Environmental sustainability in Healthcare · Data Carbon Footprint of NHS England –21.54 MtCO 2...

Environmental sustainability in HealthcareFrances Mortimer

Maria van Hove

Anya Gopfert

November 2019

Who thinks

13.11.2019 Environmental Sustainability and QI

1. Man-made Climate change is a thing

2. It will be a problem in your lifetime

3. It will affect you


How did we get into this mess?

Contents


Contents

4 Main issues


Contents


Contents

Recent developments


Contents


UK Policy Conext

• Net Zero 2050

• Long Term Plan

• Trusts declare Climate emergencies

• Simon Stevens NHSE

• Arms-length bodies and NGOs

(NICE, THF)


Contents

Health Impacts of Environmental Breakdown


This is what this looks like


Mitigation + Adaptation


DataCarbon Footprint of NHS England – 21.54 MtCO2e


Supply

Chain

Community

Core

Commissioned healthcare

Core: NHS organisations

have direct control over –

energy, waste, water,

anaesthetic gases, business

travel/ fleet

Supply Chain: This has to

do with the supply of goods

and services

Community: Staff, patient

and visitor travel, MDIs

SDU 2018. Reducing the use of natural resources in health and social care 2018 report

AnaestheticgasesInhaler

s

Waste


How will 80% be achieved


What if… sustainability became a mainstream part of quality improvement?

Sustainability as a domain of quality

SustainablePatient

CentredEquitable

Efficient

Effective

Timely

Safe

Dr Donal O’Donoghue

National Clinical Director for

Kidney Care 2007-13

Sustainable clinical practice: principles

Reduce carbon without reducing

health

Reduce activity

Prevention

Patient empowerment

Lean pathways

Reduce carbon intensity

Low carbon alternatives

Sustainable estates

Outcome needed

Secondary drivers

Primary driver

Primary driver

Mortimer-F. The Sustainable Physician Clinical Medicine 2010, Vol 10, No 2: 110–11



health

Reduce activity

Prevention

Patient empowerment

Lean pathways



Sustainable estates

Outcome needed

Secondary drivers

Primary driver

Primary driver


e.g. streamlined

pre-op

assessment

e.g. pre-

habilitation

e.g. warm, pain-

free patients

post-op



health

Reduce activity

Prevention

Patient empowerment

Lean pathways



Operational resource use


Outcome needed

Secondary drivers

Primary driver

Primary driver e.g. sevoflurane

vs desflurane

(1:20)

e.g. capture and

resupply of

volatiles

e.g. regional vs

general

anaesthesia

e.g. streamlined

pre-op

assessment

e.g. pre-

habilitation

e.g. warm, pain-

free patients

post-op

What if… sustainability became a mainstream part of quality improvement?How?

Mortimer F, Isherwood J, Wilkinson A, Vaux E. Sustainability in quality

improvement: redefining value. Future Healthcare Journal, 2018 Vol.5(2):88-

93

Understanding env/soc/£ impacts: process map

Environmental hotspotsEnv impact Hotspots

Greenhouse gas emissions

Inhalers, anaesthetic gases, medical equipment, pharmaceuticals, operating theatres

Air pollution Transport, energy

Deforestation Rubber plantations; meat

Water consumption Dialysis?

Scarce resources Conflict minerals in medical instruments

Plastic pollution Single use (133,000 tonnes plastic/year)

Eco-toxicity (PBT) Antibiotics, OCP, antidepressants, propofol

Scanning for social impactsPatients Carers Community Supply

chain

Staff

Housing

Poverty

Health

Education

Employment

Safety/security

Satisfaction

Participation

Social gradient

Case study: measuring environmental costsA primary care team noticed that some patients who were referred for hip and knee replacements were being referred back to the GP surgery after pre-operative assessment at the local hospital. This was because parameters, such as blood pressure, were either outside the target range or were not communicated properly in the referral information. An audit revealed that 1 in 6 patients looped through the system – 10/ year.

Activity Financial cost

(£)

Environmental

cost (CO2e)

Extra GP consult £451 18 kg2

Extra Hospital consult £1121 23 kg2

Total savings (for 10 loops) £1570 410 kg

1. Unit Costs of Health and Care, PSSRU, December 2015. Available at: http://www.pssru.ac.uk/project-pages/unit-

costs/2015/index.php

2. Carbon Hotspots update for the health and care sector in England 2015, Sustainable Development Unit, January 2016.

Dr. Charlie Kenward, Severn GP ST3 Sustainability Scholar 2014-15

Social Impacts – identifying outcome measures

Group affected Impact area Outcome measure

e.g. carers employment % in employment / time off work

e.g. staff health sickness / absence

Thinking sustainably within a QI project

1. Apply sustainability approach at the different stages of ANY

project

2. Choose a project area that relates closely to sustainability,

e.g.

a. Prevention, patient empowerment, etc.

b. Reducing pharmaceutical waste

c. Reducing over-investigation / over-treatment

SusQI open access learning resources

http://networks.sustainablehealthcare.org.uk/sus-qi-

resources

In practice…

Example project: emergency departmentWhat to focus on?

SDU 2018. Reducing the use of natural resources in health and social care 2018 report

Medical equipment

Example project: emergency departmentProblem identified

ED staff team thought that large number of patients cannulated but

many cannulae not used

Example project: emergency departmentProblem identified

ED staff team thought that large number of patients cannulated but

many cannulae not used

Measures

Number of cannulae inserted per week

Number of cannulae used in ED

Intervention tested

Campaign in ED to engage staff THINK before you cannulate!

Example project: emergency departmentChange achieved

59% drop in total number of cannulae inserted from 178 to 73 / week

66% reduction in number of cannulae not used

Impact on patient outcomes (not measured)

potential for reduction in infections

Social impact (not measured)

•reduced pain and discomfort for no therapeutic benefit

•reduced physical restriction

•encouraging use of the oral route for fluids and medications

•staff time released - improved work flow/satisfaction

Example project: emergency departmentEnvironmental and financial impact

•105 fewer cannulae used per week (Cost: £1.80, weight: 0.061kg)

•98 fewer bionectors used per week (Cost: £3.51, weight: 0.01kg)

GHG emissions factors used:

Medical/surgical equipment: 0.3 kgCO2e/£

Waste incineration: 220 kgCO2e/tonne

(105* 1.80*0.3) + (105*0.061/1,000*220) = 58.11 kgCO2e

(98*3.51*0.3) + (98*0.01/1,000*220) = 103.41 kgCO2e

= 161.52 kgCO2e and £533 saved per week

What staff say:“The project has brought about real cultural and

behavioural changes in the department. Now that we have

participated … many clinicians are approaching me with

ideas for other sustainability projects. We have a long

list!”

Dr Cassie Worth, Emergency Medicine Consultant, Royal

Devon & Exeter hospital

What does this mean to you?

1. How can you incorporate environmental thinking into your

work?

2. Can you use SusQI?


Get involved

SIG

SusQI


Stay in touch

• Q: www.health.org.uk/Q and [email protected]

• Frances Mortimer / Centre for Sustainable Healthcare

@FrancesMortimer #susQI

• Maria van Hove @Mc_vanhove

• Anya Gopfert / Q SIG: [email protected] @AnyaGopfert

• https://q.health.org.uk/community/groups/sustainable-healthcare/


http://www.health.org.uk/Q

mailto:[email protected]

mailto:[email protected]

https://q.health.org.uk/community/groups/sustainable-healthcare/

About Q

A connected community working

together to improve health and care

quality across the UK


Thank you

Environmental sustainability in Healthcare · Data Carbon Footprint of NHS England –21.54 MtCO 2...

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