient safety improvement efforts and enhanced reporting practices.11 So far, however, principles for transformational change have yet to be applied to US healthcare sustainability initiatives that currently encompass programs pledging to reduce GHG emissions, as well as sustainability awards and certificates (Table 1). These efforts, launched over the past few years, aim to motivate HCOs to participate in climate-related initiatives voluntarily. However, these well-intentioned efforts do not yet disclose verified data to support claims. Lack of transparency makes it difficult to evaluate promised improvements and opens the door to greenwashing—the act, whether intentional or inadvertent, of making false or misleading statements about the environmental benefits of a product or practice and one of the biggest threats to effective and timely climate action.12 The UN Secretary General warns that bold pledges must be matched with concrete, measurable data and calls for zero tolerance for greenwashing. Accountability, transparency, and public reporting of standardized metrics are foundational principles needed to advance patient safety and are also the antidotes to greenwashing. American Society for Healthcare Engineering's Sustainability Champions Award and Gold Standard Awards for Health Care Facility Energy Savings https://www.ashe.org/energytocare/awards-sustainability-champion EPA ENERGY STAR Certification https://www.energystar.gov/about/how-energy-star-works/energy-star-certification Practice Greenhealth awards (a subsidiary of Healthcare Without Harm) https://practicegreenhealth.org/data-and-awards/awards-and-recognition The Joint Commission (TJC) Sustainable Health Care Certification https://www.jointcommission.org/what-we-offer/certification/certifications-by-setting/hospital-certifications/sustainable-healthcare-certification/ Vizient Environmentally Preferred Sourcing Excellence Award https://www.vizientinc.com/who-we-serve/members/member-awards The White House/Health and Human Services Health Sector Climate Pledge https://www.hhs.gov/climate-change-health-equity-environmental-justice/climate-change-health-equity/actions/health-sector-pledge/index.html#:~:text=On%20Earth%20Day%202022%2C%20the,net%20zero%20emissions%20by%202050 Several recent voluntary opportunities for HCOs to engage in sustainability efforts highlight the challenges posed by lack of transparency. In 2022, the White House and the US Department of Health and Human Services (HHS) called for HCOs and other healthcare-aligned businesses to sign the Health Sector Climate Pledge to, at a minimum, reduce organizational emissions by 50% by 2030 and achieve net-zero emissions by 2050 while “publicly accounting for progress on this goal every year.” Two years on, HCOs’ progress related to the pledge is unclear as no data have yet been publicly shared. The Joint Commission (TJC), the largest healthcare accrediting agency in the United States, recently announced a voluntary Sustainable Healthcare Certification Program to inspire climate action. Health systems seeking this certification are evaluated by accreditors; however, the certificate does not require public disclosure of measures of sustainable operations such as GHG emissions.13 Both of these laudable programs would be strengthened if they incorporated publicly available data to support claims and mark progress toward the pledge or certificate. Data transparency is an opportunity to create a clear accountability structure, build trust from stakeholders, encourage action by other HCOs, and help avoid perceptions of greenwashing. Table 1 describes characteristics related to transparency, verification, and public reporting of current US healthcare sustainability award programs. More recently, the CMS Innovation Center proposed a voluntary GHG reporting opportunity for HCOs participating in the new 5-year episode-based alternative payment model called Transforming Episode Accountability Model (TEAM).14 The proposed Decarbonization and Resilience Initiative could help create the foundation for sustainability data capture for the entire US healthcare system, starting with the use of the well-established EPA ENERGY STAR program. To incentivize HCOs, the rule also proposes that “badges” be awarded for varying levels of successful engagement. Making the supporting data for badges or awards public would be an excellent opportunity to align with established sustainability accounting practices routinely used by other sectors where transparency is the norm. Ensuring transparency would also provide insights into opportunities for continuous improvement at the organizational and sector-wide level necessary to rapidly decarbonize health care. It could help avoid some future challenges that persist in the patient safety movement, such as issues related to insufficient data, unclear performance evidence, and the gamification of safety measures. Lessons from the patient safety movement also provide insight into practical pathways for implementing future sustainability programs. Effective patient safety teams are interdisciplinary, gather relevant data from various sources within an organization, and use a sociotechnical approach that includes technology, process improvement, organizational change management principles, and culture and behavior change. Sustainability teams can adopt these same strategies to build effective programs. Following the experience in the patient safety field, future regulations, accreditation, payment incentives, and mandatory reporting of metrics will be necessary to advance environmental sustainability.2, 9, 15-17 This, however, may be years away. Hence, proactive actions are warranted now to help drive meaningful action and prevent greenwashing. A crucial lesson gleaned from the patient safety experience is that some of the most valuable insights and innovations came from high-reliability industries outside of health care—most notably aviation. The increasingly sophisticated science of sustainable enterprise has been developed almost entirely outside of health care and, if tapped, wo

• openalex https://doi.org/10.1002/jhm.13493first seen 2026-08-02 18:09:52