Scope 3 - Moving from strategy to action to deliver value
This article outlines practical actions leaders are taking to turn the targets from aspirational statements into operational reality and financial outperformance.
As healthcare systems worldwide confront rising demand, constrained resources, and mounting pressure to meet net-zero commitments, one truth is becoming clear: prevailing approaches to measuring healthcare emissions lack the contextual grounding that makes the data actionable.
For more than 15 years, ERM has supported health systems, pharmaceutical companies, and sustainability coalitions in understanding the real environmental footprint of care delivery. What we have learned is simple, but transformative: meaningful decarbonization happens along the care pathway, not at the product level alone.
Care Pathway Assessments offer a systems view that uncovers the true drivers of environmental impact, enabling leaders to make smarter, more sustainable decisions that support better patient outcomes and lower emissions. As regulatory expectations intensify and product disclosure requirements evolve, Care Pathway Assessments are emerging as one of the most practical, evidence-based tools to future-proof healthcare.
Why Care Pathways Are Becoming a Strategic Priority
Health systems are accelerating their decarbonization plans, yet many still use top-level reporting or focus narrowly on product-specific LCAs. While essential, product LCAs alone paint an incomplete picture. The emissions associated with real-world care (such as from diagnostics, hospital stays, devices, patient travel, and preventable complications) influenced by the products used often far exceed those of the products themselves.
Care Pathway Assessments shift the focus from “What is the footprint of this product?” to “What is the footprint of delivering this care?”. This perspective shift matters.
Care Pathway Assessments provide a consistent, transparent method for evaluating:
- the environmental impact of current care models,
- the benefits of prevention and early intervention,
- alternative treatment scenarios, and
- opportunities to reduce Scope 1, 2 and 3 emissions at scale.
There are three primary drivers for conducting a care pathway assessment:
- Optimizing an existing pathway to understand its environmental impact and hotspots. A Care Pathway Assessment identified the substantial climate, water, and waste impact of anastomotic leak treatment1, enabling informed decision-making and targeted solutions to reduce emissions, water use, and waste.
- Evaluating new or alternative pathways to compare the environmental impact of different treatment options and identify opportunities for improvement. A Care Pathway Assessment2 found that outpatient antimicrobial therapy (OPAT) pathways had a lower climate change, water, and waste impact than inpatient treatment.
- Evaluating preventative pathways, including the avoided burden of care, comparing a preventative pathway against the pathway a patient would follow without it. A Sustainable Healthcare Coalition (SHC) and AstraZeneca study3 found that a Smartinhaler device reduced the climate change, water, and waste impact of a year of treatment through avoided hospital admissions.
Care pathway assessments go beyond traditional pharmaceutical product LCAs
Care Pathway Assessments provide a means for analyzing the environmental impact of healthcare. They apply the LCA approach as defined in international standards to a patient care pathway to assess the overall impact of patient care, from diagnosis to recovery. The assessment identifies environmental hotspots and can compare the respective environmental costs and benefits of alternative treatment options. Care Pathway Assessments take a holistic approach to healthcare emissions, enabling treatment efficacy to be considered and complex patient pathways to be assessed. The result is the full picture of patient care, not a single snapshot.
Care Pathway Assessments complement product LCAs, offering wider insights into product context. ERM has delivered many care pathway assessments for clients alongside medicine and medical device LCAs. By considering the care pathway in which their product is used, pharmaceutical companies can better design products for sustainable care.
Why this matters in the boardroom
Care Pathway Assessments are not an environmental reporting exercise, they are a strategic lens on where value and risk actually sit in healthcare delivery and present a great opportunity for the sector to innovate together.
Three shifts make this a leadership priority:
- Decarbonization roadmaps are a disclosure and procurement reality, not a future risk. The emissions that increasingly concern regulators, investors, and health systems live in the care pathway, not the product datasheet. Organizations that can evidence pathway-level impact will be well positioned to respond as procurement and tender requirements evolve. While few buyers are asking for pathway-level data today, expectations are tightening, and organizations that can already evidence this impact will be ready to differentiate themselves.
- Decarbonization and margin move in the same direction. Preventable complications, avoidable admissions, and inefficient treatment models are simultaneously the largest emissions hotspots and the largest cost burdens. Care Pathway Assessments surface both in one view, turning a sustainability mandate into an operational-efficiency and value case.
- Pathway evidence is a commercial differentiator. For pharma and med-tech, demonstrating that a product lowers the footprint of delivering care, not just its own manufacturing, reframes the conversation with health systems from price to system value, strengthening partnerships and protecting market access.
The bottom line: the organizations that win the net-zero healthcare transition will be those that can prove, with evidence, that better care and lower emissions are the same decision. Care Pathway Assessments provide proof. The question isn't whether to act, but whether you'll lead the transition or be shaped by it.
