Carbon footprints are a useful tool for visualising the carbon dioxide emissions that different industries and trades generate, and to map out the potential for reducing them. In hospitals, however, there are numerous different and sometimes complex secondary processes (see info box) at work. Measuring them is time-consuming and complicated, so their climate impact is usually only being roughly estimated.

Two business economics professors from HWR Berlin wanted to find out more and improve the carbon footprints of hospitals. Prof Dr Andrea Pelzeter, an expert in facility management, and Prof Dr Silke Bustamante, who heads the Institute for Sustainability at the HWR, are therefore focusing on secondary processes in hospitals in their KlinKe project.

All these processes generate their own carbon footprint but are either so minor or so complex that they have simply been summarised as “Others” in previous carbon footprints. However, the share of these processes in the overall balance is still large enough to justify taking a closer look at them and checking for optimisation opportunities.   

Even small contributions can make a big difference

In Germany, the healthcare sector contributes around five per cent of emissions to the overall carbon footprint. Efforts to reduce emissions were therefore often focusing on other sectors such as transport and energy production, which emit more CO2 and thus ostensibly offer a greater potential for savings. However, five per cent is still a substantial contribution, especially if there is a lot of room for changes – and in hospitals, secondary processes can account for up to 70 per cent of total emissions. If you look at the carbon footprint of an individual hospital, secondary processes are just as important as air conditioning and lighting.

Secondary processes in hospitals are particularly interesting because they are so difficult to capture, says Andrea Pelzeter. And Silke Bustamante describes her motivation for the project from an additional angle: “Climate and health are mutually dependent, and the health consequences of climate change can be considerable. Hospitals, on the other hand, are places of health – or at least they should be. So, we believe it is all the more important to make all the processes inside a hospital as climate-friendly as possible.”

First of all, however, the team had to work out which processes exist in hospital operations and which of these really are secondary process. Following this inventory, 43 selected processes were categorised as A, B and C: A processes were to be considered in depth, while C processes were only roughly estimated. In this selection process, KlinKe could play to one of its great strengths: The collaboration with their project partners, which is particularly important in this project. They were involved in the analysis right from the start and have contributed significantly to the project results ever since.

Participation as a success factor in the project

“We have been conducting successful research in participatory projects for years,” says Pelzeter. “Around half of the partners in KlinKe are participating actively, and the hospitals in particular are heavily involved.” This high level of participation was prearranged: All project partners – which include hospitals and hospital service providers as well as the relevant professional associations for hospital technology and facility management – had to guarantee a certain level of involvement before the project even started.

Since then, the core group of partners has met every two months for discussions or workshops and then starts the next project phase with homework. The data that the participating hospitals and service providers gather for the project is systematically collected and processed by the project team. The aim of the whole project is to produce guidelines that hospitals and healthcare facilities can use to calculate and optimise their carbon footprint more accurately.

After two and a half years and numerous workshops, this data collection is largely complete and the two project leaders can draw their first conclusions. Pelzeter says that it is particularly interesting to see how significantly the mobility of staff and patients – i.e. their journeys to the hospital and the means of transport they choose – influence the carbon footprint. Together with other processes such as laundry, central laboratory, waste disposal, and food supply, it will therefore play a special role in the guidelines.

Moreover, the mobility aspect can be applied to the entire working world: “We all have to get to work in the morning and back home in the evening,” says Bustamante. "So why do people live where they live and not closer to their workplace? Which travel options do they have, and is it possible to positively influence them? It's not just hospitals that will have to consider these questions in future, but all employers.”

Only those who feel involved will support change

The project results from KlinKe certainly demand a willingness to change from those involved: Analysing processes also means questioning them and then possibly having to leave the beaten tracks. Hence, special change workshops with some of the project partners are also part of the project. In these workshops, participants draw up specific project plans for optimising processes and then work out how to get people on board. “If you want to change processes, you always need the people to do it,” says Bustamante. And Pelzeter adds: “Theoretical considerations are often so far removed from practice that you first have to translate them into the reality of everyday life through comprehensible communication.”

This is why KlinKe also analyses human obstacles and motivational factors. The two researchers believe that it is important to keep an eye on the big picture in order to maintain people's willingness to participate. “Our analysis has shown how diverse the potential savings are,” says Pelzeter. “Even small things can help, such as reducing the standby consumption of medical devices.”

At this stage of the project, one crucial question remains: Is it feasible to determine saving potentials at this level of detail for other industries as well? Pelzeter and Bustamante are convinced that their work can be transferred to processes outside of hospitals, for example in logistics. They are already making plans for follow-up projects and are also thinking about digitising their guidelines. One thing is clear for both of them: the results of KlinKe must not disappear into a drawer, they should “hit the streets” and help to change the world step by step – because even small changes can have a big impact in the end.