Implementing Clinical Decarbonization Actions: Lessons Learned from the University of California Health System.

Background: Clinical decarbonization actions are needed to ensure that hospitals achieve commitments to reduce carbon emissions. Elucidating barriers and facilitators is key to developing sustainable and scalable clinical mitigation actions.

Methods: Semistructured interviews with key stakeholders sought to document barriers and opportunities in implementing clinical sustainability initiatives at the University of California Health System. The following Consolidated Framework for Implementation Research (CFIR) domains were used to shape the interview guide and analyses: (1) individual characteristics, (2) innovation characteristics (3) inner setting, and (4) outer setting. Work responsibilities, knowledge of and interest in sustainability, project role, and recommendations for future sustainability and decarbonization efforts were also explored.

Results: Fourteen frontline healthcare workers participated in the study, including 13 clinicians and one supply chain officer. All participants encountered challenges and solutions across CFIR domains. All participants acknowledged, explicitly or implicitly, the existence of multiple competing priorities as the strongest barrier to decarbonization implementation. Participants identified several required resources to achieve and sustain efforts: access to experienced peer professionals, data, dedicated time and funding, commitment to resolving supply chain issues, and embedding sustainability within the hospital's core mission.

Conclusion: Implementing clinical decarbonization actions is complex, requiring alignment between numerous stakeholders. Overcoming implementation challenges requires strategic action at the individual and organizational levels and alignment across internal and external constituents, including supply chain partners, state and federal policymakers, and industry, to build and sustain efforts.