Sustainability is becoming more important in numerous industries, including healthcare. Action to achieve sustainability is undertaken by various means, such as the Green Deal Healthcare. Several tools exist that can assess the environmental impact of a certain industry or company, but no tools exist that aid in actively lowering this environmental impact. Therefore, the HSMEA (Healthcare Sustainability Mode and Effect Analysis) tool was developed. This method is based on the Lean philosophy and HFMEA (Healthcare Failure Mode and Effect Analysis) tool and consists of six steps that aid in making a healthcare process more sustainable, in terms of waste production, energy use, or water use. With this tool, processes that contribute to these factors are identified in a highly structured and systematic way, and practical solutions are created and executed for these situations by a multidisciplinary team. This tool was validated in the academic hospital in Leiden, the Netherlands (Leids Universitair Medisch Centrum). Next, it was applied to two clinical case studies, assessing two processes that are currently present in the operating rooms of the LUMC. The HSMEA tool showed that with the implementation of four solutions, great improvements can be achieved in terms of waste and CO2-equivalents production and recycling rate. These four interventions are currently being implemented in the LUMC. This novel sustainability tool has therefore proved its usefulness and clinical applicability in a healthcare setting. By implementing this tool throughout the hospital, it will support the hospital reaching its sustainability goals.

Climate change is a large and global concern. The healthcare sector contributes between 6% and 10% to national carbon emissions in developed countries. Within the healthcare sector, operation rooms are very resource-intensive. A lot of energy, medical products, equipment and pharmaceuticals are required to perform surgery on a daily basis. This report explores methods to calculate the carbon footprint of Dutch operation rooms. Based on these, a tool is developed to calculate total carbon footprint and identify contributing processes. A data collection trial is completed during this development, identifying difficulties in the data collection and calculation process as well as generating some emission results. A tool is designed from the results of this trial. It is based on life cycle analysis, while also including emission factors calculated from sector carbon disclosures. Differences from either one of these carbon emission calculation methods are evaluated and if possible, compared. A final selection of calculation methods for each process is selected and used in the tool. The tool is capable of both internally monitoring carbon emissions over different time periods and comparing emission results with other hospitals. Both these functions can be used to identify emission hotspots, inspire improvements and monitor changes in emissions. Sensitivity of the model to different characterization methods and scope definitions is tested. Ultimately, this tool is aimed to aid in reducing CO2-eq emissions within operation rooms. Recommendations are made to further improve this tool and its data collection procedure.