/ en Tue, 29 Jul 2025 23:18:14 -0500 Thu, 24 Jul 25 21:45:00 -0500 /guidesreports/2025-07-24-strategies-improving-postpartum-hemorrhage-outcomes <div class="container"> .container h2{ color:#9d2235; } .container h3{ color:#003087; } <div class="row"><div class="col-md-8"><p>Postpartum hemorrhage is one of the most common and serious complications of childbirth. It is characterized by rapid and significant blood loss, causing a dangerous drop in blood pressure that can result in organ failure or, in extreme cases, death. Occurring in 3% to 5% of all deliveries, PPH is responsible for <a href="https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-issue-51-proactive-prevention-of-maternal-death-from-maternal-hemorrhage/quick-safety-51-proactive-prevention-of-maternal-death-from-maternal-hemorrhage/#:~:text=Maternal%20mortality%20by%20the%20numbers&text=5%20Approximately%203%2D5%25%20of,will%20experience%20a%20postpartum%20hemorrhage.&text=These%20preventable%20events%20are%20the,11.2%25%20of%20U.S.%20maternal%20deaths." title="From the Joint Commission" arial-label="Maternal mortality by the numbers">11.2% of maternal deaths</a> in the United States. It also is the leading cause of <a href="https://pubmed.ncbi.nlm.nih.gov/28937571/#:~:text=Hemorrhage%20that%20leads%20to%20blood,disseminated%20intravascular%20coagulation%20(2)." title="From the National Library of Medicine" arial-label=" Postpartum Hemorrhage">severe maternal morbidity</a>. Notably, <a href="https://my.clevelandclinic.org/health/diseases/22228-postpartum-hemorrhage" title="From Cleveland Clinic" arial-labe="Postpartum Hemorrhage">40% of such hemorrhages</a> occur in patients without any risk factors.</p><p>Early detection and treatment of PPH are critical to ensure a full recovery. Fortunately, most cases are not life threatening if managed promptly. Incorporating tools into electronic health records and labor and delivery workflows can enhance providers’ ability to effectively diagnose and treat PPH.</p><p>The ���������� Association and Epic are partnering to raise awareness of EHR tools that can help providers detect and treat PPH, no matter what software platform they use. These tools can help save lives of new mothers.</p><h2>Assess Patient Risk for Postpartum Hemorrhage</h2><p>Hospitals can identify patients’ risk of hemorrhage by embedding a hemorrhage risk assessment into their obstetric workflows (see Additional Resources below). According to clinicians, the PPH risk assessment should be done at admission, at the start of the second stage of labor, upon transfer to postpartum care and whenever the patient’s condition changes. These assessments categorize patients into low-, medium- and high-risk categories, providing recommendations for medications and other supplies to prevent and treat hemorrhage within each risk category.</p></div><div class="col-md-4"><div><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/07/Strategies-for-Improving-Postpartum-Hemorrhage-Outcomes.pdf" target="_blank" title="Download the print version of the Insights Report: Strategies for Improving Postpartum Hemorrhage Outcomes">Download the Report PDF</a></div><div><a class="btn btn-wide btn-primary" href="/press-releases/2025-07-24-american-hospital-association-and-epic-collaborate-toward-improving-maternal-health-outcomes" title="View the Press Release: ���������� Association and Epic Collaborate Toward Improving Maternal Health Outcomes">View the Press Release</a></div><div><a class="btn btn-wide btn-primary" href="/aha-patient-safety-initiative" target="_blank" title="Click here to visit the AHA Patient Safety Initiative landing page.">Learn More about the AHA Patient Safety Initiative</a></div><div><a href="/system/files/media/file/2025/07/Strategies-for-Improving-Postpartum-Hemorrhage-Outcomes.pdf" target="_blank" title="Download the print version of the Report: Strategies for Improving Postpartum Hemorrhage Outcomes"><img src="/sites/default/files/2025-07/Postpartum-Hemorrhage-Outcomes-cover-352x456.jpg" alt="Cover image of the Report: Strategies for Improving Postpartum Hemorrhage Outcomes" width="NaN" height="NaN"></a></div></div></div><div class="row"><div class="col-md-12"><div class="row"><div class="col-md-10 col-md-offset-1 spacer"><h3>EHR Considerations:</h3><ul class="arrow"><li class="arrow">Embed the assessment in admission documentation alongside other admission workflows.</li><li class="arrow">Configure the EHR to automatically update the risk score throughout the admission.</li><li class="arrow">Show a notification in the patient chart or tracking board to indicate when the assessment is incomplete.</li><li class="arrow">Show PPH risk assessment scores on admission/delivery summaries, tracking boards and handoffs.</li><li class="arrow">Include written treatment instructions alongside the patient’s risk score.</li><li class="arrow">When a patient is medium or high risk, configure the EHR to automatically recommend necessary supplies in an order set.</li></ul></div></div><div class="col-md-3"><img src="/sites/default/files/2025-07/Postpartum-Hemorrhage-Outcomes-img1-250x400.jpg" width="250" height="400"></div><h2>Be Prepared for Postpartum Hemorrhage</h2><p>Clinicians should have access to essential digital tools for responding to PPH from a single, centralized location within the EHR. This hub should allow them to more quickly queue common hemorrhage-related orders, record vital signs and assessments, efficiently document medication administrations and IV placements, and access a quantitative blood loss calculator.</p><h2>Improve Hemorrhage Detection and Response with a Quantitative Blood Loss Calculator</h2><p>QBL calculators help clinicians know how much blood a patient has lost, allowing teams to identify and respond to hemorrhage sooner and ideally before a patient’s vital signs deteriorate. Embedding a QBL calculator in the organization’s EHR helps to avoid forcing clinicians to break their workflows or perform manual calculations during a high-stakes clinical episode.</p><p>A QBL calculator works by subtracting the dry weight of materials involved in the clinical episode from the total wet weight of the materials to determine the volume of blood loss. It’s essential to measure the dry weight of all materials that might become blood soaked, including drapes, canisters and sponges.</p><div class="row"><div class="col-md-10 col-md-offset-1 spacer"><h3>EHR Considerations:</h3><ul class="arrow"><li class="arrow">Include an inventory of supplies and their weights in the EHR so clinicians can quickly input the type and number of supplies and allow the system to automatically calculate the dry weight.</li><li class="arrow">Include a row for substituted items in case a team runs out of a particular item.</li><li class="arrow">Show the QBL calculator in a prominent area of the patient chart for delivery workflows.</li><li class="arrow">Make sure that clinicians can easily access total blood loss information for patients.</li></ul></div></div><h2>Track Usage and Impact</h2><p>Your organization’s EHR reporting tools should be able to monitor both compliance and patient outcomes:</p><ul class="arrow"><li class="arrow">Compliance measures may include C-section rates, frequency of QBL calculations and whether appropriate medications were ordered for patients at medium and high risk of PPH.</li><li class="arrow">Patient outcomes can be tracked through metrics such as PPH rates for vaginal and cesarean deliveries, as well as the percentage of deliveries requiring blood transfusions.</li></ul><div class="col-md-3"><img src="/sites/default/files/2025-07/Postpartum-Hemorrhage-Outcomes-img2-250x400.jpg" width="250" height="400"></div><h2>Reduce Risk of Postpartum Hemorrhage</h2><p>Reducing the percentage of cesarean deliveries without medical indication can lower the risk of PPH. Incorporating C-section risk calculators into the EHR helps providers and patients more efficiently make informed decisions about whether to transition to a C-section.</p><p>With improved data reporting and advanced data analysis tools, predictive analytics models can help more accurately assess a patient’s risk for PPH and identify effective interventions to reduce maternal morbidity and mortality.</p><h2>Implementing the Toolbox</h2><p>Hospitals and health systems working with Epic Systems can connect with their primary Epic contact to activate any or all of these toolbox components.</p><p>Hospitals and health systems working with other EHR providers can use this fact sheet to either identify existing similar tools in their own EHRs or outline a roadmap to build a version of this toolbox unique to their own EHR environment.</p></div></div><div class="row spacer"><div class="col-md-10 col-md-offset-1"><div class="panel module-typeC"><div class="panel-heading"><h3 class="text-align-center panel-title">Additional Resources</h3></div><div class="panel-body"> ul.IRolNumBox li { list-style-type: none; position: relative; margin-bottom: 15px; } <ul class="IRolNumBox"><li><a href="https://www.awhonn.org/resources-and-information/nurse-resources/pph-risk-assessment-tools/" title="AWHONN | Access Free Resources: Risk Assessment Tool & Postpartum Hemorrhage (PPH) Stages Algorithm" target="blank" arial-label="External resource to access free resources from AWHONN">Association of Women’s Health, Obstetric and Neonatal Nurses’ Postpartum Risk Assessment Tool</a></li><li><a href="https://www.cmqcc.org/toolkits-quality-improvement/hemorrhage" title="CMQCC | Center for Academic Medicine, Neonatology" arial-label="Ecternal resource on hemorrhage">California Maternal Quality Care Collaborative’s Obstetric Risk Factor Assessment</a></li><li><a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/12/quantitative-blood-loss-in-obstetric-hemorrhage" title="ACOG | Quantitative Blood Loss in Obstetric Hemorrhage" arial-label="External resource from The American College of Obstetricians and Gynecologists">ACOG Committee Opinion — Quantitative Blood Loss in Obstetric Hemorrhage</a></li></ul><p><em>The clinican approaches described in this document are provided for informational purposes only and are not intended to replace individualized medical judgment. Implementation of these approaches does not guarantee specific patient outcomes. Clinicial decisions should always be based on the healthcare provider’s professional assessment, the patient’s unique circumstances, and the most current standards of care.</em></p></div></div></div></div></div> Thu, 24 Jul 2025 21:45:00 -0500 Guides/Reports /sustainability/health-care-leaders-guide/business-case <div class="raw-html-embed"> </div><div class="raw-html-embed"> .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 0px auto; } .LogoInsert { position: absolute; top: 0px; height:100%; left:0px; } .LogoInsert img{ max-width:500px; max-height:125px; top:calc(50% - 125px/2); left:calc(100% + 50px); position:absolute; } .LogoInsert h1{ position:absolute; left:0px; bottom:0px; width:500px; opacity:0; margin: 0px; padding: 0; } @media (max-width:640px) { .LogoBG { object-fit: cover; height: 200px; } .LogoInsert img { max-width: 250px; left: calc(100% + 15px); top: calc(50% - 112px/2); background-color: #00584499; padding: 25px; border-radius: 30px 0px; } } @media (max-width:320px) { .LogoBG { height: 150px; } } <header class="Banner_Title_Overlay_Bar"> <img alt="Banner Image - Glass Earth sitting in a hand over tall grass" class="LogoBG" src="/sites/default/files/2023-03/sustainability-roadmap-web-home-banner-1170x250.jpg"> <div class="LogoInsert"> <img alt="Sustainability Roadmap for Health Care | Achieving Your Sustainability Goals - Logo" src="/sites/default/files/2023-03/SustainabilityRoadmap_Logo_Hor-white_700x217.png"></div> </header> </div> .shcIntro{ background-color:#78be2022; padding: 5px 50px 15px 50px; margin-bottom:20px; } .shcIntro h1, .shcIntro h2, .shcIntro h3 { color: #005844; text-align: center; } .shcIntro h1{ font-size:2em; } .shcIntro h2{ font-size:1.6em; } shcIntro ul{ color: grey; } <div class="shcIntro"><h1>The Business Case to Environmental Stewardship</h1></div><div class="raw-html-embed"> <div class="row"> /* TocMini */ .TocMini { margin: 0px auto 25px; padding-bottom: 5px; color: #005844; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; width: 80%; } .TocMini .TocMiniBar { border: 1px solid #78be20; padding: 5px 10px; overflow: auto; border-radius: 20px 0px; } .TocMini .TocMiniBar .TocMiniGroup a:after { content: "|"; padding: 0 3px 0 6px; color: #253b80; font-weight: 700; } .TocMini .TocMiniBar .TocMiniGroup a:last-child:after { content: ""; } .TocMini .TocMiniGroup { float: right; } .TocMini .TocMiniHome { text-transform: uppercase; color: #005844; font-weight: 700; } .TocMini .TocMiniChild { font-weight: 500; opacity: .9; color: #555; } .TocMini .TocMiniHome:hover, .TocMini .TocMiniChild:hover { text-transform: ; color: #5fa1d0; } .TocMini .TocMiniActive{ font-weight: 700; color: #5fa1d0; } /* TocMini // */ <div class="TocMini"> <div class="TocMiniBar"> <a class="TocMiniHome" href="/sustainability" target="_blank" title="Home - Sustainability Roadmap for Health Care">Sustainability Roadmap for Health Care</a> <div class="TocMiniGroup"> <a class="TocMiniChild" href="https://www.ashe.org/sustainability" target="_blank" title="ASHE Sustainability for Health Care Facilities">Sustainability for Health Care Facilities</a> <a class="TocMiniChild" href="/sustainability/glossary" target="_blank" title="Glossary">Glossary</a> <a class="TocMiniChild" href="https://www.ashe.org/sustainability/healquest" target="_blank" title="HealQuest">HealQuest<sup>TM</sup></a> </div> </div> </div> </div> </div> .btn-primary { background-color: #005844; } .shcItemsLine { border-bottom:solid 1px #78be20; margin-top:10px; margin-bottom:25px; } .shcHighlight h3{ color:#333; font-size:16px; text-align:center; margin:0px } .shcHighlight span{ font-weight:700; color:#78be20; } p.center_Lead, ul li.center_Lead{ color: #63666A; font-weight: 300; line-height: 1.4; font-size: 20px; } <div class="row shcHighlight BulletCircle"><div class="col-sm-6 col-md-7"><p class="center_Lead">Sustainability and environmental stewardship are transformational for each health care organization — and the sector as a whole. The business concepts “Create Value” and “Reinforce the Mission” help to show the importance of sustainability and decarbonization. Adapting these examples to your own organization and community will make an even more compelling case.</p><div class="col-md-10 col-md-offset-1 shcItemsLine"> </div></div><div class="col-sm-6 col-md-5"> <div data-entity-type="webform" data-entity-uuid="82c58bca-9296-40b2-8941-0c6929d9ef6b" data-embed-button="webform_embed" data-entity-embed-display="view_mode:webform.token" data-langcode="en" data-entity-embed-display-settings="[]" class="embedded-entity"> <div class="antibot-no-js antibot-message antibot-message-warning">You must have JavaScript enabled to use this form.</div> <div id="edit-sustainability-menu-code" class="js-form-item form-item js-form-type-processed-text form-item- js-form-item- form-no-label"> <div class="raw-html-embed"> .webform-submission-form { margin: 0em auto; max-width: 100%; padding: 0 0px; .ResourceHolder-1 { background-color: #78be2022; padding: 25px 9px; display: inline-block; border-radius: 50px 50px 0 0; width: 100% } .ResourceHolder-1 h2 { color: ; line-height: 18px; font-size: 18px; margin: 10px 0 15px 0; text-align:center; } .ResourceHolder-1 h2 a { color: #005844; } .ResourceHolder-1 h2 a:hover { color: #4579bc; } <div class="ResourceHolder-1"> <div class="col-md-4"> <a href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="The Health Care Leader's Guide to Sustainability and Environmental Stewardship"><img src="/sites/default/files/2025-07/Sus-Guide-Cover-777x600.png" alt="Cover image of the AHA's guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship" width="100%"></a> </div> <div class="col-md-8"> <h2><a href="/sustainability/health-care-leaders-guide" title="Start at the begining of the Guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">The Health Care Leader’s Guide</a></h2> .RuralAgendaTOC { text-align: center; font-weight: 700; font-size: 15px; background-color: ; padding: 0 15px 15px 15px; } .RuralAgendaTOC a:link { color: #005844; text-decoration: none; } .RuralAgendaTOC a:hover { color: #FED141aa; } .RuralAgendaTOC a:hover { color: #4579bc; ; } .RuralAgendaTOC a:active { color: green; } <h3>Sections:</h3> <div class="RuralAgendaTOC"> <a href="/sustainability/health-care-leaders-guide/team" title="Go to section on: The Sustainability and Environmental Stewardship Team">Sustainability Team </a>| <a href="/sustainability/health-care-leaders-guide/ceos" title="Go to section on: CEO’s Guide">CEO </a>| <a href="/sustainability/health-care-leaders-guide/coos" title="Go to section on: COO’s Guide">COO </a>| <a href="/sustainability/health-care-leaders-guide/cfos" title="Go to section on: CFO’s Guide">CFO </a>| <a href="/sustainability/health-care-leaders-guide/board" title="Go to section on: Board's Guide">Board </a>| <a href="/sustainability/health-care-leaders-guide/business-case" title="Go to section on: The Business Case">Business Case</a> </div> <div> <a class="btn btn-primary btn-wide" href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="Download the printable version: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">Printable Version</a> </div> </div> </div></div> </div> <div class="homepage-textfield js-form-wrapper form-wrapper"><div class="js-form-item form-item js-form-type-textfield form-item-homepage js-form-item-homepage"> Leave this field blank </div> </div> </div></div></div><h2 class="text-align-center">Sections</h2> .Sticky { position: sticky; top: 0; background-color: #fff; z-index: 1000; border-radius: 0 0 25px 25px; z-index:1000; color: #78be20; width: fit-content; margin: auto; padding: 0px 10px 5px; font-size:14px; } .Sticky nav p{ font-size:14px; font-weight:700; line-height:13px } @media (max-width:790px){ .Sticky nav p{ font-size:11px; } } .Sticky a { color: #005844; text-decoration: none; } .Sticky .scroll-watcher { height: 10px; position: relative; top: 0; left: 0; z-index: 1000; background-color: #78be20; width: 100%; scale: 0 1; transform-origin: left; animation: scroll-watcher linear; animation-timeline: scroll(y); } @keyframes scroll-watcher { to { scale: 1 1; } } <div class="scroll-watcher"> </div><nav><p><a href="#Value">Create Value</a> | <a href="#Reinforce">Reinforce the Mission</a> | <a href="#EnvironmentalRisks">Environmental Risks</a> | <a href="#RecognizeRisks">Risks/Impact</a> | <a href="#ActionSteps">Action Steps</a> | <a href="#Financial">Financial Sustainability</a> | <a href="#Investments">Investments/Foundation</a> | <a href="#Question">Ask Question</a></p></nav> .SessionWrapper { border: solid 2px #005844; margin-bottom: 20px; } h2.SessionTitle { font-weight: 700; background-color: #00584422; color: #005844; padding: 15px; margin-top: 0px; margin-bottom: 25px; font-size: 33px; } .SessionEvents { margin-bottom: 30px; display:inline-block; } .SessionEvents br { margin-bottom: 10px; } .SessionEvents h3 { font-size: 30px; } .SessionEvents h4 { color: #9d2235; } .SessionEvents ul { list-style: none; /* Remove default bullets */ padding-left: 25px; margin-bottom: 25px; } .SessionEvents ul li { margin-bottom: 7px; line-height: 1.5em; font-size: 16px; } .SessionEvents ul li::before { content: "●"; font-size: 1em; position: relative; top: 0px; color: #78be20; text-indent: -20px; padding-right: 10px; } .SessionEvents ul li { padding-left: 23px; text-indent: -23px; } .SessionEvents img { margin-top: 25px; } <div class="container SessionWrapper" id="Value"><div class="row"><h2 class="SessionTitle">Create Value</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><h3>A strong environmental stewardship proposition links to value creation in five essential ways.</h3><div class="table-responsive"><table class="table-bordered table-striped"><tbody><tr><th> </th><td>Strong environmental stewardship proposition (examples)</td><td>Weak environmental stewardship proposition (examples)</td></tr><tr><th>Top-line growth</th><td>Attract B2B and B2C customers with more sustainable products<br>Achieve better access to resources through stronger community and government relations</td><td>Lose customers through poor sustainability practices (eg, human rights, supply chain) or a perception of unsustainable/unsafe products<br>Lose access to resources (including from operational shutdowns) as a result of poor community and labor relations</td></tr><tr><th>Cost reductions</th><td>Lower energy consumption Reduce water intake</td><td>Generate unnecessary waste and pay correspondingly higher waste-disposal costs<br>Expend more in packaging costs</td></tr><tr><th>Regulatory and legal interventions</th><td>Achieve greater strategic freedom through deregulation<br>Earn subsides and government support</td><td>Suffer restrictions on advertising and point of sale<br>Incur fines, penalties, and enforcement actions</td></tr><tr><th>Productivity uplift</th><td>Boost employee motivation<br>Attract talent through greater social credibility</td><td>Deal with “social stigma,” which restricts talent pool<br>Lose talent as a result of weak purpose</td></tr><tr><th>Investment and asset optimization</th><td>Enhance investment returns by better allocating capital for the long term (eg, more sustainable plant and equipment)<br>Avoid investments that may not pay off because of longer-term environmental issues</td><td>Suffer stranded assets as a result of premature write-downs<br>Fall behind competitors that have invested to be less “energy hungry”</td></tr></tbody></table></div><p class="center_Lead">Recognizing that health care is competitive in most markets, the value proposition to patients is higher quality care at lower cost with an organization that is promoting wellness in their community and mitigating harmful environmental effects.</p></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Reinforce"><div class="row"><h2 class="SessionTitle">Reinforce the Mission</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><div class="col-md-6"><h3>The imperative:</h3><p>Environmental factors can affect health and health care delivery, and hospitals deal with these types of impacts frequently. Reducing GHG emissions can help protect the health of patients, employees, and communities.</p><h3>Mission alignment:</h3><p>Health care’s energy intensity and carbon footprint are significant, and hospitals can benefit from reducing the impact.</p><h3>Operational benefits:</h3><p>Reducing energy and GHG emissions leads to cost savings and makes hospitals more resilient in the face of extreme weather events.</p></div><div class="col-md-6"><h3>Cleveland Clinic Environmental Stewardship Pitch Summary</h3><div class="table-responsive"><table class="table-bordered table-striped"><thead><tr><th>Sustainability “hook”</th><th>Sample message for the leader</th></tr></thead><tbody><tr><td>Mitigation</td><td>Save $50 million+</td></tr><tr><td>Engagement</td><td>Attract the best</td></tr><tr><td>Resillence</td><td>Adjust to the future</td></tr><tr><td>Relationships</td><td>Build partnerships</td></tr><tr><td>Population health</td><td>Impact regional health</td></tr><tr><td>Societal transformation</td><td>Change the nexus</td></tr><tr><td>Transpersonalism</td><td>Be the change</td></tr><tr><td>Moral obligation</td><td>Do the right thing</td></tr><tr><td>Leadership</td><td>Lead the sector</td></tr></tbody></table><p><strong>Source:</strong> Presented by Jon Utech and Jessica Wolf during CleanMed 2018, “Demystifying Greenhouse Gas and Goal-setting in Health Care”</p></div></div></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Reinforce"><div class="row"><h2 class="SessionTitle">Reinforce the Mission</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><div class="col-md-6"><blockquote><h3>University of Alabama Birmingham (UAB) commits to carbon reductions and clean energy for hospitals</h3><p>“As UAB is a leading academic research institution, healthcare facility and the largest single employer in th estate —effective and sustainable operations are essential to UAB’s mission”</p><p>Ray Watts, President,<br>University of Alabama Birmingham</p></blockquote></div><div class="col-md-6"><blockquote><h3>Health Partners approaches Sustainability and Triple Aim simultaneously</h3><p>“The Future of Health and the Future of Sustainability are bound Together”</p><p>Andrea Walsh, CEO,<br>Health Partners</p></blockquote></div></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="EnvironmentalRisks"><div class="row"><h2 class="SessionTitle">Environmental Risks to Hospitals</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead">The harmful effects of the environment are experienced across the U.S., ranging from flooding to wild fires, and extreme temperatures that stress our infrastructure systems beyond their capabilities.</p><p class="center_Lead">In 2020 alone, 22 environmental related disasters caused over $111 billion in losses. Over the last five years, a total of 86 billion-dollar events have totaled $451 billion. Hospitals have emergency response plans for these events, and might recognize the connections between the environment and carbon emissions.</p><p class="center_Lead">These shocks and stressors add to the cost of care, disrupt operations that can prevent timely care, and present significant risks to the health care sector’s ability to serve the community.</p><p class="center_Lead">In underserved communities, these shocks and stressors disproportionally affect people</p><p class="center_Lead">who are least able to prepare for and recover from heat waves, poor air quality, flooding and other impacts.</p><p class="center_Lead">Environmental awareness can help to improve hospital resilience and the community’s ability to absorb and recover from weather and environmental risks.</p><img src="/sites/default/files/2025-07/Sus-2023-Billion-Map.JPG" alt="This map denotes the approximate location for each of the 28 separate billion-dollar weather and climate disasters that impact the United States in 2003."></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="RecognizeRisks"><div class="row"><h2 class="SessionTitle">Recognize the Risks and Quantify the Impact</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><h3>Risks, Opportunities, and Financial Impact</h3><img src="/sites/default/files/2025-07/Sus-Risks-Opportunities-Financial-Impact.JPG" alt="Visual flow: Transition Risks (Policy & Legal, Technology, Market, Reputation) and Physical Risks (Acute, Chronic) merge into Risks that combine with Opportunities (Resource Efficiency, Energy Source, Products/Services, Markets, Resilience) into Strategic Planning Risk Management, which flows into Financial Impact: breaking out into; Income Statement, Cash Flow Statement, Balance Sheet. Income Statement breaks out into Revenues and Expenditures, and Balance sheet breaks out into Assets & Liabilities and Capital & Financing."><p class="center_Lead">Identifying the near-future environmental risks to operations and quantifying the financial impact of an event allows leadership to incorporate risk management into strategic planning.</p><p class="center_Lead">Environmental stewardship and sustainability projects may reduce the risk, which can be operationalized and support the business case.</p><p class="center_Lead">Keeping the hospital open during weather events will be increasingly challenging, but environmental planning can position for success.</p></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="ActionSteps"><div class="row"><h2 class="SessionTitle">Immediate Action Steps</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead">Health care executives and emergency planners have a responsibility to ensure their facilities are safe for staff, patients and visitors.</p> ol.sg-olHeader > li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; font-weight:700 } ol.sg-olHeader > li > ul li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; } ul.sg-ulHeader1 > li{ font-size: 20px; color: #63666A; line-height: 1.4; } <ol class="sg-olHeader"><li>Identify priority environmental impacts specific to your operations/facilities.</li><li>Conduct/update hazard vulnerability assessment (HVA) to include these impacts.</li><li>Update system/facility-level surge plans.</li><li>Incorporate weather events into system/facility-level utility outage plans and alternative sources.</li><li>Work with supply chain partners to plan for emergency supplies to sustain operations.</li><li>Prepare all functions with clear, concise messaging to anticipate operational practices during expected events.</li></ol> .shcItemsLine { border-bottom:solid 1px #005844; margin-top:25px; margin-bottom:50px; } <div class="col-md-10 col-md-offset-1 shcItemsLine"> </div><h3>Questions to discuss the tangible impacts of weather and environment:</h3><ul class="sg-ulHeader1"><li>What are the new risks we are encountering related to the environment?