The Way Forward
Healthcare transformation is accelerating. As the sector continues to innovate, from digital therapeutics to decentralized care and precision medicine, the ability to understand and optimize the environmental impact of real-world care has never been more important.
Care Pathway Assessments offer a practical, actionable approach to reducing emissions, strengthening partnerships with health systems, and unlocking new forms of value. They provide the evidence organizations need to support better patient outcomes today while building a more sustainable healthcare system for tomorrow.
Care pathway assessments offer a practical, actionable approach to reducing emissions, strengthening partnerships with health systems, and unlocking new forms of value. By comparing treatment options and highlighting the benefits of preventative approaches, they support better outcomes for both patients and the planet.
On the vanguard: partnering with the Sustainable Healthcare Coalition (SHC)
ERM’s expertise in care pathway assessments spans practical application and our role as authors of the care pathway assessment method4, published by the Sustainable Healthcare Coalition in 2026. The SHC method and guidance documents, first published in 2015 and recently updated, were developed collaboratively by ERM with the NHS, SHC members, and SHC partners from across the sector. ERM is now collaborating with the SHC and Patient Care Pathway Consortium to expand the care pathway assessment toolkit and the uptake of care pathway assessments across healthcare systems, as recently announced by SHC.
ERM has worked closely with the SHC to assess the environmental impact of various healthcare activities and has published the findings on the SHC website. With the support of AstraZeneca, we measured inpatient stays, surgery and an emergency department visit, assessed the environmental impact of dialysis and common healthcare activities at hospitals internationally, including Unidade Local de Saúde Matosinhos, Hospital Pedro Hispano, in Portugal5.
Identifying the environmental impact of common healthcare activities, often referred to in care pathway assessments as modules, expands the pool of environmental data available for assessment. With support from the SHC and the PCP consortium, ERM continues to collaborate with healthcare providers worldwide to appraise the environmental impact of common healthcare activities to facilitate the appraisal of care pathways in different jurisdictions. ERM combines deep LCA expertise with a decade of care pathway assessment experience, and partnerships across health systems, enabling clients to move from insight to implementation.
By bringing ERM’s technical rigor to the Patient Care Pathway Consortium, we are turning high-level climate goals into actionable data that helps the NHS and global health systems deliver lower-carbon, high-quality care. The transition to a sustainable health economy demands bold, cross-sector leadership. ERM’s commitment to the SHC’s work and that of its partners within the Sustainable Markets Initiative (SMI) reinforces their role as a vital collaborator in the global effort to align industrial action with health priorities. Systemic change is only possible when we bridge the gap between technical expertise and clinical delivery. ERM’s involvement in our PCP Consortium and their broader membership in the SMI exemplify the collaborative spirit needed to accelerate the path to a Net Zero healthcare future worldwide.
Connect with our team
To explore how to quantify and reduce emissions across your Care Pathways, or how Care Pathway Assessments can support more informed, system-level decision making in your organization, get in touch with ERM’s experts.
[1] Bischofberger, S., Adshead, F., Moore, K., Kocaman, M., Casali, G., Tong, C., Roy, S., Collins, M. and Brunner, W. (2023). Assessing the environmental impact of an anastomotic leak care pathway. Surgery Open Science, 14, pp.81–86. doi:https://doi.org/10.1016/j.sopen.2023.07.001.
[2] Cole, A., Aspin, J., Laird, S., Acri, F., Galley, S. and Collins, M. (2025). The environmental impact of intravenous antimicrobial therapies: a comparison of OPAT and inpatient administration care pathways. JAC Antimicrobial Resistance, 7(2). doi:https://doi.org/10.1093/jacamr/dlaf030.
[3] AstraZeneca and Adherium (2017). Environmental impacts of poor control and improved control of paediatric asthma by use of intelligent digitally-connected Dry Powdered Inhalers (DPI). [online] Sustainable Healthcare Coalition, pp.1–4. Available at: https://shcoalition.org/environmental-impacts-of-poor-control-and-improved-control-of-paediatric-asthma-by-use-of-intelligent-digitally-connected-dry-powdered-inhalers-dpi/ [Accessed 20 Jan. 2026].
[4] Sustainable Healthcare Coalition (2023). Sustainable Care Pathways Guidance. [online] Sustainable Healthcare Coalition, pp.1–87. Available at: https://shcoalition.org/sustainable-care-pathways-guidance/ [Accessed 20 Jan. 2026].
[5] AstraZeneca UK Limited (2025). Appraisal of Environmental Impact of Hospital Activities at ULS Matosinhos, Portugal. [online] Sustainable Healthcare Coalition, pp.1–5. Available at: ttps://shcoalition.org/appraisal-of-environmental-impact-of-hospital-activities-at-uls-matosinhos-portugal/ [Accessed 20 Jan. 2026].
