Global Care

Andy Garman (M.S. IPSY ’00) doesn’t preach.

That seems to be his superpower. As a climate change advocate working to influence top administrators in an industry as massive as health care, preaching doesn’t get much traction. Aggressive grandstanding against type-A executives gets even less.

Instead, Garman—armed with a reasonable demeanor that seems quintessentially helpful—calmly lays out why hospitals should consider a smaller carbon footprint. The biggest problem, he says, is that those top leaders tend to be busy.

“It’s so easy for a health care leader to decide they don’t have to do something today. And it’s always today,” Garman says. “A lot of my work is, ‘How do we get this in front of health system leaders so it’s not standalone problem #13’ that they’re being asked to solve. Well, it’s legitimately not problem 13 but a solution to problem one through 12.”

After decades working as a professor in health systems management at Rush University in Chicago, as well as the CEO of a health nonprofit for many years, Garman has accepted a new role that has taken him international. In addition to maintaining his role at Rush, he now conducts executive trainings in environs such as Dubai as the senior adviser for leadership development at the Switzerland-based Geneva Sustainability Centre, a subsidiary of the International Hospital Federation, which represents 25,000 hospitals across 60 countries.

“Because he’s a psychologist by training, he takes an approach to understanding a people perspective. He never tries to push the agenda on anyone; he tries to bring people into thinking about it with thoughtful arguments,” says Sonia Roschnik, executive director of the Geneva Sustainability Centre. “He doesn’t try to compete with anyone—these executives are leaders. He’s humble, and he deeply understands the level of change that is required.”

Others at the Centre do trainings, but Garman has one of its toughest audiences: executives in the United States.

“Climate change is just not on the radar of U.S. health systems on the same level of other countries,” Garman says. “It’s become politicized here. People unfortunately frame it as a political issue and dismiss it, when really it’s a thermodynamics issue—and thermodynamics doesn’t care about our politics. Outside the U.S., at the World Hospital Congress, we’ll easily fill a training program, while in the U.S. we’ll struggle to get a critical mass to run something.”

But Garman comes armed with what he believes are persuasive arguments, and he sees a shift in conversations within the federal government that are encouraging.

THE NON-PITCH

In a recent survey of hospital chief executives, two top concerns stood out: paying the bills and staffing.

When it comes to cost savings, Garman argues that lowering emissions will save health systems money anyway, in both energy and waste disposal costs. As for staffing, Garman notes that in addition to surveys that say younger generations care more about climate change and want to work for employers that share their values, a recent survey by the Commonwealth Fund found that 80 percent of clinicians shared the same view.

Garman says such findings aren’t surprising.

“If there is any sector that is going to come together and put a stake in the ground and say, ‘We need to change how we operate and then lead others to change how they operate,’ it is going to be health care,” Garman says. “Our mission is improving health. And if we’re really about health, we need to be avoiding things that are causing harm.”

The Geneva Sustainability Centre, he notes, has tools that help with what he describes as his non-pitch.

They’ve developed a simulation-based learning program that challenges participants to decarbonize a hospital while also managing operating costs, care quality, employee engagement, and organization reputation. They’ve also built a sustainability accelerator tool, an organizational assessment that allows health systems to take a look at their own practices and compare them to practices in leading hospitals across the world.

“To the extent health systems look at this as a global not a local problem, there’s more of an opportunity for best practice sharing,” Garman says.

The Centre also works with accrediting bodies and has a close relationship with an international health care group known as the Joint Commission. In many countries, not including the U.S., the commission’s accreditation is required by payment systems similar to Medicaid or Medicare. Beginning in 2026, to qualify for such accreditation, hospitals will be required to meet new sustainability standards, including measuring their carbon footprint and saying how they’ll bring it down.

Such certification is not required in the U.S., after pushback from the health care industry. The commission still offers an optional “sustainable health care” certification, which 80 hospitals in the U.S. have. The Biden Administration also created a voluntary health sector pledge in 2022, which about 15 percent of hospitals have signed on to so far.

“I think this is going to become a much bigger story in the years ahead, but it’s still all very new,” Garman says.

STAYING MOTIVATED

On a personal level, Garman grew interested in climate change many years ago, but didn’t feel informed enough to get professionally involved. Before coming to the Centre in 2022, he served for nine years as CEO of the National Center for Health Care Leadership, a nonprofit that advocates for improved leadership practices in health care research and education.

As climate science progressed, and the Paris Climate Agreement was adopted in 2015, Garman began researching climate change further. “They were able to say with some precision, the tipping points with temperature,” he says. “For a scientist, that’s a very different message than, ‘You should do less than this.’”

And as an organizational psychologist by training, Garman saw how health systems could lead to immense benefits—or harms.

Early in his career, Garman worked on organizational change initiatives at Chicago-Read Mental Health Center’s inpatient facility, after the hospital was sued by the U.S. Department of Justice on behalf of the mentally ill and lost its accreditation. “I developed a profound appreciation of how important it was to have a well-functioning system in order for clinicians to be able to do their best work,” Garman says.

When it comes to staying motivated, Garman says, “I think the optimist/pessimist split in my assessment has more to do with whether I am looking at what could be or what is. If I look at what could be exclusively, it’s very easy to get demoralized. We’re nowhere near where we need to be in terms of the concrete steps.

“On the flipside, if I look at how much of an incredible miracle it is we’re here in the first place, as complex organisms, it’s extraordinary that we’re even able to have this conversation with each other. It’s exciting to think that we could be moving toward a solidarity in which the entire human population gets together and says, ‘We want to work together for a healthier collective future.’”