Creating healthier communities through a comprehensive carbon management plan

Providence, United States.

Case study summary

Providence has committed to robust climate mitigation and resiliency planning in equitable care delivery and community partnerships. This case study describes mitigation, adaptation, and advocacy strategies.


Demographic information

  • City: Renton
  • State/province/region: Washington
  • Country: United States
  • Type of institution: Complex health system with 51 hospitals, 1,000 clinics, residential care, university, high school, health plan, and multiple spinoff companies
  • Number of full-time staff: 120,000 FTE
  • Number of part-time staff: with above
  • Patient population served annually 
    • 5 million patients served annually (total of inpatient and outpatient)
    • Geographic area served: Seven western states (Alaska, Montana, Washington, Oregon, California, Texas, New Mexico)
    • Top 1-3 health equity concerns experienced by the population: Poverty, racism, housing
  • Number of beds: 11,500

Health System goal

On Earth Day, 2020, Providence announced their goal to work toward becoming carbon-negative by 2030. Providence leaders understood the moral imperative of a response and the urgency reflected in climate science, which called for action this decade.


Sustainability strategy implemented

Providence developed the WE ACT framework, identifying five major sources of emissions: waste, energy/water, agriculture/food, chemicals, and transportation. They adopted a purchasing policy to reflect their commitment, asking that all purchasing decisions are reviewed for their environmental impacts. Their climate resiliency plan, called WE REACH, stands for resiliency, equity, adaptation, climate, and health. These plans address the readiness of infrastructure and form community partnerships to reduce harm and encourage preparedness. They also work with clinical staff to ensure the availability of knowledge and resources to deliver care in a warming world, particularly regarding health inequities and communities most impacted by climate change.

Implementation process

Providence has developed programs for each category of the WE ACT framework. To reduce waste, they gather volume and cost data on each stream for each hospital. They have conducted waste assessments and developed action plans for each site and are working to optimize waste flow. Providence is conducting energy and water audits to make recommendations for increased efficiency while developing their 100% renewable electricity strategy. Providence is reducing the carbon intensity of meals served while addressing preparation and post-consumer food waste. Providence is a leader in reducing emissions from several chemicals, including volatile anesthetic agents, nitrous oxide, and inhaler propellants. Providence is addressing transportation by limiting business travel, encouraging telehealth where appropriate, supporting infrastructure for electric vehicles, and working with vendors for efficient delivery of products.

Providence is also developing their climate resiliency plan. Population health work includes identifying individuals at risk from heat and smoke. Community health investment is assessing climate risk in communities they serve. Providence is preparing buildings for heat and smoke hazards and working with clinicians to provide care and knowledge during extreme heat events, flooding, and heavy smoke.

The issue

Providence is committed to providing care to all, especially the poor and vulnerable. This is made more challenging by the impacts of climate change, which is driving negative health outcomes. At the same time, health care organizations are significant contributors to climate change from their heavy use of energy and other resources. As a large health system spanning seven states, Providence needs to account for a wide range of climate disasters — as well as resulting health impacts — such as wildfires, heat waves, blizzards, flooding, and more. Providence leaders recognize the importance of preparing for care delivery under extreme conditions, and they are creating a climate resiliency plan to ensure they can continue to serve all people equitably. They recognize the ethical obligation to reduce unwanted harm, and they have established a strategy for reducing greenhouse gas emissions across many areas. 

Tracking progress

Providence developed the WE ACT scorecard, which tracks use, cost, and carbon emissions for many resources and is provided monthly for each of their 51 hospitals. This automated platform consolidates data from dozens of sources including invoices, vendor reports, and employee reports using emission factors from national and international reference guides. The scorecard provides an ongoing carbon emissions tracker and the ability to identify high and low performance to help hospitals with planning and prioritization. Providence set an annual goal to reduce emissions by 3 to 5% per year. This is tied to executive compensation across the organization and reported quarterly to leaders and caregivers.

Progress achieved

Providence has been developing structures to plan, measure, and report progress. The WE ACT scorecard is under continual development and expansion. Their waste optimization strategy has been implemented at all 51 hospitals. Their real estate team contracted for dozens of energy and water audits and made significant improvements to achieve better efficiency. Their energy procurement team secured numerous contracts for renewable electricity. Their clinical team significantly reduced emissions from anesthetic agents and nitrous oxide. Their food service is reducing the carbon intensity of meals served. By the end of 2022, Providence had reduced emissions by 11.5% and was saving $11M annually. Leaders continue to advocate for sound climate policy and serve in numerous national groups working to advance the decarbonization of health care.

Challenges and lessons learned

This work is complex and challenging, especially through a crushing pandemic and historical financial headwinds. Providence is a large organization, and an integrated approach requires alignment across the system, with continual leadership support and engagement of caregivers in their daily work. A key to Providence’s success has been to anchor this work in their mission and core values. Recognizing that success depends on societal change in the economy, energy grid, transportation infrastructure, and supply chain, Providence continues to iterate for solutions on all fronts, while testing, measuring, and reporting to help advance knowledge in the field.

Next steps

Providence is developing their WE REACH climate resiliency plan focusing on infrastructure, community commitments, and clinical transformation and working with key leaders to hardwire the expectation of environmental stewardship in daily operations and decisions across the organization. They are structuring their clinical environmental stewardship program and reaching out to their 90,000 clinicians to help transform how care is delivered.