At Rede D’Or São Luiz, we seek to increase our operational efficiency in order to minimize our environmental impacts in the regions where we operate. We channeled our efforts to support social development, health and safety of all stakeholders, being environmentally responsible and taking into consideration the economic development in the regions where we operate. Energy efficiency, conscious water use, proper waste disposal and factors that may accelerate climate change are ongoing concerns to our management.
For environmental indicators, we rely on an internally-developed KPI system, from which the hospital maintenance activities manager and other business areas monthly report their data. Data is monitored by the Sustainability department, in partnership with the Infrastructure Executive Office, which also monitors this information, except for waste, which is the sole responsibility of the Sustainability department. For 2022, we will implement Schneider’s Resource Advisor system, offering a more robust process.
78
units
among hospitals, oncology clinics and labs take stock of their greenhouse gas (GHG) emissions
Our Sustainability and Environmental Corporate Policies, which are available on Rede D’Or São Luiz’s website, are
the underpinnings of our sustainability management. We have mapped the most relevant environmental risks in our operations and implemented projects to mitigate them. To verify legal compliance, adherence to the plan and achievement of proposed environmental management goals, we perform regular environmental audits, both internal and external. When we identify noncompliances, they are classified in accordance with their risk (critical, high, medium and low) and their roots; audit reports are forwarded to the units’ officers, who then send them to the managers, who are responsible for preparing the respective action plans to address such non-compliances.
Systematically performed since 2012, internal environmental audits are focused on nursing and care delivery,
healthcare hospitality, pharmacy, maintenance, nutrition and laboratories. In 2021, we conducted more than 170
internal environmental audits at more than 80 units (hospitals, oncology clinics, clinic analysis labs and others),
through which we have identified the need for 3,014 corrective actions, and only 4% of them have been considered high or critical risks. We also performed 31 analysis of architecture projects, in which we verify if projects meet legal and technical environmental and sanitary requirements, allowing us to develop corrective actions still in the project conception and representation phase of the buildings.
We have also conducted 15 technical visits for environmental diagnosis units acquired by Rede D'Or São Luiz, called integration audits. 12 of these audits have been conducted at hospital units (learn more on Integration of new units). Furthermore, we actively participated in 30 technical analysis and 10 visits at the operation sites of service providers that perform waste collection, transportation, treatment and final disposal to comply with bidding processes organized by the Indirect Supplies team.
We have a Licensing department that controls and monitors licenses for all Rede D'Or São Luiz’s units. In 2021, the
department had 9,401 licenses under its management. Over the past year, 1,353 licenses were renewed and 35 new
ones granted. Corporate and construction licenses are addressed in our internal policies.
Since 2020 we have been signatories of UN’s Global Compact, taking on the commitment to implement publicly its 10 principles and transparently in our business strategy. We are already engaged in the Action for Climate platform from Brazil Network, which addresses SDG 7 and 13, and develops sector and themed initiatives related to climate, with projects related to energy and forests.
In 2021, we kept our commitment to expanding our activities towards a daily practice that is more aware of our impacts to society. We began the construction works for Maternidade Star, in an upscale part of southern São Paulo, with more than 36,000 m2, with a sustainable and innovative concept.
Rede D’Or São Luiz’s project will have as advantage the exclusive excellence concept consolidated by Vila Nova Star. With an investment of nearly R$1.5 billion, it includes the sustainable remodeling of a building originally designed to be an office tower, built in 2012 in compliance with sustainability guidelines. The entire process is supported by a LEED tool (certification for sustainable buildings), based on internationally validated ESG features, always aimed at ensuring the health and safety of everyone using the building, which include environmental, social and economic aspects.
Maternidade Star’s details were devised according to the environmental and social impacts that they generate, from its location – a neighborhood that offers quality public transportation access and many amenities, such as restaurants, drugstores and banks.
Learn more about the sustainable advantages of Maternidade Star:
In 22 floors and 173 beds, Maternidade Star will operate focused on service excellence, including well-known specialist physicians and cutting-edge technology. Apartments and suites will be decorated and automated with artificial intelligence, voice commands and automated communication between patients and nursing teams, as well as automatic blinds, lighting and air conditioning, providing comfort for families. There are also large spaces designed for patient and family comfort, in addition to a restaurant with panoramic view on the 20th floor. Opening is expected to happen in 2022.
