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In a hospital the size of Carilion Roanoke Memorial Hospital, Roanoke, Va., reducing the facility’s carbon footprint is an enormous challenge. But through a coordinated, facility-wide effort that touches everyone from top leadership to front-line employees, the hospital has drastically reduced its energy and water use, decreased medical supply and food waste by tens of thousands of pounds per year, and significantly slashed greenhouse gas emissions — all in a relatively short span of time.