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KEY TAKEAWAYS
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Demographic information
Mass General Brigham (MGB) is a large, not-for-profit, integrated health care system serving Eastern Massachusetts and Southern New Hampshire. MGB consists of two academic hospitals, three specialty hospitals, and seven community hospitals alongside home care services; a health insurance plan; a network of specialty practices, urgent care facilities, outpatient clinics, surgical centers, and community health centers; and the Massachusetts General Hospital (MGH) Institute of Health Professions. MGB has the largest hospital-based research enterprise in the United States with over $2 billion in research activities. MGH and Brigham and Women’s Hospital are the largest private hospital recipients of National Institutes of Health funding in the nation. MGB is also the largest employer in Massachusetts, with approximately 80,000 employees and nearly 2,500 trainees in 300 physician residency and fellowship programs. MGB serves over 2.5 million patients annually and has around 4,000 total patient beds. The health system is focused on reducing health inequities through initiatives addressing hypertension, substance use disorder, maternal health, and cancer outcomes, and is strongly committed to sustainability.
Executive summary
MGB recognizes the need for health professional leadership in advancing climate-smart health care. The health system established the Center for the Environment and Health and created four medical/clinical director of sustainability positions. Through the leadership of the health professionals in these roles, MGB reduced its environmental impact and achieved significant advancements, including reducing anesthetic gas emissions by about 50%. Key to MGB’s success were collaboration and a distributed responsibility model with central leadership support. Despite challenges with changing behavior, MGB's focus on health benefits and continuous engagement cultivated a supportive culture. The medical/clinical directors of sustainability also relied on networks like the Health Care Without Harm Physician Network to learn from other organizations and health professionals. With its robust non-clinical and clinical expertise, MGB is moving toward ambitious climate goals and demonstrating that health professionals are integral to achieving net-zero emissions and resilience in health care.
“Clinical decisions are a major driver of health care’s environmental impact. Clinician engagement and leadership is essential if we’re going to redesign care to optimize outcomes for patients and the planet.” -Dr. Gregg Furie, medical director of climate and sustainability, Brigham and Women’s Hospital
The challenge
Clinical care is the single largest factor driving health care emissions, which means the health care sector will not be able to reduce emissions sufficiently without reducing the climate impact of clinical care. Further, nursing is the largest health profession in the United States, and clinicians often make up the largest percentage of a hospital’s workforce. It is essential to engage health professionals in sustainability initiatives. MGB recognized the importance of engaging health professionals to ensure the success of their sustainability initiatives.
The solution
Acknowledging the value of health professional leadership in advancing equitable, resilient, zero-emissions health care, MGB created leadership opportunities for physicians and nurses at the individual hospital and system level to educate and engage clinicians and ensure alignment between climate-smart health care efforts and clinical care. MGB partnered with Practice Greenhealth to build a comprehensive sustainability program and foster a culture of sustainability throughout the organization.
Implementation process
MGB has been a leader in the sustainable health care movement for decades. However, clinician involvement in climate and sustainability initiatives has been minimal. In 2017, a small group of clinicians at MGB started discussing opportunities to accelerate progress at the individual hospital and system level through increased clinician involvement.
Following a presentation about the value of clinical sustainability leadership, organizational leaders at MGH created the Executive Sustainability Committee, chaired by the hospital’s chief financial officer. The committee included physicians, nurses, administrators, and operational leaders, who drafted an environmental stewardship plan. Increasing awareness from community members, legislators, clinicians, and administrators about the intersection of the environment, health, and health care, and recognition that additional efforts and resources were needed to meet sustainability goals led to the founding of the MGH Center for the Environment and Health (the Center) in April 2021.
The Center works with MGH leadership to integrate sustainability into the hospital’s clinical, research, and educational activities, and pursues its mission through four pillars. The Center’s leadership includes an executive committee chaired by the Center’s director, Dr. Jonathan Slutzman, along with an administrative executive sponsor, the president of the hospital's physician organization, and several physicians in funded leadership roles, with guidance from an advisory board. Initial funding was provided by the hospital for administrative and salary support, and education and outreach efforts.
When the Center was launched, Slutzman was named the medical director of environmental sustainability for MGH. Slutzman has a 0.2 FTE position and reports to both MGH’s executive vice president of administration and the chief executive officer of the Mass General Physicians Organization. He is joined in the clinical leadership of the Center by associate directors for education and outreach, advocacy, and research and publications, who total 0.5 FTE, and they are supported by a project coordinator at 1.0 FTE. Slutzman’s primary focus is overseeing all facets of the Center’s activity. He also serves as the primary lead for the sustainable operations pillar, chairs the hospital’s Executive Sustainability Committee, and participates in multiple operational subcommittees.
