Request for Proposal: Defining Standardized Hospital Sustainability Quality Improvement Measures 

 Deadline for Application: March 10, 2025 and must be submitted to contracts@hcwh.org 

Inquiries: Jenny Keroack, jkeroack@hcwh.org 

Location: Virtual

Organization Description

Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a community anchor for sustainability and leader in the global movement for environmental health and justice. Working closely with Health Care Without Harm, Practice Greenhealth is the leading sustainable health care organization, delivering environmental solutions to more than 1,700 hospitals and health systems in the United States and Canada.

Commitment to Diversity, Equity, and Inclusion

Health Care Without Harm (HCWH) and Practice Greenhealth are committed to seeking and sustaining culturally and ethnically diverse organizations, and to the principles that promote inclusive practices. We are dedicated to not only building a diverse staff, but also a diverse set of consultants and partners with expertise and interest in serving the mission of the organizations in respectful ways. Health Care Without Harm believes that our work can only be transformed when a diversity of voices, perspectives, and lived experiences are a part of the movement for change. We strongly encourage consultants and organizations that represent BIPOC and LGBTQ communities to apply.

Project Description 

Health Care Without Harm is seeking proposals from qualified researchers to leverage our extensive dataset to identify and standardize the most impactful quality improvement metrics for measuring direct and indirect emissions reduction in hospitals.

Overarching Goals

American health care organizations have the opportunity to improve operational efficiency and reduce their environmental impact through lowering their direct and indirect greenhouse gas emissions. For example, electrifying mobile fleets reduces ground-level air pollution as well as emissions that contribute to the climate crisis, which itself drives morbidity and mortality through increasingly frequent and severe storms, heat waves, wildfire events, and other hazards. In addition to fleet vehicle electrification, key decarbonization actions include electrifying health care facilities and switching to low-emissions anaesthetic gases.

Quality improvement frameworks have systematically improved care across a number of key outcomes, including reducing patient safety incidents and maternal morbidity and mortality. Applying a quality improvement lens to health sector emissions reduction leverages proven models to address the most important health threat of the 21st century. However, the health sector does not currently use standard and comparable methods to measure emissions reduction. Another challenge is a lack of peer-reviewed literature validating the key steps toward decarbonization and structural elements that help decarbonization efforts succeed. The sector would benefit from identifying and building consensus around a small number of reliable, valid, and feasible quality improvement metrics for reducing direct and indirect emissions. 

This research initiative aims to address this critical knowledge gap by identifying quality measures that are strong predictors of emissions reduction in hospitals. Health Care Without Harm and its membership organization Practice Greenhealth possess a unique longitudinal dataset, spanning 11 years of data and featuring over 900 hospitals, that will be made available to the selected researcher(s). This data is self-reported as part of Practice Greenhealth’s Environmental Excellence Awards and is not independently audited.

Deliverables

Project deliverables include:

• Normalization for scope 1 and 2 measurement: Utilize our comprehensive dataset to test different normalizing factors for Scope 1 and 2 emissions so as not to penalize facilities for structural and operational characteristics (e.g. CMI, climate zone, facility size, patient population, urban/rural status). Comparing hospitals based on improvement (e.g., reduction in emissions from baseline) should also be considered. The goal of this process will be the creation of a measure of Scope 1 and 2 emissions that fairly assesses hospitals and compares like-with-like.
• Analysis of key drivers of emissions reduction: Analyze the programmatic and operational measures collected by Health Care Without Harm/Practice Greenhealth to identify key actions that lead to Scope 1 and 2 emissions reduction in hospitals. Such actions might include a reduction in gas-powered fleet vehicles, installing onsite renewable energy systems, electrifying building equipment, decommissioning central piped nitrous oxide, and eliminating desflurane use. 
• Identification of key structural elements: Evaluate the leadership and strategy measures collected by Health Care Without Harm/Practice Greenhealth to identify key structural elements that are highly correlated with Scope 1 and 2 emissions reduction in hospitals. Such elements could include tying executive compensation to improved environmental performance, making an organizational commitment to emissions reduction and resilience, and formulating a sustainability program budget.
• Developing standardized measures: Considering the normalized measures of Scope 1 and 2 emissions as well as the key drivers and structural elements identified, propose one or more quality improvement measure(s) for direct and indirect emissions for hospitals. Measures should be designed to equitably and appropriately compare facilities. A composite structural measure with many elements would be acceptable, as would several distinct measures that could be part of a quality improvement program. 
  • Measure specifications: The measure(s) must each have a precise definition and calculation formula and, if it is a composite measure, a justification for the weighting of its components. 
  • Model Measures: In considering different measure approaches, researchers should consider innovative models from other areas of quality improvement. For example, the patient safety structural measure and maternal morbidity structural measure.
  • Reporting burden: Any measure or measures suggested should strive to reduce reporting burden by considering opportunities to minimize additional data collection.
• Publication: Publish a peer-reviewed paper describing the proposed quality measure(s), including the measure specifications. This paper will educate the health sector and support the integration of the quality measure(s) into pilot programs and existing frameworks like federal or state quality improvement programs.

