They explain that protecting the environment and sustainability are ‘fundamental concerns’ for the Order as a sizeable healthcare provider.
The healthcare sector is responsible for 4.4% of global net emissions (two gigatons of carbon dioxide equivalent), and the sector’s climate footprint is equivalent to the annual emissions of 514 coal-fired power plants. If the healthcare sector were its own state, it would be the world’s fifth largest emitter.1 The sector is therefore in an unexpectedly paradoxical situation: on the one hand, it is called upon to promote the health of us all – to heal and alleviate illnesses, and, where healing is no longer possible, to accompany people on their final journey. On the other, it is one of the biggest emitters of harmful greenhouse gases, and its activities thus cause lasting environmental damage.
However, many different, efficient, and sustainable ‘therapeutic measures’ can be taken. The environmental management of the Hospitaller Brothers of Saint John of God, one of the largest private non-profit healthcare providers in Austria, therefore extends to all areas of its hospitals and other care facilities.
How the Brothers of Saint John of God ‘protect the environment’
‘Man is not above creation, but a part of it.’ In order to do justice to the issue of sustainability, the Brothers of Saint John of God have decided to focus on a drive to protect and safeguard the environment – in particular focusing on de-carbonisation – and in recent years have also succeeded in certifying all the company’s operational facilities to the EMAS III environmental management system.2
Harnessing this system, the charity’s management teams have available to them both the basis, and key data, for decisions that will reduce or eliminate environmental impacts in the future. Environmental aspects are identified and assessed by an Environmental officer with the support of local environmental teams. For each individual activity, direct and indirect emissions to air, as well as noise, water consumption, discharge of in-house wastewater, material efficiency, and indirect environmental impacts such as transport, purchasing, and construction, are assessed. To evaluate the environmental impacts, a system of utility value analysis is applied, which records the various factors behind environmental impact. Energy use has so far emerged as the most significant environmental aspect across the organisation, followed by waste generation and water consumption
Motivation to act
The fact that the Hospitaller Order of Saint John of God is intensively involved in efforts to safeguard and protect the environment might, at first glance, seem surprising. However, protecting our environment and sustainability are fundamental concerns for us as a healthcare provider. As early as 2000, an internal document stated: ‘We must foster strategic attitudes which create responsible relationships with the environment in which we live and which we share, and of which we are merely stewards.’3
Another milestone was the publication of the encyclical Laudato si’ by Pope Francis in 2015. Sentences in this document such as: ‘There is an urgent need to develop policies so that, in the next few years, the emission of carbon dioxide and other highly polluting gases can be drastically reduced, for example by substituting fossil fuels and developing sources of renewable energy’, and ‘Worldwide there is minimal access to clean and renewable energy’,4 are an obligation for a Catholic order to act ecologically, and to eliminate the emission of CO2 into the atmosphere as rapidly as possible. From the Pope’s standpoint, we are all called upon not to leave environmental protection to chance, and to take responsibility for action. As a religious community active in 52 countries worldwide, the Brothers of Saint John of God have taken up this guiding principle.
Energy and CO2 goals in Austria5
CO2 emissions are produced directly or indirectly in a business’s daily operations – directly through heating systems, cars’ or trucks’ combustion engines in an organisation’s own fleet, the use of emergency power generators, or natural gas-powered steam generators for air humidification, and, indirectly – via the production of electricity, community heating, and community cooling. The main goals that we developed, and decided to aim for, were CO2 neutrality for all our Austrian facilities, and drawing our energy supply from sustainable and fossil-free energy sources. These two goals were in turn divided into sub-goals:
Use of renewable energy sources as a basic requirement.
Obtaining our heat supply from renewable energy sources or industrial waste heat.
Producing ‘green electricity’ from photovoltaic systems, with existing roof surfaces utilised to the maximum.
To achieve these ambitious goals, it is necessary to do more than just change energy suppliers to switch from nuclear power to electricity from hydropower plants. Numerous additional and accompanying activities are needed – with a ‘special toolbox’ required. Key elements include:
Assessing the construction of all buildings, with new facilities built entirely in accordance with ecological, sustainable guidelines.
Introduction of a company-wide energy system, with standardised key data.
Establishment of a management system for the acquisition of state or local subsidies.
Cooling of buildings via community cooling – through community heating networks wherever possible.
Promotion of sustainable procurement.
