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Center for Sustainable Business | Healthcare Delivery Systems Decarbonization Framework

Return on Sustainability Investment™

Healthcare Delivery Systems Decarbonization Framework

ROSI™ empowers healthcare delivery systems to reduce their carbon emissions by monetizing investments in decarbonization practices

Healthcare accounts for 4.5% of greenhouse gas (GHG) emissions globally, and 8.5% of US emissions. Healthcare emissions are also growing, and could reach six gigatons per year by 2050 if no action is taken. Climate change affects both our need for healthcare and our ability to have consistent access to healthcare.

Leveraging the unique Return on Sustainability Investment (ROSI™) methodology developed by NYU Stern CSB, The Healthcare Delivery Systems Decarbonization Framework identifies 8 decarbonization strategies that healthcare delivery systems can use to make the internal business case for implementing decarbonization practices, develop more resilient organizations and drive financial value. 

Healthcare systems practitioners can use the framework to:

  • Understand which decarbonization options fit with their budget and decarbonization journey
  • Understand how to calculate the tangible and intangible value associated with the implementation of each sub-practice, including which costs to anticipate
  • Make the internal business case for decarbonization to secure resources

Key Takeaways:

  • If you haven’t started decarbonization yet, there is an entry point for every budget, and the Framework can help you make the business case for starting
  • With an appropriate choice of projects to implement, immediate savings could be realized that can be reinvested into the additional energy efficiency measures, creating a revolving fund for new decarbonization projects 
  • The Inflation Reduction Act (IRA) has decarbonization assistance for both nonprofit and for profit hospitals. Benefits are highest in the early years of the IRA.


Strategies and Critical Enablers: based on research, experience, and engagement with industry leaders, researchers identified the following decarbonization strategies and enablers that are being used by the industry

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Strategies: The eight strategies impact healthcare delivery systems' Scope 1, 2, and some influenceable Scope 3 emissions and are described below:

  • Energy Management: Implement practices that reduce energy required and switch to renewable energy sources
  • Building Design & Maintenance: Design and build hospitals and clinics that require less energy, incorporate renewable energy sources, and enhance resilience to extreme weather
  • Sustainable Sourcing: Utilize sourcing practices that minimize waste and toxic chemicals, incorporate circularity, and reward suppliers that help achieve decarbonization goals
  • Food Service Optimization: Implement practices that procure foods from local sources, produce less waste, and incorporate plant-based options
  • Low Emissions Clinical Care: Use clinical care solutions that minimize the carbon footprint of anesthetic gases and patient travel
  • Waste Reduction: Produce less waste through circularity, proper sorting of waste, and using waste for energy production
  • Responsible Investments: Prioritize investments focused on sustainability and with portfolios of companies that show progress towards carbon reduction goals
  • Reduced Transportation: Implement practices that optimize and decarbonize hospital-related transportation 


Critical Enablers: A combination of committed leadership, adequate funding allocation, and investment in education can create the right enabling environment, that is ultimately critical to speed the adoption of decarbonization practices and ensure they are maintained over time.


The Return on Sustainability Investment (ROSI™) Framework was used to determine the tangible and intangible benefits associated with the practices that were identified.


ROSI snake


Decarbonization Case Studies & Models

Advocate Health: Reprocessing Medical Devices

The ROSI framework identified financial benefits for switching from single use to reprocessed medical devices for Advocate Health. The analysis showed a net positive financial benefit, the 10-year NPV was assessed at $20.3 M. On an average annual basis, the net benefit was likely to be $3.5 M over the same period (~3% of annual operating income of Advocate Health in 2023). The emission analysis showed that on an average basis each reprocessed device reduces emissions by 1.5Kg COequivalent.

Read the Case Study

Reprocessing Monetization Model

CSB has created an Excel-based monetization template that captures the benefits of switching from single use to reprocessed medical devices. Users are advised to access the template and enter data relating to their facility. 

Download the Model

Cardinal Health: Optimizing Last-Mile Pharmaceutical Delivery

The ROSI framework was applied to Cardinal Health’s hospital deliveries to explore the benefits created through optimizing delivery schedules. The methods and lessons from this case can be used by other organizations that deliver products to healthcare customers. The analysis demonstrated that through the early optimization of delivery schedules, distributors can increase operational efficiency, reduce fuel costs, reduce carbon emissions, and help customers meet their decarbonization goals.

Read the Case Study

Last-Mile Delivery Model

CSB has created an Excel-based monetization template that captures the benefits of optimizing last-mile delivery schedules for pharmaceutical customers. Users are advised to access the template and enter data relating to their specific organization. The values currently in the model are generic values to demonstrate the functionality of the model. 

Download the Model

Gundersen Health System: Reducing GHG Emissions Through Retrofits and New Construction

Gundersen Health engaged the ROSI methodology to determine benefits of energy management by adopting low GHG emission measures in the retrofitting and new construction of healthcare facilities. Analysis showed ~10 year payback for the energy retrofits, with reduced emissions of 7% and benefit of ~$1 per sqft on an average annual basis. New construction had a payback period of 24 years for the incremental capital investment, with a 30% reduction of GHG emissions and $2 per sqft in annual benefits

Read the Case Study

Thank You to our Sponsor, Hospital System Research Partners and Research Team

The decarbonization framework was designed with funding support from the Commonwealth Fund.  Inputs into the framework included Commonwealth Fund-supported ROSI™ research collaborations with Advocate Health, Cardinal Health,and Gundersen Health,  interviews and expansive literature review. 

CSB contributors to the project include Tensie Whelan, Chisara Ehiemere, Divya Chandra, Beverly Teng, and consulting support from Dr. Cassandra Thiel. Lastly, we thank our student researchers Roshan Poudel (MD MBA '23) and Susan Mwaniki (EMBA '24).



Additional ROSI™ Research


ROSI™ Resources

CSB offers in-depth resources on ROSI™, including a step-by-step overview, research publications, industry case studies, and Excel tools for download.


Apparel Industry Sustainable Strategies Framework

CSB partnered with a set of apparel companies including Eileen Fisher, REI and, Reformation to estimate the value of tangible and intangible benefits that apparel companies can accrue by making strategic investments in more sustainable business practices.

ROSI strats

Food & Agriculture Sustainability Strategies Framework

CSB applied the ROSI™ methodology to the food and agriculture value chain, identifying 12 strategies and creating case studies to demonstrate the practices in action.