Data Rights

Health Care Without Harm will provide data to the selected researcher(s) confidentially. Health Care Without Harm shall retain all rights and privileges to all furnished data. The researcher(s) shall neither retain nor reproduce for private or commercial use any data or other materials furnished under this contract. 

The data is provided to Health Care Without Harm by hospitals participating in the Environmental Excellence Awards voluntarily. Any actions that jeopardize the confidentiality agreement between Health Care Without Harm and such hospitals – including but not limited to distribution, retention, and reproduction of data – would violate this project’s data use agreement and result in legal action.

Upon contract award, a separate Data Sharing Agreement detailing data handling protocols, security requirements, and permitted uses will be provided for execution prior to any data transfer.

Reporting & Check-Ins

This will include a series of virtual check-in calls including but not limited to: 

• Orientation to the project and dataset
• Monthly check-in calls
• Pre-submission paper review call

Process, Timeline, and Budget

The research will be conducted through partnered research, with researchers and practitioners from Health Care Without Harm working together to analyze the data, interpret findings, and increase the relevance and impact of the final research paper. At every stage, close participation in the research and development process by researchers and Health Care Without Harm will enhance the rigor and applicability of the measures developed. Health Care Without Harm will also have final approval over the manuscript prior to journal submission.

The researcher will work with a core team from Health Care Without Harm to complete the project within 18 months of the award. Key deadlines include:

• Month 3: A detailed project plan and preliminary exploratory data analysis report, including a data quality assessment and proposed approach to ensure data quality.
• Month 6: A draft report on the normalized Scope 1 & 2 emissions measures, including sensitivity analyses showing how different normalization approaches affect hospital rankings.
• Month 10: A draft report identifying key drivers and structural elements.
• Month 13: A draft report proposing quality improvement measure(s) based on the analysis, including an analysis of how the measure(s) meets each of CMS’ four primary criteria.
• Month 16: A final report and a manuscript draft suitable for submission to a peer-reviewed journal. The report should include complete measure specifications with precise definitions and calculation formulas. Health Care Without Harm must approve such manuscript prior to submission to a peer-reviewed journal.
• Month 18: Paper submitted to a peer-reviewed journal. 

The allocated budget for the project is between $30,000 - $50,000. Note that $30,000 of this amount will come from a current/active grant with an additional $20,000 projected from pending funding applications. Note that other expenses such as creative assets that may need to be purchased, travel time, printing, etc will not be covered by Health Care Without Harm separately.  We appreciate creative approaches to leverage this available funding for engaging early career researchers. We also welcome proposals to leverage an organization’s internal funding opportunities to supplement this award.

The selected researcher(s) will be expected to lead any subsequent edits or rewrites to facilitate publication following the grant period.

Qualifications

The ideal research partner(s) will possess expertise in sustainability, healthcare policy, quality improvement, data analysis, and statistics. We are particularly interested in researchers who can develop compelling narratives around their findings to attract further funding and build consensus among stakeholders. We anticipate this collaboration will lead to significant contributions to both public good and the advancement of sustainable healthcare practices.

