- Practice Greenhealth, a nonprofit membership and networking organization, awarded Mount Sinai a Top Health System Award as part of its 2026 Environmental Excellence Awards.
- Mount Sinai Health System’s targeted upgrades, including LED lighting, real-time HVAC controls, and nitrous oxide decommissioning, have cut carbon emissions by roughly 30 percent.
- For a recent project for The Mount Sinai Hospital campus on the Upper East Side, the healthcare organization installed a heat-recovery chiller, which captures the heat from equipment such as CT machines, to reheat water, offsetting some of the facility’s natural gas needs.
For Mount Sinai Health System (New York), one of the largest hospital networks in New York state, environmental health and patient health go hand in hand, says Dr. Muoi Trinh, medical director of sustainability at Mount Sinai.
Dr. Muoi Trinh (Image credit: Mount Sinai Health System)
“We’re in the business of health. … What we’re doing (with our sustainability initiatives) is not just best for the patient in front of us but also broadly for all patients, staff, and the community” she says. “We know that greenhouse gases and climate change have both short and long-term health effects on patients including worsening asthma, COPD, and heart failure exacerbations.”
At Mount Sinai, those efforts include LED lighting upgrades for energy conservation and decommissioning piped nitrous oxide to reduce emissions.
This year, Practice Greenhealth, a nonprofit membership and networking organization, awarded Mount Sinai a Top Health System Award as part of its annual Environmental Excellence Awards. The honor recognizes Mount Sinai for scoring in the top 5 percent of healthcare systems that applied to the organization’s Partner for Change program, which measures high performance based on reductions in greenhouse gas emissions.
According to Trinh, “what the award does is it validates and communicates that sustainability and patient care are interconnected.”
In this Q+A with Healthcare Design, Trinh and Colin Barrett, vice president of infrastructure and special projects at Mount Sinai Health System, discuss the organization’s efforts and strategies to link sustainable design to better outcomes.
Healthcare Design: What initiatives have had the greatest measurable impact on your efforts to reduce greenhouse gas emissions?
Colin Barrett (Image credit: Mount Sinai Health System)
Barrett: From an energy perspective, Mount Sinai really started focusing on reducing emissions in the late 2000s. The initiatives we’ve implemented have reduced our carbon emissions by about 30 percent over the past two decades. In the early stages, we tackled the low-hanging fruit, such as transitioning from fuel oil to natural gas, which seems like a simple thing that everyone should do.
Other instrumental initiatives include short payback projects such as LED lighting upgrades and adding real time energy management controls to our HVAC systems to reduce peak energy demand and overall energy usage. Now we’re moving on to more complex projects that are a bit more expensive to implement, such as waste heat recovery, where we try to reduce the simultaneous heating and cooling of our buildings.
Trinh: Decommissioning nitrous oxide has been another. We compared the amount of purchased nitrous with clinically use from electronic medical records, and we found a huge discrepancy. We were losing more than 90 percent of our purchased nitrous oxide through the pipelines.
Once we discovered this, we decommissioned piped nitrous. Now, instead of being situated in large, centralized tanks two blocks away from the hospital, the gas is in smaller cylinders directly connected to our anesthesia machines.
It was a huge initiative that required working with our engineers, facilities team, and clinicians to align everyone around the goals of the project and how we would implement the change safely. After we removed piped nitrous, we reduced our carbon emissions by close to 5,000 metric tons, which is equivalent to approximately 550,000 gallons of gasoline.
HCD: How do you balance decarbonization and other sustainability goals with the clinical, operational, and regulatory requirements that make healthcare environments unique?
Trinh: Ultimately, patient care always comes first. For example, decommissioning nitrous oxide wasn’t about providing less care; it was getting rid of the waste. Our approach has been to ask: Are there equivalent alternatives? Are they equally safe? Are they equally efficacious? If there are alternatives, can we consider using something with a lower environmental impact? At the same time, we also need to consider operational needs, infection prevention, resiliency, and regulatory requirements. Sustainability has to work within all of those constraints. It can’t come at the expense of patient care.