</li><li>Will virus related changes affect the response?</li><li>Can building systems continue to meet temperature and humidity requirements?</li></ul></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Financial"><div class="row"><h2 class="SessionTitle">Financial Sustainability</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead">A 2022 Deloitte survey shows CFOs see their contributions as:</p><ul class="sg-ulHeader1"><li>Supporting the business case for investments.</li><li>Meeting reporting disclosure standards and requirements.</li><li>Tracking progress with KPIs.</li></ul><p class="center_Lead"><strong>Investments, banking, and lending can have significant scope 3 emissions. CFOs are recognizing this and taking action.</strong></p><h3>Finance’s expected impact</h3><p class="center_Lead">Looking ahead, what do you believe will likely have been the most impactful change that you and/or your finance organization will have made to address sustainability? (N=53)</p><img src="/sites/default/files/2025-07/Sus-Finances.png" alt="Bar graph: 30% Building / evaluating business cases for investments, 30% Meeting reporting disclosure standards and requirements, 27% Providing data, KPIs targets and reporting on progress, 9% Financing investments, 3% Other"></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Investments"><div class="row"><h2 class="SessionTitle">Investments and the Foundation</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead">Investments can represent 20 to 30% of scope 3 emissions in health care operations, depending on investment strategies. The financial sector has recognized an interest in organizations wishing to build sustainable investments by offering some mechanisms for sustainable investing.</p><p class="center_Lead">In addition, some health care foundations seek investments that actively support projects to help communities adapt to environmental factors and also have a desirable return on investment.</p></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Question"><div class="row"><h2 class="SessionTitle">The Power of Asking the Question</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><h3>Can you transform the marketplace by asking a question?</h3><p class="center_Lead">A free market economy self regulates with supply and demand. Innovations can reduce costs and give suppliers an edge. Customers can also drive innovation, but customers need to inform the marketplace of their interests. Asking suppliers if they can meet environmental stewardship and sustainability targets is a great place to start.</p><p class="center_Lead">In the case of health care, medical supplies and equipment need to be cost-effective and meet specific criteria for their clinical use. Quality cannot be compromised in the interest of sustainability — and this is where opportunities exist for innovation.</p><p class="center_Lead">The construction industry has a great example of transforming the marketplace by encouraging innovation with a clear goal: to reduce volatile organic compounds (VOCs) in paint. Glidden Company developed the first VOC-free coatings in 1992, but they had significantly higher cost. In the 2000s, the Leadership in Energy and Environmental Design (LEED) rating system incentivized construction projects to use low-VOC paint, so architects and contractors began asking the question, “Can you meet this target?”</p><p class="center_Lead">Innovations to reduce carbon and improve sustainability are possible in health care. Health care systems should ask the question to inform and incentivize the market.</p><div class="row"><div class="col-md-10 col-md-offset-1 shcItemsLine"> </div></div><p class="center_Lead"><strong>Banking, lending, insurance</strong> all have associated scope 3 emissions in health care. At your next opportunity, ask these partners:</p><ul class="sg-ulHeader1"><li>How is their business addressing environmental stewardship through their internal operations?</li><li>Can their business offer any programs that promote environmental stewardship?</li><li>How is their business addressing environmental stewardship in their investments?</li></ul></div><div class="col-md-1"> </div></div></div> Fri, 18 Jul 2025 19:00:00 -0500 Guides/Reports /sustainability/health-care-leaders-guide/board <div class="raw-html-embed"> </div><div class="raw-html-embed"> .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 0px auto; } .LogoInsert { position: absolute; top: 0px; height:100%; left:0px; } .LogoInsert img{ max-width:500px; max-height:125px; top:calc(50% - 125px/2); left:calc(100% + 50px); position:absolute; } .LogoInsert h1{ position:absolute; left:0px; bottom:0px; width:500px; opacity:0; margin: 0px; padding: 0; } @media (max-width:640px) { .LogoBG { object-fit: cover; height: 200px; } .LogoInsert img { max-width: 250px; left: calc(100% + 15px); top: calc(50% - 112px/2); background-color: #00584499; padding: 25px; border-radius: 30px 0px; } } @media (max-width:320px) { .LogoBG { height: 150px; } } <header class="Banner_Title_Overlay_Bar"> <img alt="Banner Image - Glass Earth sitting in a hand over tall grass" class="LogoBG" src="/sites/default/files/2023-03/sustainability-roadmap-web-home-banner-1170x250.jpg"> <div class="LogoInsert"> <img alt="Sustainability Roadmap for Health Care | Achieving Your Sustainability Goals - Logo" src="/sites/default/files/2023-03/SustainabilityRoadmap_Logo_Hor-white_700x217.png"></div> </header> </div> .shcIntro{ background-color:#78be2022; padding: 5px 50px 15px 50px; margin-bottom:20px; } .shcIntro h1, .shcIntro h2, .shcIntro h3 { color: #005844; text-align: center; } .shcIntro h1{ font-size:2em; } .shcIntro h2{ font-size:1.6em; } shcIntro ul{ color: grey; } <div class="shcIntro"><h1>The Board's Guide to Environmental Stewardship</h1></div><div class="raw-html-embed"> <div class="row"> /* TocMini */ .TocMini { margin: 0px auto 25px; padding-bottom: 5px; color: #005844; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; width: 80%; } .TocMini .TocMiniBar { border: 1px solid #78be20; padding: 5px 10px; overflow: auto; border-radius: 20px 0px; } .TocMini .TocMiniBar .TocMiniGroup a:after { content: "|"; padding: 0 3px 0 6px; color: #253b80; font-weight: 700; } .TocMini .TocMiniBar .TocMiniGroup a:last-child:after { content: ""; } .TocMini .TocMiniGroup { float: right; } .TocMini .TocMiniHome { text-transform: uppercase; color: #005844; font-weight: 700; } .TocMini .TocMiniChild { font-weight: 500; opacity: .9; color: #555; } .TocMini .TocMiniHome:hover, .TocMini .TocMiniChild:hover { text-transform: ; color: #5fa1d0; } .TocMini .TocMiniActive{ font-weight: 700; color: #5fa1d0; } /* TocMini // */ <div class="TocMini"> <div class="TocMiniBar"> <a class="TocMiniHome" href="/sustainability" target="_blank" title="Home - Sustainability Roadmap for Health Care">Sustainability Roadmap for Health Care</a> <div class="TocMiniGroup"> <a class="TocMiniChild" href="https://www.ashe.org/sustainability" target="_blank" title="ASHE Sustainability for Health Care Facilities">Sustainability for Health Care Facilities</a> <a class="TocMiniChild" href="/sustainability/glossary" target="_blank" title="Glossary">Glossary</a> <a class="TocMiniChild" href="https://www.ashe.org/sustainability/healquest" target="_blank" title="HealQuest">HealQuest<sup>TM</sup></a> </div> </div> </div> </div> </div> .btn-primary { background-color: #005844; } .shcItemsLine { border-bottom:solid 1px #78be20; margin-top:10px; margin-bottom:25px; } .shcHighlight h3{ color:#333; font-size:16px; text-align:center; margin:0px } .shcHighlight span{ font-weight:700; color:#78be20; } p.center_Lead, ul li.center_Lead{ color: #63666A; font-weight: 300; line-height: 1.4; font-size: 20px; } <div class="row shcHighlight BulletCircle"><div class="col-sm-6 col-md-7"><p class="center_Lead">Boards are charged with maximizing the value of an organization and they are increasingly acknowledging the opportunities and risks that sustainability and environmental stewardship present. As ambassadors for the organization, board members act as stewards for the long term and understand the priority impact areas around sustainability, which also inform long-term strategy.</p><div class="col-md-10 col-md-offset-1 shcItemsLine"> </div></div><div class="col-sm-6 col-md-5"> <div data-entity-type="webform" data-entity-uuid="82c58bca-9296-40b2-8941-0c6929d9ef6b" data-embed-button="webform_embed" data-entity-embed-display="view_mode:webform.token" data-langcode="en" data-entity-embed-display-settings="[]" class="embedded-entity"> <div class="antibot-no-js antibot-message antibot-message-warning">You must have JavaScript enabled to use this form.</div> <div id="edit-sustainability-menu-code--2" class="js-form-item form-item js-form-type-processed-text form-item- js-form-item- form-no-label"> <div class="raw-html-embed"> .webform-submission-form { margin: 0em auto; max-width: 100%; padding: 0 0px; .ResourceHolder-1 { background-color: #78be2022; padding: 25px 9px; display: inline-block; border-radius: 50px 50px 0 0; width: 100% } .ResourceHolder-1 h2 { color: ; line-height: 18px; font-size: 18px; margin: 10px 0 15px 0; text-align:center; } .ResourceHolder-1 h2 a { color: #005844; } .ResourceHolder-1 h2 a:hover { color: #4579bc; } <div class="ResourceHolder-1"> <div class="col-md-4"> <a href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="The Health Care Leader's Guide to Sustainability and Environmental Stewardship"><img src="/sites/default/files/2025-07/Sus-Guide-Cover-777x600.png" alt="Cover image of the AHA's guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship" width="100%"></a> </div> <div class="col-md-8"> <h2><a href="/sustainability/health-care-leaders-guide" title="Start at the begining of the Guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">The Health Care Leader’s Guide</a></h2> .RuralAgendaTOC { text-align: center; font-weight: 700; font-size: 15px; background-color: ; padding: 0 15px 15px 15px; } .RuralAgendaTOC a:link { color: #005844; text-decoration: none; } .RuralAgendaTOC a:hover { color: #FED141aa; } .RuralAgendaTOC a:hover { color: #4579bc; ; } .RuralAgendaTOC a:active { color: green; } <h3>Sections:</h3> <div class="RuralAgendaTOC"> <a href="/sustainability/health-care-leaders-guide/team" title="Go to section on: The Sustainability and Environmental Stewardship Team">Sustainability Team </a>| <a href="/sustainability/health-care-leaders-guide/ceos" title="Go to section on: CEO’s Guide">CEO </a>| <a href="/sustainability/health-care-leaders-guide/coos" title="Go to section on: COO’s Guide">COO </a>| <a href="/sustainability/health-care-leaders-guide/cfos" title="Go to section on: CFO’s Guide">CFO </a>| <a href="/sustainability/health-care-leaders-guide/board" title="Go to section on: Board's Guide">Board </a>| <a href="/sustainability/health-care-leaders-guide/business-case" title="Go to section on: The Business Case">Business Case</a> </div> <div> <a class="btn btn-primary btn-wide" href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="Download the printable version: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">Printable Version</a> </div> </div> </div></div> </div> <div class="homepage-textfield js-form-wrapper form-wrapper"><div class="js-form-item form-item js-form-type-textfield form-item-homepage js-form-item-homepage"> Leave this field blank </div> </div> </div></div></div><div class="row spacer"> @media (min-width:720px){ .srIntro2{ column-count: 2; } } <div class="col-md-12 srIntro2"><p class="center_Lead">Environmental stewardship should now be considered a supporting element of the health care mission to heal and promote well-being. The field is encouraged to recognize and acknowledge community expectations regarding environmental stewardship, along with the risks the environment poses to hospitals’ physical assets. As such, the sector’s actions merit support for creating a new avenue for financial savings through the reduction of energy, water, and carbon emissions, with health care organizations considering environmental stewardship among its strategic initiatives. As such, the sector’s actions merit support for worldwide reductions in carbon emissions, with health care organization considering the inclusion of sustainability and decarbonization among its strategic initiatives.</p><p class="center_Lead">The board of directors is uniquely positioned to consider both the opportunities and risks the environment presents to the organization. Charged with maximizing the value of the organization and acting in the organization’s best interest, the board of directors recognizes the savings opportunities, environmental risks, and environmental awareness of the community.</p></div></div><h2 class="text-align-center">Sections</h2> .Sticky { position: sticky; top: 0; background-color: #fff; z-index: 1000; border-radius: 0 0 25px 25px; z-index:1000; color: #78be20; width: fit-content; margin: auto; padding: 0px 10px 5px; font-size:14px; } .Sticky nav p{ font-size:14px; font-weight:700; line-height:13px } @media (max-width:790px){ .Sticky nav p{ font-size:11px; } } .Sticky a { color: #005844; text-decoration: none; } .Sticky .scroll-watcher { height: 10px; position: relative; top: 0; left: 0; z-index: 1000; background-color: #78be20; width: 100%; scale: 0 1; transform-origin: left; animation: scroll-watcher linear; animation-timeline: scroll(y); } @keyframes scroll-watcher { to { scale: 1 1; } } <div class="scroll-watcher"> </div><nav><p><a href="#Responsibility">The Board’s Responsibility</a> | <a href="#Recommendations">Recommendations for the Board of Directors</a></p></nav> .SessionWrapper { border: solid 2px #005844; margin-bottom: 20px; } h2.SessionTitle { font-weight: 700; background-color: #00584422; color: #005844; padding: 15px; margin-top: 0px; margin-bottom: 25px; font-size: 33px; } .SessionEvents { margin-bottom: 30px; display:inline-block; } .SessionEvents br { margin-bottom: 10px; } .SessionEvents h3 { font-size: 30px; } .SessionEvents h4 { color: #9d2235; } .SessionEvents ul { list-style: none; /* Remove default bullets */ padding-left: 25px; margin-bottom: 25px; } .SessionEvents ul li { margin-bottom: 7px; line-height: 1.5em; font-size: 16px; } .SessionEvents ul li::before { content: "●"; font-size: 1em; position: relative; top: 0px; color: #78be20; text-indent: -20px; padding-right: 10px; } .SessionEvents ul li { padding-left: 23px; text-indent: -23px; } .SessionEvents img { margin-top: 25px; } <div class="container SessionWrapper" id="Responsibility"><div class="row"><h2 class="SessionTitle">The Board’s Responsibility</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead">While the board’s duty is to oversee the organization, the words and actions of individual board members can elevate strategic initiatives and strengthen the culture of the organization. Board members are ambassadors for the organization and have a responsibility to help the CEO be successful.</p><p class="center_Lead">The board often acts as stewards for the long term, and helps to evaluate the impact the environment has on business performance. The board can oversee a materiality assessment to understand priority areas and inform long-term strategy. Organizations might formalize the board’s role by including references to environmental stewardship in the board’s charters and annual training.</p><p class="center_Lead">If sustainability and environmental stewardship are new concepts to the board of directors, there are resources available on the Sustainability Roadmap that provide insights and resources for the health care enterprise, including operations, procurement, purchasing, maintenance, and new models of care.</p><p class="center_Lead">U.S. health care systems are beginning to make structural changes to support the strategic initiative of sustainability as a transformational program for their organizations.</p><p class="center_Lead">Organizations that learn from other leaders will celebrate achievements along the way, garnering support from stakeholders and positioning the organization to maximize value.</p></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Recommendations"><div class="row"><h2 class="SessionTitle">Recommendations for the Board of Directors</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"> ol.sg-olHeader > li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; font-weight:700 } ol.sg-olHeader > li > ul li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; } <ol class="sg-olHeader"><li>Become familiar with and learn about the principles of environmental stewardship.</li><li>Review/oversee a materiality assessment to understand the impact the environment plays on business performance.</li><li>Consider formalizing the board’s role by including environmental stewardship and sustainability as priorities in the board manual, charters, and annual training.</li><li>Plan regular board trainings on sustainability and environmental stewardship in health care.</li><li>Support and oversee management efforts to track progress towards the plan.</li><li>Create a board committee or include environmental stewardship discussions in an existing board committee.</li><li>Board members, in their roles as ambassadors, could consider reinforcing the importance of environmental stewardship in the community.</li></ol></div><div class="col-md-1"> </div></div></div> Fri, 18 Jul 2025 19:00:00 -0500 Guides/Reports /sustainability/health-care-leaders-guide/cfos <div class="raw-html-embed"> </div><div class="raw-html-embed"> .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 0px auto; } .LogoInsert { position: absolute; top: 0px; height:100%; left:0px; } .LogoInsert img{ max-width:500px; max-height:125px; top:calc(50% - 125px/2); left:calc(100% + 50px); position:absolute; } .LogoInsert h1{ position:absolute; left:0px; bottom:0px; width:500px; opacity:0; margin: 0px; padding: 0; } @media (max-width:640px) { .LogoBG { object-fit: cover; height: 200px; } .LogoInsert img { max-width: 250px; left: calc(100% + 15px); top: calc(50% - 112px/2); background-color: #00584499; padding: 25px; border-radius: 30px 0px; } } @media (max-width:320px) { .LogoBG { height: 150px; } } <header class="Banner_Title_Overlay_Bar"> <img alt="Banner Image - Glass Earth sitting in a hand over tall grass" class="LogoBG" src="/sites/default/files/2023-03/sustainability-roadmap-web-home-banner-1170x250.jpg"> <div class="LogoInsert"> <img alt="Sustainability Roadmap for Health Care | Achieving Your Sustainability Goals - Logo" src="/sites/default/files/2023-03/SustainabilityRoadmap_Logo_Hor-white_700x217.png"></div> </header> </div> .shcIntro{ background-color:#78be2022; padding: 5px 50px 15px 50px; margin-bottom:20px; } .shcIntro h1, .shcIntro h2, .shcIntro h3 { color: #005844; text-align: center; } .shcIntro h1{ font-size:2em; } .shcIntro h2{ font-size:1.6em; } shcIntro ul{ color: grey; } <div class="shcIntro"><h1>The CFO’s Guide to Environmental Stewardship</h1></div><div class="raw-html-embed"> <div class="row"> /* TocMini */ .TocMini { margin: 0px auto 25px; padding-bottom: 5px; color: #005844; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; width: 80%; } .TocMini .TocMiniBar { border: 1px solid #78be20; padding: 5px 10px; overflow: auto; border-radius: 20px 0px; } .TocMini .TocMiniBar .TocMiniGroup a:after { content: "|"; padding: 0 3px 0 6px; color: #253b80; font-weight: 700; } .TocMini .TocMiniBar .TocMiniGroup a:last-child:after { content: ""; } .TocMini .TocMiniGroup { float: right; } .TocMini .TocMiniHome { text-transform: uppercase; color: #005844; font-weight: 700; } .TocMini .TocMiniChild { font-weight: 500; opacity: .9; color: #555; } .TocMini .TocMiniHome:hover, .TocMini .TocMiniChild:hover { text-transform: ; color: #5fa1d0; } .TocMini .TocMiniActive{ font-weight: 700; color: #5fa1d0; } /* TocMini // */ <div class="TocMini"> <div class="TocMiniBar"> <a class="TocMiniHome" href="/sustainability" target="_blank" title="Home - Sustainability Roadmap for Health Care">Sustainability Roadmap for Health Care</a> <div class="TocMiniGroup"> <a class="TocMiniChild" href="https://www.ashe.org/sustainability" target="_blank" title="ASHE Sustainability for Health Care Facilities">Sustainability for Health Care Facilities</a> <a class="TocMiniChild" href="/sustainability/glossary" target="_blank" title="Glossary">Glossary</a> <a class="TocMiniChild" href="https://www.ashe.org/sustainability/healquest" target="_blank" title="HealQuest">HealQuest<sup>TM</sup></a> </div> </div> </div> </div> </div> .btn-primary { background-color: #005844; } .shcItemsLine { border-bottom:solid 1px #78be20; margin-top:10px; margin-bottom:25px; } .shcHighlight h3{ color:#333; font-size:16px; text-align:center; margin:0px } .shcHighlight span{ font-weight:700; color:#78be20; } p.center_Lead, ul li.center_Lead{ color: #63666A; font-weight: 300; line-height: 1.4; font-size: 20px; } <div class="row shcHighlight BulletCircle"><div class="col-sm-6 col-md-7"><p class="center_Lead">Finance teams led by the chief financial officer support sustainability and environmental stewardship initiatives through bolstering the value proposition, defining outcomes, and tracking and measuring progress toward sustainability goals. Whether through analyzing pricing or assessing risk, CFO’s play an integral role in in environmental stewardship.</p><div class="col-md-10 col-md-offset-1 shcItemsLine"> </div></div><div class="col-sm-6 col-md-5"> <div data-entity-type="webform" data-entity-uuid="82c58bca-9296-40b2-8941-0c6929d9ef6b" data-embed-button="webform_embed" data-entity-embed-display="view_mode:webform.token" data-langcode="en" data-entity-embed-display-settings="[]" class="embedded-entity"> <div class="antibot-no-js antibot-message antibot-message-warning">You must have JavaScript enabled to use this form.</div> <div id="edit-sustainability-menu-code--3" class="js-form-item form-item js-form-type-processed-text form-item- js-form-item- form-no-label"> <div class="raw-html-embed"> .webform-submission-form { margin: 0em auto; max-width: 100%; padding: 0 0px; .ResourceHolder-1 { background-color: #78be2022; padding: 25px 9px; display: inline-block; border-radius: 50px 50px 0 0; width: 100% } .ResourceHolder-1 h2 { color: ; line-height: 18px; font-size: 18px; margin: 10px 0 15px 0; text-align:center; } .ResourceHolder-1 h2 a { color: #005844; } .ResourceHolder-1 h2 a:hover { color: #4579bc; } <div class="ResourceHolder-1"> <div class="col-md-4"> <a href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="The Health Care Leader's Guide to Sustainability and Environmental Stewardship"><img src="/sites/default/files/2025-07/Sus-Guide-Cover-777x600.png" alt="Cover image of the AHA's guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship" width="100%"></a> </div> <div class="col-md-8"> <h2><a href="/sustainability/health-care-leaders-guide" title="Start at the begining of the Guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">The Health Care Leader’s Guide</a></h2> .RuralAgendaTOC { text-align: center; font-weight: 700; font-size: 15px; background-color: ; padding: 0 15px 15px 15px; } .RuralAgendaTOC a:link { color: #005844; text-decoration: none; } .RuralAgendaTOC a:hover { color: #FED141aa; } .RuralAgendaTOC a:hover { color: #4579bc; ; } .RuralAgendaTOC a:active { color: green; } <h3>Sections:</h3> <div class="RuralAgendaTOC"> <a href="/sustainability/health-care-leaders-guide/team" title="Go to section on: The Sustainability and Environmental Stewardship Team">Sustainability Team </a>| <a href="/sustainability/health-care-leaders-guide/ceos" title="Go to section on: CEO’s Guide">CEO </a>| <a href="/sustainability/health-care-leaders-guide/coos" title="Go to section on: COO’s Guide">COO </a>| <a href="/sustainability/health-care-leaders-guide/cfos" title="Go to section on: CFO’s Guide">CFO </a>| <a href="/sustainability/health-care-leaders-guide/board" title="Go to section on: Board's Guide">Board </a>| <a href="/sustainability/health-care-leaders-guide/business-case" title="Go to section on: The Business Case">Business Case</a> </div> <div> <a class="btn btn-primary btn-wide" href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="Download the printable version: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">Printable Version</a> </div> </div> </div></div> </div> <div class="homepage-textfield js-form-wrapper form-wrapper"><div class="js-form-item form-item js-form-type-textfield form-item-homepage js-form-item-homepage"> Leave this field blank </div> </div> </div></div></div><div class="row spacer"><div class="col-md-4"><p class="center_Lead">Sustainability initiatives in health care organizations should include operational practices and focused projects — both of which require funding. As a key voice in the financial analysis for these projects and initiatives, the chief financial officer and finance team can support the value proposition by helping to define expected outcomes. Finance teams also have the skills to support internal measurement and tracking to monitor progress towards sustainability goals.</p></div><div class="col-md-4"><p class="center_Lead"><strong>KPIs for sustainability and decarbonization may include:</strong></p><ul><li class="center_Lead">Energy consumption and associated emissions.</li><li class="center_Lead">Fuel consumption in owned and leased vehicles and calculated emissions.</li><li class="center_Lead">Emissions from business travel.</li><li class="center_Lead">Emissions from anesthetics.</li></ul></div><div class="col-md-4"><p class="center_Lead"><strong>Because 80% of health care emissions are from purchased goods and services:</strong></p><ul><li class="center_Lead">Track spending to analyze scope 3 emissions within the organization.</li><li class="center_Lead">Work with operations and procurement to identify suppliers that can reduce scope 3 emissions.</li></ul></div></div><div class="row spacer"><div class="col-sm-6"><img src="/sites/default/files/2025-07/Sus-GHG-Emissions.png" alt="Hospital GHG Emissions Impact by Category, a visual graph of items shown between Ease of Data Collection and Mitigation Opportunity"></div><div class="col-sm-6"><img src="/sites/default/files/2025-07/Sus-Quote-Jamie.png" alt="Jamie Dimon, CEO of JPMorgan Chase, 'We have a goal to reduce the carbon intensity of our financing portfolio… and we are minimizing the environmental impact of our physical operations.'"></div></div><h2 class="text-align-center">Sections</h2> .Sticky { position: sticky; top: 0; background-color: #fff; z-index: 1000; border-radius: 0 0 25px 25px; z-index:1000; color: #78be20; width: fit-content; margin: auto; padding: 0px 10px 5px; font-size:14px; } .Sticky nav p{ font-size:14px; font-weight:700; line-height:13px } @media (max-width:790px){ .Sticky nav p{ font-size:11px; } } .Sticky a { color: #005844; text-decoration: none; } .Sticky .scroll-watcher { height: 10px; position: relative; top: 0; left: 0; z-index: 1000; background-color: #78be20; width: 100%; scale: 0 1; transform-origin: left; animation: scroll-watcher linear; animation-timeline: scroll(y); } @keyframes scroll-watcher { to { scale: 1 1; } } <div class="scroll-watcher"> </div><nav><p><a href="#Benchmarking">Benchmarking Outside of Health Care</a> | <a href="#Recommendations">Recommendations for the Health Care CFO</a></p></nav> .SessionWrapper { border: solid 2px #005844; margin-bottom: 20px; } h2.SessionTitle { font-weight: 700; background-color: #00584422; color: #005844; padding: 15px; margin-top: 0px; margin-bottom: 25px; font-size: 33px; } .SessionEvents { margin-bottom: 30px; display:inline-block; } .SessionEvents br { margin-bottom: 10px; } .SessionEvents h3 { font-size: 30px; } .SessionEvents h4 { color: #9d2235; } .SessionEvents ul { list-style: none; /* Remove default bullets */ padding-left: 25px; margin-bottom: 25px; } .SessionEvents ul li { margin-bottom: 7px; line-height: 1.5em; font-size: 16px; } .SessionEvents ul li::before { content: "●"; font-size: 1em; position: relative; top: 0px; color: #78be20; text-indent: -20px; padding-right: 10px; } .SessionEvents ul li { padding-left: 23px; text-indent: -23px; } .SessionEvents img { margin-top: 25px; } <div class="container SessionWrapper" id="Benchmarking"><div class="row"><h2 class="SessionTitle">Benchmarking Outside of Health Care</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead">Some chief financial officers (CFOs) are treating non-financial KPIs and targets with the same prudence as traditional financial targets and linking sustainability to value drivers.</p><p class="center_Lead">68% of CFOs globally take responsibility for their organization’s environmental stewardship performance.</p><p class="center_Lead">73% of investors surveyed say they will devote considerable time and attention to evaluating the physical risk implications from the environment when they make asset allocation and selection decisions (see figure).