← Becker’s Healthcare Podcast
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- [00:00]
A
Hi everyone, and thank you for listening to the Becker's Healthcare Podcast. I'm Erica Carbajal, an editor with Becker's Hospital Review. Joining me on Today's podcast are Dr. Winnie Armand, the Associate Director at the Mass General center for the Environment and Health, and Dr. Greg Furey, medical Director for Climate and Sustainability at Brigham and Women's Hospital. Thank you both so much for joining me today.
- [00:26]
B
Thank you for having us.
- [00:27]
C
Yeah, thank you. It's a pleasure.
- [00:29]
A
Yeah, I think it's a really great time for this discussion. I think sustainability is coming up more and more. There's definitely energy growing around the topic when we're talking to hospital and health system leaders. So can you start us off by telling us a little bit about the big picture here? I know the healthcare sector contributes around 9% of U.S. greenhouse gas emissions, and we're starting to see more systems be intentional here and start to take action. So. So can you tell us a little bit about when sustainability actually first emerged as a strategic imperative at Mass General Brigham, and what are some of the most significant investments that the system has made to date to reduce its environmental footprint?
- [01:14]
B
Sure, I'm happy to take this one. So first of all, I think it's critical to state that climate change is a public health crisis. And at mgb, we feel that contributing to a crisis that's taking a devastating toll on human health is at direct odds with our fundamental mission to promote health and well being. And as a leader in sustainable healthcare delivery, we're committed to addressing climate change and its threats to our community's health. So we've actually been doing this work for decades. We've been a leader in this space for a number of years now. But I think what's important to note is that the scope of that work has changed over time. So going back 20, 25 years, this work was largely focused on energy and full transparency. That was driven in large part by the financial savings that could be achieved through energy conservation on site, renewable energy production and purchasing renewable energy. But during that entire time, we've recognized that there was alignment not just with kind of the financial piece of this, but also with, as I mentioned, the public health implications of reduce are reducing our impact on the environment. So some of the big investments that Mass General Brigham has made over the past 25 years in this space, particularly around energy, have been, as I mentioned, on energy conservation. This was largely through what we've called our Strategic energy Master Plans 1 and 2 investments in onsite renewables. So a number of our facilities have Rooftop solar. More recently we have been investing in offsite renewables through something called a virtual power purchase agreement. Initially we worked on purchasing renewable energy from a wind farm in New Hampshire. Quite recently, in collaboration with Harvard, MIT and Apex Clean Energy as well as a few other smaller players, we established something called the Consortium for Climate Solutions and which is basically invested in two large scale renewable energy projects that will provide clean energy equivalent to the annual usage of about 130,000 homes over 15 years. So for now 25 years, Mass General Brigham has really made a concerted effort to address emissions associated with just energy consumption and has been really successful in that space. Moving forward, we're plan to continue doing this work. We're actually just finishing up something that we call the Decarbonization Master Plan that's going to be essentially a roadmap for many of our facilities to essentially decarbonize and eliminate the remaining emissions associated with our facilities. It's not the only way. We're kind of thinking about this in relationship to our facilities. We understand that not only is energy, our energy use really critical, but also just the ability of our buildings to really be resilient in the face of climate change. So one of our buildings at the Spalding Rehabilitation center in Boston was really, it's right on the water on Boston harbor and it was designed to basically take into account the fact that over time we're going to be seeing increased flooding and impacts from climate change on that, on that particular building. And so it's designed to be able to withstand those types of threats. We're also working on building a new building at actually Winnie's Institution, Mass General Hospital that's going to be nearly a net zero building. So it's probably, it's the most environmentally sustainable building that MGB has ever embarked upon and I think serves as a model for many health care institutions who are considering building kind of similar types of buildings that I would say align our goals of providing high quality and excellent clinical care to our patients and but also doing so in a way that has minimal environmental impact. Then the other thing I would just add is that I mentioned those have been some of the types of projects that we've been working on for many years now. But as I mentioned before, the breadth of work has expanded beyond just energy and real estate and into other corriers of our mission like clinical care research and education. So we have projects that are focused on reducing emissions related to anesthesia care from metered dose inhalers. We have a lot of work going on around single use device reprocessing, which allows us to essentially buy back at a reduced price devices that are labeled in single use, but which the FDA actually allows us to have reprocessed by a third party and ensure that they maintain their sterility and their efficacy in providing clinical care. We have a project around greening our research laboratories and reducing emission and energy consumption and emissions associated with research. And I would say we're doing other things to really ensure that employees and trainees really begin to understand the critical connections between climate change, human health, healthcare delivery, and a role in driving those solutions. So I think this work really started with energy, but it's expanded substantially over the past 20 years. And now I think we're beginning to see the same kind of approach to sustainability begin to be visible and present in much of the work that we're doing across MGB.
