Why is sustainability an issue for hospitals in Singapore?

Like many hospital systems around the world, healthcare in Singapore is facing several key challenges including an aging population, an untenable increase in healthcare expenditures (government expenditure has tripled in the past 10 years from 3.7 billion in 2010 to $11.3 billion in 2019, and is expected to almost triple again to about $27 billion by 2030), and a growing demand for healthcare that outpaces workforce expansion.  

For Tan Tock Seng Hospital (TTSH), addressing these key concerns required innovative thinking. Developing a sustainability strategy that spans the entire organization became crucial to meet the evolving health needs of the population while mitigating the environmental impact of their activities. 

Sustainability from the national to the local context 

TTSH is part of the Hospitals of Singapore (HOS) Network, which represents the collective leadership of hospitals in Singapore towards the future of hospitals. The network serves to inspire and focuses on patient-centred value, integrating care better with the communities, and promoting healthcare sustainability for future generations. 

In this context, the HOS Network is dedicated to supporting Singapore’s goal to achieve net-zero emissions by 2050. In pursuit of this, they aim to achieve a 10% reduction in energy and water consumption based on the baseline average level in the period from 2019–2022, and a 30% decrease in waste disposal from the 2022 baseline level by 2030. 

To address the current healthcare challenges, Singapore has embarked on the Healthier SG initiative which aims to promote health and quality of life among the population. Family doctors are working with residents to develop personal health plans for more holistic care, including disease prevention and improved chronic care, lifestyle adjustments, regular health screenings, and recommended vaccinations. Residents are also enrolled in a clinic of their choice to foster a stronger long-term relationship with their family doctor, focused on enhancing their health and wellbeing. In addition, through social prescribing, residents are connected with community assets and services to support their involvement in sports and activities to promote good health. As integral members of the public healthcare system, the HOS are supporting the delivery of the national Healthier SG initiative. This population health initiative will not only enhance the health and wellbeing of the population, but will also yield the added benefit of reducing waste and carbon emissions by minimizing avoidable healthcare consumption. 

Accelerating action with the SAT 

One of the largest and oldest hospitals in Singapore, TTSH was established in 1844 and currently has over 2,000 beds and a workforce of 11,000 people. As with many hospitals and health systems around the world, a formal approach to sustainability had not been in place. However, a stock-taking exercise revealed that many ground-up sustainability initiatives were already underway at TTSH, including initiatives to promote the use of telehealth. Other examples include actions to: 

• Reduce use of desflurane in the operating theatre. 
• Reduce the prescription of metered-dose inhalers. 
• Significantly reduce the volume of food waste sent for incineration and landfill through use of a food-waste digester. 
• Convert in-house diesel vehicles to electric vehicles. 
• Upcycle old uniforms. 
• Digitalize medical information leaflets. 
• Implement a hospital-wide recycling programme.  

However, many of these initiatives were sporadic and not sufficiently developed and scaled to make a significant and sustained impact at system level. 

To ensure an objective understanding of the sustainability progress across TTSH, the hospital turned to the Sustainability Accelerator Tool (SAT) to assess the hospital maturity level. The assessment allowed for strategic clarity on where focus was needed going forward, particularly in the areas where little or no action had yet been taken (see ‘entry’ column in the summary table).  

TTSH then combined its stock-taking activity with the results from the SAT’s maturity assessment, leading to the development of a hospital-wide sustainability framework. This strategic framework focuses on four key action areas with four enablers to ensure the success of these action areas. 

With these four focus areas and enablers, TTSH aims to achieve a more coordinated approach on their sustainability journey. A renewed governance structure for healthcare sustainability includes a: 

• Strategic layer (including key working groups and programme oversight). 
• Management layer (to translate strategy to on-the-ground activities). 
• Operational layer (including communities of practice and department level projects). 

In July 2024, the Sustainability Academy as launched as part of the Centre for Healthcare Innovation. This academy focuses on workforce training and providing technical input to all layers of the governance structure. 

To increase workforce engagement and empowerment in support of sustainability, TTSH’s senior management took active steps, including a Townhall, small group engagement with middle managers, and electronic media. In addition, to better monitor the progress of its efforts in the coming years, TTSH established a suite of sustainability indicators and targets, including for the use of environmental resources, which will be reviewed by the hospital’s senior management on a regular basis. The hospital also plans to conduct a repeat assessment using the SAT tool in 2–3 years’ time to track its progress in improving its organizational maturity for sustainability.   

Driving sustainability impact with the SAT 

Overall, TTSH found that the Sustainability Accelerator Tool provided considerable benefits to the development and implementation of their sustainability framework. These benefits included the following reflections on the SAT tool: 

• SAT provides an objective and comprehensive way to assess the current state of sustainability and identify opportunity for improvement.
• The content and guidance of the tool is clear, specific, and understandable. 
• The wide range of sustainability topics covered in the tool proved useful in engaging the workforce across various departments of the hospitals, helping to bridge silos. 
• SAT has a focus beyond just environmental impact, and includes health equity and wellbeing considerations, which is important in reducing avoidable healthcare consumption and the associated emissions. 
• The tool supports benchmarking of the hospital’s progress with overseas counterparts. 

Ensuring progress towards sustainability 

The challenges that TTSH face in Singapore are shared by hospitals and health systems around the world. To achieve sustainability, hospitals need to rethink service delivery, prioritize prevention to reduce demand, and embed sustainability into governance and training. Focusing on governance for sustainability and workforce training ensures embedding sustainability across the organization. The Sustainability Accelerator Tool (SAT) is the go-to tool to develop a structured strategy for hospitals to make progress on sustainability. 

The SAT provides an assessment framework that digitally empowers hospitals and healthcare leaders​ to drive sustainable, low-carbon, equitable, and resilient healthcare.