March/April 2018 - Greening Up Healthcare by Advocates for Better Health

March/April 2018

Greening Up Health Care

In This Issue: • • • •

Healthcare Systems Strive for Green TCMS Annual Meeting/First a Physician Award Shotwell Award Presented Luminary of Twin Cities Medicine

“Your patients will thank you for referring them to Dr. Crutchfield.”

A FAC E O F A M I N N E SOTA DE R M ATOL O GIST Recognized by physicians and nurses as one of the nation’s leading dermatologists, Charles E. Crutchfield III MD has received a significant list of honors including the Karis Humanitarian Award from the Mayo Clinic, 100 Most Influential Health Care Leaders in the State of Minnesota (Minnesota Medicine), and the First a Physician Award from the Minnesota Medical Association, for positively impacting both organized medicine and improving the lives of people in our community. He has a private practice in Eagan and is the team dermatologist for the Minnesota Twins, Wild, Vikings and Timberwolves. Dr. Crutchfield is a physician, teacher, author, inventor, entrepreneur, and philanthropist. He has several medical patents, has written a children’s book on sun protection, and writes a weekly newspaper health column. Dr. Crutchfield regularly gives back to the Twin Cities community including sponsoring academic scholarships, camps for children, sponsoring programs for children with dyslexia, mentoring under-represented students from the University of Minnesota, and establishing a Dermatology lectureship at the University of Minnesota. As a professor, he teaches students at both Carleton College and the University of Minnesota Medical School. He lives in Mendota Heights with his wife Laurie, three beautiful children and two hairless cats.

AES

THET I C

L OF APPROVA L SEA

CRUTCHFIELD DER MATOLOGY Experience counts. Quality matters. Mayo Clinic Medical School Graduate | University of Minnesota Dermatology Trained Top Doctor Minneapolis St. Paul Magazine | Best Doctors for Women Minnesota Monthly Magazine Team Dermatologist for the Minnesota Twins, Vikings, Timberwolves and Wild 1185 Town Centre Drive, Suite 101, Eagan | 651.209.3600 | www.CrutchfieldDermatology.com

CONTENTS VOLUME 20, NO. 2 MARCH/APRIL 2018

IN THIS ISSUE

Are You on Healthcare’s Green Team? By Thomas E. Kottke, MD

PRESIDENT’S MESSAGE

Continuing the Legacy of Collaboration and Cooperation with ICSI By Thomas E. Kottke, MD

TCMS IN ACTION By Nancy K. Bauer, Interim CEO GREENING UP HEALTH CARE

Page 7

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Colleague Interview: A Conversation with Bruce Snyder, MD

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Environmental Sustainability —How are Healthcare Systems Responding? By M. Osman Akhtar, John H. Noseworthy, MD, Kurt Thielen, Andrea Walsh, and Penny Wheeler, MD

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SPONSORED CONTENT:

The Case for Surgeon Leadership in Operating Room Sustainability By Rafael Andrade, MD •

Waste Reduction and Reuse in a Healthcare Setting: A Physician’s Role By Crystal Saric Fashant, DBA

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Environmental Health —The Beneﬁts of a Carbon Fee and Dividend on Health Care By M. Michael Menzel, MD

Page 32

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March/April 2018

Greening Up Health Care

Health Professionals for a Healthy Climate

TCMS Annual Meeting Held

First A Physician Award

Sanne Magnan, MD, PhD Receives Shotwell Award In This Issue:

In Memoriam

From Hospice to Center Stage Career Opportunities

32 Page 27

MetroDoctors

LUMINARY OF TWIN CITIES MEDICINE

Cassius Marcellus Clay Ellis III, MD The Journal of the Twin Cities Medical Society

• Healthcare Systems Strive for Green • TCMS Annual Meeting/First a Physician Award • Shotwell Award Presented • Luminary of Twin Cities Medicine

This issue of MetroDoctors explores the opportunities the healthcare industry has found to reduce its carbon footprint. What are you doing to reduce yours? Articles begin on page 7.

March/April 2018

Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

Physician Co-editor Peter J. Dehnel, MD Physician Co-editor Thomas E. Kottke, MD Physician Co-editor Robert R. Neal, Jr., MD Physician Co-editor Marvin S. Segal, MD Physician Co-editor Richard R. Sturgeon, MD Physician Co-editor Charles G. Terzian, MD Medical Student Co-editor Mac Garrett Managing Editor Nancy K. Bauer TCMS INTERIM CEO Nancy K. Bauer Production Manager Sheila A. Hatcher Advertising Representative Erica Nelson Cover Design by Annie Krapek MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at St. Paul, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reﬂect the ofﬁcial position of TCMS.

TCMS Ofﬁcers

President: Thomas E. Kottke, MD President-elect: Ryan Greiner, MD Secretary: Andrea Hillerud, MD Treasurer: Nicholas J. Meyer, MD Past President: Matthew A. Hunt, MD

MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Advertisements published in MetroDoctors do not imply endorsement or sponsorship by TCMS. Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Nancy Bauer at (612) 623-2893.

March/April 2018

Classiﬁed Ad .......................................................19 Crutchﬁeld Dermatology..................................... Inside Front Cover

TCMS Executive Staff

Nancy K. Bauer, Interim CEO, and Managing Editor, MetroDoctors (612) 623-2893; nbauer@metrodoctors.com Karen Peterson, Executive Director, Honoring Choices Minnesota (612) 362-3704; kpeterson@metrodoctors.com Lynn Betzold, Program Coordinator, Honoring Choices Minnesota (612) 362-3703; lbetzold@metrodoctors.com Trish Greene, Administrative Specialist, Honoring Choices Minnesota (612) 362-3739; tgreene@metrodoctors.com Grace Higgins, Senior Project Coordinator, Physician Advocacy Network (612) 362-3706; ghiggins@metrodoctors.com Annie Krapek, Assistant Project Coordinator, Physician Advocacy Network (612) 362-3715; akrapek@metrodoctors.com Sadie Rubin, Executive Director, The Convenings (612) 362-3724; srubin@metrodoctors.com Katy Vanderwood, Project Coordinator, The Convenings (612) 362-3705; kvanderwood@metrodoctors.com

Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com. For advertising rates and space reservations, contact: Erica Nelson 4084 Jana Ave. NE St. Michael, MN 55376 phone: (763) 497-1778 fax: (763) 497-8810 e-mail: erica@pierreproductions.com

March/April Index to Advertisers

Entira Family Clinics .......................................30 Fairview Health Services .................................31 Gislasen & Hunter, LLP .................................27 HealthPartners....................................................28 Lakeview Clinic .................................................31 M Health ............................................................... 6 Minnesota Adult & Teen Challenge ...........15 Physician Advocacy Network ........................22 St. Cloud VA Medical Center ............................ Inside Back Cover U.S. Army .......................... Outside Back Cover

MONDAY, APRIL 16, 2018 Have you asked your patients if they have done their Advance Care Planning? National Healthcare Decisions Day ƌĞŵŝŶĚƐ ƵƐ ƚŚĂƚ ĞǀĞƌǇ ĂĚƵůƚ ƐŚŽƵůĚ ƚĂůŬ ǁŝƚŚ ƚŚĞŝƌ ůŽǀĞĚ ŽŶĞƐ ĂŶĚ ƚŚĞŝƌ ĚŽĐƚŽƌƐ ĂďŽƵƚ ĨƵƚƵƌĞ ŚĞĂůƚŚĐĂƌĞ ƉƌĞĨĞƌĞŶĐĞƐ͘

HonoringChoices.org ĨŽƌ ŝŶĨŽƌŵĂƚŝŽŶ ĂŶĚ ƌĞƐŽƵƌĐĞƐ ƚŽ ƐŚĂƌĞ ǁŝƚŚ ǇŽƵƌ ƉĂƚŝĞŶƚƐ͘

Observed annually on April 16 because, as Benjamin Franklin reminded us, nothing in this life is certain except death and taxes!

MetroDoctors

The Journal of the Twin Cities Medical Society

IN THIS ISSUE...

Are You on Healthcare’s Green Team?

am particularly pleased to introduce a few members of Minnesota’s healthcare green team in this issue of Metro Doctors. In the past many of us — me included — have thought that health care was exempt — deserving a pass on the size of its carbon footprint, the amount of material sent to landfills, and the waste — because, after all, the mission of health care is health. The downside of health care is that, because of pollution from energy sources and waste, the net effect of the healthcare industry could be poorer, not better, health. The good news is that healthcare leaders are aware of this fact and are taking action: In this issue of MetroDoctors the CEOs of the five largest healthcare systems in the region each reveal what their organization is doing to “go green.” I’m impressed and heartened by their answers. We begin our overview of this topic with an interview of environmental activist Dr. Bruce Snyder. After a 43-year career as a neurologist, Bruce has become a strong and effective advocate for clean energy. One reason we need clean energy is so that we can eat the fish that swim in our lakes. Because of the mercury emitted from coal-fired power plants to the west of us, the Minnesota Department of Health recommends that children under the age of 15 and women who are or who might become pregnant not eat Minnesota walleye, northern pike, lake trout and several other species more than once a month. While the diverse initiatives of HealthPartners — ranging from but not limited to increasing energy efficiency, minimizing waste, and engaging stakeholders — and the work of MHealth focused in the operating room impresses me, it is the work of students that gives me the most hope for the future. Two years ago, a group of medical and nursing students sensed a need for health care to reduce its environmental impact; they organized Health Students for a Healthy Climate. We should support these passionate students as they work to improve our industry. By Thomas E. Kottke, MD Member, MetroDoctors Editorial Board

MetroDoctors

The Journal of the Twin Cities Medical Society

In health care’s search to protect the patient from iatrogenic infection, disposables have become its signature: Instruments are thrown in the trash after being used once or not at all. But does it have to be that way? How clean is clean enough? Crystal Saric Fashant’s answers may surprise you. She tells us to forget about collecting used, outdated or opened supplies for a third world country; they can’t be used there, either. By contrast, many of those same supplies can be safely reprocessed right here in the metro area. One local company diverts nearly three million pounds from the waste stream each year as it reprocesses equipment and supplies. I think that the last time I saw Dr. Cassius M. C. Ellis III, our Luminary, was more than 40 years ago when I was a medical student. In my mind he was both a physical and an intellectual giant with a compassion for his patients, his community, and for medical students who were struggling as they were working to understand and assume their new role. Dr. Marvin Segal’s elegant biography of Dr. Ellis tells me that my memory has remained true despite the passage of time. You don’t need to believe that human activity is causing climate change to recognize the need to greenup now. Waste — whether it is wasted energy or wasted material dumped in landﬁlls — is expensive. Every dollar that we spend heating and lighting a low quality building is a patient’s dollar wasted; every dollar we spend burying surgical instruments that could be reprocessed is a patient’s dollar, too. My world and your world are rich with opportunities to green-up our acts. Are you on the team? If so, many thanks; if not, join us for the health of it.