</p><div class="row"><div class="col-sm-6"><img src="/sites/default/files/2025-07/Sus-Percentage-respondents.png" alt="Percentage of respondents who say they usually conduct a structured, methodical evaluation of nonfinancial disclosures. 27%, 32%, 72%"></div><div class="col-sm-6"><img src="/sites/default/files/2025-07/Sus-Framework-environmental.png" alt="Framework for environmental stewardship reporting (TCFD); Governance, Strategy, Risk Management, Metrics, and Targets are each displayed in smaller concentric circles."></div></div></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Recommendations"><div class="row"><h2 class="SessionTitle">Recommendations for the Health Care CFO</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"> ol.sg-olHeader > li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; font-weight:700 } ol.sg-olHeader > li > ul li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; } <ol class="sg-olHeader"><li>Review financial analysis practices to recognize environmental impacts. For example:<ul><li>Assess risk to disruption in operations.</li></ul></li><li>Inquire with financing, banking and insurance providers about environmental stewardship practices:<ul><li>Competition in the marketplace creates incentives for providers to innovate in environmental stewardship, if they understand the organization values it.</li><li>How do partners incorporate sustainability in the services they offer?</li></ul></li><li>Recognize sustainability in non-financial reporting for your organization:<ul><li>Annual environmental stewardship report</li></ul></li></ol></div><div class="col-md-1"> </div></div></div> Fri, 18 Jul 2025 19:00:00 -0500 Guides/Reports /sustainability/health-care-leaders-guide/coos <div class="raw-html-embed"> </div><div class="raw-html-embed"> .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 0px auto; } .LogoInsert { position: absolute; top: 0px; height:100%; left:0px; } .LogoInsert img{ max-width:500px; max-height:125px; top:calc(50% - 125px/2); left:calc(100% + 50px); position:absolute; } .LogoInsert h1{ position:absolute; left:0px; bottom:0px; width:500px; opacity:0; margin: 0px; padding: 0; } @media (max-width:640px) { .LogoBG { object-fit: cover; height: 200px; } .LogoInsert img { max-width: 250px; left: calc(100% + 15px); top: calc(50% - 112px/2); background-color: #00584499; padding: 25px; border-radius: 30px 0px; } } @media (max-width:320px) { .LogoBG { height: 150px; } } <header class="Banner_Title_Overlay_Bar"> <img alt="Banner Image - Glass Earth sitting in a hand over tall grass" class="LogoBG" src="/sites/default/files/2023-03/sustainability-roadmap-web-home-banner-1170x250.jpg"> <div class="LogoInsert"> <img alt="Sustainability Roadmap for Health Care | Achieving Your Sustainability Goals - Logo" src="/sites/default/files/2023-03/SustainabilityRoadmap_Logo_Hor-white_700x217.png"></div> </header> </div> .shcIntro{ background-color:#78be2022; padding: 5px 50px 15px 50px; margin-bottom:20px; } .shcIntro h1, .shcIntro h2, .shcIntro h3 { color: #005844; text-align: center; } .shcIntro h1{ font-size:2em; } .shcIntro h2{ font-size:1.6em; } shcIntro ul{ color: grey; } <div class="shcIntro"><h1>The COO’s Guide to Environmental Stewardship</h1></div><div class="raw-html-embed"> <div class="row"> /* TocMini */ .TocMini { margin: 0px auto 25px; padding-bottom: 5px; color: #005844; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; width: 80%; } .TocMini .TocMiniBar { border: 1px solid #78be20; padding: 5px 10px; overflow: auto; border-radius: 20px 0px; } .TocMini .TocMiniBar .TocMiniGroup a:after { content: "|"; padding: 0 3px 0 6px; color: #253b80; font-weight: 700; } .TocMini .TocMiniBar .TocMiniGroup a:last-child:after { content: ""; } .TocMini .TocMiniGroup { float: right; } .TocMini .TocMiniHome { text-transform: uppercase; color: #005844; font-weight: 700; } .TocMini .TocMiniChild { font-weight: 500; opacity: .9; color: #555; } .TocMini .TocMiniHome:hover, .TocMini .TocMiniChild:hover { text-transform: ; color: #5fa1d0; } .TocMini .TocMiniActive{ font-weight: 700; color: #5fa1d0; } /* TocMini // */ <div class="TocMini"> <div class="TocMiniBar"> <a class="TocMiniHome" href="/sustainability" target="_blank" title="Home - Sustainability Roadmap for Health Care">Sustainability Roadmap for Health Care</a> <div class="TocMiniGroup"> <a class="TocMiniChild" href="https://www.ashe.org/sustainability" target="_blank" title="ASHE Sustainability for Health Care Facilities">Sustainability for Health Care Facilities</a> <a class="TocMiniChild" href="/sustainability/glossary" target="_blank" title="Glossary">Glossary</a> <a class="TocMiniChild" href="https://www.ashe.org/sustainability/healquest" target="_blank" title="HealQuest">HealQuest<sup>TM</sup></a> </div> </div> </div> </div> </div> .btn-primary { background-color: #005844; } .shcItemsLine { border-bottom:solid 1px #78be20; margin-top:10px; margin-bottom:25px; } .shcHighlight h3{ color:#333; font-size:16px; text-align:center; margin:0px } .shcHighlight span{ font-weight:700; color:#78be20; } p.center_Lead, ul li.center_Lead{ color: #63666A; font-weight: 300; line-height: 1.4; font-size: 20px; } <div class="row shcHighlight BulletCircle"><div class="col-sm-6 col-md-7"><p class="center_Lead">Chief operating officers hold a unique opportunity to build and empower teams and accelerate environmental stewardship initiatives. Recognizing that all functional roles can impact sustainability, the COO can support individuals and teams to promote cross-functional teamwork and stimulate innovative sustainability solutions throughout the operations of the organization.</p><div class="col-md-10 col-md-offset-1 shcItemsLine"> </div></div><div class="col-sm-6 col-md-5"> <div data-entity-type="webform" data-entity-uuid="82c58bca-9296-40b2-8941-0c6929d9ef6b" data-embed-button="webform_embed" data-entity-embed-display="view_mode:webform.token" data-langcode="en" data-entity-embed-display-settings="[]" class="embedded-entity"> <div class="antibot-no-js antibot-message antibot-message-warning">You must have JavaScript enabled to use this form.</div> <div id="edit-sustainability-menu-code--4" class="js-form-item form-item js-form-type-processed-text form-item- js-form-item- form-no-label"> <div class="raw-html-embed"> .webform-submission-form { margin: 0em auto; max-width: 100%; padding: 0 0px; .ResourceHolder-1 { background-color: #78be2022; padding: 25px 9px; display: inline-block; border-radius: 50px 50px 0 0; width: 100% } .ResourceHolder-1 h2 { color: ; line-height: 18px; font-size: 18px; margin: 10px 0 15px 0; text-align:center; } .ResourceHolder-1 h2 a { color: #005844; } .ResourceHolder-1 h2 a:hover { color: #4579bc; } <div class="ResourceHolder-1"> <div class="col-md-4"> <a href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="The Health Care Leader's Guide to Sustainability and Environmental Stewardship"><img src="/sites/default/files/2025-07/Sus-Guide-Cover-777x600.png" alt="Cover image of the AHA's guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship" width="100%"></a> </div> <div class="col-md-8"> <h2><a href="/sustainability/health-care-leaders-guide" title="Start at the begining of the Guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">The Health Care Leader’s Guide</a></h2> .RuralAgendaTOC { text-align: center; font-weight: 700; font-size: 15px; background-color: ; padding: 0 15px 15px 15px; } .RuralAgendaTOC a:link { color: #005844; text-decoration: none; } .RuralAgendaTOC a:hover { color: #FED141aa; } .RuralAgendaTOC a:hover { color: #4579bc; ; } .RuralAgendaTOC a:active { color: green; } <h3>Sections:</h3> <div class="RuralAgendaTOC"> <a href="/sustainability/health-care-leaders-guide/team" title="Go to section on: The Sustainability and Environmental Stewardship Team">Sustainability Team </a>| <a href="/sustainability/health-care-leaders-guide/ceos" title="Go to section on: CEO’s Guide">CEO </a>| <a href="/sustainability/health-care-leaders-guide/coos" title="Go to section on: COO’s Guide">COO </a>| <a href="/sustainability/health-care-leaders-guide/cfos" title="Go to section on: CFO’s Guide">CFO </a>| <a href="/sustainability/health-care-leaders-guide/board" title="Go to section on: Board's Guide">Board </a>| <a href="/sustainability/health-care-leaders-guide/business-case" title="Go to section on: The Business Case">Business Case</a> </div> <div> <a class="btn btn-primary btn-wide" href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="Download the printable version: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">Printable Version</a> </div> </div> </div></div> </div> <div class="homepage-textfield js-form-wrapper form-wrapper"><div class="js-form-item form-item js-form-type-textfield form-item-homepage js-form-item-homepage"> Leave this field blank </div> </div> </div></div></div><div class="row spacer"><div class="col-md-6"><p class="center_Lead">As the leader responsible for health care operations, the chief operating officer’s actions can effectively accelerate environmental stewardship initiatives. Conversely, without COO support, meaningful improvements in environmental stewardship are unlikely. The COO need not be an expert in sustainability but must actively strive to integrate sustainability into business processes.</p><p class="center_Lead">The Institute for Healthcare Improvement (IHI) uses the triple aim as a framework to optimize health system performance, which can also be applied to environmental stewardship. The triple aim seeks improvements in health care by optimizing practices that:</p><ul><li class="center_Lead">Improve the patient experience.</li><li class="center_Lead">Improve population health.</li><li class="center_Lead">Reduce per capita costs of care.</li></ul></div><div class="col-md-6"><p class="center_Lead">The IHI says it recognizes that improvements happen when teams have the will, which unlocks ideas that are supported for implementation.</p><p class="center_Lead">Tapping into this familiar thought process, organizations can seek out improvements for environmental stewardship. The COO can recognize that all functional roles impact sustainability in health care and empower individuals to participate in problem-solving to help with employee recruitment and retention. Framing sustainability as a growth mindset helps to identify areas for improvement, promote cross-functional teamwork and stimulate solutions — many likely to come from the supply chain.</p><p class="center_Lead">Any strategic initiative must have leadership. While sustainability teams can be a great way to start, too often they are composed of only volunteers. Environmental stewardship could be included in job descriptions for supervisors to support the initiative. When individuals have clear support for these efforts, they give it the time it needs.</p></div></div><h2 class="text-align-center">Sections</h2> .Sticky { position: sticky; top: 0; background-color: #fff; z-index: 1000; border-radius: 0 0 25px 25px; z-index:1000; color: #78be20; width: fit-content; margin: auto; padding: 0px 10px 5px; font-size:14px; } .Sticky nav p{ font-size:14px; font-weight:700; line-height:13px } @media (max-width:790px){ .Sticky nav p{ font-size:11px; } } .Sticky a { color: #005844; text-decoration: none; } .Sticky .scroll-watcher { height: 10px; position: relative; top: 0; left: 0; z-index: 1000; background-color: #78be20; width: 100%; scale: 0 1; transform-origin: left; animation: scroll-watcher linear; animation-timeline: scroll(y); } @keyframes scroll-watcher { to { scale: 1 1; } } <div class="scroll-watcher"> </div><nav><p><a href="#Leading">Leading Toward Sustainability</a> | <a href="#Recommendations">Recommendations for the Health Care COO</a></p></nav> .SessionWrapper { border: solid 2px #005844; margin-bottom: 20px; } h2.SessionTitle { font-weight: 700; background-color: #00584422; color: #005844; padding: 15px; margin-top: 0px; margin-bottom: 25px; font-size: 33px; } .SessionEvents { margin-bottom: 30px; display:inline-block; } .SessionEvents br { margin-bottom: 10px; } .SessionEvents h3 { font-size: 30px; } .SessionEvents h4 { color: #9d2235; } .SessionEvents ul { list-style: none; /* Remove default bullets */ padding-left: 25px; margin-bottom: 25px; } .SessionEvents ul li { margin-bottom: 7px; line-height: 1.5em; font-size: 16px; } .SessionEvents ul li::before { content: "●"; font-size: 1em; position: relative; top: 0px; color: #78be20; text-indent: -20px; padding-right: 10px; } .SessionEvents ul li { padding-left: 23px; text-indent: -23px; } .SessionEvents img { margin-top: 25px; } <div class="container SessionWrapper" id="Leading"><div class="row"><h2 class="SessionTitle">Leading Toward Sustainability</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead">Improving sustainability within health care organizations requires all departments (and truly, all employees and contractors) to:</p><ol class="sg-olHeader"><li>Understand the importance of improving sustainability (connect to mission).</li><li>Commit to seeking out opportunities to change current practice in a way that improves key performance indicators.</li><li>Collaborate with other stakeholders to review and assess ongoing performance.</li></ol><p class="center_Lead">The complexity of health care facility operations and sourcing requires sustainability and decarbonization to be a strategic priority to achieve meaningful change in KPIs like carbon emissions.</p></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Recommendations"><div class="row"><h2 class="SessionTitle">Recommendations for the Health Care COO</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"> ol.sg-olHeader > li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; font-weight:700 } ol.sg-olHeader > li > ul li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; } <ol class="sg-olHeader"><li>Build a cross-functional team of leaders to drive strategy.<ul><li>Allocate time and incorporate sustainability in job descriptions.</li><li>Instruct the team of leaders to work with all departments to implement initiatives.</li><li>Ask team to provide regular updates, such as monthly operations meetings.</li></ul></li><li>Establish a management system for environmental stewardship.<ul><li>Track KPIs that will measure real progress alongside patient outcomes.</li><li>Incorporate sustainability KPIs into department-level goals.</li><li>Realign internal processes to support sustainability.</li></ul></li><li>Encourage a growth mindset by supporting education for sustainability.<ul><li>Host learning sessions with local experts.</li><li>Sponsor focused training for employees to become experts.</li><li>Share your own successes with other organizations.</li></ul></li></ol></div><div class="col-md-1"> </div></div></div> Fri, 18 Jul 2025 19:00:00 -0500 Guides/Reports /sustainability/health-care-leaders-guide/ceos <div class="raw-html-embed"> </div><div class="raw-html-embed"> .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 0px auto; } .LogoInsert { position: absolute; top: 0px; height:100%; left:0px; } .LogoInsert img{ max-width:500px; max-height:125px; top:calc(50% - 125px/2); left:calc(100% + 50px); position:absolute; } .LogoInsert h1{ position:absolute; left:0px; bottom:0px; width:500px; opacity:0; margin: 0px; padding: 0; } @media (max-width:640px) { .LogoBG { object-fit: cover; height: 200px; } .LogoInsert img { max-width: 250px; left: calc(100% + 15px); top: calc(50% - 112px/2); background-color: #00584499; padding: 25px; border-radius: 30px 0px; } } @media (max-width:320px) { .LogoBG { height: 150px; } } <header class="Banner_Title_Overlay_Bar"> <img alt="Banner Image - Glass Earth sitting in a hand over tall grass" class="LogoBG" src="/sites/default/files/2023-03/sustainability-roadmap-web-home-banner-1170x250.jpg"> <div class="LogoInsert"> <img alt="Sustainability Roadmap for Health Care | Achieving Your Sustainability Goals - Logo" src="/sites/default/files/2023-03/SustainabilityRoadmap_Logo_Hor-white_700x217.png"></div> </header> </div> .shcIntro{ background-color:#78be2022; padding: 5px 50px 15px 50px; margin-bottom:20px; } .shcIntro h1, .shcIntro h2, .shcIntro h3 { color: #005844; text-align: center; } .shcIntro h1{ font-size:2em; } .shcIntro h2{ font-size:1.6em; } shcIntro ul{ color: grey; } <div class="shcIntro"><h1>The CEO's Guide to Environmental Stewardship</h1></div><div class="raw-html-embed"> <div class="row"> /* TocMini */ .TocMini { margin: 0px auto 25px; padding-bottom: 5px; color: #005844; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; width: 80%; } .TocMini .TocMiniBar { border: 1px solid #78be20; padding: 5px 10px; overflow: auto; border-radius: 20px 0px; } .TocMini .TocMiniBar .TocMiniGroup a:after { content: "|"; padding: 0 3px 0 6px; color: #253b80; font-weight: 700; } .TocMini .TocMiniBar .TocMiniGroup a:last-child:after { content: ""; } .TocMini .TocMiniGroup { float: right; } .TocMini .TocMiniHome { text-transform: uppercase; color: #005844; font-weight: 700; } .TocMini .TocMiniChild { font-weight: 500; opacity: .9; color: #555; } .TocMini .TocMiniHome:hover, .TocMini .TocMiniChild:hover { text-transform: ; color: #5fa1d0; } .TocMini .TocMiniActive{ font-weight: 700; color: #5fa1d0; } /* TocMini // */ <div class="TocMini"> <div class="TocMiniBar"> <a class="TocMiniHome" href="/sustainability" target="_blank" title="Home - Sustainability Roadmap for Health Care">Sustainability Roadmap for Health Care</a> <div class="TocMiniGroup"> <a class="TocMiniChild" href="https://www.ashe.org/sustainability" target="_blank" title="ASHE Sustainability for Health Care Facilities">Sustainability for Health Care Facilities</a> <a class="TocMiniChild" href="/sustainability/glossary" target="_blank" title="Glossary">Glossary</a> <a class="TocMiniChild" href="https://www.ashe.org/sustainability/healquest" target="_blank" title="HealQuest">HealQuest<sup>TM</sup></a> </div> </div> </div> </div> </div> .btn-primary { background-color: #005844; } .shcItemsLine { border-bottom:solid 1px #78be20; margin-top:10px; margin-bottom:25px; } .shcHighlight h3{ color:#333; font-size:16px; text-align:center; margin:0px } .shcHighlight span{ font-weight:700; color:#78be20; } p.center_Lead { color: #63666A; font-weight: 300; line-height: 1.4; font-size: 20px; } <div class="row shcHighlight BulletCircle"><div class="col-sm-6 col-md-7"><p class="center_Lead">Sustainability and Environmental Stewardship are being integrated into hospital operations and health care delivery in hospitals and health systems across the nation. While environmental stewardship concepts were once seen as “add-ons”, CEO’s are recognizing the impact these concepts can make in reinforcing their organizational missions. Using a “transformational change” approach, CEOs are establishing a culture of sustainability, engaging the entire organization, and taking action to solidify change.</p><div class="col-md-10 col-md-offset-1 shcItemsLine"> </div></div><div class="col-sm-6 col-md-5"> <div data-entity-type="webform" data-entity-uuid="82c58bca-9296-40b2-8941-0c6929d9ef6b" data-embed-button="webform_embed" data-entity-embed-display="view_mode:webform.token" data-langcode="en" data-entity-embed-display-settings="[]" class="embedded-entity"> <div class="antibot-no-js antibot-message antibot-message-warning">You must have JavaScript enabled to use this form.</div> <div id="edit-sustainability-menu-code--5" class="js-form-item form-item js-form-type-processed-text form-item- js-form-item- form-no-label"> <div class="raw-html-embed"> .webform-submission-form { margin: 0em auto; max-width: 100%; padding: 0 0px; .ResourceHolder-1 { background-color: #78be2022; padding: 25px 9px; display: inline-block; border-radius: 50px 50px 0 0; width: 100% } .ResourceHolder-1 h2 { color: ; line-height: 18px; font-size: 18px; margin: 10px 0 15px 0; text-align:center; } .ResourceHolder-1 h2 a { color: #005844; } .ResourceHolder-1 h2 a:hover { color: #4579bc; } <div class="ResourceHolder-1"> <div class="col-md-4"> <a href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="The Health Care Leader's Guide to Sustainability and Environmental Stewardship"><img src="/sites/default/files/2025-07/Sus-Guide-Cover-777x600.png" alt="Cover image of the AHA's guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship" width="100%"></a> </div> <div class="col-md-8"> <h2><a href="/sustainability/health-care-leaders-guide" title="Start at the begining of the Guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">The Health Care Leader’s Guide</a></h2> .RuralAgendaTOC { text-align: center; font-weight: 700; font-size: 15px; background-color: ; padding: 0 15px 15px 15px; } .RuralAgendaTOC a:link { color: #005844; text-decoration: none; } .RuralAgendaTOC a:hover { color: #FED141aa; } .RuralAgendaTOC a:hover { color: #4579bc; ; } .RuralAgendaTOC a:active { color: green; } <h3>Sections:</h3> <div class="RuralAgendaTOC"> <a href="/sustainability/health-care-leaders-guide/team" title="Go to section on: The Sustainability and Environmental Stewardship Team">Sustainability Team </a>| <a href="/sustainability/health-care-leaders-guide/ceos" title="Go to section on: CEO’s Guide">CEO </a>| <a href="/sustainability/health-care-leaders-guide/coos" title="Go to section on: COO’s Guide">COO </a>| <a href="/sustainability/health-care-leaders-guide/cfos" title="Go to section on: CFO’s Guide">CFO </a>| <a href="/sustainability/health-care-leaders-guide/board" title="Go to section on: Board's Guide">Board </a>| <a href="/sustainability/health-care-leaders-guide/business-case" title="Go to section on: The Business Case">Business Case</a> </div> <div> <a class="btn btn-primary btn-wide" href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="Download the printable version: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">Printable Version</a> </div> </div> </div></div> </div> <div class="homepage-textfield js-form-wrapper form-wrapper"><div class="js-form-item form-item js-form-type-textfield form-item-homepage js-form-item-homepage"> Leave this field blank </div> </div> </div></div></div><div class="row spacer"> @media (min-width:720px) { .srIntro2 { column-count: 2; } } <div class="col-md-12 srIntro2"><p class="center_Lead">Sustainability, which was once characterized in health care as an optional “add-on” to hospital operations and health care delivery, is now becoming an operations priority. Today, we recognize that health care has a great impact on the economy and the environment, and health care operations directly affect the health and wellness of patients and communities.</p><p class="center_Lead">Nationally, some health care systems are showing the value from integrating sustainability into functions of the organization. Organizations with a plan can more quickly respond to opportunities for partnerships and participation in incentive programs.</p><p class="center_Lead">Success stories are shared in every region and for organizations of every size. There is no shortage of educational resources on sustainability, but it can be hard to know where to start. This resource collects current best practices (as of 2022) and identifies action steps to jumpstart your sustainability journey.</p></div></div> @media (min-width:400px){ .img2Side { display: flex; } } .img2SideImg { flex: 50%; } <div class="row img2Side spacer"><div><img src="/sites/default/files/2025-07/Sus-CEO-1.png" alt="Three groups lead into the next set; Set 1, Establish a culture of sustainability: Designate a Sustainability Champion, Build a Green Teem, Establish a Vision and Set Targets"></div><div><img src="/sites/default/files/2025-07/Sus-CEO-2.png" alt="Set 2, Engaging the entire organization: Establish Stakeholder Buy-in, Empower Action, Celebrate Short-Term Wins"></div><div><img src="/sites/default/files/2025-07/Sus-CEO-3.png" alt="Set 3, Taking Action and Solidifying Change: Keep it Going, Integrate in Normal Operation (arrow extends out)"></div></div><h2 class="text-align-center">Sections</h2> .Sticky { position: sticky; top: 0; background-color: #fff; z-index: 1000; border-radius: 0 0 25px 25px; z-index:1000; color: #78be20; width: fit-content; margin: auto; padding: 0px 10px 5px; font-size:14px; } .Sticky nav p{ font-size:14px; font-weight:700; line-height:13px } @media (max-width:790px){ .Sticky nav p{ font-size:11px; } } .Sticky a { color: #005844; text-decoration: none; } .Sticky .scroll-watcher { height: 10px; position: relative; top: 0; left: 0; z-index: 1000; background-color: #78be20; width: 100%; scale: 0 1; transform-origin: left; animation: scroll-watcher linear; animation-timeline: scroll(y); } @keyframes scroll-watcher { to { scale: 1 1; } } <div class="scroll-watcher"> </div><nav><p><a href="#Change">“Transformational Change” Approach</a> | <a href="#Reinforce">Reinforce the Mission</a> | <a href="#Recommendations">Recommendations for the Health Care CEO</a></p></nav> .SessionWrapper { border: solid 2px #005844; margin-bottom: 20px; } h2.SessionTitle { font-weight: 700; background-color: #00584422; color: #005844; padding: 15px; margin-top: 0px; margin-bottom: 25px; font-size: 33px; } .SessionEvents { margin-bottom: 30px; display:inline-block; } .SessionEvents br { margin-bottom: 10px; } .SessionEvents h3 { font-size: 30px; } .SessionEvents h4 { color: #9d2235; } .SessionEvents ul { list-style: none; /* Remove default bullets */ padding-left: 25px; margin-bottom: 25px; } .SessionEvents ul li { margin-bottom: 7px; line-height: 1.5em; font-size: 16px; } .SessionEvents ul li::before { content: "●"; font-size: 1em; position: relative; top: 0px; color: #78be20; text-indent: -20px; padding-right: 10px; } .SessionEvents ul li { padding-left: 23px; text-indent: -23px; } .SessionEvents img { margin-top: 25px; } <div class="container SessionWrapper" id="Change"><div class="row"><h2 class="SessionTitle">Use a "transformational change" approach for sustainability and environmental stewardship.</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead">No single person or department can make health care sustainable: meaningful change will require all functions to find new ways of delivering better outcomes. The complexities of the health care system require top-down leadership and creative problem-solving from the bottom-up to increase value. Outside of health care, some organizations have found a corporate commitment to sustainability boosts employee motivation and improves retention and recruitment.</p></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Reinforce"><div class="row"><h2 class="SessionTitle">Reinforce the Mission</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead"><strong>The imperative:</strong> the environment affects parts of health and health care delivery, and some hospitals are dealing with the impacts today. Reducing green house gas emissions and air pollution can protect the health of patients, employees and communities.</p><p class="center_Lead"><strong>Mission alignment:</strong> Health care's global carbon footprint is significant, hospitals can take meaningful actions to improve the health of all people and the environment in which they live - by setting a sustainable course for the future.</p><p class="center_Lead"><strong>Operational benefits:</strong> Reducing GHG emissions leads to cost savings and can contribute to hospitals’ resiliency when faced with extreme weather events.</p></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Recommendations"><div class="row"><h2 class="SessionTitle">Recommendations for the Health Care CEO</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"> ol.sg-olHeader > li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; font-weight:700 } ol.sg-olHeader > li > ul li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; } <ol class="sg-olHeader"><li>Make sustainability a transformational program for the organization:<ul><li>CEOs can acknowledge that sustainable hospitals offer unique benefits to their surrounding communities.</li><li>Engage the board of directors and show the value of sustainability.</li><li>Be clear that this is an executive priority and long-term commitment.</li></ul></li><li>Identify internal leaders and allocate the resources needed for success:<ul><li>Frame sustainability in a growth mindset to embrace the challenges of sustainability by seeking innovations.</li></ul></li><li>Communicate initiatives and progress regularly to your community and the sector:<ul><li>Show the value.</li><li>Recognize the functional roles for leadership and innovation.</li><li>Collaborate with other CEOs to share successes and overcome obstacles.</li></ul></li></ol></div><div class="col-md-1"> </div></div></div> Fri, 18 Jul 2025 19:00:00 -0500 Guides/Reports /sustainability/health-care-leaders-guide/team <div class="raw-html-embed"> </div><div class="raw-html-embed"> .