The master plan also includes the sustainable construction works of a 12-story tower, which will be an expansion of Hospital Vila Nova Star and will enable us to add 140 beds to the hospital’s apacity. Opening is expected to happen in the 1st half of 2023.
In 2021, the Star (DF Star, Copa Star and Vila Nova Star), São Luiz São Caetano, São Luiz Itaim, São Luiz Anália Franco, Barra D’Or and Assunção hospitals received the Green Kitchen seal, a quality certification that recognizes the continuous improvement of nutrition services in order to achieve quality and sustainability of the entire production process, fostering healthy food habits at the hospital. Other three Rede D'Or São Luiz’s units (Niterói D’Or, Quinta D’Or and Copa D’Or) are under the certification process and other four units are being assessed by the Green Kitchen team.
The seal is a recognition to the teams, especially the Nutrition Team (SND, in Portuguese) for the initiatives developed at the hospital environment, targeted at improving service quality even further. The certification granted by the program ratifies good kitchen management practices. For example:
Energy consumption at hospitals is linked to lighting, air conditioning, water heating and pumping systems, as well as elevators and medical equipment. This includes direct energy from fuel to supply the generators and indirect energy from concessionaires, in the form of electricity. Generators work only when there is electric power outage by the concessionaire, or for a short period each month due to equipment maintenance, and through installed equipment it is possible to check the tanks fuel volume.
In 2021, total energy consumption at Rede D’Or São Luiz was 1,129,626.80 GJ, 22% up on the previous year, due to the acquisition of new hospitals and the incorporation of oncology clinics (not located at the hospital units) in the environmental indicators management. Electricity accounts for approximately 87% of total energy used in 2021.
Since 2015, we have developed an energy autonomy project, which aims to mitigate hydrological risks by increasing drinking water reserves, drilling of artesian wells, addition of generators, increase of backup and coverage for the emergency electric system.
One of Rede D’Or São Luiz’s highlights on the topic was the investment in low carbon initiatives, especially giving priority to using energy from renewable sources, which comes from the gradual relocation to the Wholesale Energy Market (incentivized energy), which accounted for almost 30% of energy consumption.
The project was boosted in the second half of 2021, when we reached almost 50% of hospital units in the Wholesale Energy Market. At the same time, we are looking for energy-reduction solutions, such as implementing more efficient equipment, automating the air conditioning system, heat recovery system and monitoring the consumption standard, therefore tackling the largest hospital energy outlays.
Energy consumption within the organization
| Non-renewable fuel consumption (GJ) | 2019 | 2020 | 2021 |
|---|---|---|---|
| Diesel | 61,980.00 | 19,476.31 | 20,347.43 |
| Natural Gas | 93,492.29 | 100,831.80 | 127,793.1 |
| Total | 155,472.29 | 120,308.11 | 148,140.53 |
| Energy used (GJ) | 2019 | 2020 | 2021* |
|---|---|---|---|
| Electricity1 | 748,126.01 | 805,646.67 | 981,486.27 |
| Total | 748,126.01 | 805,646.67 | 981,486.27 |
1 - Includes the consumption of incentivized energy (Wholesale Energy Market).
| Total energy used (GJ) | 2019 | 2020 | 20212 |
|---|---|---|---|
| Non-renewable fuel consumption | 155,472.29 | 120,308.11 | 148,140.53 |
| Electricity used2 | 748,126.01 | 805,646.67 | 981,486.27 |
| Electricity sold3 | N.A. | N.A. | N.A. |
| Total | 903,598.30 | 925,954.78 | 1,129,626.80 |
2 - 2021 data includes Hospital São Lucas (RJ) information only for August. 2021 data does not include information on Hospital Guaianases from January to June.
3- Includes the use of incentivized energy (Wholesale Energy Market).
| Energy Intensity (GJ) | 2019 | 2020 | 20214 |
|---|---|---|---|
| Energy consumption (kWh/patient - day) | 113.23 | 194.56 | 228.67 |
4- Increase in consumption due to the expansion of Rede D’Or São Luiz’s bed capacity.