March/April 2018

President’s Message

Continuing the Legacy of Collaboration and Cooperation with ICSI THOMAS E. KOTTKE, MD

“ALL TOGETHER OR NOT AT ALL,” was the theme that Dr. Don Berwick chose for his

plenary session at the 2017 IHI National Forum on Quality Improvement in Health Care. He told the audience that we can brag that the U.S. healthcare system is the best, but the truth is different. While our per capita cost of health care outstrips that of all other countries in both absolute and relative terms, our mortality rates are on par with 3rd world countries. We’re also losing ground when compared to other developed economies. Unless we figure out how to control the cost of health care and improve health, there will be little left for our children and grandchildren except crushing debt and chronic disease. But Berwick did suggest a solution: collaboration and cooperation. He told the audience that collaboration and cooperation, not competition, is the only way that we will be able to improve health and control the cost of health care for our patients and our communities. Back home in Minnesota we’ve benefited from collaboration and cooperation for 25 years with ICSI, the Institute for Clinical Systems Improvement. Over its lifetime, ICSI has helped physicians improve care by co-creating guidelines and care protocols and by learning systematic improvement processes and culture together. In its role as a neutral convener of care improvement collaboration, ICSI has helped improve diabetes and depression care, reduce hospital readmissions and increase the efficient use of hi-tech diagnostic imaging. Most recently it has brought 18 CEOs together to develop patient-oriented, provider-sensitive strategies that address the opioid epidemic and the mental health crisis. When others look at health outcomes in Minnesota, they ask, “What is your secret sauce?” I think that the work of ICSI embodies our secret sauce: collaboration. I admit that the times are changing, but that doesn’t mean that the questions that we need ICSI to address are going away. The days of creating guidelines de novo may be over, but that doesn’t mean the need to vet new guidelines and guideline revisions is past. Do clinicians really need to be treating blood pressure to 130/80 when we don’t have the luxury of having every patient sit for five minutes without talking or being talked to? As a cardiologist, should I really be prescribing a statin for every man over the age of 65 (including me) simply because of their age? Can we develop better information and office systems that help us manage the burgeoning number of patients who need care for multiple chronic conditions? How will we eliminate the glaring health disparities that harm all Minnesotans? Could we simultaneously reduce the burden of prior authorization and runaway drug costs by creating a single state-wide process and formulary? Can we design a healthcare system that really is driven by value? Times change, but the need to develop ways to deliver affordable, high-value care through collaboration and cooperation won’t. As physicians, we need ICSI as the space for us to come together and answer the questions that are most important to us and our patients because physicians can’t answer them alone. We still, and always will, need the capability to collaborate with other healthcare professionals, health plans, the public, and other stakeholders. We can’t do it without ICSI. ICSI provides the neutral space where we can cooperatively develop the science and tools of health services delivery and determine the most appropriate approaches to treating illness, promoting health and optimizing well-being. If we want to compete, let’s compete on providing unimaginably superior outcomes and experience for our patients. But let’s all continue to cooperate through ICSI and keep Minnesota moving on our path to a quadruple aim: population health, individual well-being, affordable health care and clinicians who experience joy in their work.

March/April 2018

MetroDoctors

The Journal of the Twin Cities Medical Society

TCMS IN ACTION NANCY K. BAUER, INTERIM CEO

Annual Meeting Held

Thomas E. Kotte, MD, MSPH, ofﬁcially assumed the role of TCMS President at the January 15, 2018 meeting of the Board of Directors. (See related article on page 26.)

•

• Joining Dr. Kottke on the 2018 TCMS Executive Committee are: • • • • • •

Ryan Greiner, MD – President-Elect Matthew Hunt, MD – Immediate Past-President Nicholas Meyer, MD – Treasurer Andrea Hillerud, MD – Secretary Rupa Austria, MD – At Large Member Jennifer Janssen, medical student – At Large Member

Accomplishments Highlighted Included:

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Physicians and medical students of the Physician Advocacy Network helped to pass eight local tobacco prevention policies in Minnesota in 2017. 13 Physician Advocacy Network members testiﬁed in support of protecting youth from the harms of tobacco in 2017. The Physician Advocacy Network provided 34 educational presentations on tobacco prevention and cessation to nearly 1,000 healthcare

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The Journal of the Twin Cities Medical Society

providers and students across the state in 2017. TCMS won an EMMY® for our partnership in The Convenings. Hosted live by Cathy Wurzer, MPR news anchor, The Convenings has organized six communities throughout the state, bringing meaningful conversations about what matters most now and at the end of our lives. A $500,000 appropriation was received from the legislature to support the continued statewide implementation of advance care planning resources by Honoring Choices Minnesota. Honoring Choices staff successfully ﬁnished a second year and began a third year of providing advance care planning orientation for 4th year medical students as part of their ICU rotation at the University of Minnesota. A new advance care planningfocused orientation was launched for ﬁrst- and second-year medical students during their long-term care clerkship, matching them with volunteers from the community to practice providing advance care planning conversations. Two additional states have joined the Honoring Choices National Network, bringing the network to 13 members. And, keeping on task for our physician wellness strategic goal, several meetings have been held with the

board of Physicians Serving Physicians resulting in a management agreement with the organization to strengthen and build its program and services. PAN Update

The Physician Advocacy Network continues to support tobacco prevention efforts across the state. Physicians contacted city councils in North Mankato and Mankato in support of raising the tobacco sales age to 21 in both communities and the Duluth city council in support of restricting the sale of menthol and other ﬂavored tobacco products to adult only tobacco stores. University of Minnesota medical students joined Dr. Caleb Schultz in January for a presentation on the power of physician advocacy for public health. Dr. Tom Kottke and Grace Higgins presented on the health risks of e-cigarette use to high school students at the Kitty Andersen Youth Science Center in January.

Physician Advocacy Network advocates: medical students Alex Feng (L) and Dave Bergstrand (R) with Dr. Caleb Schultz.

March/April 2018

2018 Bariatric Education Days MANAGING OBESITY THROUGH THE LIFESPAN

Thursday, May 24 – Friday, May 25, 2018 Westin Edina Galleria, Edina, MN This course, exclusively for health care practitioners, will emphasize ways to improve the care of the obese patient throughout diﬀerent stages of life. National and local experts in the ﬁeld of obesity treatment will present research, innovations, and controversies for this complex disease. Learn more and register.

Visit MHealth.org/bariatricdays

University of Minnesota Health is a collaboration between University of Minnesota Physicians and University of Minnesota Medical Center. ©2017 University of Minnesota Physicians and University of Minnesota Medical Center

Greening Up Health Care

Colleague Interview: A Conversation with Bruce Snyder, MD

r. Bruce Snyder retired after a practice of Neurology that spanned 43 years. A graduate of Johns Hopkins School of Medicine, he began his career as a faculty member at the University of Minnesota School of Medicine ultimately serving as Chair of Neurology at St. Paul-Ramsey Medical Center (now Regions Hospital) and as Associate Professor of Neurology. Subsequently Dr. Snyder left academia to practice with the Minneapolis Clinic of Neurology then joining the HealthPartners Dept. of Neurology where he became department Chair. Dr. Snyder has published numerous scientiﬁc papers, book chapters and review articles. He is a Clinical Professor of Neurology, Fellow of the American Academy of Neurology and of the American Neurologic Association and has served as an examiner for the American Board of Psychiatry and Neurology. He is a member of APHA, Minnesota Public Health Association, the Public Health Committee of the MN Medical Association and the Twin Cities Medical Society Environmental Health Task Force. Dr. Snyder coordinates Health Professionals for a Healthy Climate, an organization with over 500 Minnesota care provider members/supporters. He also works closely with several environmental organizations including Physicians for Social Responsibility and the Minnesota Chapter of the Sierra Club where he is a member of the Clean Air and Renewable Energy Committee. Dr. Snyder is directing his efforts toward building awareness of Climate Change as a major threat to public health. He enjoys hiking, biking, baseball and gardening.

How did you decide to become active on the issue of climate change and health? In what ways have you been working on this? Although a fundamental understanding of the greenhouse effect dates to the 1850s and even though the ﬁrst Intergovernmental Panel on Climate Change Assessment Report appeared in 1990(1) most of us had overlooked this issue. About 10 years ago books and articles began to appear that brought climate concerns to my attention. I was very busy in my practice, but I began to educate myself and got more involved. I became active with several environmental organizations and met a number of similarly concerned medical and nursing colleagues. We decided that we could have a positive impact by helping educate our colleagues and developed “Climate Change and Public Health — An Interprofessional Review,” an accredited course for health professionals, presented in Minneapolis in November 2015. As well, I submitted a Climate and Health Policy Statement, based on AMA policy that was adopted by the Minnesota Medical Association (MMA) in 2014. MetroDoctors

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Out of this work grew Health Professionals for a Healthy Climate (HPHC), an organization of Minnesota (MN) physicians, nurses, students, and allied health professionals. We’ve concentrated on education and advocacy of clean energy public policy (more information at hpforhc.org). HPHC was awarded the MN Climate Adaptation Award for 2017. Along the way we’ve had strong support from the Twin Cities Medical Society (TCMS), the MN Public Health Association, the MN Organization of Registered Nurses, and others. HPHC members were instrumental in the formation of the TCMS Environmental Health Task Force and I serve on the MMA Public Health Committee. I’ve talked about the health implications of Climate Change to a variety of groups including the Mayo Foundation Chapter of Sigma Xi, the TCMS Senior Physicians Association, the MN Public Health Association, and community organizations throughout Minnesota and North Dakota. I serve as a faculty advisor to Health Students for a Healthy Climate, an authorized University of Minnesota student group. I’ve had the privilege to work with senior members of the University of Minnesota Academic Health (Continued on page 8)

March/April 2018

Greening Up Health Care Colleague Interview (Continued from page 7)

Centers faculty on issues relating to the development of climate change information for the health sciences curricula.

