The Specialist - Issue 124

WALKING THE TALK ON SUSTAINABILITY

ELIZABETH BROWN | SENIOR COMMUNCIATIONS ADVISOR

The Lancet has billed climate change as the greatest threat to human health in the 21st century. In many hospitals, specialists are at the forefront of sustainability initiatives, driving culture change with clinical expertise and a desire to make things better for patients, the planet, and the next generation.

When it comes to climate change, sustainability and health care, Middlemore Hospital anaesthetist Dr Rob Burrell describes what he sees as “cognitive dissonance”.

You are supposed to be here to help people, but we are creating so much havoc and mess around us by putting piles of crap into the atmosphere and the ground and leaving it for future generations to sort.

It is estimated that New Zealand’s health care sector contributes as much as 8% of New Zealand’s total greenhouse gas emissions, and according to the Energy Efficiency and Conservation Authority, health is the largest emitter in the public sector.

Our hospitals generate a huge environmental footprint as high-end users of gas, electricity, water, and transport. They churn out hundreds of thousands of tonnes of waste each year, which are dumped into our landfills. They consume millions of single-use plastic and plastic-wrapped items.

BRINGING CHANGE

But the worm is slowly turning, prodded along by clinicians and hospital staff concerned by the impact of climate change on human health and the environment.

In 2011 staff at Counties Manukau DHB took a ground-breaking step and formed an environmental steering group to measure and reduce the DHB’s carbon emissions.

At its last audit last year, it had reduced its carbon footprint by 26% through a number of initiatives, including the use of reusable cups, rideshare programmes, reducing anaesthetic gases, and better recycling. It has been recognised as one of Toitū Envirocare’s top carbon reducers for 2020.

ICU specialist Dr David Galler was involved from the start and describes it as life changing.

“We started off just doing carbon reduction around waste, energy and travel, and it’s turned into a regenerative philosophy which has completely changed my world view.”

Standing in a theatre next to recycling bins and cleaner anaesthetic gases, which he successfully lobbied for, Rob Burrell says a lot of progress has been made but there is so much more to do, especially in terms of procurement.

Dr Rob Burrell with a single use intubation device

A 2019 report by the Ministry of Health titled Sustainability and the Health Sector stated: “Procurement is responsible for an estimated 61 percent of all carbon emissions related to health care … This is the carbon emitted while extracting, manufacturing, packaging, storing, and transporting pharmaceuticals and supplies … Making sustainable procurement part of decision-making processes across all health care sectors will help signal a shift in demand toward a more sustainable health care system.”

A DISPOSABLE CULTURE

Holding up a plastic packet with a single disposable intubation device, Dr Burrell says hospitals are great at throwing things away. The devices, which are currently popular worldwide for intubating Covid-19 patients, are made in Canada and cost $30 each. Dr Burrell says the same company makes a reusable but much more expensive titanium option.

“In the long run, buying five of the expensive ones would be cheaper because we hoover through the disposable ones. Plus, our environmental footprint would be a tiny fraction. We wouldn’t have thrown anything away, there’d almost be no packaging, we’d be safe if Covid hit hard because the supply chain would be local, we’d be employing locals to clean stuff and our carbon emissions would drop because we’re not constantly re-supplying from overseas.”

Frustratingly, he says the disposable items come out of the DHB’s operational budget, which is huge, while the reusable devices would come out of the capital budget, which is tightly held.

The system is set up to consume. We need to keep pushing hospitals to change the way they make decisions about what they purchase.

The volume of waste created by surgical gowns and plastic drapes also weighs on his mind, not to mention the cost of landfill disposal.

Thinking big, Dr Burrell says New Zealand should be making compostable gowns or investing in upcycling to turn the waste into items like combs, park benches or cabling.

PROVING A POINT

Up the road at Auckland Hospital, Dr Marty Minehan is another anaesthetist putting a sustainability lens on clinical practice with some interesting results. Approximately 175,000 plastic drug trays annually were being used across Auckland DHB each year. While the trays could be recycled, most were being sent directly to landfill.

Dr Marty Minehan munching on a potato starch tray

Dr Minehan, who works in Women’s Health, took matters into his own hands. He conducted a life-cycle product analysis, and after a successful pilot, drug trays made from potato starch are now being rolled out across the hospital.

The trays are compostable and biodegradable. He jokes:

We tell the registrars if they’re hungry, to grab a bottle of sauce and start eating them.

He took the project on to prove a point.

“I rang each of the suppliers and sent them an email with 20–30 questions about their products. We did a spreadsheet of all the different products and how much they cost.

“We took it to the senior leadership team and what we’ve ended up with is a cheaper product, with a significantly smaller footprint, something which is easy to dispose of, has virtually zero environmental impact, is locally made so the money goes back into the economy – and you can eat it.”

His advice to his fellow SMOs is to question suppliers about their products.

“Ask what their environmental credentials are, what makes their product better in terms of its environmental footprint, how is their company engaged in terms of sustainability?”

WASTE AUDITING AND REDUCTION

A few floors down in the hospital’s Renal Department, green initiatives began about two years ago, led by technical advisor Dr Jason Wei and supported by Clinical Director Dr David Semple. They conducted a waste audit and have successfully decreased medical waste from each dialysis process by 40%.

According to Dr Wei, “For our clinical related projects to be successful it was up to SMOs’ support because if they are not on board, other staff won’t be confident to ensure all changes will be implemented properly.”

Auckland Renal Department recycling champions Drs David Semple and Jason Wei

Green initiatives are now a standing item in the department’s regular service management meetings. It is estimated four million litres of water a year could be saved from water-heavy dialysis processes. As a result, staff are being educated around simple ways to reduce water use, and Dr Semple has been in discussions with Watercare about potential large-scale infrastructure changes to help achieve that.

Changing models of care are also being looked at.

“We transport patients about 600,000 kilometres a year to and from dialysis because we have a treatment model which is convenient for us, but often not for our patients. If we have units closer to where people are, that’s going to save travel time, carbon emissions and achieve equity goals and better patient care.”

When you’re a junior doctor you focus on the patient in front of you, but as I’ve moved through my SMO role I’ve realised my responsibility to the health of my population and my country as a whole. Dr Semple says.

‘POCKETS OF BRILLIANCE’

The number of clinical sustainability initiatives is steadily growing, but the reality is they require corporate sponsorship and partnerships so they can be cost neutral to the DHB. Many of the opportunities have been identified, followed through, and endorsed by senior doctors.

They include a recycling pilot in which plastic syringes are being collected and repurposed into things like fenceposts, a programme in which single use medical instruments are converted back to their mineral content so they can enter the recycling chain, and the recycling of PVC products like fluid bags and oxygen masks into playground matting.

Surgical tool recycling

SMOs have also been behind a push to get more charging stations for electric vehicles in DHB carparks.

Auckland DHB has reduced its emissions by 28% in four years, and the achievement has been recognised with several global and local awards. Like Counties Manukau DHB, Auckland DHB has also been recognised this year by Toitū Envirocare as one of the country’s top carbon reducers.

Deputy CMO and Director of Cancer and Blood Services at Auckland DHB Dr Richard Sullivan believes the challenge is to take the “pockets of brilliance” around sustainability and embed them into the organisation’s culture and leadership structure.

“Ideally, when we have our strategic imperatives such as Te Tiriti, equity, and digital enablement, in two to three years, there will be one around sustainability.

“We are one of the biggest employers in New Zealand and we should be leading that space, and the reality is that doctors have a major influence in those decisions,” he says.