- [06:43]
A
Yeah, thank you, Dr. Ferri. Helpful to hear of the context and overview of that evolution that you mentioned, Dr. Armand. I know that employee engagement is a big part of this work, and we're seeing that increasingly in different surveys. One of the bigger ones is four in five clinicians have said that they want their hospitals to address climate change and they see it aligned with their organization's mission. To your point earlier, Dr. Furry, and that's according to to a 2024 survey from the Commonwealth Fund. So what are you seeing on this front from employees at Mass General Brigham? How are you gauging their response to some of the health system's work and commitments around sustainability?
- [07:24]
C
Yeah, our employees have a very similar response, similar to the survey that you mentioned. It's clear that our employees also care about climate change and most of them feel that we as an institution should try to address this. And in fact, in 2023, Mass General Hospital offered education on climate change and healthcare sustainability as one of our biannual quality incentive measures. And while this training was optional, we had over 95% of our clinicians do this optional training. So over 2,400 clinicians, and we actually did survey them and the vast majority felt that this type of training was very relevant to both their personal lives, but also their clinical practice, because we do see how climate change is affecting patients and how it can actually interfere also with our health care delivery. So we had a lot of feedback from these physicians that took the training, that they were very grateful for this education and they were also very grateful for the steps that Mass General Brigham was taking. And you can actually refer to more details on that study if you're if your audience is interested, it was published. Our findings are published in the JAMA Network open last year. So. And the other thing I'll just mention is that we are also trying to do more education, not just within our own facility, but share the expertise that some of our colleagues offer from Mass General Brigham. So Greg and I are also launching a sustainability course called Pathways to Net Zero. It's coming up, it's a half day live virtual course on November 5th. And as I mentioned, many of our colleagues, leading experts across disciplines, will be speaking and it's designed to educate about creating a more sustainable healthcare system. And it's open to everybody, staff, executives, administrators, clinicians. And so we do hope you'll join us. But I also want to mention that it's just not Mass General Brigham is paying attention to the staff and healthcare systems more broadly, but also to our patients. We have a number of initiatives that try to address climate change and how it's affecting our own patients. So some of the initiatives I'll mention is an AI tool that's a project that's done in collaboration with IBM and it's to help identify our patients who are most vulnerable to extreme heat and ensuring that they are aware of the resources to help keep them safe. And most recently, we just completed our Community Health Needs Assessment, which is a survey conducted across all of our Mass General Brigham hospitals. And we did include investigations to try to understand better how climate change and pollution is affecting the communities that we serve.
- [10:19]
A
Yeah, thank you, Dr. Aman. While that 95% on an optional training, that's impressive, it's good to hear. And I imagine there's like a recruitment and retention aspects to that too, just, you know, based on those survey numbers and being able to be directly involved in some of those initiatives that you mentioned too. On the clinical care side, I wanted to ask too, just what changes have had the biggest effect in reducing the health system's environmental footprint so far? Do you have any estimates on savings achieved through these efforts or other measures and lenses that you're trying to gauge how big of an impact these efforts are having?