Is the medical community concerned about climate change? What is being done by physicians and healthcare organizations? The global health community has expressed high levels of concern about the health impacts of climate change. Over 1,700 national and international health organizations including the World Health Organization, American Medical Association, the American Nurses Association, the American Public Health Association, the American Academy of Pediatrics, the American Academy of Family Practitioners, the American Academy of Allergy, Asthma, and Immunology, the American College of Physicians and others representing worldwide some 13 million doctors, nurses, and public health professionals have called for an urgent end to polluting fossil fuels as our primary energy source and a rapid transition to clean renewables.(2) The American Medical Association policy statement on health and climate change states in part: “… global climate change … [carries the] potential… for devastating events with serious health implications, including extreme heat and cold events, ﬂooding and droughts, increases in vectors carrying infectious diseases, and increases in air pollution. The health effects from these events should be of concern to the medical community and require action.” In 2017 the AMA issued a policy of divesting of investments in fossil fuel companies.(3) The American Academy of Pediatrics has stated that the “... effects of climate change...include: physical and psychological sequelae of weather disasters; increased heat stress; decreased air quality; altered disease patterns of some climate sensitive infections; and food, water, and nutrient insecurity in vulnerable regions. The social foundations of children’s mental and physical health are threatened by the specter of far-reaching effects of unchecked climate change, including community and global instability, mass migrations, and increased conﬂict. Given this knowledge, failure to take prompt, substantive action would be an act of injustice to all children.”(4)

Is climate change affecting health in Minnesota? How about around the country and the world? Human societies currently emit ~32 B metric tons CO2 annually. The emissions rate in 2016 was the highest yet and 2016 was the warmest year on record. But to fully understand the health effects of fossil fuels one must also consider fossil fuel related air and water pollution (micro-particulates, mercury, toxic organics, etc.). The World Health Organization estimates that in 2012 there were approximately 7 million deaths attributable to air pollution alone.(5) Climate change and fossil fuel pollution have impacted every 8

March/April 2018

category of human illness including allergies, cardiopulmonary disease, infectious disease; developmental disorders; malignancies; mental health; stroke and cognitive decline. As Minnesota has warmed: increasingly high rates of tick-born illnesses are being reported; the pollen season has lengthened by over three weeks triggering more allergies and asthma; air pollution is a signiﬁcant trigger for asthma attacks and acute myocardial infarction; toxic algae blooms are poisoning more lakes; summer heat threatens athletes and outdoor workers; extreme storms and ﬂoods damage crops, homes and businesses contributing to anxiety and depression among those who have experienced these disruptions. Our Somali neighbors know all too well the devastation wrought by historic droughts (in-part due to climate change) and famine that have riven their homeland.

What do you see as the main dangers of climate change to health? In the near-term, population displacement and conflict are the primary concerns. As polar ice melts and sea levels rise, as global warming increases the water vapor concentration in the atmosphere and destabilizes the jet stream, we are experiencing extreme storms with enhanced storm surges inundating coastal lands, displacing large populations, and disrupting housing, social services, health care, manufacturing, and agriculture. The recent Puerto Rico experience is a good example of this type of event. Natural disasters (primarily weather related) account for most of the global total of those displaced from their homes. In 2016, weather disasters (floods, droughts, extreme storms) were responsible for 23.5 million displacements. The number of new climate and weather-related disaster displacements in 2016 was above the annual average since 2008 of 21.7 million persons. Heavily populated low-lying river deltas are at high risk of inundation in the next 15-20 years. These include the Nile, Mekong, Mississippi, and Ganges-Brahmaputra deltas.(6) These population shifts cause extreme stress for refugees and strain the resources of host regions or countries raising the risks of political instability and armed conflict. Refugee status carries severe health consequences.

What is meant by “mitigation” and “adaptation” in relation to climate change and health care? How does this relate to health care “sustainability”? Mitigation refers to actions to reduce the severity and damage done by an adverse circumstance. In relation to climate change this refers to measures that reduce greenhouse gas emissions and pollution. Adaptation refers to measures designed to reduce the impact of climate change on healthcare personnel and institutions. Disaster response planners have learned important adaptation lessons from disasters like Hurricanes Sandy and Katrina that put hospitals, clinics, pharmacies, nursing homes, transportation and information systems off-line. The particular vulnerabilities of low MetroDoctors

The Journal of the Twin Cities Medical Society

income communities have been apparent in New Orleans, New York, Houston, and of course Puerto Rico. U.S. healthcare organizations have been improving their energy efﬁciency, transitioning to less expensive renewable energy sources, cutting waste and increasing recycling, reducing their waste stream and in the process saving many millions of dollars annually. HealthPartners, for example, has done award-winning work in this area. This encompasses the notion of sustainability — the goal is to continue operations and account for growth while consuming fewer nonrenewable resources and reducing impact on the environment. Useful information and resources can be found at Healthcare Without Harm (noharm-uscanada.org). For healthcare organizations sustainability work beneﬁts the bottom line and serves the core mission: to protect and improve the health of patients, families, and communities. Healthcare sustainability has been the subject of a great deal of research and investment. The topic has generated numerous publications, panels, reports, and conferences (e.g. the CleanMed 2017 conference recently held in Minneapolis) and yet patients and clients are largely unaware of these efforts. So far, the communication resources of health care have not delivered the message of concern and action around climate change and pollution to the public. We are not doing our part in informing the public debate on climate change.

To what degree is your work regarding clean air, renewable energy and climate change impacted by today’s political disagreements? Fundamentally successful work on climate change should appeal to both liberals and conservatives. Logically, conservatives should be concerned about the rising cost of climate disasters. In recent years estimated economic losses, damages and health costs from climate-related weather disasters and fossil fuel pollution cost the U.S. economy an average of $240 billion in damages. This is about 40% of the current annual growth of the U.S. economy, a figure that does not include the enormous public health impact and trauma that will continue to plague our communities for years to come. Over the past decade the number of annual multi-billion dollar climate disasters has increased sharply. Rising sea levels are threatening coastal cities, putting trillions of dollars of real estate at risk. And conservatives ought to embrace the economic benefits of a rapidly growing, good jobs producing, renewable energy industry.(7) Liberals are concerned that the cost and frequency of climate disasters are further fraying the social safety net, endangering workers, and destroying our environmental legacy. Persons of all political persuasions should be concerned that climate change, habitat destruction and pollution are responsible for a massive tide of extinctions threatening food supplies and biodiversity. Authoritative medical and scientific voices have identified climate change as a major threat to human societies and even survival. Can we afford to ignore these warnings? Why are healthcare organizations silent about their constructive work and MetroDoctors

The Journal of the Twin Cities Medical Society

legitimate concerns? Are political and economic factors silencing us in the face of what is arguably the greatest public health threat we will ever encounter? The challenge for all of us is to rise above our sets of conﬂicting interests and beliefs in order to preserve a future for generations to come.

Given the degree of change already here and coming, what could/should we as physicians/society be doing to make the best of this bad situation for our patients/ families/neighbors? What are some consequential things we can/should do? Physicians are schooled in our responsibility to our patients. We will do everything in our power to save the person whose life we have in our hands. But how can we be satisfied that we have done our best if we don’t broaden our focus to consider the world in which our patient lives? The safety and consistency of our weather and climate, the stability of the seas, the vibrancy of the natural world are critical determinants of human health. Healthcare professionals and organizations have a special obligation, and moreover a special expertise, to step forward in defense of human well-being. We are a trusted, respected, and important part of the scientific leadership of this country and people look to us for our opinions and advice. My recommendations to my colleagues are: 1. Accept that climate change is real; there is no longer any time, basis, or purpose for arguing. 2. Learn about the implications of climate change and fossil fuel pollution for public health and inform others. 3. Work with your organizations and associations to develop and present accurate compelling messaging about the urgent need for action on climate change. 4. Convey your priorities and concerns as individuals and members of a caring profession that is above all dedicated to the well-being of all, to lawmakers, regulators, candidates, and office holders. Insist that the support of health care is contingent on the development of informed and aggressive public policy to rapidly transition us away from a carbonbased economy. 5. Maintain your optimism, determination, integrity and above all, hope. References 1. IPCC First Assessment Report. http://www.ipcc.ch/index.htm. 2. Climate 911. http://www.climate911.org. 3. AMA to Protect Human Health from the Effects of Climate Change by Ending Its Investments in Fossil Fuel Companies (Divestment). https://www. ama-assn.org. 4. Global Climate Change and Children’s Health. Pediatrics 2015;136;99. DOI: 10.1542/peds.2015-3. 5. World Health Organization, Ambient (outdoor) air quality and health, Fact sheet N° 313, March 2014. 6. Global Report ON INTERNAL DISPLACEMENT. Norwegian Refugee Council http://www.internal-displacement.org/global-report/grid2017/pdfs/2017GRID.pdf. 7. The Economic Case for Climate Action in the United States. Universal Ecological Fund. https://feu-us.org/case-for-climate-action-us/.

March/April 2018

Greening Up Health Care

Environmental Sustainability — How are Healthcare Systems Responding?

M. Osman Akhtar, Chief Operating Ofﬁcer, Fairview Health Services

John H. Noseworthy, MD, President and Chief Executive Ofﬁcer, Mayo Clinic

Kurt Thielen, Associate Director, Minneapolis Veterans Administration Healthcare System

Andrea Walsh, President and CEO, HealthPartners

Penny Wheeler, MD, President and CEO, Allina Health

Editor’s Note: In this issue of MetroDoctors, five healthcare institutions identified as having active sustainability initiatives responded to our request to participate in a written dialogue about what their system is currently doing in five sustainability areas. Your editors sought this input as a great opportunity to bring attention to what healthcare corporations are doing to achieve environmental sustainability and what more could be done.

What is Your Organization Doing to Achieve:

Energy efﬁciency (to include conservation, sustainable transportation, renewable energy commitments, etc.). Fairview facilities staff have partnered with our utility vendors to optimize building performance across the system. Through the use of various assessments, we’ve identiﬁed both short- and long-term projects that will continue to have an impact on our system’s energy use. By working to update our lighting systems to LED lights, replacing vacuum pumps, reviewing our air exchange numbers and volumes, and conducting retro-commissioning studies, we’ve been able to realize a total of 6,666,565 kilowatt hours of energy savings over the last three years. That’s the greenhouse gas emissions equivalent of taking 1,062 passenger vehicles off of the road for one year. – M. Osman Akhtar, Fairview Health Services Mayo Clinic works to reduce energy consumption by the way we design and operate our facilities. We are designing for more energy 10

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efﬁciency in new construction, making renovations to existing facilities, upgrading our utilities and equipment, and inspiring our staff to “think green” in their practices at work. I’m excited to announce that Mayo Clinic’s largest campus in Rochester, MN — a campus of approximately 15 million square feet — has committed to reducing energy use by 20% by 2020, and we met the goal in September 2017. We’re now evaluating opportunities to further energy conservation, including sourcing more renewable energy. The Rochester campus installed solar panels on a parking ramp in 2010, and three Mayo Clinic Health System sites currently participate in community solar programs. – John Noseworthy, MD, Mayo Clinic The Minneapolis Veterans Administration Healthcare System (MVAHCS) has been using Facility’s Fleet Manager software system to track and encourage alternative fuel use which resulted in 68% of fuel purchased in 2017 to be alternative fuels. We have installed more than 200 sub-meters to track energy use in MetroDoctors