The following organizations are eligible to submit proposals:

• Two- and four-year Institutions of Higher Education (including community colleges) accredited in, and having a campus located in the U.S., acting on behalf of their faculty members.
• Independent professional societies and similar organizations located in the U.S. that are directly associated with educational or research activities.

Submission Guidelines

Please submit your proposal no later than March 10 to contracts@hcwh.org. Your submission must include:

1. Names and curriculum vitae of individuals who will be involved in completing the services.
2. Qualifications – why and how you are best-suited to meet the deliverables. This should include an explanation of your qualifications for this work, past examples of similar work (including a list of former clients for similar services if able), and qualifications of key personnel who will be involved. Please include any relevant licenses, certifications, etc.
3. A completed conflict of interest form.
4. A written declaration that you can agree to the general terms and conditions included in this RFP.
5. Health Care Without Harm supports positive efforts to utilize small businesses, minority-owned firms, women’s business enterprises, and Labor Surplus Area firms. Please indicate whether or not you fall within one or more of these categories.
6. A proposed methodology and timeline for how you plan to meet the deliverables, with documentation of the development process, milestones, assumptions and expectations of HCWH staff. 
7. A cost breakdown of this work, including a list of any staff that would be assigned to the project, their roles, and any subcontractors you plan to employ.
8. A timeframe of validity of your proposal (must be at least 60 days).

Criteria for the Assessment of Proposal

• The expertise of the proposal and experience of the organization or consultant and key personnel indicated in the proposal.
• Methodology, its appropriateness to the conditions and timeline set forth in the RFP.
• Financial considerations.
• HCWH is willing to award the contract to more than one service provider.

Proposals should include the following sections: (1) a detailed plan as described below, (2) organizational background, (3) team qualifications, and a (4) budget description.

The detailed plan must describe:

• A proposed approach to data quality analysis that acknowledges dataset limitations (self-reported data from engaged hospitals may not be representative of all U.S. hospitals) and describes strategies to address these limitations.
• A proposed methodology for determining appropriate normalization factor(s) for scope 1 and 2 emissions measurement. The methodology should consider how to compare like-with-like and avoid disfavoring certain hospitals, particularly safety-net hospitals, rural facilities, and those serving vulnerable populations.
• A proposed methodology for identifying key drivers of emissions reduction and key structural elements correlated with emissions reduction. 
• A proposed methodology for measure development that satisfies the Centers for Medicare & Medicaid Services four primary criteria:
  • Importance (including how sustainability protects patient and staff health and wellbeing)
  • Feasibility
  • Scientific acceptability (validity and reliability)
  • Usability and use
• Consideration of hospital implementation barriers, organizational capacity requirements and strategies to minimize reporting burden.

Applications will be scored on the following criteria:

Score Weighting: 40%

Item: Detailed plan

Key Questions: 

• How well does the plan address all of the key elements listed in Proposal Guidance?
• Does the plan seem likely to produce research that is impactful at driving healthcare sustainability and quality? 
• Is the plan grounded in healthcare quality improvement and measure development research theory and methods?
• Does the plan incorporate a partnered research approach to integrate Health Care Without Harm’s healthcare sustainability expertise?

Score Weighting: 10%

Item: Organizational Background 

Key Questions: 

• Is the organization able to advance the physical and personnel resources to ensure the research project is successful?
• Is the project aligned with the organization’s mission and values (e.g., promoting health equity, environmental stewardship, and resilient systems)?

Score Weighting: 30%

Item: Team Qualifications

Key Questions: 

• The project team must have expertise in sustainability, healthcare policy, quality improvement, data analysis, and statistics. Does the team have the credentials and experience to successfully execute the project plan? 
• Have members of the research team successfully completed healthcare sustainability, quality improvement, and/or measure development projects previously? 
• Have team members successfully completed projects touching all three disciplines at once?

Score Weighting: 20%

Item: Budget Description

Key Questions: 

• Can the applicant meet the core grant requirements with a budget of $50,000?
• Does the applicant present a thoughtful and rigorous use of additional funding to improve the project?
• Are indirect costs limited to those strictly necessary?

Inquiries

Inquiries can be made to Jenny Keroack at jkeroack@hcwh.org. (Note that your proposals should be submitted to contracts@hcwh.org).