In 2021, Dr. Gregg Furie was appointed as medical director of climate and sustainability at Brigham and Women’s Hospital. He has a 0.33 FTE position and reports to the vice president of primary and value-based care, public policy, and administrative operations at Brigham and Women’s Hospital. His work focuses on three areas: preparing clinicians to address health threats from climate change, reducing the hospital’s climate impacts (especially impacts from clinical operations), and mobilizing health professionals to advocate for climate policy solutions. Both Slutzman and Furie also report to the MGB chief financial officer regarding system-wide efforts and serve on the MGB Climate and Sustainability Leadership Council.
Recognizing the value of health professional sustainability leadership roles, MGB also named clinical directors of sustainability at two community hospitals. Salem Hospital appointed Dr. Adrienne Allen as the senior medical director of quality, safety, and sustainability. Newton Wellesley Hospital named Madeleine Bartzak, R.N., as the clinical director of environmental sustainability.
Insights & lessons learned
Expanding a sustainability program in a large organization requires patience and humility. While focusing on health impacts – everyone at MGB’s mission – can be helpful, all staff are already keyed into their tasks and ensuring they can provide the best care to patients. Competing pressures mean sustainability is not always top-of-mind, and change takes time.
Additionally, MGB does not currently have a dedicated central sustainability team or a director of sustainability. The system uses a distributed responsibility model in which more staff see sustainability as part of their jobs, but such an approach means that coordination and support are harder to manage. This approach to sustainability is being reassessed at MGB, with a recognition of the potential benefits of a more centralized effort.
Appointing medical and clinical directors of sustainability, establishing the Center, and broadly engaging and empowering health professionals are proving to be invaluable elements of MGB’s climate-smart health care journey. Health professionals in unique, patient-facing roles demonstrate they are not only highly effective sustainability leaders but are integral to the success of MGB’s efforts to achieve equitable climate resilience and net-zero emissions by 2050.
The results
While MGB has long been recognized as a sustainable health care leader, since appointing medical/clinical directors of sustainability and establishing the Center, the system rapidly expanded the scope of its sustainability work and accelerated its progress. For example, sustainability professionals at MGB greatly improved the design of a new clinical building – including increasing energy efficiency and eliminating the need for a methane gas line, crafted a proactive public advocacy plan, and contributed to a reduction in anesthetic gas emissions at MGH by approximately 50%.
During their years as medical directors of sustainability, Furie and Slutzman have found value in being part of a cohort of medical/clinical directors of sustainability maintained by the Health Care Without Harm Physician Network, and learning from, collaborating with, and sharing best practices with others in similar roles.
Achievements led by the Center include hosting a health care sustainability podcast, a “Greening the Lab” consult service, climate and health webinars, symposia, departmental grand rounds, and health professional engagement and communication efforts. In addition, the Center is committed to research around the intersections of the environment, health, and health care, with many publications authored by Center-affiliated health professionals and researchers.
At Brigham and Women’s Hospital, Furie leads efforts to educate and engage faculty, staff, and trainees; established funding for sustainability initiatives through a seed grant program; brought greater visibility to local sustainability initiatives and broader climate and sustainability issues through internal and external communications; participated in advocacy efforts at the state and federal levels; and mentored trainees with an interest in climate and health care sustainability.
The medical/clinical directors collaborate closely to advance climate and sustainability initiatives at the system level. Since their appointments, they successfully advocated for creating the MGB Climate and Sustainability Leadership Council, chaired by the system’s chief financial officer, and have led that group’s work to establish system-wide climate and sustainability goals. The Council is leading MGB’s first comprehensive scopes 1, 2, and 3 emissions inventory. The medical/clinical directors also helped create a formal climate and sustainability public policy advocacy strategy. MGH and Brigham and Women’s Hospital worked together to develop a first-of-its-kind climate and health residency curriculum, which led to a partnership with other academic institutions and the development of Climate Resources for Health Education. The medical/clinical directors are working closely with MGB’s supply chain leads to increase single-use device reprocessing, and their work is a model for future collaboration among clinical, sustainability, and purchasing experts. The medical/clinical directors are also leading an initiative to address the climate impact of metered-dose inhalers. These efforts encourage others at MGB to incorporate sustainability into their activities. The MGB Enterprise Department of Radiology has formed its own MGB Radiology Center for Sustainability, with a radiologist serving as its part-time director.