The Journal of the Twin Cities Medical Society

specific areas. In 2017, 18.1% of the total facility energy was from renewable electricity sources. The facility reviewed footprint and space usage to develop and implement a reduction of utility consumption by implementing setback of the HVAC systems in unoccupied space which included OR suites. We conduct facility energy audits annually to track efficiency improvements. We promoted facility compliance with federal sustainable acquisition requirements, including EPEAT and acquired EPEAT-registered products for 99.3% of covered monitors, PCs, and laptops. EPEAT is an environmental product rating system that evaluates and rates high-performance electronics. – Kurt Thielen, Minneapolis Veterans Administration Healthcare System At HealthPartners we view sustainability as central to our mission of improving health and well-being. For efficiency, we collaborate with our local energy companies and other organizations to lower our energy consumption. This has involved installing new, energyefficient lighting at our buildings, exploring opportunities for new construction or renovation projects to improve efficiency, and conducting energy audits to pinpoint improvement opportunities. We expect these kinds of initiatives to save our organization over $500,000 in rebates and reduced consumption, and every dollar we save helps us serve our members and patients better. There is still much work to be done. We’re beginning new community solar agreements this year, for example, through which we’ll buy solar-generated electricity equivalent to what 2,000 houses would use. We’re also partnering with an organization called Commuter Services to offer our colleagues enhanced alternative transportation resources. – Andrea Walsh, HealthPartners Allina Health has committed millions of dollars to improving the efficiency of our physical plants including building automation systems, LED lighting upgrades, pool system modernizations and technology like occupancy sensors to reduce overall energy use. Our Facilities Management teams conduct energy audits and continuously use data to identify opportunities to optimize building systems. Improvements to our physical plants are assessed for energy efficiency and operational effectiveness. These efforts have resulted in a 5.4% reduction in our energy utilization over the past three years and a corresponding reduction in our carbon footprint of over 10,575 metric tons. Allina Health focuses on providing the best facilities to deliver the highest level of care, while reducing energy use, lowering costs and ensuring sustainability for generations to come. – Penny Wheeler, MD, Allina Health

Waste minimization (recycling, organic waste segregation, smart packaging, etc.) Finding creative ways to divert waste has always been a priority for Fairview. In 2010, our largest hospital, University of Minnesota Medical Center, led the Twin Cities metro area in establishing a recycling program for sterile blue wrap, which is commonly used to wrap sterile surgical instruments. Fairview facilities now divert approximately 20 tons of wrap annually. In 2013 our retail MetroDoctors

The Journal of the Twin Cities Medical Society

pharmacy services converted their plastic foam coolers used for in-home deliveries to a biodegradable starch material, saving more than 50,000 polystyrene containers from being sent to patient homes annually. In 2016, we eliminated the use of plastic foam products in our hospital cafeterias and partnered with our food service teams to collect more than 100 tons of organic waste. – M. Osman Akhtar, Fairview Health Services Mayo Clinic strives to reduce waste produced in daily operations and find new ways to recycle. More than 31% of our overall waste stream is recycled, and we’ve operated our own recycling facility on the Rochester campus for 25 years. Organic waste in Rochester is sent to a local hog farm as animal feed; in LaCrosse, WI, organic waste is converted to compost via vermicomposting (using worms to eat and digest food scraps). Our Mankato, MN, campus participates in a traditional composting program. Reusing supplies also helps reduce Mayo Clinic waste. We offer office supply reuse programs on the main Mayo Clinic campuses and also donate usable medical supplies and edible food to charitable organizations to help community members in need. – John Noseworthy, MD, Mayo Clinic MVAHCS increased their emphasis on recycling resulting in 63.4% of all solid waste diverted to recycling this year. Through specifications in construction contracts, 77% of all construction and demolition waste in 2017 was recycled. Waste amounts and unit costs are tracked and compared annually to determine areas needing improvement. We use the Green Product Analyzer module to compare product’s environmental impact to find potential safer substitutes. MVAHCS reduced waste generation by purchasing reusable items that include gowns, textiles, basins, reusable sharps container systems and reusable hard cases for sterile surgical instrumentation packaging. We increased waste avoidance by reformulating OR kits to remove unnecessary or frequently wasted items. – Kurt Thielen, Minneapolis Veterans Administration Healthcare System HealthPartners believes in responsibly disposing of all the waste generated across our organization. Aside from our robust waste management and recycling program, we’ve made large strides in finding ways to dispose of other waste sources. For example, in 2017 our compost program diverted 166 tons of organics from landfills. I’m also very proud of our medicine take-back program, which has collected 14,000 pounds since it began in 2011. Currently, we have collection kiosks at 11 of our locations that can also accept controlled substances. This program benefits our community in two important ways. First, it can reduce the number of pills in homes that can harm people or be misused. It can also keep medications out of our water system. – Andrea Walsh, HealthPartners

(Continued on page 12)

March/April 2018

Greening Up Health Care Environmental Sustainability (Continued from page 11)

Each year, Allina Health identifies numerous opportunities and champions a variety of initiatives designed to minimize waste. These initiatives have focused on a wide range of products and programs such as reusable sharps containers, reusable sterilization trays, sterilization wrap recycling, reusable containers for the medical supply distribution process, a food waste program and reusable food containers in our cafeterias. As a measure of these programs’ effectiveness, the reusable sharps container program eliminates 70 tons of plastic from the landfill each year, and the food waste program diverts nearly 250 tons of food waste each year to pig farms rather than sending it to a landfill. Paper, cardboard and electronics are all recycled. Overall, Allina Health recycles nearly 30% of all its waste annually. – Penny Wheeler, MD, Allina Health

Materials/resources conservation (purchasing, greening the OR, single-use device reprocessing, air and water resource protection/mitigation, etc.) Fairview’s supply chain department consistently works to uphold the system’s sustainability goals by doing everything from reducing the amount of paper used in our accounts payable department to assessing the environmental impact of our vendors. The supply chain team is encouraged to make decisions by identifying the true cost of products, including the environmental cost. In 2016, Fairview’s supply chain department contracted with a medical device reprocessing vendor. Through this partnership, we have been able to divert almost 80,000 pounds of single-use medical devices from the waste stream system-wide. These include non-invasive items such as compression sleeves and more invasive items such as harmonic scalpels. Collected devices are disinfected, cleaned, remanufactured, tested, packaged and sterilized before being put back into service. – M. Osman Akhtar, Fairview Health Services Mayo Clinic is reducing or eliminating chemicals of concern such as mercury, polyvinyl chloride and phthalates in our operations. We are committed to growing our green product portfolio and recently created an environmentally preferable purchasing policy. We saw an opportunity to encourage the development of more sustainable products in health care and became a founding member of Greenhealth Exchange, a purchasing cooperative that accelerates the adoption of health care products that are safer and healthier for people, communities and the environment. We’ve also had success with resource conservation in our surgical areas. In addition to energy conservation and recycling efforts, last year, single-use surgical device reprocessing helped prevent over 16 tons of surgical devices from the waste stream. Device reprocessing helps us reduce our waste disposal costs and purchasing back select reprocessed devices saves on supply costs. – John Noseworthy, MD, Mayo Clinic

March/April 2018

MVAHCS received several awards for our efforts including: National EPA Sustainability Awards in 2017 for Leadership in Operating Rooms Waste Reduction and Regional EPA Federal Green Challenge award for paper reduction and environmentally preferable purchasing and sustainability projects. In 2017, the Minneapolis VA decreased its printer and copier paper purchased by 44% from the previous year, saving $125,600. We reduced potable water use intensity 280% from baseline; through installing water-wise products and utilizing a laundry water recycling program. MVAHCS’s Engineering staffs’ efforts were recognized with a VA Sustainability Award for a facilitywide deicing program, utilizing less salt, substantially reducing pollutant run-off into the nearby Mississippi River. – Kurt Thielen, Minneapolis Veterans Administration Healthcare System Operating rooms generate 20 to 30% of a hospital’s total waste. HealthPartners joined other leading healthcare institutions in tackling this problem by identifying a set of best practices that can reduce costs while also reducing waste, energy, and worker and patient exposure to hazardous materials. Through reprocessing single-use devices, improving fluid management and implementing reusable sharps containers, we have diverted 793,000 pounds of waste from landfills and saved over $940,000 in 2016. We’ve also integrated our supply chain to a centralized system, and formalized many sustainable purchasing practices and policies. One example is our recent switch to compostable cups. We used to use thousands of Styrofoam cups. Now, we buy more than three million compostable cups from the veteran-owned Renewables LLC right here in Minneapolis. – Andrea Walsh, HealthPartners Recent initiatives include eliminating lead indicators and tape (a testing material used to ensure products processed by heat sterilization did in fact reach the desired temperature and duration) with a non-hazardous product, using “sewer zero pharmaceuticals,” and implementing waste containers that prevent controlled substances from entering the environment. Last year, Allina Health began recycling single-use products in operating rooms. Devices (such as vessel sealing; and ultrasonic, arthroscopic and orthopedic devices) and guides (including laparoscopic scissors, Trocars and suture passers) are recycled. Plastic bottles and hard plastic from sterile products are recycled. We switched from completely disposable laparoscopic scissors to a product where only the tip is disposable, and the handle and shaft are reusable. Smoke capture devices are used for surgical plume, and Neptune devices for fluid capture eliminate the need for a disposable suction canister. We also donate disposables, medical supplies and equipment to Allina Health’s medical mission partner. – Penny Wheeler, MD, Allina Health

Stakeholder engagement (community group leadership, green employee beneﬁt, speaker presentations, etc.) Creating an environment that empowers and engages staff MetroDoctors

The Journal of the Twin Cities Medical Society

is essential for a program’s success. While Fairview has been recognized by Practice Greenhealth for our sustainability work across our hospital locations with both System for Change awards as well as Partner for Change awards for the past seven years, we’ve continued to strive to find new ways to energize our staff and minimize our environmental impacts. Fairview’s Green Masters clinic program was established to guide our ambulatory staff through the concepts of sustainability, practical application of sustainable models in the healthcare field, and connecting these ideas to the health of the community and our patients. Participating clinic staff members sign a pledge to create sustainable improvements in energy, waste, purchasing and food systems, and then take steps to create and sustain change at their sites. Engaging our clinic staff has allowed us to more than double the recycling rate at these locations since beginning this program, increase regulatory compliance rates, as well as build community ties by encouraging clinic staff to participate in local volunteer activities such as neighborhood cleanup events. – M. Osman Akhtar, Fairview Health Services Several Mayo Clinic experts have had opportunities to present about Mayo’s experiences, successes and challenges on a variety of sustainability topics ranging from energy, water, greening the operating room, waste and recycling. We also have several community partnerships that are helping make sustainability improvements in the communities in which we live and work. A few examples include partnering with the city of Phoenix, AZ, on the Reimagine Phoenix initiative to increase waste diversion and recycling; supporting community gardens and healthy nutrition education efforts in LaCrosse; and partnering with the city of Rochester and Destination Medical Center Economic Development Agency to leverage the DMC initiative to help our community “leapfrog” in setting and attaining sustainability goals. – John Noseworthy, MD, Mayo Clinic The facility conducts quarterly GEMS (Green Team meetings) which are open to all staff. MVAHCS hosted an Earth Day 2017 electronics recycling event that collected more than 11,252 pounds from staff, volunteers and patients. The Facility participated with Healthcare Environmental Awareness & Resource Reduction Team Midwest to sponsor a seminar on Food Waste Reduction in Health Care. We share best practices with all technical peers at VA and other medical facilities. We monitor, measure, report and verify regulatory compliance at all levels. MVAHCS focuses on improving sustainability by staff education, energy efficiency, water and natural resource conservation in all departments. We offered all staff a special series entitled Mini-Master Recycling Program that offered sessions on Solid Waste, Recycling, Plastics, Food Waste, and Waste Prevention. – Kurt Thielen, Minneapolis Veterans Administration Healthcare System Partnership is one of HealthPartners’ values and it’s how we approach everything we do. Our partnerships include involvement MetroDoctors