Barrett: Sustainability can complement a lot of these other needs. From an infrastructure perspective, we’ve been effective at linking them to other projects that are driven by clinical needs, whether it’s building a new cancer hospital or replacing an old façade. If we can make what we were going to build anyway a little more energy efficient, it complements the other goals and drivers.
HCD: What metrics do you use to evaluate progress beyond greenhouse gas emissions, and how do those metrics influence future projects and investments?
Barrett: The fundamental metric is energy use intensity (EUI). We look at this regionally because it can vary greatly based on where you are in the U.S. or globally or on the climate. In New York City, it’s hot in the summer and humid in the winter, so we have massive cooling and heating demands at various times of the year. But life cycle cost is also important; most health systems are struggling to continue to invest in their facilities.
Every time we design or plan a project that incorporates electrification or decarbonization, we look at not only the capital cost involved but also the future operational costs. That might be as simple as comparing energy costs (electric versus gas), but it also includes operational costs in terms of how many staff we need to operate these more complex facilities.
HCD: Can you share a recent project where sustainability goals directly influenced the design, engineering, materials, or systems selected?
Barrett: We’re wrapping up a project now at The Mount Sinai Hospital campus on the Upper East Side. The campus is about 5 million square feet, houses over 1,000 inpatient beds, and shares facilities with the Icahn School of Medicine. A big infrastructure challenge is that we don’t have enough cooling capacity to meet … all these demands for new diagnostic and treatment technologies that put off a lot of heat and need a lot of cooling.
In the past, we probably would have added an air-cooled chiller in the mezzanine, which would exhaust all that heat into the atmosphere. Instead, for this project, we installed a heat-recovery chiller, which captures the heat from equipment, such as CT machines, to reheat water to adjust the temperatures throughout our buildings.
These projects cost a little bit more upfront to build but instead of exhausting that heat into the atmosphere, we’re using it to offset some of the natural gas that we would have burned at the boiler plant to produce the hot water.
HCD: What have you learned from implementing sustainability strategies across such a large healthcare system?
Barrett: Over the past five or six years, as New York City has implemented Local Law 97 Greenhouse Gas Emissions Reduction, which incentivizes greenhouse gas reductions and encourages electrification, we decided that all new buildings or renovations would be 100 percent electric. But one lesson we’ve learned is that in the short term, that might not be 100 percent practical, for a couple of reasons.
One is that the local electrical grid is not ready for 100 percent electrification. We know empirically that the grid is very strained in the summer and winter, so we need provisions in place, such as backup heating systems, to protect our patients from electricity voltage reductions and blackouts.
Number two is that the electrical costs, particularly from local utilities, are very high, so we need to protect our patients from the financial impacts. What we’re really looking at now is a hybrid approach, where we electrify as much as possible while keeping some backup fuel, such as natural gas, for times when the electrical grid is not available. This strategy helps us reduce costs and improve the resiliency of our facilities.
It also means making sure we’re taking advantage of every opportunity for waste heat recovery. That’s really the best way to reduce our energy costs: by not burning fuel to make heat while we are also exhausting heat to the atmosphere.
Trinh: What I’ve learned is that it’s important to connect what we’re doing with sustainability to patient care, because ultimately, we are here to take care of our patients. When staff understand how these initiatives support better care, reduce unnecessary waste, have a lower environmental impact, and improve resource utilization, there is better engagement.
The other thing is that you really need to pilot these programs on a small scale. You need to understand the workflow issues, identify any infection prevention issues or supply chain restraints, and understand potential unintended consequences before rolling out at scale at a system-wide level.
HCD: What can healthcare design professionals do differently to help health systems accelerate progress toward lower-carbon, more resilient facilities?
Barrett: The first thing is that we need experts who are flexible and practical. It’s important for our design consultants not to come in with a dogmatic approach. Every project is unique, every client is unique, and we need to make sure that solutions are built around their needs.
Trinh: Another important thing when you’re trying to drive change is measuring and having the data. [This] allows you to identify the greatest opportunities, establish a baseline, and measure whether an intervention was effective. It allows us to demonstrate the impact of the work and helps build support for broader change.
Robert McCune is senior editor of Healthcare Design and can be reached at [email protected].