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 0px auto; } .LogoInsert { position: absolute; top: 0px; height:100%; left:0px; } .LogoInsert img{ max-width:500px; max-height:125px; top:calc(50% - 125px/2); left:calc(100% + 50px); position:absolute; } .LogoInsert h1{ position:absolute; left:0px; bottom:0px; width:500px; opacity:0; margin: 0px; padding: 0; } @media (max-width:640px) { .LogoBG { object-fit: cover; height: 200px; } .LogoInsert img { max-width: 250px; left: calc(100% + 15px); top: calc(50% - 112px/2); background-color: #00584499; padding: 25px; border-radius: 30px 0px; } } @media (max-width:320px) { .LogoBG { height: 150px; } } <header class="Banner_Title_Overlay_Bar"> <img alt="Banner Image - Glass Earth sitting in a hand over tall grass" class="LogoBG" src="/sites/default/files/2023-03/sustainability-roadmap-web-home-banner-1170x250.jpg"> <div class="LogoInsert"> <img alt="Sustainability Roadmap for Health Care | Achieving Your Sustainability Goals - Logo" src="/sites/default/files/2023-03/SustainabilityRoadmap_Logo_Hor-white_700x217.png"></div> </header> </div> .shcIntro{ background-color:#78be2022; padding: 5px 50px 15px 50px; margin-bottom:20px; } .shcIntro h1, .shcIntro h2, .shcIntro h3 { color: #005844; text-align: center; } .shcIntro h1{ font-size:2em; } .shcIntro h2{ font-size:1.6em; } shcIntro ul{ color: grey; } <div class="shcIntro"><h1>The Sustainability and Environmental Stewardship Team</h1></div><div class="raw-html-embed"> <div class="row"> /* TocMini */ .TocMini { margin: 0px auto 25px; padding-bottom: 5px; color: #005844; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; width: 80%; } .TocMini .TocMiniBar { border: 1px solid #78be20; padding: 5px 10px; overflow: auto; border-radius: 20px 0px; } .TocMini .TocMiniBar .TocMiniGroup a:after { content: "|"; padding: 0 3px 0 6px; color: #253b80; font-weight: 700; } .TocMini .TocMiniBar .TocMiniGroup a:last-child:after { content: ""; } .TocMini .TocMiniGroup { float: right; } .TocMini .TocMiniHome { text-transform: uppercase; color: #005844; font-weight: 700; } .TocMini .TocMiniChild { font-weight: 500; opacity: .9; color: #555; } .TocMini .TocMiniHome:hover, .TocMini .TocMiniChild:hover { text-transform: ; color: #5fa1d0; } .TocMini .TocMiniActive{ font-weight: 700; color: #5fa1d0; } /* TocMini // */ <div class="TocMini"> <div class="TocMiniBar"> <a class="TocMiniHome" href="/sustainability" target="_blank" title="Home - Sustainability Roadmap for Health Care">Sustainability Roadmap for Health Care</a> <div class="TocMiniGroup"> <a class="TocMiniChild" href="https://www.ashe.org/sustainability" target="_blank" title="ASHE Sustainability for Health Care Facilities">Sustainability for Health Care Facilities</a> <a class="TocMiniChild" href="/sustainability/glossary" target="_blank" title="Glossary">Glossary</a> <a class="TocMiniChild" href="https://www.ashe.org/sustainability/healquest" target="_blank" title="HealQuest">HealQuest<sup>TM</sup></a> </div> </div> </div> </div> </div> .btn-primary { background-color: #005844; } .shcItemsLine { border-bottom:solid 1px #78be20; margin-top:10px; margin-bottom:25px; } .shcHighlight h3{ color:#333; font-size:16px; text-align:center; margin:0px } .shcHighlight span{ font-weight:700; color:#78be20; } p.center_Lead { color: #63666A; font-weight: 300; line-height: 1.4; font-size: 20px; } <div class="row shcHighlight BulletCircle"><div class="col-sm-6 col-md-7"><p class="center_Lead">Sustainability and Environmental Stewardship Teams are passionate about environmental stewardship and sustainability and are empowered to lead their organization’s environmental efforts. The sustainability and environmental stewardship teams are responsible for building relationships across the organization, breaking down silos, and sharing knowledge and expertise to empower their colleagues to take action and celebrate sustainability wins.</p><div class="col-md-10 col-md-offset-1 shcItemsLine"> </div></div><div class="col-sm-6 col-md-5"> <div data-entity-type="webform" data-entity-uuid="82c58bca-9296-40b2-8941-0c6929d9ef6b" data-embed-button="webform_embed" data-entity-embed-display="view_mode:webform.token" data-langcode="en" data-entity-embed-display-settings="[]" class="embedded-entity"> <div class="antibot-no-js antibot-message antibot-message-warning">You must have JavaScript enabled to use this form.</div> <div id="edit-sustainability-menu-code--6" class="js-form-item form-item js-form-type-processed-text form-item- js-form-item- form-no-label"> <div class="raw-html-embed"> .webform-submission-form { margin: 0em auto; max-width: 100%; padding: 0 0px; .ResourceHolder-1 { background-color: #78be2022; padding: 25px 9px; display: inline-block; border-radius: 50px 50px 0 0; width: 100% } .ResourceHolder-1 h2 { color: ; line-height: 18px; font-size: 18px; margin: 10px 0 15px 0; text-align:center; } .ResourceHolder-1 h2 a { color: #005844; } .ResourceHolder-1 h2 a:hover { color: #4579bc; } <div class="ResourceHolder-1"> <div class="col-md-4"> <a href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="The Health Care Leader's Guide to Sustainability and Environmental Stewardship"><img src="/sites/default/files/2025-07/Sus-Guide-Cover-777x600.png" alt="Cover image of the AHA's guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship" width="100%"></a> </div> <div class="col-md-8"> <h2><a href="/sustainability/health-care-leaders-guide" title="Start at the begining of the Guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">The Health Care Leader’s Guide</a></h2> .RuralAgendaTOC { text-align: center; font-weight: 700; font-size: 15px; background-color: ; padding: 0 15px 15px 15px; } .RuralAgendaTOC a:link { color: #005844; text-decoration: none; } .RuralAgendaTOC a:hover { color: #FED141aa; } .RuralAgendaTOC a:hover { color: #4579bc; ; } .RuralAgendaTOC a:active { color: green; } <h3>Sections:</h3> <div class="RuralAgendaTOC"> <a href="/sustainability/health-care-leaders-guide/team" title="Go to section on: The Sustainability and Environmental Stewardship Team">Sustainability Team </a>| <a href="/sustainability/health-care-leaders-guide/ceos" title="Go to section on: CEO’s Guide">CEO </a>| <a href="/sustainability/health-care-leaders-guide/coos" title="Go to section on: COO’s Guide">COO </a>| <a href="/sustainability/health-care-leaders-guide/cfos" title="Go to section on: CFO’s Guide">CFO </a>| <a href="/sustainability/health-care-leaders-guide/board" title="Go to section on: Board's Guide">Board </a>| <a href="/sustainability/health-care-leaders-guide/business-case" title="Go to section on: The Business Case">Business Case</a> </div> <div> <a class="btn btn-primary btn-wide" href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="Download the printable version: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">Printable Version</a> </div> </div> </div></div> </div> <div class="homepage-textfield js-form-wrapper form-wrapper"><div class="js-form-item form-item js-form-type-textfield form-item-homepage js-form-item-homepage"> Leave this field blank </div> </div> </div></div></div><div class="row spacer"> @media (min-width:720px){ .srIntro2{ column-count: 2; } } <div class="col-md-12 srIntro2"><p class="center_Lead">As members of the sustainability team, you have the passion to share your knowledge of sustainability with your colleagues, the responsibility to build relationships with all functional roles, and the power to inspire all stakeholders to advance sustainability (contractors, visitors, the community, the sector).</p><p class="center_Lead">You are curious — seeking to understand existing systems and operational practices, and learn from other experts. Building trust will open doors to identifying opportunities that improve sustainability.</p><p class="center_Lead">You are empowered to be leaders in your organization — speak up when you need resources and be clear about the value of sustainability initiatives in support of the executive strategy. Remember to prepare your coworkers (the functional leaders in your organization) to celebrate achievements. Achieving a sustainability goal is not a win for only the chief sustainability officer or the sustainability team, it is a win for the organization.</p></div></div><h2 class="text-align-center">Sections</h2> .Sticky { position: sticky; top: 0; background-color: #fff; z-index: 1000; border-radius: 0 0 25px 25px; z-index:1000; color: #78be20; width: fit-content; margin: auto; padding: 0px 10px 5px; font-size:14px; } .Sticky nav p{ font-size:14px; font-weight:700; line-height:13px } @media (max-width:790px){ .Sticky nav p{ font-size:11px; } } .Sticky a { color: #005844; text-decoration: none; } .Sticky .scroll-watcher { height: 10px; position: relative; top: 0; left: 0; z-index: 1000; background-color: #78be20; width: 100%; scale: 0 1; transform-origin: left; animation: scroll-watcher linear; animation-timeline: scroll(y); } @keyframes scroll-watcher { to { scale: 1 1; } } <div class="scroll-watcher"> </div><nav><p><a href="#Mission">Articulate Your Why</a> | <a href="#Value">Recommendations for the Experts</a></p></nav> .SessionWrapper { border: solid 2px #005844; margin-bottom: 20px; } h2.SessionTitle { font-weight: 700; background-color: #00584422; color: #005844; padding: 15px; margin-top: 0px; margin-bottom: 25px; font-size: 33px; } .SessionEvents { margin-bottom: 30px; display:inline-block; } .SessionEvents br { margin-bottom: 10px; } .SessionEvents h3 { font-size: 30px; } .SessionEvents h4 { color: #9d2235; } .SessionEvents ul { list-style: none; /* Remove default bullets */ padding-left: 25px; margin-bottom: 25px; } .SessionEvents ul li { margin-bottom: 7px; line-height: 1.5em; font-size: 16px; } .SessionEvents ul li::before { content: "●"; font-size: 1em; position: relative; top: 0px; color: #78be20; text-indent: -20px; padding-right: 10px; } .SessionEvents ul li { padding-left: 23px; text-indent: -23px; } .SessionEvents img { margin-top: 25px; } <div class="container SessionWrapper" id="Mission"><div class="row"><h2 class="SessionTitle">Articulate Your Why</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><div class="row"><div class="col-md-6"><p class="center_Lead">Share a consistent, persuasive message for sustainability and environmental stewardship in your organization and with various stakeholders. This Cleveland Clinic figure provides a few examples, but it is most impactful to work with your internal leaders and craft a message that speaks directly to the context of your operations, considering location and community.</p></div><div class="col-md-6"><h3 class="text-align-center">Cleveland Clinic Environmental Stewardship Pitch Summary</h3><div class="table-responsive"><table class="table-bordered table-striped"><thead><tr><th>Sustainability “hook”</th><th>Sample message for the leader</th></tr></thead><tbody><tr><td>Mitigation</td><td>Save $50 million+</td></tr><tr><td>Engagement</td><td>Attract the best</td></tr><tr><td>Resillence</td><td>Adjust to the future</td></tr><tr><td>Relationships</td><td>Build partnerships</td></tr><tr><td>Population health</td><td>Impact regional health</td></tr><tr><td>Societal transformation</td><td>Change the nexus</td></tr><tr><td>Transpersonalism</td><td>Be the change</td></tr><tr><td>Moral obligation</td><td>Do the right thing</td></tr><tr><td>Leadership</td><td>Lead the sector</td></tr></tbody></table><p class="text-align-center"><strong>Source:</strong> Presented by Jon Utech and Jessica Wolf during CleanMed 2018, “Demystifying Greenhouse Gas and Goal-setting in Health Care”</p></div></div></div></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Value"><div class="row"><h2 class="SessionTitle">Recommendations for the Experts</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead">Consider these suggestions, but review the context for your organization and take the time to build support and consensus at all levels (top-down and bottom-up). For more ideas, review the assessment for your sustainability journey on ASHE.org.</p> ol.sg-olHeader > li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; font-weight:700 } ol.sg-olHeader > li > ul li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; } <ol class="sg-olHeader"><li>Support the CEO to make sustainability a transformational program for the entire organization:<ul><li>Articulate the sustainability vision for the organization and repeat often.</li><li>Connect sustainability to the mission and vision of the organization.</li><li>Engage the board of directors and show the value of sustainability.</li><li>Be clear that this is an executive priority. Transformational initiatives require leaders at all levels (bottom-up), but also require C-suite leadership (top-down).</li><li>Create a plan with metrics and milestones, report progress and celebrate achievements.</li><li>Identify high-impact areas (materiality assessment) and define strategy to include relevant internal functions and external/third parties.</li></ul></li><li>Work with the chief operating officer (COO) to realign internal processes to support sustainability. Create key performance indicators (KPIs) that will measure progress towards sustainability goals.<ul><li>Identify internal leaders and allocate the resources needed for success.</li><li>Frame the sustainability agenda in a “growth mindset,” encouraging leaders to embrace the challenges of sustainability by seeking opportunities to innovate.</li></ul></li><li>Communicate initiatives and progress externally to your community and the sector.<ul><li>Be transparent about ambitions, current performance and value created from sustainability initiatives.</li><li>To achieve meaningful improvements, one health system cannot change the field alone. Collaborating with other community organizations and across the health care sector can help to share successes and overcome obstacles</li></ul></li></ol></div><div class="col-md-1"> </div></div></div> Fri, 18 Jul 2025 19:00:00 -0500 Guides/Reports /sustainability/health-care-leaders-guide <div class="raw-html-embed"> </div><div class="raw-html-embed"> .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 0px auto; } .LogoInsert { position: absolute; top: 0px; height:100%; left:0px; } .LogoInsert img{ max-width:500px; max-height:125px; top:calc(50% - 125px/2); left:calc(100% + 50px); position:absolute; } .LogoInsert h1{ position:absolute; left:0px; bottom:0px; width:500px; opacity:0; margin: 0px; padding: 0; } @media (max-width:640px) { .LogoBG { object-fit: cover; height: 200px; } .LogoInsert img { max-width: 250px; left: calc(100% + 15px); top: calc(50% - 112px/2); background-color: #00584499; padding: 25px; border-radius: 30px 0px; } } @media (max-width:320px) { .LogoBG { height: 150px; } } <header class="Banner_Title_Overlay_Bar"> <img alt="Banner Image - Glass Earth sitting in a hand over tall grass" class="LogoBG" src="/sites/default/files/2023-03/sustainability-roadmap-web-home-banner-1170x250.jpg"> <div class="LogoInsert"> <img alt="Sustainability Roadmap for Health Care | Achieving Your Sustainability Goals - Logo" src="/sites/default/files/2023-03/SustainabilityRoadmap_Logo_Hor-white_700x217.png"></div> </header> </div> .shcIntro{ background-color:#78be2022; padding: 5px 50px 15px 50px; margin-bottom:20px; } .shcIntro h1, .shcIntro h2, .shcIntro h3 { color: #005844; text-align: center; } .shcIntro h1{ font-size:2em; } .shcIntro h2{ font-size:1.6em; } shcIntro ul{ color: grey; } <div class="shcIntro"><h1>The Health Care Leader's Guide to Sustainability and Environmental Stewardship</h1><h2>Communicate Goals and Actions in Environmental Stewardship</h2></div><div class="raw-html-embed"> <div class="row"> /* TocMini */ .TocMini { margin: 0px auto 25px; padding-bottom: 5px; color: #005844; letter-spacing: 1.5px; font-weight: 400; font-size: .7em; width: 80%; } .TocMini .TocMiniBar { border: 1px solid #78be20; padding: 5px 10px; overflow: auto; border-radius: 20px 0px; } .TocMini .TocMiniBar .TocMiniGroup a:after { content: "|"; padding: 0 3px 0 6px; color: #253b80; font-weight: 700; } .TocMini .TocMiniBar .TocMiniGroup a:last-child:after { content: ""; } .TocMini .TocMiniGroup { float: right; } .TocMini .TocMiniHome { text-transform: uppercase; color: #005844; font-weight: 700; } .TocMini .TocMiniChild { font-weight: 500; opacity: .9; color: #555; } .TocMini .TocMiniHome:hover, .TocMini .TocMiniChild:hover { text-transform: ; color: #5fa1d0; } .TocMini .TocMiniActive{ font-weight: 700; color: #5fa1d0; } /* TocMini // */ <div class="TocMini"> <div class="TocMiniBar"> <a class="TocMiniHome" href="/sustainability" target="_blank" title="Home - Sustainability Roadmap for Health Care">Sustainability Roadmap for Health Care</a> <div class="TocMiniGroup"> <a class="TocMiniChild" href="https://www.ashe.org/sustainability" target="_blank" title="ASHE Sustainability for Health Care Facilities">Sustainability for Health Care Facilities</a> <a class="TocMiniChild" href="/sustainability/glossary" target="_blank" title="Glossary">Glossary</a> <a class="TocMiniChild" href="https://www.ashe.org/sustainability/healquest" target="_blank" title="HealQuest">HealQuest<sup>TM</sup></a> </div> </div> </div> </div> </div> .btn-primary { background-color: #005844; } .shcHighlight h3{ color:#333; font-size:16px; text-align:center; margin:0px } .shcHighlight span{ font-weight:700; color:#78be20; } p.center_Lead { color: #63666A; font-weight: 300; line-height: 1.4; font-size: 20px; } <div class="row shcHighlight BulletCircle"><div class="col-sm-6 col-md-7"><p class="center_Lead">In navigating the complex landscape of environmental stewardship within the health care field, engaged, effective leadership is key. Leaders set goals, such as reducing energy consumption, waste generation and greenhouse gas emissions. In addition, leaders foster cultures of innovation and collaboration by encouraging interdisciplinary teams to explore and implement environmentally friendly solutions throughout their organizations.The Health Care Leader's Guide to Sustainability and Environmental Stewardship provides a toolkit of tangible action items for <a href="/sustainability/health-care-leaders-guide/ceos" title="Learn more for the CEOs">CEOs</a>, <a href="/sustainability/health-care-leaders-guide/board" title="Learn more for the board">boards and trustees</a>, <a href="/sustainability/health-care-leaders-guide/team" title="Learn more about the sustainability team">sustainability teams</a>, <a href="/sustainability/health-care-leaders-guide/coos" title="Learn more for the COOs">COOs</a>, and <a href="/sustainability/health-care-leaders-guide/cfos" title="Learn more for CFOs">CFOs</a>, demonstrating how each can <a href="/sustainability/health-care-leaders-guide/business-case" title="The Business Case">lead the charge</a> in environmental stewardship.</p></div><div class="col-sm-6 col-md-5"> <div data-entity-type="webform" data-entity-uuid="82c58bca-9296-40b2-8941-0c6929d9ef6b" data-embed-button="webform_embed" data-entity-embed-display="view_mode:webform.token" data-langcode="en" data-entity-embed-display-settings="[]" class="embedded-entity"> <div class="antibot-no-js antibot-message antibot-message-warning">You must have JavaScript enabled to use this form.</div> <div id="edit-sustainability-menu-code--7" class="js-form-item form-item js-form-type-processed-text form-item- js-form-item- form-no-label"> <div class="raw-html-embed"> .webform-submission-form { margin: 0em auto; max-width: 100%; padding: 0 0px; .ResourceHolder-1 { background-color: #78be2022; padding: 25px 9px; display: inline-block; border-radius: 50px 50px 0 0; width: 100% } .ResourceHolder-1 h2 { color: ; line-height: 18px; font-size: 18px; margin: 10px 0 15px 0; text-align:center; } .ResourceHolder-1 h2 a { color: #005844; } .ResourceHolder-1 h2 a:hover { color: #4579bc; } <div class="ResourceHolder-1"> <div class="col-md-4"> <a href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="The Health Care Leader's Guide to Sustainability and Environmental Stewardship"><img src="/sites/default/files/2025-07/Sus-Guide-Cover-777x600.png" alt="Cover image of the AHA's guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship" width="100%"></a> </div> <div class="col-md-8"> <h2><a href="/sustainability/health-care-leaders-guide" title="Start at the begining of the Guide: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">The Health Care Leader’s Guide</a></h2> .RuralAgendaTOC { text-align: center; font-weight: 700; font-size: 15px; background-color: ; padding: 0 15px 15px 15px; } .RuralAgendaTOC a:link { color: #005844; text-decoration: none; } .RuralAgendaTOC a:hover { color: #FED141aa; } .RuralAgendaTOC a:hover { color: #4579bc; ; } .RuralAgendaTOC a:active { color: green; } <h3>Sections:</h3> <div class="RuralAgendaTOC"> <a href="/sustainability/health-care-leaders-guide/team" title="Go to section on: The Sustainability and Environmental Stewardship Team">Sustainability Team </a>| <a href="/sustainability/health-care-leaders-guide/ceos" title="Go to section on: CEO’s Guide">CEO </a>| <a href="/sustainability/health-care-leaders-guide/coos" title="Go to section on: COO’s Guide">COO </a>| <a href="/sustainability/health-care-leaders-guide/cfos" title="Go to section on: CFO’s Guide">CFO </a>| <a href="/sustainability/health-care-leaders-guide/board" title="Go to section on: Board's Guide">Board </a>| <a href="/sustainability/health-care-leaders-guide/business-case" title="Go to section on: The Business Case">Business Case</a> </div> <div> <a class="btn btn-primary btn-wide" href="/system/files/media/file/2025/03/Leaders-Guide-Environmental-Stewardship.pdf" target="_blank" title="Download the printable version: The Health Care Leader's Guide to Sustainability and Environmental Stewardship">Printable Version</a> </div> </div> </div></div> </div> <div class="homepage-textfield js-form-wrapper form-wrapper"><div class="js-form-item form-item js-form-type-textfield form-item-homepage js-form-item-homepage"> Leave this field blank </div> </div> </div></div></div><div class="raw-html-embed"> <div class="anchortag" id="HealthEquity"></div> </div> @media (min-width:500px){ .img2Side { display: flex; } } .img2SideImg { /*flex: 50%;*/ } <div class="row spacer"><div class="col-sm-10 col-sm-offset-1 img2Side"><div class="img2SideImg"><img src="/sites/default/files/2025-07/Sus-BlueChart-1.jpg" alt="The U.S. health care sector is responsible for 8.5% of U.S. emissions. | Notably, the U.S. health care sector is responsible for 35% of global health care emissions."></div><div class="img2SideImg"><img src="/sites/default/files/2025-07/Sus-BlueChart-2.jpg" alt="Global actions to reduce emissions increase the focus on the U.S. health care system’s actions. | 80% of emissions in the U.S. health care are from goods and services in the supply chain."></div></div></div><h2 class="text-align-center">Sections</h2> .Sticky { position: sticky; top: 0; background-color: #fff; z-index: 1000; border-radius: 0 0 25px 25px; z-index:1000; color: #78be20; width: fit-content; margin: auto; padding: 0px 10px 5px; font-size:14px; } .Sticky nav p{ font-size:14px; font-weight:700; line-height:13px } @media (max-width:790px){ .Sticky nav p{ font-size:11px; } } .Sticky a { color: #005844; text-decoration: none; } .Sticky .scroll-watcher { height: 10px; position: relative; top: 0; left: 0; z-index: 1000; background-color: #78be20; width: 100%; scale: 0 1; transform-origin: left; animation: scroll-watcher linear; animation-timeline: scroll(y); } @keyframes scroll-watcher { to { scale: 1 1; } } <div class="scroll-watcher"> </div><nav><p><a href="#Mission">Mission Readiness</a> | <a href="#Value">Create Value</a> | <a href="#KeyTerms">Key Terms and Definitions</a> | <a href="#Carbon">Carbon in Health Care</a> | <a href="#Measuring">Measuring Carbon in your Organization</a></p></nav><div> .TearDropRight { /* gap: 20px; */ flex-wrap: wrap; display: flex; flex-direction: row; justify-content: center; align-items: center; margin: 30px auto; } .TearDropRight .TDRitem{ /* background-color: red; */ padding: 18px; /* flex: auto;*/ } .TearDropRight .TDRborder{ border: solid 6px #005844; border-radius: 50% 0% 50% 50%; height: 180px; width: 180px; margin: auto; rotate: 45deg; position: relative; background-color: #00584411; } .TearDropRight .TDRitem:nth-child(5) .TDRborder{ border-radius: 50% 50% 50% 50%; } .TearDropRight .TDRcopy{ font-size: 20px; rotate: -45deg; position: fixed; top: 30%; left: 9%; /* background-color: green; */ /* border: solid 4px blue; */ text-align: center; font-weight: 700; line-height: 1em; color: #005844; } @media (max-width:490px){ .TearDropRight .TDRitem{ padding: 5px; } .TearDropRight .TDRborder { height: 90px; width: 90px; } .TearDropRight .TDRcopy{ font-size: 10px; } } <div class="TearDropRight"><div class="TDRitem"><div class="TDRborder"><div class="TDRcopy">Engage a cross-functional team</div></div></div><div class="TDRitem"><div class="TDRborder"><div class="TDRcopy">Establish a Baseline</div></div></div><div class="TDRitem"><div class="TDRborder"><div class="TDRcopy">Define time-bound goals</div></div></div><div class="TDRitem"><div class="TDRborder"><div class="TDRcopy">Mobilze the organization</div></div></div><div class="TDRitem"><div class="TDRborder"><div class="TDRcopy">Communicate goals and progress</div></div></div></div></div> .SessionWrapper { border: solid 2px #005844; margin-bottom: 20px; } h2.SessionTitle { font-weight: 700; background-color: #00584422; color: #005844; padding: 15px; margin-top: 0px; margin-bottom: 25px; font-size: 33px; } .SessionEvents { margin-bottom: 30px; display:inline-block; } .SessionEvents br { margin-bottom: 10px; } .SessionEvents h3 { font-size: 30px; } .SessionEvents h4 { color: #9d2235; } .SessionEvents ul { list-style: none; /* Remove default bullets */ padding-left: 25px; margin-bottom: 25px; } .SessionEvents ul li { margin-bottom: 7px; line-height: 1.5em; font-size: 16px; } .SessionEvents ul li::before { content: "●"; font-size: 1em; position: relative; top: 0px; color: #78be20; text-indent: -20px; padding-right: 10px; } .SessionEvents ul li { padding-left: 23px; text-indent: -23px; } .SessionEvents img { margin-top: 25px; } <div class="container SessionWrapper" id="Mission"><div class="row"><h2 class="SessionTitle">Mission Readiness</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><p class="center_Lead">Hospitals are encouraged to view resiliency as a means for protecting human health. Sustainability and Environmental Stewardship aligns with health care mission to serve hospitals’ communities by providing a pathway to take action and plan for environmental risks.</p></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Value"><div class="row"><h2 class="SessionTitle">Create Value</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"> ul.sg-ulHeader1 > li{ font-size: 20px; color: #63666A; line-height: 1.4; } <p class="center_Lead">Aligning the organization to empower all employees to improve sustainability can:</p><ul class="sg-ulHeader1"><li>Build new relationships among internal functions to reduce waste and increase value.</li><li>Boost employee motivation and improve retention and recruitment.</li><li>Enhance investment returns by better allocating capital for the long term.</li></ul><p class="center_Lead">Hospitals and health systems committed to sustainability and environmental stewardship strategies could work with department leaders to:</p><ol class="sg-olHeader"><li>Understand the importance of sustainability in health care.</li><li>Commit to seeking out opportunities to change current practices.</li><li>Collaborate with stakeholders to review and assess ongoing performance.</li></ol><img src="/sites/default/files/2025-07/Sus-Wav-Function.jpg" alt="Sustainability and Environmental Stewardship: Sustainability Impacts and Strategies in Health Care – mapped to functional roles. A Visual flow chart of how different areas, ie, Energy, IEQ, Water flow into four areas, ie, Operation Support, Administrative and then split out into further areas, ie, Energy Efficiency, Protect Water, Indoor Air Quality. Source: How Sustainability and Decarbonization Intertwines with Various Organizations in Health Care"><aside> .SReference h2{ color: #9d2235; font-size:14px; } .SReference ul li{ font-size:12px; } <div class="SReference"><h2>References</h2><ul><li><a href="https://www.statnews.com/2022/10/27/health-care-hospitals-climate-pollution/" target="_blank" title="STAT | ‘If I were a hospital, I’d be reading the tea leaves’: Pressures grow on the health care industry to reduce its climate pollution">STAT</a></li><li><a href="https://www.mckinsey.com/capabilities/strategy-and-corporate-finance/our-insights/five-ways-that-esg-creates-value" target="_blank" title="McKinsey | Five ways that ESG creates value">McKinsey</a></li><li><a href="https://practicegreenhealth.org/sites/default/files/upload-files/practicegreenhealth_ghg_toolkit.pdf" target="_blank" title="Practice Greenhealth | Greenhouse Gas Reduction Toolkit">Practice Greenhealth</a></li></ul></div></aside></div><div class="col-md-1"> </div></div></div> .SessionWrapperTop { border-bottom:0px; margin-bottom:0px; } .SessionWrapperMiddle{ border-top:0px; border-bottom:0px; margin-bottom:0px; } .SessionWrapperBottom { margin-top:0px; border-top:0px; } .SessionWrapperBG{ background-color: #78be2022; } <div class="container SessionWrapper SessionWrapperTop" id="KeyTerms"><div class="row"><h2 class="SessionTitle">Key Terms and Definitions</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><div class="row"><div class="col-md-6"><h3>Sustainability</h3> ol.sg-olHeader > li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; font-weight:700 } ol.sg-olHeader > li > ul li { font-size: 20px; color: #63666A; font-weight: 300; line-height: 1.4; } <ul class="sg-ulHeader1"><li>In health care, refers to the integration of environmental stewardship and fiduciary responsibility in health care organizations to support healthy and resilient environments and communities maintained over time.