Reducing carbon emissions in the healthcare sector: a real-time delphi on challenges and enablers

Healthcare systems are increasingly committing to climate action, yet efforts to reduce their environmental footprint raise operational challenges. Decarbonization initiatives can generate concerns about cost, patient safety, care quality, and equitable access, revealing tensions that complicate implementation. This study examines how experts assess the impact and feasibility of climate-related interventions in healthcare, identifying key challenges and enablers. Using a Real-time Delphi approach, we consulted 14 specialists with ethics, sustainability, biomedical sciences, and public health backgrounds, who evaluated the relevance and applicability of five social tipping elements within the healthcare context. Interventions targeting energy systems and infrastructure were viewed as potentially high-impact but limited by regulatory complexity, infrastructural constraints, and ethical concerns. In contrast, strategies centered on education and shifts in values were perceived as more feasible, though questions about operationalization remain. Experts also noted potential issues, such as patient mistrust or clinician disengagement, if environmental goals are seen as misaligned with core commitments of healthcare practice. Overall, these findings underscore the need for inclusive, ethically robust, evidence-informed, and context-sensitive strategies that integrate sustainability goals with patient, professional, and institutional priorities. Improving access to environmental impact data and supporting shared decision-making emerged as key enablers for fostering acceptable ecological transitions in healthcare.