Promotion of e-mobility, including the construction of charging infrastructure. n Maximum expansion of photovoltaic systems (electricity) and solar thermal energy (heat).
Use of new energy-generating / storage technologies (such as hydrogen, electricity storage, etc.).
Switching to more ‘climate-friendly’ anaesthetic gases, and recycling.
Achieving these goals step by step
To achieve a reduction in CO2 emissions, it was necessary – both in the individual facilities and at the highest management level – to achieve a voluntary commitment to environmental protection. At the same time, a resolution was passed to certify all our Austrian facilities according to the EU’s environmental management system, EMAS. Environmental teams have been created for each facility, responsible for both the continuous improvement of environmental performance, and the operational implementation of the environmental programme. Teams meet regularly, with both environmental concerns, and particular projects with an ecological impact, discussed and addressed. When assembling a healthcare facility’s Environmental team, care is taken to ensure that – as far as possible – all departments of the respective hospital or care facility are represented.
An environmentally conscious approach from staff contributes significantly to improving environmental performance. To embed good environmental practices into everyday activity, all important guidelines are available on an intranet. In addition to being able to find information in the employee magazine, staff are kept informed about the environmental impact and environmental performance of their site through information events and training courses, regular ‘posts’ in site-specific employee apps, notices, and posters.
CO2 neutrality within reach
In the course of the EMAS certification exercise, the company’s management set the goal of halving CO2 emissions by 2025 compared with the base year, 2017, and achieving climate neutrality by 2030. Thanks to the motivation and commitment of all employees, the milestone goal of halving CO2 emissions was almost reached as early as 2022, with a 48% reduction. The goal of a CO2 neutral energy supply through a complete phasing out of fossil fuels (oil and natural gas) was brought forward by four years, and is now planned for 2026.
It is, however, important to point out that a complete elimination of CO2 emissions is probably not technically possible from today’s perspective. Diesel-powered hospital emergency generators or, for example, specialist fire brigade vehicles, cannot feasibly technically currently be replaced by sustainable emission-free such equipment and plant. From today’s perspective, carbon zero is therefore only 98% achievable for an operator of hospitals and care and nursing facilities
Examples already implemented
By 2022, photovoltaic systems with a total output of just over 600 kWp (kilowatt peak, defined as the maximum output of a photovoltaic system in kilowatts) had been put into operation at our sites. Some of the Brothers of Saint John of God’s facilities and buildings have existed for 400 years, and are mostly located in historic city centres (such as in Vienna, Graz, and Salzburg, etc.). Accordingly, there were a range of visual and technical requirements to address in terms of protecting and safeguarding historic monuments and properties. For example, during the renovation of a home for the elderly in Linz, a solar thermal system with a collector area of 200 m2 , and a photovoltaic system with an output of 31 kWp, were installed
By using district heating from biomass power plants or industrial waste heat, heating systems with fossil fuels are no longer necessary. A hospital in Graz, for example, will be heated in future with waste heat from a nearby paper factory
Harnessing biomass
In Kritzendorf, a retirement home was able to save 400,000 litres of heating oil annually by connecting to a local biomass heating plant, and cutting its CO2 emissions 54% in a very short time by installing a 140 kWp output photovoltaic system. A highly successful example of sustainable energy production can meanwhile be found in Kainbach near Graz, in a healthcare facility for people with disabilities located in an area of forest. The forest’s management includes the production of wood chips, which are used in a newly constructed heating system for ‘green’ heat generation. The construction of a photovoltaic system with an output of 100 kWp additionally contributes to a sustainable reduction in CO2 emissions.
Impact of purchasing
Central purchasing departments can also play a key role in environmental protection. The more ecologically conscious purchasing is, and the more sustainable the purchased products are, the greater the environmental benefit, and therefore the associated indirect reduction in CO2 emissions. A procurement catalogue was therefore developed for the sustainable procurement of medical and nursing consumables, and implemented at all locations. One of the key drivers was the increasing use of disposable consumables, especially in medicine, which had led to a corresponding rise in waste volumes. Another cause of higher waste generation is the shortening lifecycle of many products. For example, 80% of all products are thrown away after a single use, and 99% of materials become waste after six weeks.
Potential within IT
Significant potential for a reduction in CO2 emissions has been identified in information technology (IT), with a combination of measures contributing to ‘ecologically responsible’ operation of the IT infrastructure:
Environmental aspects such as energy efficiency, ecological footprint during production, and the materials used, etc., are all factored in when purchasing products.