</li><li>Meeting the needs of the present, without compromising the ability for future generations to lead healthy lives.</li><li>Based on a simple principle: Everything that we need for our survival and well being depends, either directly or indirectly, on our natural environment.</li><li>To pursue sustainability is to create and maintain the conditions under which humans and nature can exist in productive harmony to support present and future generations.</li></ul></div><div class="col-md-6"><img src="/sites/default/files/2025-07/Sus-3Circle.jpg" alt="Visual of three circles overlapping: Planet Environment, Prosperity Economic, and People Health. People (Conversation Philosophy) Prosperity (Moral Economy) People (Development, Land Use) Planet. Sustainability is the overlapping item among all three."></div></div></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper SessionWrapperMiddle SessionWrapperBG"><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><div class="row container"><div class="col-md-6"><h3>Decarbonization</h3><ul class="sg-ulHeader1"><li>The act of reducing greenhouse gas emissions.</li></ul></div><div class="col-md-6"><h3>Greenhouse Gas Protocol</h3><ul class="sg-ulHeader1"><li>Scope 1: Direct emissions</li><li>Scope 2: Indirect emissions</li><li>Scope 3: Purchased goods and services</li></ul></div></div></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper SessionWrapperMiddle SessionWrapperBG"><div class><div class="col-md-1"> </div><div class="col-md-10"><div class="col-md-12"><h3><strong>Hospitals GHG Emissions Impact by Category</strong></h3> .shcChartBox{ background-color: #; padding: 15px; margin-bottom: 30px; } .shcChartBox h4{ font-size:22px; line-height: 30px; } @media (min-width:991px){ .shcChartBox{ margin-right: 25px; } } .shcChartBox span{ font-size:larger; background-color:#005844; border:solid 3px #005844; padding:2px 10px; border-radius: 25px 0px; color:white } .shcChartBox.BulletCircle ul { list-style: none; /* Remove default bullets */ padding-left: 0px } .shcChartBox.BulletCircle ul li { margin-bottom: 7px; line-height: 1.5em; } .shcChartBox.BulletCircle ul li::before { content: "■"; font-size: 1em; position: relative; top: 0px; text-indent: -20px; /* key property */ margin-left: 20px; /* key property */ padding-right:10px; } .shcChartBox.BulletCircle ul li { text-indent: -40px; /* key property */ margin-left: 30px; /* key property */ } .shcChartBox.BulletCircle ul li.BulletCircleFacilities::before{ color:#69b3e7; } .shcChartBox.BulletCircle ul li.BulletCircleTransportation::before { color:#003087; } .shcChartBox.BulletCircle ul li.BulletCircleProcurement::before { color:#FED141; } .shcChartBox.BulletCircle ul li.BulletCircleEvs::before { color:#78be20; } .shcChartBox.BulletCircle ul li.BulletCirclePharmacy::before { color:#d50032; } .shcChartBox.BulletCircle ul li.BulletCircleDietary::before { color:#eaaa00; } .shcChartBox.BulletCircle ul li.BulletCircleTreasury::before { color:#B1B383; } .shcChartBox.BulletCircle ul li.BulletCircleAll::before { color:#63666A; } .shcChartBox.BulletCircle ul.BulletCircleToc li { float:left; margin-right:15px; } .shcChartBox.BulletCircle ul.BulletCircleToc li{ /*font-size:14px !important*/ } <div class="col-md-6"><div class="row"><div class="shcChartBox BulletCircle"><h4><span>Scope 1</span> Direct emissions emanating directly from health care facilities and health care owned vehicles.</h4><ul class="sg-ulHeader1"><li class="BulletCircleFacilities" title="In Facilities">Combustion of Natural Gas</li><li class="BulletCircleFacilities" title="In Facilities">Combustion of Diesel Generators</li><li class="BulletCircleFacilities" title="In Facilities">Emissions from Refrigerants</li><li class="BulletCircleFacilities" title="In Facilities">Medical Gas System leaks and exhaust</li><li class="BulletCircleFacilities" title="In Facilities">Landscape and misc equipment emissions</li><li class="BulletCircleTransportation" title="In Transportation">Fleet Fuel combustion</li></ul></div></div><div class="row"><div class="shcChartBox BulletCircle"><h4><span>Scope 2</span> Indirect emissions from purchased energy sources such as electricity, steam, cooling and heating.</h4><ul class="sg-ulHeader1"><li class="BulletCircleFacilities" title="In Facilities">Emissions from purchased energy</li></ul></div></div></div><div class="col-md-6"><div class="row"><div class="shcChartBox BulletCircle"><h4><span>Scope 3</span> Emissions derived from health care supply chain through the production, transport and disposal of goods and services.</h4><ul class="sg-ulHeader1"><li class="BulletCircleFacilities" title="In Facilities">Water Embodied Carbon</li><li class="BulletCircleFacilities" title="In Facilities">Building Product/Supplies Embodied Carbon</li><li class="BulletCircleTransportation" title="In Transportation">Patient Transportation</li><li class="BulletCircleTransportation" title="In Transportation">Visitor Transportation</li><li class="BulletCircleTransportation" title="In Transportation">Staff Transportation</li><li class="BulletCircleTransportation" title="In Transportation">Vendor Transportation</li><li class="BulletCircleProcurement" title="In Procurement">Equipment Embodied Carbon</li><li class="BulletCircleProcurement" title="In Procurement">Supplies Embodied Carbon</li><li class="BulletCircleEvs" title="In EVS">Waste</li><li class="BulletCirclePharmacy" title="In Pharmacy">Pharmaceuticals Embodied Carbon</li><li class="BulletCircleDietary" title="In Dietary">Food Embodied Carbon</li><li class="BulletCircleTreasury" title="In Treasury">Investments</li><li class="BulletCircleAll" title="In All">Emissions of Outsourced Services</li></ul></div></div></div> .shcItemsLine { border-bottom:solid 1px #005844; margin-top:25px; margin-bottom:50px; } <div class="col-md-10 col-md-offset-1 shcItemsLine"> </div><div class="col-md-12 shcChartBox BulletCircle"><h4>Hospital Specific Emissions by Department</h4><ul class="BulletCircleToc sg-ulHeader1"><li class="BulletCircleFacilities">Facilities</li><li class="BulletCircleTransportation">Transportation</li><li class="BulletCircleProcurement">Procurement, Clinicians, Clinical Engineering</li><li class="BulletCircleEvs">Environmental Services (EVS)</li><li class="BulletCirclePharmacy">Pharmacy, Procurement, Environmental Services (EVS)</li><li class="BulletCircleDietary">Dietary</li><li class="BulletCircleTreasury">Treasury</li><li class="BulletCircleAll">All</li></ul></div></div></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper SessionWrapperMiddle"><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><div class="row"><div class="col-md-6"><h3>Net-zero Energy</h3><ul class="sg-ulHeader1"><li>On an annual basis, uses equivalent energy from the utility grid that is provided by onsite renewable energy sources.</li><li>Not the same as “carbon neutral."</li></ul></div><div class="col-md-6"><img src="/sites/default/files/2025-07/Sus-Site-Boundary.jpg" alt="Visual for energy transfer; 'Delivered Energy' into ie, Energy Use, Building Systems that flow in the 'Building Needs' (ie, heating, cooling, ventilation). With 'Exported Energy' going back out. "></div></div></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper SessionWrapperMiddle SessionWrapperBG"><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><div class="row"><div class="col-md-6"><h3>Carbon-neutral</h3><ul class="sg-ulHeader1"><li>In addition to energy consumption (scope 1 and 2 emissions), carbon neutrality “includes emissions beyond the entity’s direct control (scope 3 emissions)."</li></ul><p>Reference: IPCC AR6 WGIII</p></div><div class="col-md-6"><img src="/sites/default/files/2025-07/Sus-Carbon-Neutral-circles.png" alt="Visuals: First, a circle (1) within a circle (2) – Net-Zero Energy is limited to Scope 1& 2 emissions. Second, three circles within each other; 3, 2, 1 – Carbon Neutrality includes Scope 1, 2,& 3 emissions for the whole organization. ~80% of emissions are from the Supply Chain."></div></div></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper SessionWrapperBottom"><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><div class="row"><div class="col-md-6"><h3>Embodied Carbon</h3><ul class="sg-ulHeader1"><li>The greenhouse gas emissions associated with the manufacturing, transportation, installation, maintenance and disposal of purchased products/materials. For example:<ul class="sg-ulHeader1"><li>Medical supplies and equipment</li><li>Pharmaceuticals</li><li>Food</li><li>Construction material</li></ul></li></ul></div><div class="col-md-6"><h3>Operational Carbon</h3><ul class="sg-ulHeader1"><li>The greenhouse gas emissions associated with daily operations. For example:<ul class="sg-ulHeader1"><li>Building energy consumption</li><li>Anesthetic gases</li><li>Refrigerants onsite</li><li>Staff commuting</li><li>Business travel</li></ul></li></ul></div></div><aside><div class="SReference"><h2>References</h2><ul><li><a href="https://www.ipcc.ch/report/sixth-assessment-report-working-group-3/" target="_blank" title="IPCC | Climate Change 2022: Mitigation of Climate Change">IPCC AR6 WGIII</a></li><li><a href="https://www.ipcc.ch/report/ar6/wg3/downloads/faqs/IPCC_AR6_WGIII_FAQ_Chapter_01.pdf" target="_blank" title="IPCC AR6 WGIII FAQ Chapter 01">IPCC FAQ Chapter 1</a></li></ul></div></aside></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Carbon"><div class="row"><h2 class="SessionTitle">Carbon in Health Care</h2></div><div class="row SessionEvents"><div class="col-md-1"> </div><div class="col-md-10"><div class="row"><div class="col-md-6"><h3>Emissions are categorized as scope 1, 2 and 3, but can also be analyzed in functional roles:</h3><ul class="sg-ulHeader1"><li><strong>Operations</strong><ul class="sg-ulHeader1"><li>Energy consumption (scope 1 and 2)</li><li>Refrigerants (scope 1)</li><li>Construction (scopes 1-3)</li><li>Water (scope 3)</li><li>Food (scope 3)</li><li>Waste (scope 3)</li><li>Information and computer technology (scope 3)</li></ul></li><li><strong>Clinical</strong><ul class="sg-ulHeader1"><li>Anesthetic gases (scope 1)</li><li>Medical waste (scope 3)</li><li>Testing and research (scope 3)</li><li>Pharmaceuticals (scope 3)</li><li>Purchased goods and services (scope 3), including medical devices and supplies</li></ul></li><li><strong>Administrative (all scope 3)</strong><ul class="sg-ulHeader1"><li>Business travel</li><li>Lending, banking, investments and insuranc</li></ul></li></ul><p><strong>Note:</strong> The figure to the right represents global health care emissions. Scope 3 for U.S. health care is calculated to be 80% of the total carbon emissions.</p></div><div class="col-md-6"><div><p><strong>Carbon and greenhouse gas (GHG) emissions are often used interchangeably. This is because GHG emissions are measured in carbon dioxide equivalent (CO2e), often abbreviated as “carbon."</strong></p></div><img src="/sites/default/files/2025-01/Sus-Relation.jpg" alt="Chart of Relationship of GHGP categories to WIOD emissions sources. Scope 1 17% with Health sector operational emissions and Transport - Scope 3 71% with ie, Transport, Agriculture, Pharmaceuticals and chemical products, Waste treatment – Scope 2 12% with distributions of electricity, gas, heat and cooling."></div></div> .SusLogos img { max-width: 200px; width: auto; display: block; margin: auto; } <div class="row spacer SusLogos"><div class="col-sm-4"><img src="/sites/default/files/2025-07/Energy-Star-Partner-Logo-687x277.png" alt="Energy Star Partner Logo"></div><div class="col-sm-4"><img src="/sites/default/files/2023-04/ASHE-logo_Primary-RGB-Tagline_R_296x142.png" alt="ASHE Logo"></div><div class="col-sm-4"><img src="/sites/default/files/2023-06/ASHE-Energy-to-Care-Logo-2023_FINAL.png" alt="Energy to Care Logo"></div></div><div class="row spacer"><div class="col-md-12"><p class="center_Lead">Over 3,500 health care facilities are tracking emissions associated with facility energy consumption in Energy to Care, the American Society for Health Care Engineering’s (ASHE’s) award-winning sustainability program for health care facility management professionals who want to add value to their organizations via an environmental sustainability focus.</p><p class="center_Lead">The majority of scope 1 and 2 emissions for health care organizations can be tracked in the Energy to Care dashboard, a free tool provided by ASHE.</p></div></div></div><div class="col-md-1"> </div></div></div><div class="container SessionWrapper" id="Measuring"><div class="row"><h2 class="SessionTitle">Measuring Carbon in Your Organization</h2></div><div class><div class="col-md-1"> </div><div class="col-md-10"><div class="raw-html-embed"> <div class="row" id="Glossary"> <div class> <div class="acc_tabs"> /* Bottom of the Wrapper*/ .acc_tabs { margin-bottom: 25px; } /* reset */ .acc_tabs ul.acc-container { margin: 0; padding: 0; list-style: none; padding: 0 10px 10px 10px; display: inline-block; } .acc_tabs input[type=radio], .acc_tabs input[type=checkbox] { display: none; } /* style */ .acc_tabs .acc-container { width: 100%; } /* Label: Nonactive */ .acc_tabs .acc-container label { display: block; position: relative; cursor: pointer; font-weight: bold; border-bottom: 3px solid #78be20; -webkit-transition: all .2s ease; -moz-transition: all .2s ease; -ms-transition: all .2s ease; -o-transition: all .2s ease; transition: all .2s ease; margin-top: 15px; font-size: 16px/*Default 18px*/; padding: 5px 10px/*Default 10px 20px*/; color: #005844; background-color: #00584411/*Default #eee*/ ; line-height:18px; } /* Label: Active */ .acc_tabs .acc-container input:checked + label, .acc_tabs .acc-container label:hover { background-color: #78be20/*Defaut #69b3e7 003087 */ ; } /* Label: Active, Hover */ .acc_tabs .acc-container input:checked + label, .acc_tabs .acc-container label:hover, .acc_tabs .acc-container input:checked + label p, .acc_tabs .acc-container label:hover p { color: #fff; } /* Arrow: Closed */ .acc_tabs .acc-container label:after { content: ""; width: 0; height: 0; border-top: 8px solid #005844; border-right: 6px solid transparent; border-bottom: 8px solid transparent; border-left: 6px solid transparent; position: absolute; right: 10px; top: 16px; } /* Arrow: Open */ .acc_tabs .acc-container input:checked + label:after { border-top: 8px solid transparent; border-right: 6px solid transparent; border-bottom: 8px solid #005844; border-left: 6px solid transparent; top: 6px; } /* Container */ .acc_tabs .acc-content { padding: 0 20px 20px; display: none; overflow: auto; font-weight: ; color: #555 } .acc_tabs .acc-container input:checked ~ .acc-content { display: block; /*border-left: solid 1px #d9d9d6; border-right: solid 1px #d9d9d6; border-bottom: solid 1px #d9d9d6;*/ padding-top: 10px; } .acc-items label { margin-bottom: 0px; text-align:center; height: auto; min-height: 200px; } .acc-items ul { list-style: none; /* Remove default bullets */ padding-left: 0px; margin-bottom: 25px; } .acc-items ul li { margin-bottom: 7px; line-height: 1.5em; font-size: 14px; } .acc-items ul li::before { content: "●"; font-size: 1em; position: relative; top: 0px; color: #78be20; text-indent: -20px; padding-right: 10px; } .acc-items ul li { padding-left: 0px; text-indent: -23px; font-size:20px; } /* External Wrapper */ .acc_tabs .tab ~ .tabcontent { border: solid 1px #d9d9d6; padding-top: 0px; padding-bottom: 25px; clear: both; } /* Style the tab */ /* No need for the "@media(min-width:640px){" if only have two tabs with one word */ .acc_tabs .tab { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } /* Section behind the Tabs*/ .acc_tabs .tab { background-color: #fff; width: auto; height: auto; overflow: auto; } /* Buttons - aka Tabs */ .acc_tabs .tab>[class*='tablinks'] { width: calc(100%/2 - 30px); margin: 0px 15px/*Default Margin 0px 15px, if 6 tabs 0px 7px*/ ; font-size: 20px/*Default 20px, 12px if 6 tabs*/ ; background-color: #B1b3b344/*Default #B1b3b344*/ ; color: #003087/*Default #003087 - nonactive*/ ; padding: 10px 14px 10px 14px; border: solid 1px #B1b3b344; display: block; outline: none; text-align: left; cursor: pointer; transition: 0.3s; float: left; overflow: auto; -webkit-border-top-left-radius: 15px; -webkit-border-top-right-radius: 15px; -moz-border-radius-topleft: 15px; -moz-border-radius-topright: 15px; border-top-left-radius: 15px; border-top-right-radius: 15px; font-weight: 700; } @media (max-width:500px) { /* Buttons - aka Tabs */ .acc_tabs .tab>[class*='tablinks'] { width: calc(100%/2 - 10px); font-size: 12px; margin: 0px 5px } } @media (max-width:320px) { /* Buttons - aka Tabs */ .acc_tabs .tab>[class*='tablinks'] { width: calc(100%/2 - 10px); font-size: 10px; margin: 0px 5px } } /* Change background color of buttons on hover */ .acc_tabs .tab button:hover { background-color: #003087/*Default #003087*/ ; color: #fff/*Default #fff*/ ; } /* Active/Current "tab button" */ .acc_tabs .tab button.active { background-color: #003087/*Default #003087*/ ; color: #fff/*Default #fff*/ ; } /* Style the tab content - Dont htink is needed .acc_tabs .tab .tabcontent{ float: right !important; padding: 15px 12px; border: 1px solid #ccc; width: 100%; height: auto; }*/ .acc_tabs .tablinks:after { content: '\2610'; color: #777; font-weight: bold; float: right; margin-left: 5px; } .acc_tabs .tablinks.active:after { content: "\2611"; } /* For Indented Bulleted List */ .bullet-list-optA { list-style: none; } .bullet-list-optA>li { margin-bottom: 15px; } .bullet-list-optA h3 { margin-bottom: 0px; margin: 0px; } .bullet-list-optA h4 { margin: 0px; font-size: ; } .bullet-list-optA li ul li a { font-weight: 700; } .bullet-list-optA li ul li p { margin-bottom: 0px; } @media (min-width:992px) { .acc-container>li { width: calc((100% / 4) - 26px)/*Adjust # for the number per row, will override the bootstrap - Also needed for Safari*/ ; float: left; margin:13px; } } @media (max-width:991px) and (min-width:568px) { .acc-container>li { width: calc((100% / 2) - 40px)/*Adjust # for the number per row, will override the bootstrap - Also needed for Safari*/ ; float: left; margin: 20px; } } @media (max-width:587px){ li.acc-items { margin: 15px; } } /* xxxxxxxxxxxxxxxxxxxxxxx */ .acc-container .acc-items label::before { content: ""; width: 0px; height: 0px; border-style: solid; border-width: 25px 0 25px 25px; border-color: transparent transparent transparent #78be20; transform: rotate(0deg); float: right; position: relative; right: -35px; top: -4px; } Tab 1 Tab 2 </div> --> <div class="tabcontent" id="TabOne"> <ul class="acc-container rowEqual_xxx"> <li class="acc-items"> <img src="/sites/default/files/2025-07/Sus-MeasuringCarbon-1.png" alt>Get Started: Scope and Plan Inventory <div class="acc-content"> <ul> <li>Review GHG accounting standards and methods for organizational reporting</li> <li>Determine organizational and operational boundaries</li> <li>Choose a base year</li> <li>Consider 3rd party verification</li> </ul> </div> </li> <li class="acc-items"> <img src="/sites/default/files/2025-07/Sus-MeasuringCarbon-2.png" alt>Collect Data and Quantify GHG Emissions <div class="acc-content"> <ul> <li>Identify data requirements and preferred methods for data collection</li> <li> Develop data collection procedures, tools, and guidance tools</li> <li>Compile and review facility data (e.g., electricity, natural gas</li> <li>Choose emissions factors</li> <li>Calculate emissions</li> </ul> </div> </li> <li class="acc-items"> <img src="/sites/default/files/2025-07/Sus-MeasuringCarbon-3.png" alt>Develop a GHG Inventory Management Plan <div class="acc-content"> <ul> <li>Formalize data collection procedures and document process in inventory Management Plan</li> </ul> </div> </li> <li class="acc-items"> <img src="/sites/default/files/2025-07/Sus-MeasuringCarbon-4.png" alt>Set a GHG Emission Reduction Target and Track and Report Process <div class="acc-content"> <ul> <li>Finalize data</li> <li>Complete third-party verification (recommended)</li> <li>Report data as needed</li> <li>Prepare to set publicly reported GHG target and track progress</li> </ul> </div> </li> </ul> </div> <ul class="acc-container"> item 1 <div class="acc-content"> <p>====</p> </div> </li> </ul> <div> --> </div> </div> </div> </div></div><div class="col-md-1"> </div></div></div> Fri, 18 Jul 2025 19:00:00 -0500 Guides/Reports /guidesreports/2025-06-16-more-drug-company-oversight-needed-maintain-compliance-340b-program-rules <div class="container"><div class="row"><div class="col-md-8"><p>Drug companies have repeatedly challenged the integrity of the 340B program, particularly among 340B hospitals.<a href="#fn1"><sup>1</sup></a> In fact, several drug companies have cited these concerns as a basis to pursue unilateral, unlawful self-enforcement of the program, including their recent efforts to impose a 340B “rebate model.”<a href="#fn2"><sup>2</sup></a> To investigate the veracity of these claims, the ���������� Association (AHA) reviewed the publicly available federal audit data and observed trends in findings for both 340B hospitals and drug companies over a 5-year period of fiscal years (FY) 2018-2022.<a href="#fn3"><sup>3</sup></a> The findings demonstrate that not only are hospitals subject to disproportionately greater oversight by the federal government, but that they outperform drug companies in terms of program compliance to a substantial degree. These discrepancies underscore the need for increased federal oversight of drug manufacturers, as well as rejection of their unlawful approach to convert the discount program to a rebate model.</p><h2>Background</h2><p>For over 30 years, the 340B Drug Pricing Program has been a vital resource for covered entities<a href="#fn4"><sup>4</sup></a> to stretch their limited federal resources and provide more comprehensive care to more patients. In codifying the 340B program into law, Congress recognized the importance of program integrity and entrusted this responsibility to the Health Resources and Services Administration (HRSA).<a href="#fn5"><sup>5</sup></a> The law gives HRSA both the authority to promulgate regulations and guidance that establish program rules, as well as the ability to annually conduct audits of 340B covered entities and drug companies to ensure they are in compliance with these rules.</p><p>340B covered entities are subject to numerous rules. Chief among them are statutory prohibitions against diversion (i.e., giving a 340B drug to an ineligible patient) and duplicate discounts (i.e., receiving both a 340B discount and a Medicaid rebate on the same drug).<a href="#fn6"><sup>6</sup></a> The agency monitors compliance with these rules by reviewing patient records to identify any instances of diversion or duplicate discounts. In the event a violation is found, HRSA requires the covered entity to take corrective action, which can include repayment of 340B discounts erroneously obtained back to drug companies.</p><p>Drug companies participating in the program are also subject to HRSA oversight and audits. Those companies are statutorily required to ensure they do not overcharge 340B covered entities by selling a 340B-eligible drug at above the 340B ceiling price. Similar to the requirement for covered entities, if a violation is found, drug companies must engage in corrective action, which can include payment to the covered entity for the total amount of the overcharge.</p><p>HRSA’s audit program dates back more than a decade. HRSA began auditing 340B covered entities in 2012 and performs 200 audits annually, of which approximately 160 are for 340B hospitals (or ~6% of participating hospitals). HRSA began audits for drug companies in 2015 and performs approximately five audits every year (~0.6% of participating drug companies). The results of these audits are posted publicly on HRSA’s 340B program integrity website,<a href="#fn7"><sup>7</sup></a> including the nature of any audit findings and the corrective action taken, including whether repayment was required.</p><h2>Results</h2><p><strong>The analysis of federal audit data shows high rates of compliance for audited 340B hospitals and consistently high rates of noncompliance among audited drug companies.</strong></p><p><img src="/sites/default/files/inline-images/Figure-1-Share-of-Audit-Findings-for-Diversion-and-Duplicate-Discounts-FYs-2018-2022.png" data-entity-uuid="43b9ba20-d1d1-4512-b57e-175554a5d3f7" data-entity-type="file" alt="Figure 1. Share of Audit Findings for Diversion and Duplicate Discounts, FYs 2018-2022. 2018: Diversion 39.7%; Duplicate Discounts 30.8%. 2022: Diversion: 10.7%; Duplicate Discounts 13.2%." width="668" height="398" class="align-right">Duplicate discount and diversion findings in 340B hospital audits have declined significantly, reflecting very high rates of compliance in recent years. Between FY 2018 and FY 2022, 340B hospital audit findings for duplicate discount and diversion decreased by a combined 62.1%. Specifically for duplicate discount findings, in FY 2018, 30.8% of 340B hospital audits included at least one duplicate discount finding. This percentage dropped to 13.2% by FY 2022 or a 57% decrease over this 5-year period. Similarly, in FY 2018, 39.7% of audited 340B hospitals had at least one diversion finding. That dropped to just 10.7% in FY 2022 or a 73% decrease over this 5-year period (see Figure 1).</p><p>In contrast to hospitals, drug company audits reveal a consistent pattern of noncompliance. There was a total of 30 audits conducted for drug companies between FY 2018 and FY 2022 with 60% of these audits having at least one adverse finding. Of those drug companies that had at least one adverse finding, 93% were required to issue repayments to covered entities, underscoring a pattern of noncompliance among drug companies.</p><p><img src="/sites/default/files/inline-images/Figure-2-Share-of-Adverse-Audit-Findings-Resulting-in-Repayment-Sanctions-FYs-2018-2022.png" data-entity-uuid="02dd81a5-a186-4bff-9e37-8961acdecc47" data-entity-type="file" alt="Figure 2. Share of Adverse Audit Findings Resulting in Repayment Sanctions, FY 2018-2022. 2018: Manufacturers 100%; Hospitals 71%. 2019: Manufacturers: 100%; Hospitals 55%. 2020: Manufacturers 100%; Hospitals 38%. 2021: Manufacturers 100%; Hospitals 26%. 2022: Manufacturers: 75%; Hospitals 28%." width="670" height="481" class="align-right">Repayment requirements following audit findings highlight key differences in the nature of noncompliance between hospitals and drug companies. The most egregious audit findings by 340B hospitals and drug companies require repayment to the other entity. As shown in Figure 2, the percent of audit findings where 340B hospitals were required to repay manufacturers either due to a diversion or duplicate discount finding was consistently lower and decreased from 71% in FY 2018 to 28% in FY 2022, or a 61% decrease. In contrast, 100% of drug companies with an adverse finding in FYs 2018-2021 required repayment to covered entities, with only a drop-off in FY 2022 to 75%. However, it is important to note that this drop-off represents only one fewer drug company that was required to repay covered entities in FY 2022 compared to prior years.<a href="#fn8"><sup>8</sup></a></p><h2>Discussion</h2><p>The data above demonstrate 340B hospitals’ commitment to ensuring program integrity, reflecting ongoing efforts to strengthen internal oversight, including regular self-audits of their 340B programs. Many hospitals have also established 340B committees to develop rigorous compliance frameworks, modify workflows, and hold staff accountable when errors occur, among other actions.<a href="#fn9"><sup>9</sup></a></p><p>At the same time, drug companies continue to demonstrate a high degree of noncompliance with program rules and regulations. Strikingly, nearly all audit findings require drug companies to repay 340B covered entities for overcharges. This lack of compliance is particularly concerning given that drug companies have the ability to audit covered entities when they have a legitimate concern of noncompliance, but there is no reciprocal ability of covered entities to audit drug companies when they are being overcharged for 340B drugs. Moreover, HRSA scrutinizes 340B hospitals at 10 times the rate of drug companies (6% vs. 0.6%), despite the fact that it is 340B hospitals that have shown greater rates of compliance as compared to drug companies.