- [11:00]
B
Yeah, so I think you may not be surprised to hear, based on what we discussed earlier, that really kind of our work around energy has been where we've achieved probably the most savings. I'll also say it's the easiest to quantify so we can directly measure our emissions from energy consumption, whereas some of the other aspects of healthcare sustainability can be more difficult to quantify. But in terms of our energy. So I mentioned there, there are essentially Three components to achieving reductions in emissions related to our energy consumption. One is through really through energy conservation and, and then the others through production of renewable energy and purchasing renewable energy. At this point in time, Master Nor Brigham gets about 80% of its electricity from renewable resources. So we've invested heavily in, in purchasing renewable energy. We would actually be probably closer to 100% if we weren't locked into some long term contracts with certain utility suppliers that prevent us from being able to do that. So we've made a commitment to this and that's had a really dramatic impact on reducing emissions from our electricity consumption. I mentioned before our strategic Energy master plans, which each of which really kind of emphasize those three kind of elements. And so most recently this, the Strategic Energy master plan that we've been implementing over the past four years has basically included about 122 energy conservation projects. And that's essentially achieved an annual net emissions reduction of about £39 million of CO2. That's really kind of the same amount of emissions or the emissions that would be generated by about 15,000 cars driven for a year. So really substantial savings. And I think what's most impressive and perhaps most compelling to like to leadership is the financial savings that are achieved with that. So we've reduced our energy costs annually by about $4.3 million as a consequence of implementing these types of programs. I did mention before that we're not just working in the energy space. For example, I mentioned anesthesia. What we know is that many health systems use nitrous oxide. And in anesthesia many health systems use what's called a centralized system. So there's a big tank in one location that gets piped to the ORs and other places where we are using nitrous oxide. And it turns out that those systems leak a lot. Like 90% or more of the nitrous oxide is just leaking in the system. And so at one of our hospitals we have essentially decommissioned that centralized system and moved to a different way of supplying nitrous oxide. So that's resulted in significant, really like huge savings in the amount of nitrous oxide that's being released into the atmosphere. And similarly, there are other anesthetic gases that have a big impact on the climate as well. And, and through concerted efforts just to change clinical practice, we've been able to dramatically reduce the amount of certainly the most potent greenhouse gases that are also anesthetic gases in a really meaningful way. There are other things that we're working on that I think are having an impact. We have a very large program of purchasing reprocessed single use devices as we talked about before. And increasingly we're working with our supply chain partners to identify opportunities there to reduce emissions associated with our supply chain, which we know is the largest single contributor to our overall environmental footprint. And so that means working with suppliers to identify products that have a smaller environmental footprint that we can choose preferentially over alternatives. And then I would say there are other aspects of this that are harder to quantify and weren't necessarily implemented specifically because they were seen as sustainability strategies. But certainly, for example, the dramatic shift to telehealth and virtual care that occurred in the pandemic is associated with really substantial savings in emissions. We know that patient and staff travel to and from our facilities is a relatively substantial contributor to our overall environmental footprint. And so I think it emphasizes that there are these other ways in which the rethinking the way we deliver clinical care can result in substantial emission savings.
- [15:46]
A
Yeah, thank you Dr. Furey. Interesting to hear, especially just around kind of that transition you were mentioning from energy into the more clinical space too and what's happening with the anesthesia gases. And I think we did some coverage earlier this year too on more health systems phasing out dust, fluorine, and that being an impact that has engaged a lot of clinicians have been engaged with too. That leads me to my next question. I think sometimes it can be easy for employees to feel a bit removed from some of the work historically, especially when it's focused more on infrastructure energy. So how does, can you expand a little bit on how sustainability shows up on the ground in the day to day experience perhaps for clinicians and staff?
- [16:33]
C
I'd be happy to answer that. And actually I feel like this is a wonderful segue from the last conversation about how staff really do care about this. Many of our staff do feel very passionate about this issue and they really want to be involved in sustainability efforts on a day to day level. So I'd love to share some examples from across the different departments, some stories that have been, I think really powerful and, and very impactful. For example, we did have a recent surgery resident who spearheaded an initiative called Watching Our Waste and it was a project aimed to minimize the contamination of regulated medical waste, which many people think of as red bag waste. It's waste that is potentially infectious and so it has to be treated differently. And so because of that it's much more costly financially, but also has a much larger emissions footprint, up to five to 10 times more on both fronts. That was something that one of our surgical residents initiated and really tried to think about thoughtful processes in the or. To try to minimize contamination of the red bag waste, our environmental services team paired up with our perioperative team and tried to work on repurposing or upcycling our blue wrap. So blue wrap is that very tough plastic wrapping that is used to protect surgical instruments and help keep them sterile when they're in landfill. They essentially do not degrade. And this plastic wrap generates about 7% of our hospital waste. So they were able to work together environmental services with the clinical teams to try to use a third party vendor and divert this blue wrap where it's upcycled into things like bags and other types of actual products. Our nutrition food services team has also done a number of things at Mass General. They serve a lot of meals. Our hospital kitchen serves more than 30,000 meals a day. That's our staff, our patients and their families. So in the years, most recent years, there have been growing numbers of plant based meal options. Our chicken has been antibiotic free for quite some time. And the cafeteria diverts the food waste into a composting that is then actually converted to energy through an anaerobic digestion process. And I'll make one more story I'll just share, which is actually just happening right now because it's flu season. Coming up, our occupational health services is leading a campaign to educate staff on both proper hand hygiene before giving vaccines, but also proper decisions about glove use because the gloves are not required for most routine vaccines and we use a lot of gloves. So in our hospital, in one year, in our system, in one year we had about 184 million gloves, exam gloves that were used. And so you can see from these stories, from clinical departments to non clinical departments, people are working together, collaborating on initiatives that make a difference on a day to day basis.