Ongoing measurement of the energy consumption of the server room equipment in the data centre, focusing on parameters such as utilisation and temperature, demonstrating any potential opportunities for reduced use.
‘Eco-friendly’ disposal of old appliances.
Reducing the amount of data in the active system ‘environment’, by deleting and archiving, so as to enable reduced hardware requirements.
Determining the necessary availability of applications and services in order to be able to define possible periods of nonoperation/shutdown of systems.
Systems with rotating spindles (hard disks) are no longer to be used; only systems with SSDs are to be purchased. Currently, 90% of clients have already converted to SSDs (which require only 25% of the energy of hard disks).
Physical servers have been ‘migrated’ to virtual environments as far as possible, to minimise the need for hardware servers, and realise synergies.
All IT systems are regularly checked, maintained, and replaced when necessary, to achieve the optimal efficiency
Sustainable issues and goals ‘the order of the day’
The focus of all our activities is always on the people being cared for, and the mission to ‘cultivate and tend the Garden of Eden’. In practical terms, the Brothers of Saint John of God are guided by Pope Francis’s environmental encyclical, Laudato si’. This creates the best possible framework conditions for employees to carry out their daily work. As far as sustainability is concerned, the essential topics and goals can be summarised as follows:
Socio-cultural and functional quality (ensuring health and well-being in the building, and a humane, therapeutic environment).
Economic quality (reducing lifecycle costs, and preserving the value of plant, equipment, and buildings, through space and energy efficiency).
Ecological quality (protection of the environment, and conservation of natural resources).
Significant changes in the global energy market make the issue of energy a future topic of particular importance for the Brothers of Saint John of God. In addition, reducing energy use is an essential factor for effective environmental protection. To ensure that we do not meet our present needs at the expense of future generations, the Hospitaller Brothers of Saint John of God are constantly working on innovative and sustainable environmental projects
Daniel Kreuzer
Daniel Kreuzer is a trained electronics and communications technician. He was Technical director of the Order’s hospital in St. Veit/Glan (Carinthia) for almost 20 years before moving to provincial management in 2019. Here he is strategically and organisationally responsible for construction, facilities management, and medical technology. His geographic remit includes facilities in Austria, the Czech Republic, Slovakia, and Hungary. He has been a Board member of the Austrian Association of Hospital Engineers since 2017.
Albin Knauder
Albin Knauder studied environmental management. From 2004 to 2021 he was head of the Ecology Department of the Kärntner Krankenanstalten Betriebsgesellschaft (KABEG), responsible for waste management, hazardous goods, energy management, wastewater management, environmental management, and EMAS III certifications. He has been the Environmental officer of the Brothers of Saint John of God in Austria for several years. He is a member of both the Working group on ÖNORM S2104 (medical waste) of the Austrian Standards International, and of the Austrian Waste and Environment Forum, and an experienced lecturer
Bernhard Zahrl
Bernhard Zahrl has been the head of Corporate Communications for the Austrian Province of the Hospitaller Brothers of Saint John of God since 2001, where he coordinates the work of a team of over 20 colleagues in the individual centres. He is also responsible for a monthly healthcare-related magazine. He has been involved in environmental protection since his youth
References
1 Health Care’s Climate Footprint – How the health sector contributes to the global climate crisis and opportunities for action. Health Care Without Harm / ARUP. September 2019 https://tinyurl. com/2fvmypr7
2 The EU Eco-Management and Audit Scheme (EMAS). European Commission. https://tinyurl.com/ wjacf48y
3 Hospitaller Order of Saint John of God Charter of Hospitality: Caring for the Sick and Needy in the Manner of St John of God. Rome 2000,
4 Encyclical Letter Laudato si’, Vatican 2015 Ch 26. https://www.vatican.va/content/ francesco/en/encyclicals/documents/ papa-francesco_20150524_enciclicalaudato-si.html.
5 These targets are currently based on Scope 1 and 2. The implementation of Scope 3 is being planned
Acknowledgment
This article, titled ‘Navigating the road to net-zero CO2 emissions’, first appeared in the IFHE Digest 2023. HEJ would like to thank the authors, the Digest’s Editor, and the IFHE, for allowing its reproduction in slightly edited form here