</p><p>Compliance with rules and regulations is absolutely critical for the success of any government program. This is why Congress gave HRSA the responsibility to audit both drug companies and 340B covered entities. These findings contradict allegations made by drug companies against 340B hospitals and instead unequivocally demonstrate that drug companies — not 340B hospitals — are in great need of increased scrutiny to improve compliance with 340B program rules and regulations.</p><p>Policymakers should reject the baseless claims made by drug companies of widespread program abuse by 340B hospitals and urge HRSA to increase their audits of drug companies. Greater oversight of these drug companies is necessary to ensure the continued success of the 340B program for the millions of vulnerable patients and communities nationwide who rely on it.</p><hr><h3>End Notes</h3><ol><li id="fn1"><a href="https://www.phrma.org/resources/phrma-statement-on-the-340b-drug-pricing-program" target="_blank" title="PhRMA: PhRMA Statement on the 340B Drug Pricing Program">phrma.org/resources/phrma-statement-on-the-340b-drug-pricing-program</a></li><li id="fn2">See September 2024 Johnson & Johnson rebate model announcement: <a href="https://transparencyreport.janssen.com/johnson-johnson-rebate-model-summary-letter" target="_blank" title="Johnson & Johnson Rebate Model Summary Letter">transparencyreport.janssen.com/johnson-johnson-rebate-model-summary-letter</a></li><li id="fn3">FY 2022 is the latest year of complete data available. Currently, HRSA has only posted 171 of its 200 audit results for FY 2023.</li><li id="fn4">Covered entities include six types of hospitals (CAH, SCH, RRC, DSH, PED, CAN), community health centers, and other select federal grantee organizations. <a href="https://www.hrsa.gov/opa/eligibility-and-registration" target="_blank" title="HRSA: 340B Eligibility">hrsa.gov/opa/eligibility-and-registration</a></li><li id="fn5"><a href="https://www.hrsa.gov/sites/default/files/hrsa/rural-health/phs-act-section-340b.pdf" target="_blank" title="HRSA: Sec. 340B Public Health Service Act">hrsa.gov/sites/default/files/hrsa/rural-health/phs-act-section-340b.pdf</a></li><li id="fn6">Ibid.</li><li id="fn7"><a href="https://www.hrsa.gov/opa/program-integrity" target="_blank" title="HRSA: 340B Drug Pricing Program: Program Integrity">hrsa.gov/opa/program-integrity</a></li><li id="fn8">Between 2018 and 2021, every drug company that had at least one adverse audit finding also required repayment to covered entities. However, in 2022, three out of the four drug companies that had an adverse audit finding required repayment to covered entities, hence the drop from 100% to 75% in FY 2022.</li><li id="fn9"><a href="https://www.utmb.edu/policies_and_procedures/IHOP/Clinical/Pharmacy/IHOP%20-%2009.14.05%20-%20Roles%20and%20Responsibilities%20in%20the%20340B%20Drug%20Pricing%20Program.pdf" target="_blank" title="UTMB Health: Roles and Responsibilities in 340B Drug Pricing Program">utmb.edu/policies_and_procedures/IHOP/Clinical/Pharmacy/IHOP%20-%2009.14.05%20-%20Roles%20and%20Responsibilities%20in%20the%20340B%20Drug%20Pricing%20Program.pdf</a></li></ol></div><div class="col-md-4"><a href="/system/files/media/file/2025/06/More-Drug-Company-Oversight-Needed-to-Maintain-Compliance-with-340B-Program-Rules.pdf" target="_blank" title="Click here to download the More Drug Company Oversight Needed to Maintain Compliance with 340B Program Rules: Trends in Audit Findings for 340B Hospitals and Drug Companies report PDF."><img src="/sites/default/files/inline-images/Pages%20from%20More-Drug-Company-Oversight-Needed-to-Maintain-Compliance-with-340B-Program-Rules-page-1.png" data-entity-uuid="865e2242-5187-4a91-964e-1dba7a1db0b3" data-entity-type="file" alt="More Drug Company Oversight Needed to Maintain Compliance with 340B Program Rules: Trends in Audit Findings for 340B Hospitals and Drug Companies page 1." width="695" height="900"></a><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/340b-drug-pricing-program" target="_blank" title="AHA's 340B Drup Pricing Program landing page">See More 340B Drug Pricing Program Resources</a></div></div></div></div> h2 { color: #003087; } h3 { color: #9d2235; } Mon, 16 Jun 2025 08:47:21 -0500 Guides/Reports /costsofviolence <div class="container"><div class="row"><div class="col-md-8"><div class="panel"><h3 id="findings"><span><span>KEY FINDINGS:</span></span></h3><ul><li>Violence, including workplace (in-facility) and community violence, abuse, and threatening behavior, is a significant public health issue affecting the U.S. health system and communities.</li><li>This incidence of violence has significantly increased in the U.S. over the past decade, with rising rates of assault, homicide, suicide, and firearm violence, which were further exacerbated during the COVID-19 pandemic.</li><li>This study sought to estimate the financial costs and other impacts associated with workplace and community violence.</li><li>Hospitals experience substantial financial impacts from violence.<ul><li>The total annual financial cost of violence to hospitals in 2023 is estimated at $18.27 billion U.S. dollars (USD).</li><li>Pre-event costs associated with violence in the community and within facilities are estimated at $3.62 billion (USD), primarily for prevention measures.</li><li>Post-event costs for health care, work loss costs, case management, staffing, and infrastructure repair are estimated at $14.65 billion (USD).</li><li>The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</li></ul></li><li>Additional impacts, like public perception, staff recruitment and retention, legal concerns, job satisfaction, and psychological harm to health care workers, are significant but difficult to quantify due to limited data</li></ul></div><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h2 id="summary"><span><small class="sm">EXECUTIVE SUMMARY</small></span></h2><p>Violence is a major public health problem impacting our health system and communities.<sup>1</sup> Over the past ten years, rates of violence have increased in the United States (U.S.), including rates of assault, homicide, suicide, and firearm violence.<sup>2–5</sup> Further, violence increased during the COVID19 pandemic including rates of intimate partner violence, suicide, firearm violence, and workplace violence towards health care workers, and have not yet returned to pre-pandemic levels.<sup>6–10</sup> Violence directly impacts hospitals via millions of emergency department visits and hospitalizations for fatal and nonfatal violence-related injuries each year.<sup>4,11</sup> In addition, the impact of workplace and community violence is seen within the broader health care system leading to staff turnover, absenteeism, loss of productivity, high insurance and workers’ compensation costs, and an increased risk of depression, post-traumatic stress disorder, and suicide.<sup>12–15</sup> The ���������� Association (AHA) engaged the University of Washington (UW) Harborview Injury Prevention and Research Center (HIPRC) to estimate the financial costs and other impacts to hospitals from all types of violence, abuse, and threatening behavior within their facilities and communities. <strong>Through comprehensively characterizing the impacts of violence on hospitals, this report highlights the magnitude of violence as a public health problem and informs future policy and research efforts to address violence impacting U.S. hospitals and the health care system.</strong></p><p>We used mixed methods that incorporated multiple data sources, including existing federal and state data sources, published literature, and primary data to quantify the impacts of violence on hospitals. Our estimates were guided by an analytic framework developed by the study team, experts in the field, and published literature. The framework incorporates financial costs and other impacts of violence, broken down by pre- and post-event costs. Beyond pre- and postevent costs, we analyzed financial cost estimates by violence type and examined other impacts resulting from violence, including staff satisfaction and productivity, staff retention and recruitment, psychological impacts, and legal and ethical concerns.</p><p><strong>Overall, we estimate the total annual financial cost of violence to hospitals in 2023 to be $18.27 billion (U.S. dollars, USD). This estimate includes pre- and post-event cost components.</strong> Pre-event costs were estimated to be $3.62 billion (USD) and included costs for trainings, security and staffing, policy and procedure development, outreach to build public trust, facility modifications to prevent and mitigate harm, and investments in technology to monitor events. Post-event costs were estimated to be $14.65 billion (USD) and included costs for health care, staffing, replacement and repair of infrastructure and equipment, legal costs, and community and public relations costs. The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</p><p>There are additional impacts of violence to hospitals that cannot be quantified at this time due to limited data availability. These far-reaching consequences include the impact of workplace violence on public perception, staff recruitment and retention, legal concerns impacting hospitals, job satisfaction for health care workers, and the psychological impacts on health care workers who experience or observe violence. These interconnected effects underscore the complex and pervasive nature of violence beyond immediately measurable costs to hospitals.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="intro"><span>1. INTRODUCTION</span></h3><h4 id="1.1"><span>1.1 BACKGROUND AND RATIONALE</span></h4><p>Violence is a major public health problem impacting health systems in the United States (U.S.).<sup>1</sup> In the past ten years, there has been an increase in the incidence of assault, homicide, suicide, and firearm violence in the U.S.<sup>2–5</sup> Communities are highly impacted by violence, particularly in highpoverty and under-resourced neighborhoods.<sup>16–18</sup> Additionally, the COVID-19 pandemic declared in March 2020 had direct impacts on increasing rates of intimate partner violence (IPV), suicide, firearm violence, and workplace violence (WPV) against health care workers.<sup>6–10</sup> In 2022, there were 2,105,245 nonfatal and 73,989 fatal violence-related injuries that occurred in the U.S.<sup>11,19,20</sup> Violence also occurs in hospitals, where health care workers experience significant rates of violence from patients and visitors.<sup>12,13</sup> This leads to staff turnover, absenteeism, loss of productivity, high costs in disability and indemnity, and an increased risk of depression, posttraumatic stress disorder, and suicide.<sup>14,15</sup></p><p>The ���������� Association (AHA) engaged the University of Washington (UW) Harborview Injury Prevention and Research Center (HIPRC) to estimate the financial costs and other impacts to hospitals of all types of violence, abuse, and threatening behavior within their facilities and communities. The Human Subjects Review Committee at the UW Institutional Review Board approved this study (STUDY00019266; STUDY00019881). The goal of this report was to rigorously characterize and quantify the financial costs and other impacts of workplace and community violence to hospitals and their health systems, thus producing valuable information regarding the current impact of violence as a public health problem to inform policy and future research. We used mixed methods that incorporated multiple data sources to inform this report.</p><p>This report:</p><ul><li>Estimates the financial impact of violence to hospitals using published estimates, publicly available data sources, and primary data collection.</li><li>Identifies other impacts of violence to hospitals using published estimates, publicly available data sources, and primary data collection.</li><li>Identifies policy and research implications for addressing the impacts identified in the report.</li></ul><h4 id="1.2"><span>1.2 ANALYTIC FRAMEWORK AND METHODS</span></h4><p>For a more comprehensive review of the financial and other costs of violence, we used the World Health Organization’s definition of violence: “intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.” <sup>21</sup> Figure 1 below illustrates the analytic framework used to estimate the cost of violence to U.S. hospitals and health systems. This framework was developed by the study team and was guided by input from experts in the field and by review of current literature. The framework illustrates financial and other components used to derive our cost estimates, broken down by pre- and post-event costs. As illustrated in the framework, several components encompass both financial and other costs (i.e., Infrastructure and Equipment), and pre- and post-event costs (i.e., Staff Retention and Recruitment).</p><p>Mixed methods were used to estimate the financial costs and other impacts of violence to U.S. hospitals. We conducted a scoping review of the literature to ensure we captured a comprehensive overview of existing research, knowledge, and data related to the financial and other impacts of violence to U.S. hospitals. We included articles in our review that were published after 2016, focused on the U.S. health system, and published in English. Peer-reviewed studies and government reports were prioritized. Identified studies and extracted data were managed in Covidence online systematic review software. This review informed estimates reported here of the financial and other costs of violence and gaps in knowledge about cost components meriting future research.</p><p>We further used a socioecological framework to guide rigorous synthesis of existing literature, synthesis of recent national data describing direct and indirect costs in a diverse sample of care settings and health care workers (HCW), and in primary data collection to increase understanding of the true violence-related financial and operational pressures facing U.S. hospitals and their employees and patients.<sup>22</sup> The scope of this report focuses on hospitals and their related health systems, heretofore referred to as “hospitals” unless otherwise indicated.</p><div> <div data-entity-type="media" data-entity-uuid="16389403-c8be-4030-963e-138a97e08a4e" data-embed-button="media_entity_embed" data-entity-embed-display="view_mode:media.full" data-padding-top="20px" data-padding-bottom="20px" data-padding-left="20px" data-padding-right="20px" data-margin-top="10px" data-margin-bottom="10px" data-margin-left="10px" data-margin-right="10px" data-langcode="en" data-entity-embed-display-settings="[]" class="embedded-entity"> <article> <div class="field_media_image"> <img loading="lazy" src="/sites/default/files/2025-05/costs-of-violence-figure-1-analytic-framework-for-estimating-burden-violence.png" width="729" height="415" alt="Burden of Violence Figure 1: Analytic Framework for Estimating the Burden of Violence to U.S. Hospitals & Health Systems"> </div> </article> </div></div><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="financialcost"><span>2. FINANCIAL COST OF VIOLENCE</span></h3><p>Violence is a major public health problem in the U.S. As hospitals are directly impacted by workplace and community violence, understanding the financial costs to U.S. hospitals associated with violence is essential to guide cost-effective prevention efforts and to educate administrators, policymakers, and the public about the importance of prevention. Successful prevention relies on a comprehensive understanding of the many sides of a problem and designs complementary interventions from many angles; we have similarly structured our analysis of the financial cost of violence to hospitals to enable a comprehensive understanding of the many areas in which violence results in a financial cost, and the estimated magnitude of those costs. Although hospitals cannot address all workplace and community violence in the U.S., they are in a position to potentially have a significant impact on violence prevention in their facilities and surrounding communities.</p><table><caption><strong>Table 1. Estimated 2023 Annual Cost of Violence to U.S. Hospitals & Health Systems by Cost Category.</strong></caption><tbody><tr><td rowspan="2"><strong>Cost Category</strong></td><td rowspan="2"><p class="text-align-center"><strong>In millions of USD</strong></p></td><td colspan="2"><p class="text-align-center"><strong>Location of Violence</strong></p></td></tr><tr><td><p class="text-align-center"><strong>Community</strong></p></td><td><p class="text-align-center"><strong>Workplace</strong></p></td></tr><tr><td><span><strong>Pre-Event Financial Costs</strong></span></td><td><p class="text-align-right"><span><strong>3,620.5</strong></span></p></td><td> </td><td> </td></tr><tr><td>Training costs</td><td><p class="text-align-right">1,403.7</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Security personnel and staffing</td><td><p class="text-align-right">404.3</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Violence prevention programs*</td><td><p class="text-align-right">959.2</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Policy and procedure development</td><td><p class="text-align-right">8.6</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Outreach to build public trust</td><td><p class="text-align-right">79.7</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Facility modification to prevent and mitigate harms</td><td><p class="text-align-right">306.0</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Investments in technology to monitor possible events</td><td><p class="text-align-right">459.0</p></td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td><span><strong>Post-Event Financial Costs</strong></span></td><td><p class="text-align-right"><span><strong>14,648.8</strong></span></p></td><td> </td><td> </td></tr><tr><td>Health care costs for fatal and nonfatal injuries</td><td>13,165.6</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Work loss costs for workers in the health care setting</td><td>79.0</td><td><p class="text-align-center"> </p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Case management</td><td>252.5</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center"> </p></td></tr><tr><td>Staffing</td><td>541.3</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Replacement & repair of damaged infrastructure & equipment</td><td>584.8</td><td><p class="text-align-center"> </p></td><td><p class="text-align-center">X</p></td></tr><tr><td>Community interface and public relations</td><td>25.6</td><td><p class="text-align-center">X</p></td><td><p class="text-align-center">X</p></td></tr><tr><td colspan="4"><small class="sm">Note: Values may not sum to totals due to rounding. </small><br><small class="sm">*Relates to expenses other than training</small></td></tr></tbody></table><p> </p><p>Overall, we estimated the total financial cost of violence to hospitals to be $18.27 billion (U.S. Dollars, USD) (Table 1, Figure 2). This estimate includes pre- and post-event cost components. Pre-event costs were estimated to be $3.62 billion (USD) and included costs for trainings, security and staffing, prevention programs, policy and procedure development, outreach to build public trust, facility modifications to prevent and mitigate harm, and investments in technology to monitor events. Post-event costs were estimated to be $14.65 billion (USD) and included costs for health care, staffing, replacement and repair of infrastructure and equipment, and community and public relations costs. The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</p><p> </p><div> <div data-entity-type="media" data-entity-uuid="71a3be84-13ba-4e0b-94aa-6a22eb335a21" data-embed-button="media_entity_embed" data-entity-embed-display="view_mode:media.full" data-padding-top="20px" data-padding-bottom="20px" data-padding-left="20px" data-padding-right="20px" data-margin-top="10px" data-margin-bottom="10px" data-margin-left="10px" data-margin-right="10px" class="align-center embedded-entity" data-langcode="en" data-entity-embed-display-settings="[]"> <article> <div class="field_media_image"> <img loading="lazy" src="/sites/default/files/2025-05/costs-of-violence-figure-2-percentage-breakdown-estimated-2023-violence-costs.png" width="752" height="512" alt="Burden of Violence Figure 2: Percentage Breakdown of Estimated 2023 Vilence Costs to U.S. Hospitals & Health Systems (by Pre- & Post-Event and Component Costs)"> </div> </article> </div></div><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="pre-event"><span>3. PRE-EVENT FINANCIAL COSTS</span></h3><h4 id="3.1"><span>3.1 TRAINING COSTS</span></h4><p>Preparation for violent events in the health care setting requires training of workers at each clinical location. The estimated costs associated with this pre-event violence-prevention training are summarized below. Training-related costs were divided into six categories of component costs corresponding to distinct types of training occurring within hospitals and health care facilities. Together, we estimated training costs at $1.4 billion annually, with most of the cost stemming from training staff on de-escalation, emergency preparedness, and institution-specific violence-related policies and procedures (Table 2). Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–35</sup></p><table><caption><strong>Table 2. Estimated 2023 Annual Cost of Trainings within U.S. Hospitals & Health Systems in Preparation of Violence or a Violent Event.</strong></caption><tbody><tr><td><strong>Cost Category</strong></td><td><strong>In millions of USD</strong></td></tr><tr><td>Total training costs</td><td><p class="text-align-right">1,403.7</p></td></tr><tr><td>Active shooter training</td><td><p class="text-align-right">61.7</p></td></tr><tr><td>Training to respond to lateral violence</td><td><p class="text-align-right">148.0</p></td></tr><tr><td>Training in emergency and medical surge preparedness</td><td><p class="text-align-right">369.5</p></td></tr><tr><td>Training in de-escalation in hospitals</td><td><p class="text-align-right">377.4</p></td></tr><tr><td>Training on violence-related policies and procedures in the hospital</td><td><p class="text-align-right">261.9</p></td></tr><tr><td>Training for providers to identify violence-related trauma</td><td><p class="text-align-right">185.2</p></td></tr></tbody></table><p> </p><p><span><strong>3.1.1 Active Shooter Training.</strong></span> Hospitals are not immune from experiencing WPV, including active shooter events. A study identified 88 hospital shootings in the U.S. from 2012 to 2016 noting emergency departments were the most common site (30%), followed by patient rooms (21%) and parking lots (15%). <sup>36,37</sup> Additional studies described perpetrators as those with a personal grudge against their victims and of 235 victims, at least 60-80% were bystanders to the violent event, 13% patients, 5% nursing staff, and 3% physicians. <sup>36,38,39</sup> Since most events transpire within 15 minutes, before law enforcement can arrive, the Joint Commission urges hospitals to prepare staff, particularly recommending the development of a communication plan, establishing processes and procedures to ensure patient and employee safety, training and drilling employees, and planning for post-event activities (e.g., establishing debriefing procedures). <sup>40,41</sup> Hospital training sessions often recommend the “Run-Hide-Fight” strategy and deliver other educational content through annual online modules or computer-based simulations.<sup>42,43</sup> To estimate the cost of providing active shooter trainings in U.S. hospitals, we assumed that across all hospital employees, trainings employ a dual learning approach (online virtual e-learning as well as in-person sessions with trained instructors).<sup>44</sup> We identified estimates from 2018 that indicate costs of blended types of training were approximately $32,100 (educational setting).<sup>45</sup> In the absence of formal cost estimates for this type of training, we estimated that costs for this type of training vary by hospital size, wherein larger hospitals have higher costs due to having more staff. Assuming a starting annual cost of $6,000 for the smallest hospitals (6-24 beds) and increasing costs incrementally by 20% according to hospital bed size (8 tiers) to $21,499 for the largest hospitals, we estimated that all U.S. hospitals (N=6,120) pay approximately $61.7 million<a title="* $61,743,166">*</a> annually for active shooter training, independent of other trainings described in this report. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–29</sup></p><p><span><strong>3.1.2 Training to Respond to Lateral Workplace Violence.</strong></span> Stressors that arise in the hospital workplace, combined with hierarchy and behavioral norms, can create environments that enable lateral violence. Lateral violence is a type of workplace violence, defined as workplace conflict arising from interpersonal relations between employees. In the U.S., up to 76% of health care workers have reported experiencing violence, with over 80% experiencing verbal violence and 33% experiencing physical violence.<sup>46</sup> Unfortunately, some of this violence is lateral violence arising from employees perpetrating abuse towards their colleagues via repeated behaviors of physical, psychological, or sexual abuse.<sup>47</sup> There are a multitude of interventions available to decrease the prevalence of workplace incivility, lateral violence, and abuse and bullying.<sup>48</sup></p><p>The Joint Commission Standard HR.01.05.03 requires that leadership, staff, and licensed practitioners participate in ongoing education and training in WPV; however, the content for each audience is determined by the hospital.<sup>49</sup> Additionally, individual states’ requirements for sexual harassment training (one component of lateral/workplace violence) vary considerably.<sup>50,51</sup> The length of training session and requirements can also vary by occupation.<sup>52,53</sup> To account for this variation across hospitals, occupations, state requirements, and content, we assume that 60% of the hospital workforce engage in some sort of lateral violence prevention training annually. In the absence of data on duration of training across professions or occupations, we estimated that annual training lasts an average of one hour across all hospital occupations, an estimate that also accounts for the fact that this training may be bundled with other employee training (e.g., training on policies and procedures related to violence). To estimate the cost of training, we utilized workforce and wage data for occupations employed in hospitals (NAICS Sector 62-2000)<sup>54</sup> (see Appendix).</p><p>Per these assumptions, we calculated costs as follows: ∑<em><sup>21</sup><sub>i=1</sub></em> 𝐸𝑖 x 𝑊𝑖 x 𝑇𝑖  , wherein i is the index representing each type of occupation group (Appendix Table 1), Ei is the national employment estimate for the i th occupation, Wi is the estimated mean hourly wage per employee for the ith occupation, Pi is the percentage of institutions with lateral violence training annually (60%), and T is the time spent per year in training for the i th occupation (1 hr). Based on this approach, we estimated that training on WPV prevention (lateral violence) costs hospitals $148.0 million<a href="#" title="* $148,035,403">*</a> annually. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–29</sup></p><p><span><strong>3.1.3 Training in Emergency and Medical Surge Preparedness.</strong></span> Medical surge preparedness describes the ability of health care systems to manage a sudden influx of patients following unplanned, large-impact events, such as mass casualty incidents, natural disasters, or a pandemic. While not all these events may involve violence, training in medical surge preparedness is also necessary to respond to large-scale events that do involve violence (e.g., mass shootings, bombings). Estimating costs of training personnel in preparing for medical surges (or for emergency preparedness in general) vary widely across the literature.<sup>55</sup> To estimate the costs of medical surge preparedness for U.S. hospitals, we estimated the average duration of the training as two hours per health care staff member per year, and two hours per protective services staff member per year. This estimate of duration is based on Department of Homeland Security Center for Domestic Preparedness Medical Surge Management course.