The Journal of the Twin Cities Medical Society

and leadership in Healthcare Environmental Awareness and Resource Reduction Team (HEARRT), Clean Air MN, Minnesota Sustainable Growth Coalition, and many more. We were proud to sign the Health Care Without Harm Health Care Climate Declaration in 2016, the ﬁrst health system in Minnesota to do so. Our most important stakeholders are our own 25,000 people. We track employee engagement through our annual survey, and 87% of all colleagues positively responded to our sustainability work. At our Earth Day event in 2016, for example, our colleagues helped to collect 16.5 tons of electronic waste to recycle. In 2017, HealthPartners was honored to receive 18 awards from Practice Greenhealth for our work across our organization to improve our environmental stewardship. – Andrea Walsh, HealthPartners Allina Health supports a number of environmental sustainability initiatives. We sponsored the 2017 CleanMed conferences’ Dialogue with Minnesota Leaders: Climate Change and Public Health. We ﬁnancially support the Midtown Greenway Coalition and Nice Ride Minnesota. For 17 years, we have partnered with Midtown Community Works to plant over 5,000 trees and shrubs on the Greenway. We annually donate storage space for 2,500 Nice Ride Minnesota bicycles. Our CommuteShare program provides incentives to employees who use alternative methods to get to work rather than driving alone, including providing Metropasses at a deeply discounted, subsidized rate. Employees who ride the bus or light rail, or who bike, carpool, walk or telecommute to work get a CommuteShare parking card for the days they do drive to work. – Penny Wheeler, MD, Allina Health

Infrastructure development (green teams, work plan development, climate change and sustainability commitment statements, etc.) Fairview has undergone a year of dramatic change — from an entirely new leadership team to integrating with a new health care system, HealthEast. As we continue to embrace change by implementing the new Fairview lean management system, our hope is that staff continue to feel empowered in their abilities to identify best practices, eliminate waste and optimize efﬁciencies. Doing so will drive not only our sustainability program, but also elevate our patient experiences and our health care delivery to the next level. – M. Osman Akhtar, Fairview Health Services Mayo Clinic has a long history of stewardship dating back to our founding days. In 1916, for example, Dr. Charlie Mayo established the garbage collection service for Rochester and operated a hog farm for community waste disposal. Fast forward to 2010, when we formed a Green Advisory Council to coordinate sustainability efforts across our campuses. The Green Advisory Council is comprised of physician, scientist and administrative leaders from across Mayo Clinic. The Council is responsible for facilitating environmental sustainability priorities and monitoring and (Continued on page 14)

March/April 2018

Greening Up Health Care Environmental Sustainability (Continued from page 13)

reporting on key performance indicators. Several of our main campuses also have green teams that coordinate improvement activities at the campus-level. We are continuously striving to improve performance and integrate best stewardship practices throughout our systems. – John Noseworthy, MD, Mayo Clinic A unique feature of the MVAHCS design is the inclusion of interstitial spaces between floors to house all plumbing, electrical and air-handling systems. We formed a surgeon-led Greening the OR Green Team focusing on cost reduction through better segregation of Regulated Medical Waste and improved fluid management systems, and increased recycling of materials traditionally placed in solid waste such as recycling of medical plastics. MVAHCS also produced a 45-minute video detailing the five-year process of “Greening the OR” at MVAHCS. Our Research Safety Committee has improved sustainability through reduction in the use of hazardous materials and expanded use of environmentally preferable chemicals, improved energy use with the purchase of 25 new high efficiency ultra-low freezers and removal of obsolete materials from the lab environment. – Kurt Thielen, Minneapolis Veterans Administration Healthcare System HealthPartners has worked to embed sustainability as an integral part of our culture. Our sustainability program is led by almost 200 passionate people between our sustainability department, executive sponsor team, steering committee, 17 “green teams,” and other work groups. Our work plans and goals are set by the green teams, executive sponsors and steering committee. Our green teams are groups of volunteers at our major locations that are crucial in implementing our initiatives at a local level. All of these people are what makes our program successful. Again, we view it all through our mission of improving health and well-being. Only about 20% of how healthy we are has to do with medical care. Most of it has to do with other factors like education, nutrition, and the environment. Providing a healthier, cleaner and more livable environment for our members, patients and community is one of the best things we can do for a healthier region. – Andrea Walsh, HealthPartners Two of Allina Health’s Core Values — “Trust” (We act in the best interest of our patients, physicians, communities and one another) and “Stewardship” (We use our resources wisely) — serve as the foundation of our efforts related to Greening Up Health Care. A key goal for Allina Health in 2018 will be the establishment of a formal Environmental Sustainability Program at sites across the system. Our plan is to leverage the great work our various teams already do and package those efforts in a way that will clearly define our commitment related to sustainability. Through this process, we hope to identify additional opportunities, develop new strategies, measure our performance, and provide the resources 14

March/April 2018

necessary for employees and leaders to successfully implement and maintain the program. – Penny Wheeler, MD, Allina Health M. Osman Akhtar, Chief Operating Officer, Fairview Health Services M. Osman Akhtar is the Chief Operating Officer at Fairview Health Services. Osman brings more than 19 years of experience in the health care industry and is passionate about empowering organizations and individuals to improve both the health and the healthcare experiences of the communities they serve. Before taking on his current role at Fairview, Osman served as the Bay Area Vice President of Operational Integration for Sutter Health. Osman holds a master’s degree in health administration and a bachelor’s degree in psychology, both from St. Louis University. John H. Noseworthy, MD, President and Chief Executive Officer, Mayo Clinic John H. Noseworthy, MD, President and Chief Executive Officer of Mayo Clinic, leads one of the largest not-for-profit, academic health systems in the U.S. Born in Melrose, Mass., Dr. Noseworthy received his MD degree from Dalhousie University in Halifax, Nova Scotia, Canada. He completed his neurology training at Dalhousie University and the University of Western Ontario, and a research fellowship at Harvard Medical School. He joined Mayo Clinic in 1990. Dr. Noseworthy serves as a member of the Merck Board of Directors; although he receives an annual compensation for this service, Mayo Clinic does not. Kurt Thielen, Associate Director, Minneapolis Veterans Administration Healthcare System (MVAHCS) Mr. Kurt Thielen, Associate Director, has embraced the role as Sustainability Officer at one of the largest and most complex facilities in the entire VA Health Care System (VAHCS). His imperative is to manage resources to provide the best possible health care for all, while striving to continuously improve the sustainability of his facility and the VAHCS. The MVAHCS has more than 3,500 employees. The campus is comprised of over 21 buildings. The main hospital has 350-bed in-patient beds and over 90 specialty clinics. The facility complex encompasses 1.5 million square feet. MVAHCS is one of 168 hospitals in the VA systems. The MVAHCS goes above and beyond requirements to develop facility sustainability policies which result in both financial and environmental benefit. Andrea Walsh, President and CEO, HealthPartners Andrea Walsh is President and Chief Executive Officer for Minnesotabased HealthPartners, the largest, consumer-governed, nonprofit health care organization in the nation. Throughout her career, Walsh has been passionate about health and deeply committed to making a difference in people’s lives. Today, she leads a team of more than 25,000 people focused on the mission of improving health and wellbeing in partnership with patients, members, and the community. Prior to her appointment as President and CEO in 2017, Walsh was part of the HealthPartners senior executive team for more than 20 MetroDoctors

The Journal of the Twin Cities Medical Society

years. She is a graduate of the University of Minnesota Law School and the University of Kansas. Penny Wheeler, MD, President and CEO, Allina Health Penny Wheeler, MD, is the President and Chief Executive Officer of Allina Health, one of the region’s largest not-for-profit health care systems. She leads the clinical and operational strategy across the system, which includes 65 clinics, 49 rehabilitation locations, 23 hospitalbased clinics, 12 hospitals, 15 retail pharmacies, two ambulatory care centers, and specialty medical services including hospice care, oxygen and home medical equipment, and emergency medical transportation, throughout Minnesota and western Wisconsin. Prior to her appointment as CEO, Dr. Wheeler served as the Chief Clinical Officer of Allina Health. Her educational background includes an undergraduate degree with honors from the University of Minnesota and a doctorate of medicine degree from the University of Minnesota Medical School. She is a board certified OB/GYN. RESOURCES

• • • • •

Practice Greenhealth: https://practicegreenhealth.org/ Sustainability Roadmap for Hospitals: http://www. sustainabilityroadmap.org/ 3M sustainability: https://www.3m.com/3M/en_US/ sustainability-us/ Midwest: https://hearrtmidwest.org/ Healthcare Environmental Resource Center: http://www. hercenter.org/

• • • • • • • • • • • • • •

Association for Healthcare Resource and Material Management (AHRMM): http://www.ahrmm.org/ Healthcare Without Harm: https://noharm.org/ Minnesota Pollution Control Agency: https://www.pca. state.mn.us/waste/health-care-industry Minnesota Technical Assistance Program: http://www. mntap.umn.edu/industries/facility/healthcare/ Minnesota Waste Wise and Energy Smart: http://www. mnwastewise.org/ Environmental Initiative: http://www.environmentalinitiative.org/ Minnesota Materials Exchange Program: http://www. mntap.umn.edu/services/matex/ Twin Cities Habitat for Humanity ReStore: https://restore. tchabitat.org/ Stericycle: https://www.stericycle.com/ American Society for Healthcare Engineering (ASHE): http://www.ashe.org/ Energy to Care: http://www.energytocare.org/ Greening Your Business: http://www.mntap.umn.edu/ resources/green/ Recycling Association of Minnesota: http:// recycleminnesota.org/ Recycle Across America: http://www.recycleacrossamerica. org/

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March/April 2018

Sponsored Content

The Case for Surgeon Leadership in Operating Room Sustainability Contributed by Rafael Andrade, MD

The medical community’s current focus on environmental sustainability clearly connects with the priority to improve population health by eliminating risks associated with environmental harm. Furthermore, we are showing that these efforts can reduce costs — an equally important priority — through better use of resources and more efficient operations. At University of Minnesota Health, we are utilizing the work of academic research to understand how sustainability efforts affect patient experience and outcomes. Research like Dr. Andrade’s featured here is demonstrating that our attention to sustainability can reduce waste, drive efficiency and improve the cost of care. — Macaran Baird, MD, CEO, University of Minnesota Physicians and Co-President, University of Minnesota Health Operating rooms (ORs) in the U.S. generate 20-30% of hospital waste.1 ORs produce an estimated 2,000 to 3,300 metric tons of waste per day or 730,000 to 1,200,000 metric tons of waste each year.2-5 This annual amount of waste is equivalent to two to three times the weight of the Empire State Building.6 As a surgeon, I have focused my efforts in environmental sustainability on reducing waste and achieving efficiencies in the operating room. Several initiatives I was able to lead at University of Minnesota Medical Center uncovered remarkable cost savings. They also brought forward opportunities to improve the care we offer our patients and communities. Waste-Reduction Efforts at University of Minnesota Medical Center – East Bank Operating Room Seven published, peer-reviewed reports have linked environmental sustainability efforts in the OR, in particular waste reduction efforts, with cost savings.7-13 Non-peer-reviewed reports have also emphasized this link.14,3,15 These studies, however, rely primarily on 20

