title: Carbon mitigation, patient choice and cost reduction--triple bottom line optimisation for health care planning.
abstract: OBJECTIVE
  Health services must provide safe, affordable clinical care whilst meeting efficiency, environmental and social targets. These targets include achieving reduced greenhouse gas emissions. A care pathway approach based on a decision-support tool can simultaneously reconfigure health services, improve productivity and reduce carbon emissions.
  
  
  METHODS
  Probabilistic modelling using secondary data analysis.
  
  
  METHODS
  Estimates of carbon emitted by a health service drew on a previous carbon accounting study which integrated bottom-up assessment of carbon emissions with top-down analysis of indirect emissions by Duane et al. (2012).(1) Using human resource information, estimates were applied in a decision-support model to measure the carbon footprint and service provision of theoretical scenarios. Using this model, sites with less than 60% utilisation were theoretically reconfigured to reduce carbon emissions and improve service provision.
  
  
  RESULTS
  Clinic utilisation rates improved from 50% to 78%. Human resource savings were identified which could be re-directed towards improving patient care. Patient travel for health care was halved resulting in significant savings in carbon emissions.
  
  
  CONCLUSIONS
  The proposed model is an effective health care service analysis tool, ensuring optimal utilisation of health care sites and human resources with the lowest carbon footprint.
authors.affiliation: Dental Public Health, NHS Fife, Cameron Hospital, Windygates KY8 5RG, UK. Electronic address: brettduane@nhs.net.
authors.forename: B
authors.initials: B
authors.lastname: Duane
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
authors.forename: T
authors.initials: T
authors.lastname: Taylor
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
authors.forename: W
authors.initials: W
authors.lastname: Stahl-Timmins
authors.affiliation: Public Health, NHS Fife, Cameron Hospital, Windygates KY8 5RG, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hyland
authors.affiliation: Scottish Public Health Network, C/O NHS Health Scotland, Meridian Court, 5 Cadogan St., Glasgow G2 6QE, UK.
authors.forename: P
authors.initials: P
authors.lastname: Mackie
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Pollard
mesh_terms: D058572:Carbon Footprint; D017046:Cost Savings; D003695:Delivery of Health Care / Q000191:economics*; D006285:Health Planning / Q000458:organization & administration*; D006801:Humans; D008962:Models, Theoretical; D057240:Patient Preference; D006113:United Kingdom
keywords: Carbon; Greenhouse gases; Service management; Service redesign; Sustainability