<sup>56</sup> We recognize the duration of training may vary by occupation. For cost estimations, we assumed a training session would take staff away from regular duties for those hours. The patient-facing hospital workforce was defined as health care practitioners and technical occupations (Standard Occupational Classification [SOC] 29-0000) and health care support occupations employed in hospitals (SOC 31-0000) (Appendix Table 1).<sup>54</sup> The protective services workforce (SOC 33-0000), including security guards, was also included in this calculation. Assuming 2 hours of annual training for the occupations above, we estimated that hospitals spend a total of $369.5 million<a href="#" title="* $369,543,838">*</a> on medical surge preparedness training each year. The cost of preparing and offering the training internally was not incorporated into this estimate; therefore, we believe this is likely a conservative estimate of the total (true) costs for this training. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–29</sup></p><p><span><strong>3.1.4 Training in De-Escalation.</strong></span> De-escalation skills help mitigate the deleterious impacts of conflicts within the health care setting. De-escalation training is particularly common in the hospital setting and is listed as a requirement by the Joint Commission (HR.01.05.03).<sup>49</sup> To calculate the national costs of de-escalation training for the patient-facing hospital workforce, the duration of training was estimated at an average of two hours per health care staff member per year and eight hours per protective services staff member per year.<sup>57–59</sup> We recognize that the extent of annual training likely varies by clinical specialty and location. For cost estimations, we assumed a training session would take staff away from regular duties for the training time. The actual cost of the training was not incorporated because costs vary widely and many training sessions may be developed and offered internally by health care institutions for little/no cost; our estimate is likely conservative as some hospitals may engage outside agencies to provide this training for an additional cost. See Appendix Table 1 for details on patient-facing and protective services workforce in hospitals (SOC codes 29-0000, 31-0000, and 33-0000). Assuming two hours of annual de-escalation training for patient-facing occupations and eight hours of annual training for protective personnel, we estimated hospitals spend a total of $377.4 million<a href="#" title="† $377,362,634 ">†</a> on deescalation training each year. Activities in this section fall under Joint Commission Standard HR.01.05.03 EP 29.<sup>26</sup> </p><p><span><strong>3.1.5 Training on Violence-Related Policies and Procedures in Hospitals.</strong></span> Training on violence-related policies and procedures is critical to ensure that the health care workforce is prepared to respond to violence within U.S. hospitals and is required by accrediting bodies such as the Joint Commission and federal agencies such as the Centers for Medicare & Medicaid Services.<sup>49</sup> Awareness of, and compliance with, policies help employees promote safety during violent events. Training covers zero-tolerance policies, reporting mechanisms, and appropriate staff roles and responsibilities in the event of a violent incident. The general policy/procedure training described here encompasses training on institution-specific policies and procedures and does not include specific training summarized elsewhere in the report (e.g., de-escalation training). We estimated the hospital management workforce (SOC 11-0000) engages in two hours of policy and procedure-related training related to violence prevention<sup>57–59</sup> (e.g., monitoring, reporting, and investigating events) and all other hospital employees engage in 0.5 hours of training annually (e.g., how to report events). Based on these assumptions and wage and workforce estimates (Appendix Table 1, 21 occupations), the estimated cost of training specifically on violence-related policies and procedures in hospital was calculated as follows: ∑<em><sup>21</sup><sub>i=1</sub></em> 𝐸𝑖 x 𝑊𝑖 x 𝑇𝑖 wherein i is the index representing each type of occupation group (see table below), Ei is the national employment estimate for the i th occupation, Wi is the estimated mean hourly wage per employee for the i th occupation, Ti is the number of hours spent per year in training for the i th occupation (described above). Based on this approach and 2023 mean hourly wage data reported by the Bureau of Labor Statistics, we estimated that training on violencerelated policies and procedures cost U.S. hospitals $261.9 million<a href="#" title="* $261,906,280">*</a> annually. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–28</sup></p><p><span><strong>3.1.6 Training for Providers to Identify Violence-Related Trauma.</strong></span> Educating hospital personnel to recognize trauma linked to violence is crucial for interrupting the cycle of violence and helping to ensure patients receive the care they need.<sup>60–62</sup> Conditions of note include child and elder abuse, neglect, or maltreatment, and screening for self-harm/suicide, domestic violence, human trafficking, and intimate partner violence. We estimated that the patient-facing hospital workforce dedicates, on average, one hour annually for these trainings. This estimate of time commitment is based on mandated trainings for related conditions<sup>63</sup> (e.g., 6 hours every 6 years for suicide prevention training in Washington State) with the assumption that each year, providers engage in at least one hour of training related to mandated reporting or child and elder abuse, neglect, or maltreatment, and screening for self-harm/suicide, domestic violence, and intimate partner violence. (This is likely an underestimate.) The patient-facing hospital workforce was defined as health care practitioners and technical occupations (SOC 29-0000) and health care support occupations employed in hospitals (SOC 31-0000). Additionally, we estimated four hours per year for human resources managers (SOC 11-3121) to organize and monitor the trainings and related compliance. Hourly wage estimates for 2023 were obtained from the Bureau of Labor Statistics.<sup>54</sup> We used the following equation to calculate the total cost associated with training for providers to identify violence/violent injuries: (𝐻<sub>𝐻</sub><em><sub>R</sub></em> × 𝑁<sub>𝐻</sub><em><sub>R</sub></em> × 𝑊<sub>𝐻</sub><em><sub>R</sub></em>) + (𝐻<sub>𝑃</sub><em><sub>F</sub></em> × [(𝑁<sub>29</sub> × 𝑊<sub>29</sub>) + (𝑁<sub>31</sub> × 𝑊<sub>31</sub>)] wherein H<sub>HR</sub> is the hours per year human resources managers spend providing and monitoring trainings, HPF is the hours per year the patient-facing hospital workforce dedicate to this training, NHR is the estimated number of human resources managers, N<sub>29</sub> and N<sub>31</sub> are the estimated number of patient-facing providers (for each SOC group, 29-0000 and 31-0000, respectively), WHR is the estimated mean hourly wage of human resources managers, and W<sub>29</sub> and W<sub>31</sub> are the estimated mean hourly wage of each patient-facing provider group (see Appendix Table 1 for values). We estimated that each year, U.S. hospitals spend $185.2 million<a href="#" title="† $185,156,223">†</a> to train patient-facing providers in recognition of abuse, risk for violence, and violence-related trauma. Activities in this section fall under several Medicare Conditions of Participation Standards.<sup>23–25</sup></p><h4><span>3.2. SECURITY PERSONNEL AND STAFFING</span><span> </span></h4><p>Hospitals employ security personnel to respond to incidents of violence and monitor the safety and security of the facility. Security personnel are trained to manage emergencies and work closely with health care teams to maintain a safe and secure environment. Their purpose is to prevent potential events by detecting/deterring threats while fostering a reassuring, safe environment. According to the Bureau of Labor Statistics, U.S. hospitals employed 49,280 security guards in 2023 (SOC code 33-9032). Annual mean wages for security guards in this setting is $45,080, equating to a total wage expenditure on security of $2,221,542,400. Based on previous work, assuming 18.2% of this cost is attributable to local crime rates, we estimated staffing security personnel in response to violence costs U.S. hospitals $404.3 million. <sup>64</sup><a href="#" title="* $404,320,717"><sup>*</sup></a></p><h4><span>3.3. VIOLENCE PREVENTION PROGRAMS </span></h4><p>In recent years awareness of the importance of proactive action to prevent violence, and the role of hospitals in that prevention, has grown. This focus on prevention has taken two forms; one focused on patients and keeping them safe from further violent injury while addressing psychological sequela from their current injury, and one focused on keeping employees safe. Below we described these two types of programs and estimated their costs, totaling $959.2 million annually (Table 3). However, it is important to note that we were unable to estimate the potential cost-savings these programs may create by successfully preventing violent injury. It will be important in future work to include emerging evidence about the efficacy of these programs to prevent injuries to paint a full picture of the potential cost-effectiveness of the programs.</p><table><caption><strong>Table 3. Estimated 2023 Annual Cost Associated with Violence Prevention Programs within U.S. Hospitals and Health Systems in Preparation of Violence or a Violent Event.</strong></caption><thead><tr><th><strong>Cost Category</strong></th><th><strong>In millions of USD</strong></th></tr></thead><tbody><tr><td>Violence prevention programs (expenses other than training)</td><td>959.2</td></tr><tr><td>Hospital-based violence intervention programs</td><td>270.5</td></tr><tr><td>Workplace violence prevention programs</td><td>688.7</td></tr></tbody></table><p> </p><p><span><strong>3.3.1 Hospital-based Violence Intervention Programs.</strong> </span>There has been a growing awareness among health care providers that only treating physical wounds is insufficient to prevent downstream effects following victimization, and health care staff can and should do more to address the psychosocial needs of patients by integrating violence prevention into the delivery of health care. <sup>65,66</sup> Hospital-based Violence Intervention Programs (HVIPs) seek to mitigate and prevent recurrent violent injury (trauma recidivism) by identifying and offering victims of violent injury (stabbing, gunshot wounds, assault) a range of support services while in the trauma unit. <sup>67</sup> Following recovery or stabilization of the index injury, HVIPs then seek to link patients to community-based organizations and programs external to the hospital upon discharge with the goals of preventing the patient from experiencing a subsequent violent injury, breaking the cycle of violence, and addressing social needs. HVIPs are comprised of multidisciplinary teams including trauma surgeons, nurses, social workers, and other credible messengers. These programs operate from a trauma-informed perspective reflecting a “fundamental shift in thinking from the supposition that those who have experienced psychological trauma are either ‘sick’ or deficient in moral character to the notion that they are ‘injured’ and in need of healing”.<sup>67</sup></p><p>A unique feature of HVIPs is that the team members approach patients at the bedside instead of waiting for patients to contact them for support. HVIP staff endeavor to engage victims of violent injury within the “golden hour”: the period in which victims of violent injury are most likely to agree to engage in services. HVIP staff are trained to engage patients of violent injury and build rapport with them. According to the 2022 AHA Annual Survey, an estimated 1,143 hospitals reported having violence prevention programs for the community. (This is likely an underestimate due to survey response rate; we also assume that more hospitals would have HVIP programs in 2023, given the increasing investment and interest in these programs. However, the most recent data are 2022, thus we relied on this estimate.) To estimate the costs of these programs borne by hospitals, we relied on estimates that HVIP programs cost approximately $10,798 per participant.<sup>68</sup> Assuming that each hospital with a HVIP serves proportionally as many participants as the size of their hospital, we estimated that the smallest institutions (6-24 beds) serve two participants annually and midsize institutions (300-399 beds) serve 100 participants annually.<sup>68</sup> The number of participants per hospital was thus scaled accordingly across 8 levels of hospital bed sizes (e.g., hospitals with 25-49 beds served an average of 20 participants; those with 400-499 beds served an average of 120 participants). Assuming each HVIP program will cost an average of $10,798 per participant (recognizing that the cost per participant in smaller hospitals will be higher than larger hospitals), we summed the products of overall HVIP cost per participant across all hospitals in the U.S (see equation below). These terms were used to calculate total cost as ∑ 𝐶𝐶 × 𝑃𝑃𝑛𝑛 × 𝑁𝑁𝑛𝑛 8 𝑛𝑛=1 wherein C is the average cost per participant, Pn is the number of participants per hospital scaled according to 8 levels of bed size (n) and Nn is the number of hospitals at least level of bed size. Nationally, the costs of staffing, transportation, crisis support, and operations for HVIP programs total to $901.8 million each year.<sup>68</sup> Evidence suggests expenses for HVIPs are shared across hospitals, foundations, local communities, charities, philanthropy, and federal funding.<sup>69</sup> Accordingly, we assumed that 30% of the costs of HVIP are the responsibility of the hospital, thus the total cost to hospitals for HVIPs annually is estimated at $270.5 million.<a href="#" title="* $30,060,502">*</a> Our estimate exceeds previous per-hospital HVIP costs reported in the literature, and recent investments in community violence-prevention and inflation likely account for this difference.</p><p><span><strong>3.3.2 Workplace Violence Prevention Programs.</strong></span> Programs to prevent WPV are becoming a standard practice in health care. Distinct from HVIPs, WPV prevention programs consist of strategies and policies implemented by institutions to prevent and manage violence in the workplace and foster a culture of safety.<sup>70</sup> Key components of WPV prevention programs may involve risk assessment, reporting mechanisms, incident response plans, support services, and monitoring and evaluation. They can also include several component costs discussed elsewhere in this report, such as policy development and training and education (those costs are not duplicated here). The Joint Commission requires hospitals to have a WPV prevention program (LD.03.01.01 EP9)<sup>71</sup> “led by a designated individual and developed and supported by a multidisciplinary team.”<sup>72 </sup>Multiple states also have requirements that hospitals have WPV prevention programs.<sup>73</sup> Given these requirements, we assume that all U.S. hospitals have a violence prevention program. <a href="#" title="* Although the 2022 AHA Annual Survey suggests that only 2,894 hospitals reporting having a violence prevention program for the workplace">*</a></p><p>The cost of staffing time to lead and support hospital WPV prevention programs, including completing risk assessments, establishing and maintaining reporting mechanisms, developing and disseminating incident response plans, providing support services, and overseeing monitoring and evaluation, are not publicly available. As an estimate, we assume that one coordinator will lead the program (e.g., emergency management director, SOC code 11-9161, mean annual salary of $106,670).<sup>54</sup> This individual is supported by a threat assessment team with representation from public safety, social work, physician administrators, and nursing administrators.<sup>74</sup> This team reviews threat assessment protocol workups and identifies recurring issues, as well as discussing plans, programming, and program needs. We assume the threat assessment team will meet for one hour monthly. In addition, the WPV prevention coordinator is assumed to be supported by a collaborative WPV prevention committee, which will meet quarterly to discuss incidents, review data, and discuss trends, challenges, and root causes. The membership of this committee can include leadership from across the hospital.<sup>74</sup> For this estimate, because not all hospitals have representation from all of these areas, we assume representation in the committee will include one chief executive, one medical/health services manager, a human resource manager, an emergency medicine physician, a behavioral health provider, an occupational health and safety specialist, and an operations specialties manager. This selection accounts for a wide range in member salaries (i.e., $32.65 to $192.26 per hour) in order to account for variation in hospital and committee structures across the U.S.<sup>74</sup> We estimated staffing cost based on salary estimates from the Bureau of Labor Statistics for health care providers in hospitals (NAICS code 62-2000)<sup>75</sup> (See Appendix Table 2). Overall, we estimated the average cost of staffing a WPV prevention program is $112,532 per hospital per year, totaling to $688.7 million<a href="#" title=" $688,693,637">†</a> annually. Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards.<sup>23–29</sup></p><h4><span>3.4 POLICY AND PROCEDURE DEVELOPMENT</span><span> </span></h4><p>An important aspect of prevention and response to violent events in hospitals is the development of facility-specific policies and procedures. This process involves the creation of comprehensive guidelines describing the steps to be taken before, during, and after a violent incident or event. Developing these policies and procedures includes the following tasks, which require time and effort by hospital leadership: conducting risk assessments to identify potential threats, developing reporting protocols, defining personnel roles and responsibilities, and establishing protocols for post-event support services (e.g., counseling).<sup>30</sup> Effective policies and planning should involve regular training and drills (the costs of which are covered elsewhere in this report (e.g., training and violence prevention programs)). Estimates for initial policy development and revision are approximately $3,000-5,000. <sup>76</sup> After policies are in place, maintenance is approximately $1,000/year.<sup>77</sup> We assume most hospitals in the U.S. have policies developed (90%) and are in the maintenance phase; 10% still require further policy/procedure development. Assuming policy and procedure development costs $5,000, the estimated annual hospital cost for policy and procedure development and maintenance is $8.6 million. <a href="#" title="* $8,568,000">*</a> Activities in this section fall under several Joint Commission and Medicare Conditions of Participation Standards. <sup>24,27,31–33</sup></p><h4><span>3.5. OUTREACH TO BUILD PUBLIC TRUST </span></h4><p>Proactive engagement with the public through transparent communication, educational programs, and community partnerships helps to establish trust and credibility in the hospital and its status as a place of safety in the community. This process includes engagement with not only the surrounding communities, but also building strong relationships with law enforcement and community agencies. </p><p>To estimate these costs, we used cost data from nonprofit community hospitals as these hospitals annually report to the Internal Revenue Service (IRS) on the benefits they provide to their communities. From a review of 2020 tax filings, nonprofit community hospitals spent on average 0.1% of their total expenses on community building activities. <sup>78</sup> These community building activities could include university/school partnerships, engagements in community relations committees, environmental improvements, workforce and job development, violence prevention, childcare programs, and partnerships with local law enforcement agencies. A prior report by the AHA estimated 8.1% of community building activities were generally related to programs and activities directed to prevent violence in the community. <sup>64 </sup></p><p>Using data from the 2022 AHA Annual survey, there are a total of 2,987 nonprofit community hospitals in the U.S. Given the total facility expense for these community hospitals ($984.2 billion), it is estimated that $984.2 million was spent on community building activities (assuming that the mean community investment of 0.1 percent holds across all hospitals). <sup>79</sup> Assuming that 8.1% of hospital expenses for community building and related activities, accounting for inflation from 2022 to 2023, we estimated that $79.7 million<a href="#" title="† $79,722,995">† </a>dollars were spent on community building activities generally related to preventing violence. We excluded for-profit, psychiatric, long-term care, and federal government hospitals from this estimate given the lack of publicly available reporting on these expenditures. Thus, the actual amount hospitals spend on communitybuilding activities related to preventing violence is likely greater than estimated here.</p><h4><span>3.6 FACILITY MODIFICATION TO PREVENT AND MITIGATE HARMS </span></h4><p>Another pre-event cost component is the modification of hospital facilities to prevent violent events and mitigate harm. These costs may include structural changes such as redesigning floor plans to eliminate isolated areas and ensure clear lines of sight, reinforcing entry points, and creating designated safe areas. Additional components may include improving lighting and visibility in vulnerable areas, implementing secure access controls to restrict unauthorized entry, and modifying patient rooms and common areas (public spaces) to minimize the risk of weapon use. These facility-level physical modifications are important to creating a safe environment and ensuring that health care facilities are prepared to respond effectively to potential threats. <sup>80</sup> Facility modification engineering solutions include, for example, two exit routes for rooms and an alternative route for employees in case of an emergency. Providing areas for de-escalation and ensuring lighting is not harsh or causing undue glare is important. Barrier protection includes deep counters, lockable and secure bathrooms for staff members, and enclosed receptionist desks with bulletproof glass. While data on the costs of facility modification are not available, we estimated that facility modification associated specifically with the incorporation of violenceprevention modifications in the design would amount to a mean of 0.5% of a hospital’s reported capital expenditures. The 2022 AHA Annual Survey data reports a total of $61.2 billion in capital expenditures; thus, the estimated cost of incorporating violence-prevention facility modifications would be $306.0 million<a href="#" title="* $305,983,684">*</a> per year for U.S. hospitals.</p><h4><span>3.7. INVESTMENTS IN TECHNOLOGY TO MONITOR POSSIBLE EVENTS </span></h4><p>In addition to modifications to physical facilities, hospitals and health systems must make investments in technology to predict and monitor possible events. <sup>80,</sup><a href="#" title="† This report does not include the cost of cybersecurity, as that is outside the scope of the report. Cyber-attacks have been called “threat-to-life crimes,” and the AHA is leading efforts elsewhere to address this issue.81"><sup>†</sup> </a>Costs associated with technology investments are primarily comprised of maintaining and upgrading security systems, such as installing surveillance cameras, body-worn cameras, and alarm systems. Additional costs may be associated with installation of panic or duress alarms or similar equipment and communication devices, weapons detection technology and the cost associated in operating the technology, artificial intelligence to identify patients at high risk for violence, and information technology infrastructure to identify or predict risk of violence.<sup>82</sup> Estimates of costs of individual technology approaches (e.g., metal detectors) are available; however, comprehensive data on the violence-prevention technology investments made by all hospitals in the U.S. are not available. Focusing solely on hospitals, where most violent events in the health care and social assistance industry occur, we estimate that ongoing technology expenses amount to 3% of hospital operating costs. <a href="#" title="‡ This is an estimate derived from research team affiliated hospital as this data is not publicly available.">‡</a> We assumed an investment of 1% of reported hospital capital expenditures for half of hospitals for the expense of new violence-prevention technology installment annually. <sup>83</sup> Additionally, we assumed that hospitals dedicate an additional 0.5% for maintenance of this technology. This amounts to $459.0 million<a href="#" title="* $458,975,526">*</a> per year for U.S. hospitals. Activities in this section fall under multiple Joint Commission Standards.<sup>34,35</sup></p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="post-event"><span>4. POST-EVENT FINANCIAL COSTS </span></h3><p>This section outlines financial costs incurred following a violent event. Beyond the specific component costs detailed below, a hospital’s ability to provide patient care may be compromised immediately or shortly after such an incident. This disruption can result in unmet patient needs and a potential loss of revenue for the hospital. Although challenging to quantify, this impact should be considered in conjunction with the other costs discussed in this section.</p><h4><span>4.1 HEALTH CARE COSTS FOR FATAL AND NONFATAL INJURIES </span></h4><p>Total health care costs associated with violence borne by the hospitals were generated as the sum of the following components: costs from uninsured injuries and costs due to underpayments for patients with public insurance<a href="#" title="† While other insurers may underpay, estimates of underpayment rates are variable and not easily accessible. We have included the best available data for this analysis, and estimates here are considered conservative">†</a> . We estimated 23.6% of violence-related injuries treated in hospitals and emergency departments were among uninsured patients and thus hospitals would be uncompensated for this percentage.<sup>84</sup> This estimate is consistent with recent national estimates of violence-related emergency department visits and hospitalizations. <sup>85</sup> </p><p>In addition to violence-related costs borne by the hospital resulting from uninsurance, underpayments associated with set payment schedules for public insurers also generate costs borne by the hospital, rather than the patient or payer. We estimated a 12%<sup>86, </sup><a href="#" title=" 88 cents for every dollar"><sup>‡</sup> </a>underpayment rate for Medicaid and an 18%<sup>87,</sup><a href="#" title="§ 82 cents for every dollar"><sup>§</sup></a> underpayment rate for Medicare, based on reporting from the AHA. We recognize these estimates are somewhat dated (2020 for Medicaid and 2022 for Medicare); however, they are the most recent data available from a reliable source. We estimated 39.8% of victims of violence were insured by Medicaid and 7.8% were insured by Medicare. <sup>84</sup> </p><p>For health care cost estimates for treat-and-release emergency department visits, nonfatal hospitalizations, and fatal injuries due to violence, we relied upon estimates from the Centers for Disease Control and Prevention (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS). Methodologies used to generate WISQARS estimates are reported elsewhere.<sup>88</sup> Briefly, the total health care costs are based on statistical modelling of observed injury-related medical cost data; fatal injury medical cost estimates include treatment costs as well as coroner/medical examiner costs and costs associated with ambulance transport, nursing home care, or hospice care.<sup>88</sup> Because the coroner and medical examiner costs are typically the responsibility of the patient’s family and not covered, for example, by public insurance, we excluded coroner/medical examiner costs from our estimates. It is expected that all violencerelated deaths should involve coroner/medical examiner services and the average estimated cost per exam was $3,000, which is a conservative 2018 estimate based on the U.S. Bureau of Justice Statistics reporting; the cost is likely higher now.