Consumption of incentivized energy (Wholesale Energy Market)5
| Year | Consumption (GJ)6 | Consumption (kWh) | Consumption (MWh) | Consumption (MWm) |
|---|---|---|---|---|
| 2019 | 33,847.15 | 9,401,986.96 | 9,401.99 | 1.07 |
| 2020 | 83,654.37 | 23,237,325.95 | 23,237.33 | 2.65 |
| 2021 | 292,497.87 | 81,249,407.39 | 81,249.41 | 9.28 |
5- For M&A, consumption begins in the month of acquisition.
6- Figures for consumption of incentivized energy (Wholesale Energy Market) in GI are included in “Electricity” and “Energy used”, in the tables above.
Air conditioning systems account for almost 50% of the energy consumption of a modern hospital, therefore it is important to go after a more efficient technology for our buildings.
At Rede D’Or São Luiz, we have taken up a cold water production center (CAG, in Portuguese), comprised by several water chillers and fan coils (equipment that filter and cool the air in the room).
Efficient and low-noise equipment were particularly chosen to make up this cooling system. We prefer air-cooled chillers with a system to gradually reduce the compressor’s speed, for instance, because they offer maximum performance during long hours of operation. The efficiency increase with this equipment is estimated at 30% as well as the reduction in environmental footprint due to lower greenhouse gas (GHG) emissions.
Rede D’ Or São Luiz subscribes to the Wholesale Energy Market in order to develop a sustainable management strategy, since the relocation allows the company to purchase its energy from renewable sources, therefore, reducing its environmental impact.
This initiative began in 2019, with São Lucas (SE) and UDI (MA) hospitals and continued throughout 2020 and 2021 with Perinatal Barra and Laranjeiras (RJ), Santa Cruz (PR), Aliança (BA), São Carlos (CE), Balbino (RJ), Biocor (MG), Nossa Senhora das Neves (PB) and Novo Atibaia (SP) hospitals. In 2021, Rede D’ Or São Luiz began to relocate 21 hospital units (25 measurement points), which corresponds to an average of 12.89MW incentivized energy already contracted.
Currently, 32 units are in the wholesale energy market and 4 units under the relocation process, expected to be completed in 2022.
The Wholesale Energy Market is a segment of the energy sector in which energy is purchased and sold through bilateral agreements under freely negotiated conditions. In the captive market, on the other hand, energy is supplied by the distributors and not directly by the energy generator. The market’s trade rules and procedures are defined by the Electric Energy Trading Chamber (CCEE, in Portuguese). It is a competitive trading environment, in which consumers classified as “free” can purchase energy as an alternative to the supply from the local concessionaire. To join this market, consumers need to comply with the requirements set forth by law.
In 2022, we will have 36 units in the Wholesale Energy Market (average of 18.856 MW), with the addition of four more units (Quinta D’Or – Main Building and Annexes, Centro Médico Caxias D'Or and São Marcos). This means we will have almost 50% of Rede D’Or São Luiz hospital units under this model, with presence in the states of Rio de Janeiro, São Paulo, Pernambuco, Bahia, Maranhão, Minas Gerais, Sergipe, Ceará, Paraná and Paraíba.
Directly related to the amount of Refrigeration Ton (TR) and electricity consumption, typology and material specification that make up the hospital facades are important factors when building and/or renovating Rede D’Or São Luiz’s units.
The purpose is not only to reduce monthly energy costs, but also keep the building’s hygrothermal comfort and provide safety for patients, in addition to ensuring adequate lighting during clinical and surgical procedures and the general use of the building by patients and technical team.
32.75
thousand Kwh
saved in 11 months due to our energy efficiency program
Taking into consideration that the Water Chillers are our greatest consumers of electricity, Hospital São Luiz Itaim recently hired a robust energy efficiency program.
Based on the continuous presence of a specialist, supported by a remote team of engineers and a complex automation system, the program is geared towards improving the water chillers’ performance and electrical efficiency.
Considering climate conditions and the needs of the sectors at each moment, fine adjustments are constantly made in every equipment parameter, allowing them to operate more efficiently and at the lowest energy consumption possible.