General Terms and Conditions for Bidders

Other terms and conditions will be included in an awarded contract

1. Contracts shall be made only with responsible contractors who possess the potential ability to perform successfully under the terms and conditions of the proposed procurement. Consideration shall be given to such matters as contractor integrity, record of past performance, financial and technical resources or accessibility to other necessary resources. In certain circumstances, contracts with certain parties are restricted by agencies' implementation of United States Executive Orders 12549 and 12689, “Debarment and Suspension.”
2. Awards shall be made to the bidder or the offeror whose bid or offer is responsive to the solicitation and is most advantageous to the recipient, price, quality and other factors considered.  Solicitations shall clearly set forth all requirements that the bidder or the offeror shall fulfill in order for the bid or offer to be evaluated by the recipient.  Any and all bids or offers may be rejected when it is in Health Care Without Harm’s interest to do so.
3. Health Care Without Harm suppliers and contractors must demonstrate compliance with the following ethical principles. Any breach of these provisions shall disqualify the supplier or entitle Health Care Without Harm to terminate any agreements with the supplier immediately upon notice without any liability for the termination or any other liability of any kind.
   1. Contractors shall not directly or indirectly provide material support or resources, including financial support, in-kind support, technical or organizational assistance, or any other form of support or service, to individuals that are terrorists, that are associated with acts of terrorism, or that pose a significant risk of committing acts of terrorism.
   2. Contractors must comply with all applicable anti-bribery and anti-corruption laws in the countries where it does business. Additionally, contractors understand and agree to comply with the U.S. Foreign Corrupt Practices Act, as revised, which generally prohibits the offer, promise, payment or giving of anything of value either directly or indirectly to any government official for the purpose of obtaining or retaining business or any improper advantage. 
   3. Contractors shall not engage in any practice inconsistent with the rights set forth in the Convention on the Rights of the Child, including Article 32 thereof, which, inter alia, requires that a child shall be protected from performing any work that is likely to be hazardous or to interfere with the child’s education, or to be harmful to the child’s health or physical mental, spiritual, moral or social development. Additionally, Contractor warrants that the Contractor is not engaged in the sale or manufacture of anti-personnel mines or components utilized in the manufacture of anti-personnel mines.
   4. Health Care Without Harm takes all appropriate measures to prevent sexual exploitation or abuse of anyone through its work. For these purposes, sexual activity with any person less than eighteen years of age, regardless of any laws relating to consent, shall constitute sexual exploitation and abuse of such person. In addition, contractors shall refrain from exchanging any money, goods, services, or other things of value for sexual favors or activities, or from engaging in any sexual activities that are exploitative or degrading to any person.
   5. Contractors are expected to disclose to Health Care Without Harm any situation that may appear as a conflict of interest, and disclose to Health Care Without Harm if anyone under contract with Health Care Without Harm may have an interest of any kind in the contractor's business or any kind of economic ties between contractor and Health Care Without Harm.
   6. Health Care Without Harm will fully enforce applicable laws prohibiting harassment and discrimination by or against contractors, including harassment, and/or discrimination because of race, religion, color, national origin, ancestry, marital status, sexual orientation, disability, gender, age, or other status protected by applicable law, and to maintain a business relationship free of any such harassment and discrimination. Harassment may take many forms, including but not limited to:
      1. Verbal conduct such as epithets, derogatory comments, slurs or unwanted sexual advances, invitations, innuendo, or comments
      2. Visual conduct such as derogatory posters, cartoons, drawings or gestures
      3. Physical conduct such as assault, blocking normal movement or interference with work because of sex or another protected basis    
4. Health Care Without Harm supports positive efforts to utilize small businesses, minority owned firms, and women’s business enterprises and Labor Surplus Area firms.
   1. Health Care Without Harm encourages contracts with consortiums of firms referenced above when a contract is too large for one of those firms to handle individually.
5. Contractor agrees to the acceptance, to the extent practicable and economically feasible, of products and services dimensioned in the metric system of measurement.
6. Health Care Without Harm requires, when practicable and economically feasible, for products and services that conserve natural resources and protect the environment and are energy efficient.