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cost-savings calculations rather than report on the actual ﬁnancial impact of OR waste reduction. The University of Minnesota Medical Center – East Bank OR has undertaken several waste-reduction initiatives that measured usage and costs before and after the intervention. Conducted under my leadership as a University of Minnesota Health surgeon, the initiatives have focused primarily on revisions to surgical kits, with the goal of reducing disposable supply waste. Each initiative achieved reductions in waste and costs. The calculated costs and wastereduction totals appear below. (Cost and waste reductions have been based primarily on cost and weight of identiﬁed items, with extrapolations based on volume of cases.) • Revision of chemotherapy port placement kit. This 2008 effort resulted in a calculated annual waste reduction of 80 lbs. and cost savings of $2,000.14 • First systematic review of 24 surgical kits. As a result of this 2009 initiative, we achieved an annual waste reduction of 7,792 lbs. and a calculated cost savings of $104,658. • Second systematic review of 20

high-volume surgical kits, 2014. The second review of surgical kits reduced 478 lbs. of waste per year and achieved an annual cost savings of $9,642.16. • Reusable laparoscopic trocar use (20122014). This effort achieved a calculated cost savings after three years of ~$7,500/ year. In an attempt to elevate the quality and reliability of our waste reduction and costsavings initiatives, the operating room green team at University of Minnesota Medical Center carried out a study employing extensive data analysis. In the TAVR waste reduction initiative, we wanted to not only evaluate resource usage but also set a precedent on how to evaluate waste reduction initiatives in the OR and to emphasize the value of such efforts as formal institutional initiatives. TAVR Waste Reduction Initiative Transcatheter aortic valve replacement (TAVR) is a form of heart valve replacement for aortic stenosis in patients who are considered to be too high risk for open heart surgery, often due to their advanced age.

MetroDoctors

The Journal of the Twin Cities Medical Society

Typically, patients with severe aortic stenosis are very symptomatic and sometimes require frequent admissions to the hospital. Even in very high-risk patients, TAVR can help improve quality of life dramatically with short hospital stays and little discomfort. With TAVR, the replacement heart valve is placed using a catheter inserted via the femoral artery in the groin. The procedure provides excellent functional results and allows for an expeditious recovery. Although TAVR is a minimally invasive procedure, most TAVR programs have the procedure start in the OR with a full surgical team and cardiopulmonary bypass (CPB) available at the ready in case the valve deployment goes wrong. However, with experience, streamlined TAVR programs no longer require heart surgery standby for all patients, freeing up OR personnel and perfusionists. Started in March of 2012, the University of Minnesota Health TAVR program has established itself as a mature program with excellent results. TAVR procedures within the program are typically performed by an interventional cardiologist and a heart surgeon in the OR, with the patient under general anesthesia and with CPB standby. A nurse and a technologist from the cath. lab, a nurse and technologist from the OR, and a perfusionist for CPB are present. As part of routine procedure, the OR heart surgery kit supplies are opened and readily available. We hypothesized that the University of Minnesota Health TAVR program is resource intensive, and we determined to conduct an analysis of our approach. Our study objectives were to evaluate clinical results, supply use, personnel use, and solid waste generation per case and per year. To perform this study, we retrospectively reviewed all TAVR cases performed at University of Minnesota Health locations in a 12-month span. The clinical results of the University of Minnesota Health TAVR program (n=64 cases in 2016) are similar to those reported in the 2016 Annual Report of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.17 The actual cost of open and unused supplies per patient case was $296, which represents a total of $18,944 for 64 uncomplicated cases performed in that time period. Unused personnel hours as a result of stafﬁng each case with OR and cath. lab personnel as well as with a perfusionist on standby MetroDoctors

totaled 662 hours. The median weight of open, unused, and discarded medical supplies was 18.8 lbs. per patient case and 1,203 lbs. in one year. Findings Our TAVR program has excellent clinical results, as confirmed by our findings, but it is resource and personnel intensive. Interestingly, providers’ and staff ’s mere awareness of the financial cost and environmental waste of this program has led to their pursuing changes. The heart surgery kit employed in open heart OR procedures is no longer routinely opened in preparation for these transcatheter procedures, and cross-training of cath. lab technicians staff is now complete, freeing up an OR technician to improve OR flow for other cases. From July 1, 2017 through December 31, 2017, the TAVR program performed 48 procedures and avoided 902 lbs. of waste while saving $14,400. The effort to streamline our TAVR program has also led us to think about how to best approach the highest-risk patients. Although the risk of catastrophic intraprocedural complication in TAVR remains very low, salvage surgery in this event carries a mortality risk of 50% to 75%. As a result, we have decided on specific criteria to classify a patient as high risk and to candidly ask that person what his or her expectation would be in case of a catastrophic complication. The patient can then decide whether to proceed with TAVR and whether salvage surgery should be a consideration or not, a discussion akin to a conversation about DNI/DNR. In that case, if a severe intraprocedural complication arises, the team and the family can make a quick decision based on the patient’s wishes. If a high-risk elderly patient decides that she or he would rather not undergo salvage surgery, then the procedure can be planned differently and without CPB standby. This approach centers on patients’ desires, gives the patient some control over their care, reduces the stress on the provider, and limits resource use. The analysis of our TAVR program was very labor-intensive and required a surgeonleader to initiate it and bring it to fruition. However, the effort of changing practices is even more labor-intensive. A long-standing change achieving incremental efficiencies will require a continued engagement effort. Change is difficult, but possible.

The Journal of the Twin Cities Medical Society

Environmental Sustainability Work and the “Triple Aim” of Health System Improvement As the Institute for Healthcare Improvement maintains, the optimization of health system performance must occur across three dimensions: improving the patient experience of care, decreasing the per capita cost of health care, and improving the health of populations.18 Environmental sustainability efforts in the hospital setting clearly meet this “triple aim” of improved care. The University of Minnesota Medical Center OR waste-reduction initiatives and the findings of our TAVR study demonstrate the financial and environmental benefits of sustainability efforts. Our review of surgical kit usage alone was able to remove more than 8,000 lbs. of unused and discarded medical supplies from our system per year at an annual savings of more than $114,000. Those are staggering totals. Also remarkable is the effect these green initiatives can have on our community and our patients. Reducing waste lessens our facilities’ impact on the environment and ultimately supports the health of the communities we serve. The review of standard procedures and practices can also encourage us to reflect on their impact on individual patient’s health and well-being. Renewed awareness of physician and patient discussions around end-of-life and qualityof-life decisions became a surprising outcome of one of our environmental initiatives. Seeking environmental sustainability might be, in the end, a step toward improving the patient’s experience of care. Rafael Andrade, MD, is a University of Minnesota Health thoracic surgeon and chief of the Division of Thoracic and Foregut Surgery at University of Minnesota Medical School. He is the co-founder of the University of Minnesota Medical Center Operating Room Green Team as well as an executive member of the Fairview Corporate Green Committee. He has led numerous operating-room environmental sustainability initiatives, and his efforts in this area have been recognized in both research and national publications. References and reading suggestions available upon request.

March/April 2018

Greening Up Health Care

Waste Reduction and Reuse in a Healthcare Setting: A Physician’s Role

s a healthcare sustainability professional, I often get questions about how a department or individual can increase recycling rates within a healthcare setting. While it is important to recycle those empty soda cans and old newspapers, I feel this question falls short of the real goal, which is, how do we reduce waste in healthcare? The Healthier Hospitals Initiative estimates that health care facilities can generate as much as 26 pounds of waste per patient, per day (HHI, 2018). This can be compared to a study by Duke University which suggests that Americans produce roughly 4.3 pounds of waste per person per day (Duke, 2008). As a physician, how can you help close this gap? The Conundrum of Disposables

Health care uses countless disposable products, and for good reason. An understanding of the role that cleanliness and sterility play in the prevention of infection has vastly increased our ability to make patients healthier. However, a problem that I have seen time and again is the unwrapping of disposable products that will not get used on a patient. Healthcare sustainability professionals are subsequently confronted with a problem that physicians will rarely see. These are the bins and boxes of clean supplies stacked neatly in a supply room, awaiting ‘donation’ to a medical mission organization. However, it pains me to let you in on a secret: many of these items cannot be used overseas, and will end up in a landﬁll near you.

By Crystal Saric Fashant, DBA

MetroDoctors

As a physician, have you spent time looking at the supplies that are opened and ready for you to use when seeing a patient? In one 2009 study at the University of Minnesota, Dr. Rafael Andrade reviewed the items that were queued up for his vascular access port placement procedure and was able to reduce his surgical pick from 44 items to 27 items, reducing about a pound of waste and saving almost $50 in supply costs per procedure (MnTAP, 2009). This line of thinking has caught on at medical facilities across the country, with more physicians taking a close look at the items that get pulled off the supply shelf on their behalf. Taking time to evaluate what your support staff is preparing for you, and making a commitment to only have the necessary items opened on your behalf can help us reduce this tidal wave of unused supplies destined for the landﬁll. Medical Missions: A Misunderstanding

What can be used by a medical mission group, and why are so many supplies

The Journal of the Twin Cities Medical Society

ending up in the trash can? My work with Total Health Africa helps me see exactly what items are needed when our medical teams visit Tanzania. The answer is simple. They need the basics — things like personal protective equipment, sutures, surgical instruments, sheets and blankets, and durable medical equipment. Many countries refuse to accept outdated supplies or opened items (i.e. loose and unsterile items) which are often the very items we feel ‘good’ about salvaging from the waste stream. Thus, it is important for physicians to understand exactly what their medical mission partners can use. This can be accomplished by hosting a short meeting with your medical mission partner to strategize about what items can be used by their teams, versus what items would be good candidates for reduction by your facility. The larger medical mission organizations in the Twin Cities include Global Health Ministries, Matter, and Mano a Mano. I am certain they would appreciate the opportunity to speak with you. Say Yes to Reprocessing

Another way that physicians are stemming the tide of disposable supplies headed for the landﬁll is to partner with a company engaged in reprocessing and remanufacturing of single-use devices such as trocars, drill bits and blades. Historically there may have been resistance to reprocessing programs, due to concerns about product integrity and cleanliness. Nowadays, many medical facilities have caught on to the enormous waste reduction and cost savings

(Continued on page 24)

March/April 2018

Greening Up Health Care Waste Reduction and Reuse (Continued from page 23)

opportunity that reprocessing affords, and companies like Sterilmed and Stryker Sustainability Solutions have proven themselves to take the utmost precautions; both are FDA-registered device manufacturers. On their website, Sterilmed notes that it diverts more than 2.9 million pounds of medical waste each year; Stryker Sustainability Solutions boasts more than 3,000 partner hospitals and ambulatory surgery centers across the country (Sterilmed, 2018; see also Stryker, 2018). My best advice would be to see these facilities in action by requesting a tour and seeing for yourself the rigor that goes into a reprocessing and remanufacturing program. Say Yes to Reuse

Furniture and ofﬁce supplies are great places to start when it comes to reuse within a healthcare facility, big or small. These items can oftentimes be repaired, cleaned, and placed back into circulation for use in another department. In my work with hospitals, I have helped open several “reuse centers” which are organized to take in the items that are sitting in closets, desk drawers, and in dark corners around a medical facility, and get them ready for reuse. In my experience, hospitals can save between 10-20% of their furniture and

weeks of us taking possession of them. This program works equally well at outpatient sites; in my work with long-term care facilities, I have come to understand that reuse has been a part of their work for many years. How Clean is Clean Enough?