In 12 months, the outcome was an average monthly saving of 38.21 MWh (megawatt per hour), enough to supply almost 580 average-standard Brazilian homes. Financially, it meant a monthly saving of R$ 21,400.00, or 3% in the electricity bill. However, it is important to note that the program present better results during cold weather periods. It will be necessary to wait for the upcoming months to have a definite result, whose expectation is an annual average saving of 5%.
Several of our units have a Building Management System to control, run and monitor heating, ventilation and air conditioning, (HVAC) systems. Automation regulates environments, brings convenience and reliability to the medical team, in addition to comfort and safety of the patients.
Present in surgery centers, isolation rooms, obstetric and exam rooms, the technology ensures the monitoring and control of the areas, with modern local and remote indicators, making it possible to have an efficient system management, operated by the medical and maintenance team.
We understand that climate change is one of the largest global threats to health in the 21st century. Aware of our role in protecting public health against climate change, we have been working on different fronts over the last years to reduce our emissions and expand our response capacity in view of the proposed challenges.
One of 2021 highlights was the publication of our Policy on Climate Change, approved by the Board of Directors, which lays down the company’s main guidelines and commitments to manage climate change risks and impacts on our units and business, providing mitigation and adaptation mechanisms.
To raise the awareness of our employees about this topic’s importance and spread our practices, we launched a Distance Learning training named “Sustainability Tracks”, which includes training on Sustainability Concepts, Climate Change and the Sustainable Development Goals. We also held an event about Climate Change to all our employees, with the attendance of UN’s Global Compact team and a webinar to our leadership on the same subject.
In order to showcase our transparency and commitment towards the climate change challenges ahead, since 2016, Rede D’ Or São Luiz has participated in the Brazilian GHG Protocol Program, which established the methodology to take stock of greenhouse gas emissions (GHG). In the last reporting cycle, we had already finished doing inventory of 48 units, of which 47 are certified by the Brazilian Association for Technical Standards (ABNT). We now have 78 inventories certified by the same independent body in the 2022 cycle, related to year 2021. Complete information regarding GHG inventories will be published in 2022, in the Public Record of Emissions
As part of our strategy towards sustainable development and our commitment to the United Nations’ (UN) Global Compact principles, in 2021, we began to develop a Carbon Management Plan, which is under approval stage and includes Rede D’Or São Luiz’s entire journey in terms of Climate Change. Climate change impacts and the actions needed to minimize risks and enjoy business opportunities are considered in the 2021 Corporate Risk Matrix (Climate Risk).
We have set goals to reduce greenhouse gas (GHG) emissions, in line with the Brazilian reduction goals (Nationally Determined Contributions - NDC) set forth in the Paris Agreement, and UN’s Sustainable Development Goals (SDG). Therefore, we established projects and practices targeted at reducing emissions, especially in Scope 1 and 2 sources.
In 2021, we published the GHG inventory for Rede D’Or São Luiz’s 36 hospital units for the first time on the Public Inventory Record website, a platform developed by the GHG Protocol. This information provides grounds to prepare our Carbon Management Plan, with risk mitigation and adaptation to climate change.
Some steps already performed include the definition of carbon reduction goals in line with the commitment made with the Race to Zero, of zeroing our net emissions by 2050. (the Race to Zero).
GHG emissions inventory (tCO₂e)
| Source | 2020 cycle (2019) | 2021 cycle (2020) | 2022 cycle (2021)1 |
|---|---|---|---|
| Scope 1 | 15,206.16 | 77,010.639 | 108,387.628 |
| Scope 2 | 4,303.22 | 16,252.65 | 35,612.49 |
| Scope 3 | 109.55 | 13,882.642 | 30,271.628 |
| Total | 19,618.93 | 107,145.93 | 174,271.7462,3 |
1- Inventories prepared in 2021 for the 2022 cycle include hospital units, oncology clinics and labs.
2- The significant increase in emissions, especially scope 1 emissions, arise from the acquisition of new hospital units and the measurement of emissions from oncology clinics and diagnosis labs that were not included in the previous cycle.
