Advancing environmental sustainability in health care: evaluating and prioritising sustainability measures for quality reporting and improvement

Achieving environmentally sustainable health systems represents a crucial objective for both planetary and human health. Integrating environmental measures into existing health-care quality measurement and improvement frameworks can greatly advance sustainability efforts. However, current environmental measures have not been evaluated for this purpose. In this Personal View, we evaluate commonly reported measures of environmentally sustainable health care against standard criteria and propose a minimum set of standard environmental sustainability measures compatible with quality reporting standards. Common measures of environmental sustainability were identified at the hospital and health-facility level through a literature review. We created generic, representative measures based on the environmental domain (eg, greenhouse gases, energy) and evaluated them using quality measure criteria established by the Partnership for Quality Measurement. Six generic measures were created and evaluated across the domains of greenhouse gas emissions, water use, energy use, travel, and solid waste. Although all six measures were considered of high importance, two (distance travelled by patients and staff and mass of total [scopes 1, 2, and 3] carbon dioxide-equivalent emissions per year) showed weaknesses in scientific acceptability and feasibility, and one (energy consumed per year) was highly correlated with and less informative than the others. No measures evaluated included a consistent method for standardisation. The proposed minimum set comprises measures of greenhouse gas emissions (scopes 1 and 2), water use, and solid waste production, standardised by adjusted patient-days. To our knowledge, this work presents the first proposed list of environmental measures for use in quality reporting and a pathway for integrating environmental sustainability measures into existing quality measurement frameworks.