The ﬁnal question asked of me is, how clean is clean enough? A good rule of thumb is to follow the “rational approach” by Earle H. Spaulding, which can be found on the CDC’s website. This includes sterilization for critical items that enter sterile tissue or the vascular system, a high-level disinfectant for items that may come into contact with mucous membranes or nonintact skin, and low- or intermediatelevel disinfectants for routine items used during patient care (CDC, 2008). The Minnesota Technical Assistance Program also offers helpful tips on their webpage Infection Prevention, Sterilization, and Green Cleaning, with recommendations for healthcare facilities that wish to engage in chemical and toxicity reduction, such as reducing bulk chemical purchases (that have the potential to outdate and become hazardous waste), using reusable sterilization hard cases rather than (disposable) surgical blue wrap, and switching from a glutaraldehyde to an ortho-phthalaldehyde (OPA) solution for high-level disinfection needs (MnTAP, 2018). Partnering with your organization’s infection prevention and control department is the best way to determine ways to safely reduce chemical use within your facility. Where Do We Go from Here?

nonmedical equipment costs per year, if they can implement a system easily accessible to all hospital staff. This photo shows desks and chairs that were unneeded after a department relocation at a local hospital. Because the hospital had a system for reuse, these items were redistributed within two 24

March/April 2018

Remember that as environmental sustainability increases in popularity throughout all sectors of our economy, health care is becoming a leader in this space. Your organization likely has a sustainability professional ready and waiting to receive your calls and inquiries, and would be incredibly pleased to have your support and ideas. While I haven’t touched on any of the other areas for improvement — energy use, water use, hazardous waste, climate change, environmentally preferred purchasing and more, these are the areas that

sustainability professionals are working hard at, to make a meaningful impact in lessening healthcare’s environmental footprint. If you have a passion for environmental issues and are unsure how to put your passions to good use, now is the time for you to connect with your sustainability team. You, the physician, are the most valuable partner we have, and with your support we can make boundless strides in greening up health care. Dr. Crystal Saric Fashant is a healthcare sustainability professional in the Twin Cities, ﬁrst at Fairview Health Services and more recently as a sustainability consultant for Hennepin County Medical Center. She serves on the board of directors at the Minnesota Waste Wise Foundation, Merrick Inc., and at Total Health Africa, a medical mission organization. Dr. Fashant received her Doctorate in Business Administration from Metropolitan State University. Currently, she is an Associate Professor in the Department of Public and Nonproﬁt Leadership at Metropolitan State University in Saint Paul, MN. She can be reached at crystal.fashant@ metrostate.edu. References 1. Centers for Disease Control and Prevention (2008). Guideline for disinfection and sterilization in healthcare facilities. Retrieved from https://www.cdc.gov/infectioncontrol/ pdf/guidelines/disinfection-guidelines.pdf. 2. Duke University (2008). Sustainable Duke: Procurement and waste. Retrieved from https:// dukespace.lib.duke.edu/dspace/bitstream/ handle/10161/6881/Sustainable%20Duke. pdf;sequence=1. 3. Global Health Ministries (2018). Homepage. Retrieved from www.ghm.org. 4. Healthier Hospitals Initiative (2018). Less waste. Retrieved from http://healthierhospitals.org/ hhi-challenges/less-waste. 5. Mano a Mano (2018). Homepage. Retrieved from www.manoamano.org. 6. Matter (2018). Homepage. Retrieved from www.matter.ngo. 7. Minnesota Technical Assistance Program (2009). Reducing waste from the operating room. Retrieved from http://www.mntap.umn. edu/industries/facility/healthcare/sustainability/recycling/. 8. Minnesota Technical Assistance Program (2018). Infection prevention, sterilization, and green cleaning. Retrieved from http://www. mntap.umn.edu/industries/facility/healthcare/ sustainability/infectionprev/. 9. Sterilmed (2018). Reduce your medical waste. Retrieved from https://www.sterilmed.com/ Why-Reprocess/Pages/Reduce-Waste.aspx. 10. Stryker Sustainability Solutions (2018). Homepage. Retrieved from sustainability.stryker.com.

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The Journal of the Twin Cities Medical Society

Environmental Health — The Beneﬁts of a Carbon Fee and Dividend on Health Care

ast September an 8-year-old boy presented to his physician with severe asthmatic symptoms. He was unable to attend school due to exposure from the deteriorating outdoor air quality. The raging wildfires in the western U.S. were affecting the Minnesota air quality index at that time. Physicians in Minnesota have seen a northward spread of vector borne disease such as Lyme’s. Extreme heat events affect everyone, but especially our older and younger populations. Severe flooding threatens patients’ homes and community infrastructure while the stress and grief increase mental health related care. These adverse health effects influenced by climate change cost society lives and dollars. One approach that will likely reduce the effects of climate change and improve the health of patients is carbon fee and dividend (CFD). CFD places a fee on fossil fuels at the source and 100% of the net fees are returned to households on an equal basis. This protects the middle class and lower-income households from increased energy costs. CFD makes fossil fuels’ market price reflect their true cost to society, thereby leveling the playing field for healthier energy sources. It is the policy that climate scientists and economists alike, say is an important step in reducing the likelihood of catastrophic climate change from global warming by using a simple transparent, revenue-neutral approach. CFD has been successful in British Columbia and now eight states are working on their own CFD proposals. The Lancet Commission on Health

and Climate Change has called strong and sustained carbon pricing “the most powerful strategic instrument to inoculate human health against...climate change.” Reducing CO2 emissions not only signiﬁcantly and quickly reduces harmful co-pollutants, saves lives and avoids other adverse health impacts, but also saves the economy billions of dollars in health care costs.[1] About that 8-year-old boy…he’s my grandson. You are invited to attend the

conference “Code Blue for Patient Earth” on April 20, sponsored by Health Professionals for a Healthy Climate, to learn more about the role of physicians in addressing climate change. For more information and to register: https://freshenergy.org/codeblue/. M. Michael Menzel, MD, Environmental Health Task Force Member References: 1. Schwartz, J., J. Buonocore, J. Levy, C. Driscoll, K.F. Lambert, S. Reid. 2014. Harvard University.

Health Professionals for a Healthy Climate Health Professionals for a Healthy Climate is pleased to announce an exciting day-long conference, “Code Blue for Patient Earth: Responding to the Urgent Threat of Climate Change to One Health” on April 20, 2018, at the Science Museum of Minnesota in St.Paul. We will have some very exciting speakers including: David Thorson — Polar Explorer, Sailor; and Author and Professor Mac Baird, Chair (retired) of the UMN Department of Family Medicine and Community Health. We wanted you to be one of the ﬁrst to know, as we expect the conference to ﬁll quickly. Please mark your calendar.

By M. Michael Menzel, MD

MetroDoctors

The Journal of the Twin Cities Medical Society

March/April 2018

TCMS Annual Meeting Held On Monday, January 15, 2018, Thomas E. Kottke, MD, MSPH, was installed as President of Twin Cities Medical Society, succeeding Matthew Hunt, MD. Dr. Kottke is the Medical Director for Well-Being at HealthPartners, a board certiﬁed clinical cardiologist in HealthPartners Medical Group, an epidemiologist, and a health services researcher at the HealthPartners Institute for Education and Research. He obtained his medical degree from the University of Minnesota Medical School and trained in internal medicine at the Royal Victoria Hospital (McGill University, Montreal) and at North Carolina Memorial Hospital New TCMS Board Members Kristen Helvig, MD (center) and Sarah Traxler, MD with (Chapel Hill). He President Thomas Kottke, MD. received an MSPH in epidemiology from the School of Public Health, University of North Carolina, Chapel Hill where he was also a Robert Wood Johnson Clinical Scholar. Dr. Kottke trained in cardiovascular diseases and preventive cardiology at the University of Minnesota and is board certiﬁed in internal medicine and the treatment of cardiovascular diseases. After serving on the faculty of the University of Minnesota School, Dr. Kottke moved to Mayo Clinic Rochester where TCMS Board and PAN Advocacy Members Drs. Caleb Schultz and Tyler he was a consultant in the Winkelman. Division of Cardiovascular Diseases and a Professor of Medicine in the Mayo Clinic College of Medicine until June 2004. He now holds the academic rank of Professor of Medicine at the University of Minnesota. Dr. Kottke has contributed to successful health and well-being programs in Finland and the United States for more than 40 years. Members of the TCMS Board of Directors, TCMS Foundation, 26

March/April 2018

Physician Advocacy Network, Honoring Choices Advisory Committee, Environmental Health Task Force, Past Presidents and guests celebrated the new leadership throughout the informal gathering held at Surly Brewing Co., in Minneapolis. Attendees were challenged to test their knowledge of TCMS accomplishments with mock trivia cards strategically placed on tables throughout the venue. MMA CEO Janet Silversmith Cathy Wurzer, host of with Robert Moravec, MD. Morning Edition for MPR News and co-host of Almanac for Twin Cities Public Television, was the guest speaker. Cathy is the public face and voice of The Convenings, an Emmy® Award winning partnership between TCMS/Honoring Choices Minnesota and the Bruce Kramer Collaborative. In 2010, Cathy met Bruce Kramer, who had recently been diagnosed with ALS, and together they began a journey to explore topics around living and dying well. After producing a broadcast series on MPR featuring Bruce and his story, and co-authoring a book with him President-Elect Ryan titled, We Know How This Ends, Cathy Greiner, MD. partnered with the newly-formed Bruce Kramer Collaborative and Honoring Choices Minnesota to launch The Convenings. The evening concluded with the presentation of the First A Physician Award to Chris Johnson, MD. (see related article on page 27). Emmy® Award; President's Award; First a Physician Award.