3- Emission factors have been updated according to the GHG Protocol methodology for the 2022 cycle (2021), which impacted the volume of emissions, especially for scopes 2 and 3.
| Intensity of GHG emissions (tCO2e) patient/day | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 20214 |
|---|---|---|---|---|---|---|---|
| Intensity of GHG emissions | 0.048 | 0.034 | 0.031 | 0.053 | 0.038 | 0.071 | 0.863 |
4- The increase in the Intensity of GHG Emissions is due to the increase in the number of units participating in this Inventory Cycle, as well as the increase in the number of existing units in the D'Or São Luiz Network as a whole
Number of units with inventory
| 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 |
|---|---|---|---|---|---|---|
| 1 | 1 | 3 | 8 | 10 | 48 | 78 |
Water consumption is indispensable for providing our services. Therefore, in 2021, we started the Water Efficiency Project, which currently encompasses 6 units: Hospital Oeste D’Or, Hospital São Rafael, Hospital Aliança, Hospital Cárdio Pulmonar, Hospital Barra D’Or and Hospital Rios D’Or. The project’s purpose is to reduce not only water supply costs but also water consumption, optimizing the units’ operation. The project Initiatives include detecting leaks, installing more efficient equipment (flow restrictors on faucets, aerators, etc.), using water from wells (when available), monitoring real-time consumption and awareness-raising campaigns for employees.
Hospital Norte D’Or, for example, reduces water consumption every month by setting up a system to reuse the water from filters backflush to irrigate the gardens. On the other hand, Rios D’Or and Niterói D’Or use the rainwater and HVAC condensation water in their parking lot roofs and ceilings. Units in the Federal District, IFOR, Rios D’Or actually use aerators for flow restriction in bathroom faucets, while Hospital São Luiz São Caetano harvest rainwater from roof gutters. At the new unit Maternidade Star, under construction in São Paulo (SP), in addition to harvesting rainwater for reuse, we chose materials that enable reducing water consumption by up to 90% and basins that allow using up to 60% less water. We have also reviewed the Maintenance department’s processes, with the purpose of providing more speed in discovering and solving possible problems, avoiding expenses and waste.
Water used at the units comes from three sources: concessionaires, authorized artesian wells and water tankers. All units, including those that are not part of the Water Efficiency project, rely on water management carried out through utilities bills, measurement equipment and accounting for the water volume received from water tankers during the month. The units participating in the Water efficiency project have a more detailed monitoring from our partner supplier.
In Brazilian regions where water distribution, treatment and access are a critical topic, such as the Northeast region, and represent almost 25% of total water consumption, Rede D’Or São Luiz builds a Water Treatment Plant (ETA in Portuguese), such as the case of Hospital São Marcos (PE).
In 2021, total water consumption was 2,296.240 m3, down by 28% compared to 2020, due to the water efficiency initiatives implemented by the company.
Water consumption at the organization
| Water withdrawal by source (m³) | 2019 | 2020 | 2021 |
|---|---|---|---|
| Concessionary | 1,307,937 | 2,810,117 | 1,676,447 |
| Water tanker | 116,679 | 99,546 | 209,838 |
| Artesian well | 282,342 | 295,992 | 409,956 |
| Total | 1,707,049 | 3,205,655 | 2,296,240 |
Note: 2021 data does not include information on Hospital Guaianases from January to June. 2021 data includes Hospital São Lucas (RJ) information only for August.
Water discharge
m³
Note: 2021 data includes Hospital São Lucas (RJ) information only for August.
90%
reduction
in water consumption is expected for Maternidade Star, after the construction works according to a sustainable and innovative concept are completed
Water management is a concern for Rede D’Or São Luiz’s institutions. To fight the waste of water with potential for reuse, thus reducing water expenditures and environmental impact, Hospital IFOR, located in São Paulo metropolitan region, has maintained a water reuse plan in the autoclave cycles since 2020.
With this initiative, IFOR saves 966 liters of water per cycle. In 2021, almost 4.6 thousand cycles were run, representing more than 2 million liters of water were reused, generating a reduction of more than R$ 55 thousand in water expenditures. In addition to the significant economic savings, water reuse at IFOR contributes to environmental preservation and spreading the sustainability culture across Rede D’ Or São Luiz.