- [20:03]
A
Yeah, thanks for help painting that picture. Helpful examples to hear. Well, to close us out, I would love to hear just some advice from each of you. I think obviously you both know no shortage of immediate tangible issues that health systems are navigating right now. Whether it's related to financial pressure, staffing shortages, navigating all of the shifting policies. What advice might you give to colleagues at hospitals and health systems that are in the infancy of their sustainability journey, particularly when it comes to getting the ear of their executive peers who might not be seeing climate as a tangible or urgent issue?
- [20:43]
C
I'm happy to start with a couple thoughts. I think one of the main messages to repeat over and over again is that sustainability is really aligned with our mission in the health care sector because climate change does have very dire consequences for public health and sustainability actually will strengthen our operational resilience over time. I think it shouldn't be thought of as a burden or cost, but really something that we is an, as an imperative and it is aligned with our mission. And as a follow up to that, that many of the initiatives actually offer return on investment because it's cutting waste and cost and it becomes more efficient. So actually there are multiple benefits with many of these initiatives. And then the last thing that I'll say, and I'll pass it over to Greg, is to just really start with easy wins, things that are low cost or staff led, but also share those success stories. Because I think that really does propel the culture and the excitement and the acceptance of these types of initiatives.
- [21:54]
B
I agree with everything that Winnie just said. I will build upon it a little bit, I think. And it comes back to this idea of confronting all of these pressures simultaneously. And I think to follow up what Winnie said, it's it. In many situations, sustainability initiatives are aligned with our other priorities. So I talked a lot about how our investments in energy conservation and using renewable energy have really resulted in substantial cost savings. And so similarly, when we buy reprocessed goods, not only is that reducing the environmental impact of the products that we're using, but it's also saving us money. So there are a lot of financial opportunities to be had as they relate to sustainability initiatives. That's not true for everything. But for health systems that are just getting started with it, that can be a really compelling argument. I also think it aligns with other types of priorities. A big one is just quality. So everything we do in medicine is associated with some sort of environmental impact. So for systems who are interested in also kind of reducing low value care, bringing the sustainability perspective into it aligns closely with that. Right? So if we can reduce the amount of healthcare services that we're delivering that are having minimal benefit for our patients, not only does that save money, but it also eliminates avoidable environmental harm. I think resiliency is another great example. So during the pandemic we have about 13 kind of hospitals that are part of our network. At the beginning of the pandemic and still today, 12 of those 13 hospitals were using single use disposable isolation gowns for contact precautions. The pandemic hit and as I'm sure most people remember, there was a dramatic increase in the demand for ppe. It was really hard to meet that. Our one hospital that had never switched to using disposable gowns and was just using laundry isolation gowns just weathered that storm without any problem. And so many sustainable solutions are also kind of resiliency strategies. And I think that's an important message, particularly as increasingly we were confronted with these, these challenges to either our supply chain or other kind of resilience or other challenges to our resiliency. And then I think Winnie's kind of already alluded to this, but the alignment with just kind of workforce morale, we hear a lot about burnout in the workplace. This is an issue that people care about. And I think working for an institution that they know also priorities prioritizes this is, is really helpful for workforce retention. So I think, you know, there, there are a number of different ways in which health systems can really begin to, to begin their sustainability journey, but many of them do not need to be in direct opposition to other institutional priorities.
- [25:01]
A
Yeah, I think really interesting point just around the resiliency strategy piece too. It sounds like awareness is a key part of this work and educating peers and leaders as well. Well, Dr. Armand and Dr. Furey, thank you both so much for joining me for this conversation today.
- [25:20]
B
Thank you so much for having us. We appreciate it.
- [25:22]
C
Yeah, thank you. It was really fun. I appreciate your time.
- [25:26]
A
Yeah. And listeners, thank you for tuning in. To access more episodes of the Becker's Healthcare Podcast, please visit the podcast page on our website at Becker's Hospital Review. Com. Thanks, everyone.