‘Climate change mitigation is a hot topic, but not when it comes to hospitals’: a qualitative study on hospital stakeholders’ perception and sense of responsibility for greenhouse gas emissions

Abstract

ObjectivePhysical and mental well-being are threatened by climate change. Since hospitals in high-income countries contribute significantly to climate change through their greenhouse gas (GHG) emissions, the medical ethics imperative of ‘do no harm’ imposes a responsibility on hospitals to decarbonise. We investigated hospital stakeholders’ perceptions of hospitals’ GHG emissions sources and the sense of responsibility for reducing GHG emissions in a hospital.MethodsWe conducted 29 semistructured qualitative expert interviews at one of Germany’s largest hospitals, Heidelberg University Hospital. Five patients, 12 clinical and 12 administrative employees on different levels were selected using purposive maximum variation sampling. Interviews were transcribed verbatim and analysed using the framework approach.ResultsConcerning GHG emissions, hospital stakeholders perceived energy and waste as most relevant emission sources followed by mobility. Climate change mitigation in general was considered as important. However, in their role as patients or employees, hospital stakeholders felt less responsible for climate change mitigation. They saw providing best possible medical care to be the top priority in hospitals and were often concerned that patients’ health could be jeopardised by climate change mitigation measures.ConclusionPerceptions of most important emission sources did not coincide with those in literature, highlighting the need to inform stakeholders, for instance, about pharmaceuticals as important emission source. A frequently perceived conflict between reducing emissions and providing high-quality medical care could be eased, if reducing emissions would not only be justified as a contribution to mitigation, but also as a contribution to preventing ill health—a basic principle of medical ethics.

How colleges should lead on climate

“…◆ care decarbonisation will result in lower quality care. 14 These educational activities are important, first, as sources of evidence-based information and, second, as an illustration of college leadership and commitment in this area.…”

“…This work on educating and engaging with members is important due to the diversity of views on climate change within medical specialists, 12 , 13 and misconceptions among health professionals that health care decarbonisation will result in lower quality care. 14 These educational activities are important, first, as sources of evidence‐based information and, second, as an illustration of college leadership and commitment in this area.…”

Testing of a Multiple Criteria Assessment Tool for Healthcare Facilities Quality and Sustainability: The Case of German Hospitals

“…Hospital facilities are complex infrastructures and an integral part of the system due to their social, environmental, and organizational implications [5]. Frequent conflicts between improving sustainability and providing high-quality service have been highlighted in recent studies [6,7].…”

Thinking clearly about climate change and mental health

“…1 They note this conflicts with the common-sense position of many health stakeholders that while ‘climate change mitigation in general was considered…important… [t]hey saw providing best possible medical care to be the top priority in hospitals and were often concerned that patients’ health could be jeopardised by climate change mitigation measures’. 2…”

“…1 They note this conflicts with the common-sense position of many health stakeholders that while 'climate change mitigation in general was consid-ered…important… [t]hey saw providing best possible medical care to be the top priority in hospitals and were often concerned that patients' health could be jeopardised by climate change mitigation measures'. 2 The RANZCP has also recommended systemic changes with unknown impacts on patient health 3,4 based on a UK RCPsych position statement. 5 Despite identifying 'few published studies at a system-or countrylevel' a review of the impact of climate change on health by the RACP endorsed by the RANZCP recommended all Australian governments and healthcare systems '[c]ommit to delivering net zero healthcare by 2040'.…”