In another initiative, the Hospital São Luiz’s Itaim unit drilled an artesian well to prevent possible water scarcity issues. With an average production of 1.5 m³/h of good quality water, the authorized well has capacity to serve almost 18% of the unit’s consumption.
Through this initiative, the unit does not depend as much on water tankers and is better prepared to face possible shortages in scenarios of water crisis and rationing. Rede D’Or São Luiz will avoid purchasing 1,080 m³ of water from the concessionaire every month, a volume big enough to supply nearly 90 average homes in Brazil. Financially, discounting all maintenance costs for the well and water treatment, the monthly saving will be 8%, which means R$ 136 thousand/year.
Waste management at Rede D’O São Luiz complies with the procedures set forth in the Healthcare Waste Management Plan (PGRSS in Portuguese), approved by health and environmental agencies. The plan is part of the environmental and sanitary licensing process and includes process related to waste generation, separation, storage, recycling, treatment and final disposal, as well as public health and environmental protection. Moreover, Rede D’Or São Luiz has several corporate operational rules and procedures, which lay down good waste management practices.
The units weigh in the volume of waste generated every day and through pre-defined indicators, monitor waste generation. Figures are monthly reported for analysis by the Sustainability corporate department, identifying the type and volume of materials to be disposed.
Initiatives to reduce waste generation and to improve waste treatment are carried out periodically. Our Environmental Indicators Program receives data on waste volume across groups A, B, D and E of hospitals throughout Brazil. Whenever a new unit is added to Rede D'Or São Luiz, we assess its waste management and, when necessary, schedule changes.
Seeking to reduce waste sent to landfills (reducing GHG emissions, increasing useful life of landfills and raising the reuse and recycling awareness and support among employees), hospital units began to implement a series of measures, such as:
In 2021, investments in the PGRSS (waste collection, transportation, treatment and final disposal) totaled 19.6 million. In 2020, 27,784 thousand people have been trained on PGRSS, 8,578 thousand of whom are own employees and 19,206 thousand are third parties. In this reporting cycle, we have generated 40,283.23 tons of waste, 34% of which are hazardous and, therefore, sent for proper disposal – i.e. incineration, mass burn (3% of total waste) or electro- thermal deactivation. Out of the more than 26 thousand tons of nonhazardous waste, almost 10% have been sent for recycling and 23,891.69 tons were sent to landfills. There has been no record of significant spills of any nature
We must also emphasize internal waste- related campaigns conducted throughout the year. We have identified an increase in waste generation due to the pandemic and organized a webinar to raise our employees’ awareness about proper waste disposal, named “A live event to rethink the present while focused on the future”, geared towards the importance of raising awareness to change the current scenario. In nother initiative, in view of the World Recycling Day, Rede D’Or São Luiz organized a special campaign to encourage employees to properly dispose of electronic devices they have at home, which resulted in more 100 thousand tons of electronic waste sent to recycling in the year.
Hazardous waste disposal by type and disposal method (t)
| Method | Type of waste | 2019 | 2020 | 2021 |
|---|---|---|---|---|
| Incineration (mass burn) | Chemicals (group B) | 298.38 | 317.38 | 1.126.78 |
| Autoclaving/ electro-thermal deactivation/ incineration | Infectious waste (A) and contaminated sharps (B) | 4,756.38 | 7,090.24 | 12,712.38 |
| Total | 5,054.76 | 7,407.62 | 13,839.16 |
Total non-hazardous waste disposal by type and disposal method (t)
| Method | Type of waste | 2019 | 2020 | 20211 |
|---|---|---|---|---|
| Recycling | Plastic, paper, cardboard, glass, metal and organic | 2,195.75 | 1,591.93 | 2,552.382 |
| Recycling | Electronic devices | 100.06 | 156.99 | 133.68 |
| Landfill | Regular waste | 16,491.74 | 15,65.55 | 23,891.69 |
| Total | 18,787.55 | 17,406.47 | 26,577.743 |
1- 2021 data includes Hospital São Lucas (RJ) information for August and September, only.
2- Figures for 2021 includes organic waste from Jabaquara, Criança (SP), Niterói D'Or and Caxias D'Or hospitals.
3- Before 2021, electronic devices were not included in regular waste.
1. Considering 2020 as reference year and hospital units