<sup>89</sup> The estimated medical examiner/coroner amount was removed from the calculations.</p><p>The estimates for costs and total number of fatalities due to violence are derived from CDC WISQARS, which generates 2021 USD estimates. These values were adjusted for inflation to 2023 USD using the Bureau of Economic Analysis Index annual change estimate (for health).<sup>90,</sup><a href="#" title="* U.S. Bureau of Economic Analysis, "Table 2.5.4. Price Indexes for Personal Consumption Expenditures by Function" (accessed Friday, October 11, 2024)."><sup>*</sup> </a></p><p>Based on these data and assumptions, total health care cost borne by U.S. hospitals was estimated using the equation below (variable definitions and sources in Appendix Table 3). <em>1 × {[𝐶<sub>hospital</sub> + 𝐶<sub>𝐸D</sub> + (𝐶<sub>fatal</sub> − (𝐶<sub>examiner</sub>))] × [(𝑚 × 𝑢<sub>𝑚</sub>) + (𝑐 × 𝑢<sub>𝑐</sub>) + (𝑛 × 𝑢<sub>𝑛</sub>)]}</em> Using this approach, the total estimated health care costs borne by hospitals for fatal and nonfatal injuries is $13.2 billion† in 2023 USD. This estimate represents only the costs for which the hospital is responsible due to un/under-reimbursed care and comprises 29.8% of the total estimated treatment costs for violence-related injuries in 2023 ($44.2 billion, Chospital + CED + Cfatal as reported by CDC WISQARS and adjusted for inflation to 2023 USD). </p><p>We also calculated costs associated with medical care for violence-related injuries for three types of violent injuries: cut/pierce, struck by/against, and firearm-related injury. Cut and pierce injuries involve an incision, slash, perforation, or puncture by a pointed or sharp instrument, weapon, or object (e.g., stabbings).<sup>91</sup> Injuries classified as “struck by/against” involve a strike by or against an object or other person.<sup>92</sup> The costs associated with these injuries which contribute to the total estimate of $13.2 billion are $4.1 billion for struck by/against injuries, $3.3 billion for firearm injuries, and $2.5 billion for cut/pierce/stab injuries. (Other injuries could be attributed to falls, inhalation, ingestion, suffocation, poisoning, or other causes.)</p><h4><span>4.2 WORK LOSS COSTS FOR HOSPITAL WORKERS</span></h4><p>The health care field accounts for approximately three-quarters of all nonfatal violence-related occupational injuries and illnesses in the U.S.<sup>93</sup> The total cost to hospitals associated with time away from work for violence-related injuries among health care workers was estimated based on the Bureau of Labor Statistics data for the U.S. health care workforce.<sup>94</sup> In 2022, an estimated 16,990 workers in hospitals had a violence-related nonfatal occupational injury or illness that involved days away from work. Another 8,740 hospital workers had days of restricted work activity or job transfer due to violence-related occupational injury or illness.</p><p>Across all industries, occupational injuries or illnesses from intentional injury resulted in a median of 7 days away from work. The distribution of days away from work is as follows: 1 day – 14.9%, 2 days – 11.9%, 3-5 days – 19.4%, 6-10 days – 12.9%, 11-20 days – 11.4%, 21-30 days – 6.4%, 31 or more days – 23.1%.<sup>94</sup> Assuming that time loss within the health care field due to these injuries is similar to time loss across all industries and 2022 rates are similar to 2023, we estimated the costs of missed work based on the mean hourly salary for workers in hospitals: ∑<em><sup>7</sup><sub>i=1</sub> </em>(𝑤 × ℎ × 𝐷<sub>𝑖</sub> × 𝐼 × 𝑃<sub>𝑖</sub>), wherein w is the mean hourly wage for workers in the health care and social services fields, h represents the assumed number of hours in a workday, Di is the days missed at the ith interval, I is the number of violence-related occupational injuries, Pi is the percentage of workers reported above at the ith interval. For the days away from work with ranges, we used the highcentral digit (e.g., for 21-30, we used 25 days). Together, this sums to $52.7 million<a href="#" title="* $ 52,731,466">*</a> in costs associated with time away from work due to violence-related occupational injuries and illnesses within the health care field. This estimate includes the entire workforce, including security guards.</p><p>As noted above, 8,740 hospital workers had days of restricted work activity or job transfer due to violence-related occupational injury or illness. No published estimate exists of the cost of changes in jobs or transfer due to violence-related occupational illness or injury. For this analysis, we are assuming a minimum cost of $3,000 per employee required to restrict work activity or transfer jobs (including vocational rehabilitation) due to violence-related occupational injury or illness.<sup>95,96</sup> This estimate is thought to account for the wide range of possible restrictions and the cost of retraining employees and amounts to a total of $26.2 million.<a href="#" title="† $ 26,220,000 ">†</a> </p><p>Together, we estimated work loss costs for the hospital workforce injured due to violence and missing at least one day of work is $79.0 million<a href="#" title="‡ $ 78,951,466 ">‡</a> per year. This is likely to be an underestimate and does not account for reduced productivity or time loss due to untreated elements of injury, such as psychological harm, work missed due to post-traumatic stress disorder (PTSD), or unreported injuries. The experience of violence is common in the hospital workplace and underreporting frequently occurs for myriad reasons.<sup>97</sup></p><h4><span>4.3 CASE MANAGEMENT</span> </h4><p>Case managers are unique health care professionals who work directly with patients to provide personalized support and guidance, including connecting to community resources and coordinating care and services. By efficiently coordinating care, case management is associated with improved outcomes, shorter lengths of stay, and lower readmissions rates. By overseeing the care of patients with violence-related injuries, hospitals can also optimize the use of resources. Previous work estimated that utilization management accounted for 2.1% of all patient care costs for hospitalized patients.<sup>64</sup> Based on an annual estimate of 1.43 million nonfatal hospitalizations due to violence-related injuries amounting to $12.0 billion (inflation-adjusted from CDC WISQARS estimate to 2023 USD),<sup>90</sup> this equates to a national inflation-adjusted hospital cost of $252.5 million.<sup>98</sup></p><h4><span>4.4 STAFFING</span> </h4><p>Violence in the workplace impacts workers beyond injuries and illnesses. WPV can be associated with employee absenteeism, loss of productivity, and turnover. Each of these component costs is summarized below. Together, these costs equate to an estimated $541.3 million annually (Table 4).</p><table><caption><strong>Table 4. Estimated 2023 Annual Cost Associated with Staffing in U.S. Hospitals and Health Systems in Preparation of Violence or a Violent Event.</strong></caption><thead><tr><th><strong>Cost Category</strong></th><th><strong>In millions of USD</strong></th></tr></thead><tbody><tr><td>Staffing</td><td>541.3</td></tr><tr><td>Absenteeism</td><td>139.2</td></tr><tr><td>Loss of productivity</td><td>183.8</td></tr><tr><td>Turnover</td><td>218.3</td></tr></tbody></table><p> </p><p><span><strong>4.4.1 Employee Absenteeism.</strong></span> Exposure to violent incidents can lead to not only physical injuries, but also emotional trauma, heightened levels of stress, reduced morale, and burnout. These effects may contribute to an increase in employee absenteeism. Costs associated with employee absenteeism include increased expenditures on temporary staffing or overtime to account for absent workers and potential loss of revenue. Absenteeism associated with time loss for an occupational injury or illness was discussed earlier; this estimate focuses on health care worker absenteeism resulting from exposure to violence within the workplace or in the community, including within their own circle (e.g., IPV). This absenteeism can take place in the form of sick days or unpaid days, both of which impact the health care system. Estimates of absenteeism for victims of violence range from 5 to 25 days.<sup>99</sup> According to the Bureau of Justice Statistics at the U.S. Department of Justice, the rate of violent victimization (including rape, sexual assault, robbery, aggravated assault, or simple assault) was 23.5 victimizations per 1,000 persons in 2022.<sup>100</sup> Specific occupations, such as patient-facing occupations (e.g., health care practitioners or health care support occupations) face higher rates of exposure to violent events. For this estimate, we assumed a 2.35% WPV exposure rate for most occupations in hospitals.<sup>100</sup> For patient-facing occupations and security/protective services occupations, we assume an exposure rate of 62%.<sup>101</sup></p><p>Based on an estimated 6.2 million people working in hospitals in the U.S. and WPV exposures rates noted above, we estimated 146,515 hospital workers may be exposed to/victims of violence each year. Assuming that among those who experience violence, approximately 15% have 8 hours (1 day) missed from work annually.<sup>102</sup> This is a conservative assumption: some research suggests up to 5 days.<sup>102</sup> We estimated that the cost of absenteeism due to violence is $139.2 million.<a href="#" title="* $139,217,404">*</a></p><p><span><strong>4.4.2 Employee Loss of Productivity.</strong> </span>A frequent outcome of exposure to violence is loss of productivity in the workplace, which can be characterized by poor decision-making and attitude, disengagement, and overall low morale. In the health care setting, this can also result in poor patient outcomes. Costs associated with loss of productivity include the need to increase staffing to account for loss of revenue. Given the complexities of occupations and job tasks within hospital settings, loss of productivity is challenging to estimate. Among the estimated 2.8 million hospital workers estimated to experience violence annually, we conservatively assume one in twenty experience a reduction in productivity of 3% on average (approximately 60 hours per year for a full-time worker). Based on estimated annual salaries specific to each occupation and anticipated exposure to violence (varying by occupation time), we estimated that costs due to lost productivity amount to $183.8 million<a href="#" title="† $183,761,981 ">†</a> annually. </p><p><span><strong>4.4.3 Employee Turnover.</strong> </span>Similar to employee absenteeism and loss of productivity, the physical and psychological toll of exposure to violence in hospital employees can contribute to high absenteeism rates, which can in turn strain remaining staff. Increased staff burden can lead to further burnout and turnover, ultimately impacting the quality of patient care and overall operational efficiency of the health care facility.‡ Research reveals that exposure to WPV impacts turnover intention among health care providers.<sup>103</sup> This is only one factor contributing to turnover, and it is challenging to estimate the sole impact of violence in the workplace or community on health care professional turnover, despite recognizing that this extrinsic influence exists and contributes to decision-making. We calculated the estimated turnover rate for employees in the health care sector as the average monthly total separation<sup>104</sup> divided by the average monthly employment.<sup>105</sup> For 2023, the turnover rate was calculated as 3.31% (712,250 ÷ 21,525,325). This estimate was used for all workers except health care practitioners and technical occupations (SOC code 29-0000) and health care support occupations (SOC code 31-0000), which tend to have higher rates of turnover. For these occupations, we assumed a turnover rate of 5%106 which is likely an underestimate given that home health and nursing home employees have higher turnover rates.107,108 Based on these turnover rates, we estimated 1.1 million people working in the health care and social assistance fields in the U.S. will leave their jobs annually. We assume that a small percentage of these are associated with violence (1.5% based on previous research and increases in the incidence of violence over time)<sup>109</sup> for all occupations other than health care practitioners and technical occupations, health care support occupations, and protective services occupations (SOC code 33-0000), which we assumed had a higher rate of violence exposure and thus a higher contribution of violence to turnover (3.0%). On average, the cost of turnover in health care equates to approximately 6-9 months’ worth of workers’ salaries.<sup>110</sup> Using occupationspecific mean estimates of monthly salaries,<sup>111</sup> this would equate to a range of costs from $174.7 million to $262.0 million (using 6- and 9-month salaries as cost multipliers, respectively), averaging to $218.3 million* annually.<sup>111</sup> This estimate relates specifically to turnover among hospital employees exposed to in-facility or community violence.</p><h4><span>4.5 REPLACEMENT AND REPAIR OF INFRASTRUCTURE AND EQUIPMENT </span></h4><p>Violent events and incidents result in damage to hospital/health care facility infrastructure and equipment (i.e. security equipment, walls, furniture, medical equipment, and supplies), requiring their replacement or repair.<sup>112</sup> Estimates of the actual costs of damage to infrastructure are not available. However, research has shown that rates of violent crime increase in proportion to population size.<sup>113</sup> Assuming this pattern extends to hospital facilities within communities, we estimated that damage to hospital infrastructure varies by location. Specifically, we project that metropolitan hospitals (n=4,231) experience proportionally more damage than micropolitan (n=859) or rural (n=1,103) hospitals (values based on 2022 AHA Annual Survey estimates). We estimated that each year, metropolitan hospitals are responsible for replacement and repair of infrastructure and equipment equating to 1% of their reported capital expenses. We estimated that micropolitan and rural hospitals are responsible for 0.5% and 0.25%, respectively, of their capital expenses for repairs and replacements resulting from violence within the facility and surrounding community.<a href="#" title="We confirmed that capital expenses are correlated with hospital bed size (overall and within each level of urbanicity).">†</a> Accounting for this differentiation across hospitals, we estimated that the annual cost of replacement and repair of infrastructure and equipment due to violence is $564.6 million in metropolitan hospitals, $16.8 million in micropolitan hospitals, and $3.5 million in rural hospitals, equating to a total cost of $584.8 million.<a href="#" title=" $584,846,515"> ‡</a></p><h4><span>4.6 COMMUNITY INTERFACE AND PUBLIC RELATIONS</span> </h4><p>Hospitals, as pillars of their communities, have a public health responsibility to address violent events that occur within and outside health care facilities. This may include post-event debriefing, public health communications, relationship building with communities, and media relations. Public relations managers and specialists at hospitals play key roles in these duties. In 2023, there were 1,340 public relations managers and 4,290 public relation specialists working with hospitals, with average annual salaries of $141,820 and $75,000 dollars, respectively. 114 Assuming 5% of public relations managers’ and specialists’ time is spent on duties relating to post-violent event public relations,<sup>115,116</sup> the cost to hospitals for community interface and public relations due to violence was $25.6 million<a href="#" title="§ $25,589,440"><sup>§</sup></a> dollars.</p><p>In addition to public relations managers’ and specialists' time spent on community interface and public relations addressing violent events, there are also costs attributed to materials (i.e., print and digital materials), equipment, and infrastructure for these public relations. These hospital costs are incorporated in the other cost estimates above.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="other-impacts"><span>5. OTHER IMPACTS OF VIOLENCE </span></h3><p>Data limitations restricted our ability to provide financial estimates for all identified areas in which violence affects U.S. hospitals and health care workers using the comprehensive definition of violence provided above. Most importantly, we were not able to quantify financially the full toll of violence on the psychological and emotional health of workers beyond the outcomes of absenteeism, productivity, and staff turnover. The presence of such broader mental health effects are apparent in a multitude of studies documenting correlations in exposure to violence and various mental health and workplace satisfaction outcomes in workers. In lieu of providing financial estimates for the following components, we describe more comprehensively the incidence of workplace violence in different settings to provide the best available understanding of the magnitude of exposure in health care workers. We then provide summaries of data currently available describing associations between exposure to violence, mental health, and employee satisfaction in U.S. health care settings. While we were not able to generate reliable comprehensive financial estimates of associated costs for these components, an understanding of the incidence of exposure to violence and data on related mental health outcomes yields valuable insight and comprises an essential part of a comprehensive evaluation of the true burden of violence to U.S. hospitals and hospital workers.</p><h4><span>5.1 INCIDENCE OF WORKPLACE VIOLENCE</span> </h4><p>In hospitals, WPV most often occurs in psychiatric departments, emergency departments (ED), waiting rooms, and geriatric units, with rural areas having higher prevalence rates than urban areas.<sup>117,118</sup> However, HCWs from across different geographic and clinical locations, specialties, and roles can all experience WPV. One estimate suggests WPV prevalence ranges from 24.4% to 59.3% for physicians, 9.5% to 62.1% for nurses, 15.1% to 68.4% for receptionists, and 24.5% to 40.0% for technicians.<sup>118</sup> Prevalence rates ranged from 14.0% to 57.4% for threats, 2.5% to 5.7% for bullying, 0.5% to 15.9% for physical assault, and 0.2% to 9.3% for sexual assault and harassment for HCWs in this study.<sup>118</sup> Registered nurses (RNs), nursing assistants, and patient care assistants experience particularly high rates of WPV.<sup>119–121</sup> At a South Florida community hospital, certified nursing assistants were found to experience the highest rates of workplace incivility compared to RNs and other clinical and non-clinical staff.<sup>119</sup> According to a 2024 report, half of U.S. nurses have reported being either verbally abused, physically assaulted, or both by a patient or a patient’s family member within the previous two years.<sup>122</sup> More than one in four of these nurses reported being likely to leave their positions as a result.<sup>122</sup> Additionally, among 9,150 RNs in Michigan surveyed in 2022 regarding WPV concerns, 43% reported emotional abuse, 26% reported workplace bullying, 22% reported physical abuse, and 10% reported sexual abuse in the past 12 months.<sup>120</sup> In another study that surveyed 138 RNs and patient care assistants, respondents experienced higher rates of verbal aggression than physical aggression by both patients and staff.<sup>121</sup> </p><p>Medical residents, nurses in training, and other health care trainees are also impacted by WPV. Out of 119 emergency medicine residents in New York state, 66% reported experiencing at least one act of physical violence during an ED shift. Of that sample, 97% experienced verbal harassment, 78% endorsed verbal threats, and 52% reported sexual harassment.<sup>123</sup> Female medical residents and nursing trainees experience higher rates of sexual harassment and nonphysical WPV than their male counterparts.<sup>124,125</sup> Out of 195 junior- and senior-level nursing students in the midwestern U.S., 82.6% had experienced verbal aggression, 60.5% experienced sexual harassment, and 52.3% experienced physical violence at some point during their training.<sup>125</sup> These experiences can lead individuals to question their decision to join the health care workforce and negatively impact their psychological well-being.<sup>126–128</sup> In fact, among 7,409 general surgical residents from 262 different general surgical residency programs, 30.2% had experienced verbal abuse, 38.5% reported experiencing burnout symptoms at least once a week, and 4.5% endorsed having suicidal thoughts in the past year.<sup>127</sup></p><h4><span>5.2 PSYCHOLOGICAL AND EMOTIONAL IMPACT OF VIOLENCE</span> </h4><p>Witnessing or experiencing violence in the hospital can lead to short and long-term psychological and emotional effects, including compassion fatigue, PTSD, and other mental health concerns, in addition to general satisfaction with one’s job. (We describe below compassion fatigue and PTSD, while acknowledging that the mental health impacts of exposure to violence may extend beyond these conditions.)</p><p><strong>5.2.1 Compassion Fatigue. </strong>Compassion fatigue occurs when HCWs experience burnout and secondary traumatic stress and can result in low job satisfaction and emotional detachment from one’s work.<sup>129</sup> Frequent exposure to WPV has been found to increase levels of burnout among HCW. Burnout adversely impacts workers’ physical and mental well-being, and often impairs their ability to effectively carry out workplace duties.<sup>130,131</sup> Secondary traumatic stress is a stress response to hearing or witnessing the traumatic experience of another. The symptoms mimic that of PTSD and are intricately connected with those of burnout.<sup>132</sup> In fact, high levels of distress, compassion fatigue, and low perceived institutional support have contributed to higher levels of stress among HCWs who experience mistreatment from patients.<sup>133</sup></p><p><strong>5.2.2 Post-Traumatic Stress Disorder.</strong> According to Hou (2024), experiencing violence in any form can lead to the development of PTSD, characterized by sleep disturbances, irritability, difficulty concentrating, feelings of frustration and powerlessness, intrusive recollections of the traumatic event, and emotional distress.<sup>134</sup> Among 132 ED staff surveyed in McGuire et al., 21.3% respondents had experienced symptoms of PTSD due to WPV, and 18.5% reported considering leaving their position as a result.<sup>135</sup> Similarly, Konttila et al. reported that psychiatric nursing staff who were repeatedly exposed to various forms of violence, including sexual attacks, non-verbal intimidation, and verbal threats, experienced significantly increased psychological distress and fear.<sup>136</sup></p><p><strong>5.2.3 Employee Satisfaction.</strong> In addition to the psychological, emotional, and physical impacts of exposure to violence, HCWs also experience reduced job satisfaction.<sup>137–140</sup> For example, HCWs can experience a decreased desire to interact with patients and their families after experiencing WPV.<sup>137</sup> This effect was found to be more pronounced among those working in an inpatient versus outpatient setting.<sup>137</sup> ED nurses, in particular, have reported that continuous exposure to aggressive patients has negatively impacted their attitudes about their profession, affecting their ability to care for and desire to interact with patients.<sup>138,140,141</sup> Lateral violence between health care worker colleagues also contributes to job dissatisfaction.<sup>119,141,142</sup> Out of 91 ED attending physicians, residents, and mid-level providers in Detroit, 22.2% reported a specific instance of lateral violence in the preceding 12 months that negatively impacted their ability to provide care for their patients.<sup>142</sup> Over 10% reported that lateral violence affected their personal health, led them to consider quitting their job, made them feel unsafe at work, or caused them to dread going to work due to fear of bullying.<sup>142</sup></p><h4><span>5.3 LEGAL AND ETHICAL CONCERNS</span></h4><p><span><strong>5.3.1 Legal Costs.</strong></span> Costs related to abuse or violence within hospitals, such as patient abuse, legal expenses for addressing community violence, and regulatory compliance issues are significant. However, comprehensive data on legal costs and citations are not publicly available. </p><p><span><strong>5.3.2 Reporting Workplace Violence.</strong></span> Underreporting WPV remains a significant barrier for understanding its true prevalence.<sup>118,134,135,138,143,144</sup> A common reason HCWs do not report WPV is due to unclear and unstandardized reporting channels.<sup>118,145,146</sup> Additional reasons for not reporting WPV include fear of retribution or not being believed and not wanting to get involved in litigation.<sup>126,143,146</sup> It is essential for HCWs to have access to resources that prepare them to respond to WPV and to ensure workers are empowered to report it.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="limitations"><span>6. LIMITATIONS</span> </h3><p>All financial costs in this report are estimates and may not reflect the true cost of workplace and community violence to U.S. hospitals and health systems. Many cost calculations include assumptions as there is limited published literature and data on interested cost components; the study team had to rely on the most recent data available or related data to calculate cost estimates. Assumptions for each cost calculation are included in the corresponding cost component section in this report. It is important to note that all assumptions were made so to be largely conservative in nature, suggesting that the actual financial burden of workplace and community violence to U.S. hospitals and health systems is likely much greater.</p><p class="text-align-right"><a class="btn btn-primary" href="#toc">TOP ⇫</a></p><hr><h3 id="discussion"><span>7. DISCUSSION </span></h3><p>This report estimates the financial and other impacts of violence on hospitals in the U.S. The total financial cost of violence to hospitals is estimated to be $18.27 billion (USD). This estimate includes pre- and post-event cost components. Pre-event costs were estimated to be $3.62 billion (USD) and included costs for trainings, security and staffing, violence prevention programs, policy and procedure development, outreach to build public trust, facility modifications to prevent and mitigate harm, and investments in technology to monitor events. Post-event costs were estimated to be $14.65 billion (USD) and included costs for health care (namely workers’ compensation and unreimbursed costs), staffing, replacement and repair of infrastructure and equipment, and community and public relations costs. The largest contributor to total annual costs came from post-event health care expenses to treat violent injuries.</p><p>Beyond the financial burden, there are many other costs of violence to hospitals and health care workers. Health care workers who experience or witness violence can experience many psychological impacts that affect their well-being as well as impact the health system. These psychological impacts lead to reduced workplace satisfaction and productivity, and recruitment and retention challenges, further impacting the burden of violence to hospitals. </p><p>Overall, violence is a growing public health problem affecting our communities and health systems. In the current report, we estimated a significantly higher cost of violence to U.S. hospitals compared to a 2016 report which estimated that violence costs $2.7 billion (USD).<sup>64</sup> Reasons for the large increase in costs estimated in this report include use of a more expansive definition of violence and components costs than the prior report, and an increase in violent event incidence which impacts post-event costs. Overall, this updated estimate demonstrates the significant burden born by hospitals as a result of violence and costs attributed to treat and prevent violent injuries in the U.S.</p><p class="text-align-center"><a href="/system/files/media/file/2025/05/The-Burden-of-Violence-to-US-Hospitals.pdf#page=26"><strong>REFERENCES</strong></a></p><p> </p></div><div class="col-md-4"><p><img src="/sites/default/files/2025-05/costs-of-violence-report-cover.png" alt="The Burden of Violence to U.S. Hospitals PDF Page 1" width="604" height="786" title="click to download research report: The Burden of Violence to U.S. Hospitals"></p></div></div></div> Wed, 28 May 2025 08:50:13 -0500 Guides/Reports