MetroDoctors

The Journal of the Twin Cities Medical Society

First A Physician Award Christopher Johnson, MD, an emer-

gency medicine physician at Allina Health, was presented with the First a Physician Award, recognizing a physician for effective leadership, involvement in improving the public health, or policy and/or legislative advocacy resulting in a positive impact on the practice of medicine or a healthier community. Recognizing that opiate prescribing was leading to addiction, Dr. Johnson took it upon himself to tackle the problem. He worked not only within his emergency medicine group practice to install changes in prescribing patterns, but also throughout the Twin Cities medical community. He then moved onto a larger task â&#x20AC;&#x201D; to change the way the national medical community prescribes opiates. Dr. Johnson has worked with groups

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throughout the state to develop opiate protocols, contributed articles in the New York Times and Star Tribune. He has spoken all over the country, including testifying in front of the FDA, educating the medical profession about the history of the opiate epidemic, effects of opiates on the brain, and the safe prescribing of opiates. Most recently, he developed the opiate prescribing recommendations for the Minnesota Department of Health. â&#x20AC;&#x153;Dr. Chris Johnson was nominated for this award because he saw an illness developing in society and did what a physician is supposed to do. He diagnosed a problem and has set us on the path to addressing and treating this mental health crisis,â&#x20AC;? stated Carolyn McClain, MD, TCMS Board member.

The Journal of the Twin Cities Medical Society

Drs. Carolyn McClain and Thomas Kottke presented the First a Physician Award to Chris Johnson, MD (right).

March/April 2018

Breathing new life into sustainability The future of health and sustainability are bound together. At HealthPartners, weâ&#x20AC;&#x2122;re committed to providing a healthier, cleaner and more livable environment. Itâ&#x20AC;&#x2122;s the right thing to do. It also improves the long-term health for everyone, and everything, living in our community. Our 25,000 team members are dedicated to taking care of the places we live and work. Across our organization, we have a shared focus on energy efficiency, waste minimization, resource conservation and building strong community partnerships.

Dana Slade, Director HealthPartners Sustainability Programs

In Memoriam RENO BACKUS, MD, passed away on November 24, 2017. Dr. Backus was a Pediatric Neurologist at the Minneapolis Clinic of Neurology. He joined the medical society in 1958.

Sanne Magnan, MD, PhD Receives Shotwell Award

t the top of Dr. Sanne Magnan’s curriculum vita, she states her professional objectives are to: provide leadership for improving health (physical, mental, social and spiritual well-being) in our communities through the redesign of care, redesign of incentives, and citizen and community engagement to improve the social determinants of health. Her commitment to these objectives was evidenced throughout her 30+-year career. Dr. Magnan started her career as a staff physician at Ramsey Clinic (HealthPartners) as a medical care provider and teacher of residents and medical students. Armed with a passion to improve community health, she took on leadership positions at Blue Cross Blue Shield, ﬁrst as the Associate Medical Director of Blue Plus, and then as the Medical Director of the Center for Prevention, while also working as a staff physician at the Tuberculosis Clinic at Saint Paul-Ramsey County Department of Public Health. In 2006 she accepted the position of CEO of the Institute for Clinical Systems Improvement (ICSI), an organization that focused on establishing guidelines and quality improvement markers in pursuit of the Triple Aim — better care, better health, and lower cost. Under her leadership the DIAMOND program, a ground-breaking, team-based model for caring for patients with depression in the primary care clinic, was developed. In 2007, Dr. Magnan was appointed as Commissioner of Health, State of MetroDoctors

MANUAL BINDER, MD, passed away January 20, 2018. Dr. Binder was a general surgeon practicing primarily at Mount Sinai Hospital. He joined the medical society in 1951. CHARLES T. BROWN, JR., MD, passed away on November 24, 2017. Dr. Brown practiced Obstetrics/Gynecology in St. Paul for over 40 years. He joined the medical society in 1966. GEORGE DORSEY, JR., MD, passed away on December 5, 2017. Dr. Dorsey was a partner at the Minneapolis Clinic of Neurology and Psychiatry. He joined the medical society in 1959.

Chris Johnson, MD, Chair, TCMS Foundation Board of Directors (right), presents 2017 Shotwell Award to Sanne Magnan, MD, PhD.

Minnesota; a position she held until December 2010. During this tenure she worked tirelessly to implement health reform legislation, most notably creating the Statewide Health Improvement Program (SHIP) addressing tobacco and obesity; establishing a certiﬁcation of primary clinics as health care homes; and a system for provider peer grouping. She returned to the position of ICSI CEO in 2011, serving for another ﬁve years before joining the HealthPartners Institute for Education and Research as a Senior Fellow. Throughout her career, Dr. Magnan was able to knit together all the hats she wore and was consistently a strong voice for collaboration, impacting health and wellbeing in our community. It is without hesitation, the Twin Cities Medical Society Foundation, in partnership with the Shotwell Award Selection Committee, honors the outstanding work of Sanne Magnan, MD, PhD, with the 2017 Shotwell Award.

The Journal of the Twin Cities Medical Society

RICHARD GRANQUIST, MD, passed away on December 24, 2017. An Orthopedic Surgeon, Dr. Granquist joined the medical society in 1955. ROBERT JEUB, MD, passed away on October 13, 2017. Dr. Jeub practiced Psychiatry and Neurology at Fairview, North Memorial and many other metro area hospitals. Dr. Jeub joined the medical society in 1956. MICHAEL P. KAYE, MD, passed away on December 17, 2017. Dr. Kaye was a pioneer in heart and lung transplantation, and served as Professor at the University of Minnesota and the University of California-San Diego. He joined the medical society in 2005. STEVEN KULENKAMP, MD, passed away on January 6, 2018. Dr. Kulenkamp practiced family medicine for 42 years. He joined the medical society in 1979. JEAN C. SAUER, MD, passed away on December 9, 2017. A Minneapolis based psychiatrist, Dr. Sauer was a long-time member of the TCMS Senior Physicians Association.

March/April 2018

From Hospice to Center Stage

he Convenings continues to host events around Minnesota, designed to inspire communities to explore meaningful ways of living and dying well. On January 25, Cathy Wurzer of MPR hosted a combined Faribault and Owatonna reConvening event at the Trinity Lutheran Church in Owatonna. It was a truly special evening full of music, stories and conversations on living and dying well. Joining Cathy onstage were several inspirational community members, including Haylee Brown, Music Therapist with Allina Hospice, and Mandy Blume, author, retired nurse practitioner and now a patient of Haylee’s (both pictured with

CAREER OPPORTUNITIES

March/April 2018

Thank you again to Mandy, Haylee and Cathy). Mandy shared that she “needs a everyone else who shared their stories with way to express the dying part that’s very us in Owatonna. real for me,” but she found that her family had a hard time hearing this from her. She turned to music because “it’s easier to communicate through music and it helps me know that I’m telling them what I have to say before I go.” After sharing with Cathy onstage, Mandy and Haylee honored the audience with a debut performance of their original song “Wait for Me”© (lyrics by Mandy and music by Haylee). (L to R) Haylee Brown, Music Therapist with Allina Hospice; Mandy Blume, Author and Retired Nurse Practitioner; Cathy Wurzer, Host of Morning Edition for MPR News.

See Additional Career Opportunities on page 31.

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March/April 2018

LUMINARY of Twin Cities Medicine By Marvin S. Segal, MD

CASSIUS MARCELLUS CLAY ELLIS III, MD Our Luminary’s namesake and probable distant relative, Cassius Marcellus Clay, aka Muhammad Ali — floated like a butterfly and stung like a bee while referring to himself as ‘The ‘Greatest’. There were similarities between the two Cassiuses — let’s see what they might have been. Dr. Ellis was born and raised in Frankfort, the capital of Kentucky, and grew up in that area’s segregationist atmosphere of the mid-20th century. He obtained his BS degree at his hometown Kentucky State College, and his MD at Meharry Medical College in Nashville. After internship, he served as an Army physician in Germany where he and his beloved wife, Phyllis, began raising their young family, eventually numbering four children — who, according to son Clay, have remained very close through the years. After service discharge, Cassius came to our U of M where he completed a surgical residency in 1970. His private practice of general surgery and teaching career began soon after as he deeply immersed himself into our Twin City community — a commitment that would span nearly 30 years until his untimely death at age 61. Dr. John Najarian, former U of M surgical chief, marveled at “Cassius’s God given talents.” Dr. Ellis was the Director of Surgical Education at Mt. Sinai and North Memorial Hospitals as he rose to the rank of Clinical Professor. Rotation through his teaching service was the most popular and sought-after by students and residents. It was a joy for this author to have personally witnessed that giant of a man gently impart medical wisdom to eager students and softly guide the hands of budding surgeons in the operating room. His Socratic teaching method extracted maximal effort from his students in a fair though demanding fashion. Along the way, Cass accumulated multiple teaching awards, and an Outstanding Surgical Resident award has been named for him in perpetuity at the U. Both his medical colleagues and his patients warmly respected him. As an African American physician in Minnesota, he was part of a distinct minority. He never overtly allowed that to concern him — he was tolerant, a staunch diversity proponent and ‘color blind’. He has been described as “a tireless champion of the poor and disadvantaged, possessed of that special talent of making all people feel comfortable.” He selflessly contributed countless hours in bringing his clinical expertise to major inner cities clinics. While referring to Cassius’s position as Assistant Dean of the U of M Medical School, 32

March/April 2018

Dr. Louis Sullivan — then the U.S. Secretary of Health and Human Services — stated, “as an excellent advocate, coach and mentor, his efforts were extremely successful in increasing the number of minority medical students.” He was a true leader, clearly demonstrated by positions as Chief of Staff of Mt. Sinai, board member of the William Mitchell College of Law, and President of the Minnesota State Board of Medical Examiners. Right up to his death, he enjoyed a highly successful surgical referral practice — always being available to help while somehow also finding time to publish peer-reviewed articles on a variety of surgical conditions from peptic ulcers to colonic adenomas. Cass’ wry sense of humor, infectious optimism and diligence are evident from a pair of personal encounters. Once, just after carefully settling his generous frame on to one of my brittle dining room chairs and upon hearing a very loud creaking sound, he grinningly said to me in his soft southern drawl, “Had ya worried there for a minute, didn’t I?” Another time during the torrential rain and flood of 1987, after making early evening hospital rounds, he waved good-bye as he headed home. Stopping a number of times to aid stranded citizens find high ground and safe shelter, he arrived home, soaking wet, near midnight, according to Phyllis. About 7:00 the next morning, he was back at the hospital cheerily scrubbing-in for his first case of the day. Now . . . were there really similarities between our Cassius, an accomplished surgeon, and his prize-fighting namesake younger cousin? Kentucky born and bred — yes. Bright — yes. Enthusiastic — yes. Gifted — yes. Idealistic — yes. Wise — yes. Charming — yes. Steadfast — yes. Inspiring — yes. Popular — yes. A champion — yes. “The Greatest” — oh, yes. This last page series is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine. Please forward names of physicians you would like considered for this recognition to Nancy Bauer, Managing Editor, nbauer@metrodoctors.com.

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