Dr.FrancesMortimer,MedicalDirectorCentreforSustainableHealthcare
Medact annualforum9th December2016
TheSustainableClinician
“Ourvisionofsustainablehealthandcare:Asustainablehealthandcaresystemworkswithintheavailableenvironmentalandsocialresourcesprotectingandimprovinghealthnowandforfuturegenerations.”
Protectinghealthoffuturegenerations
CENTRE forSUSTAINABLEHEALTHCARE
Sustainabilityasadomainofquality
SustainablePatient CentredEquitable
Efficient
Effective
Timely
Safe
Dr Donal O’DonoghueNational Clinical Director
for Kidney Care
Seealso:Atkinson,S.etal.Defining QualityandQualityImprovement.Clin Medvol.10,no.6537-539(2010)
Sustainable value in healthcare:
Academy of Medical Royal Colleges, 2016 (with CSH)
(goods – harms)
Informedbypatientvalues
outcomesValue =
environmental + social + financial costs(the “triple bottom line”)
CENTRE forSUSTAINABLEHEALTHCARE
EstatesClinical
Carbonfootprint– NHSEngland
Procured(pharmaceuticals,equipment,everythingelse)
Travel
Buildingenergyuse
Commissioned
CENTRE forSUSTAINABLEHEALTHCARE
NHScarbonfootprint– goodsandservicescarbonhotspots
CENTRE forSUSTAINABLEHEALTHCARE
Summaryofprogress
Sustainableclinicalpractice
Reducecarbonwithoutreducing
health
Reduceactivity
Prevention
Selfcare
Leanpathways
Reducecarbonintensity
Lowcarbonalternatives
Sustainableestates
Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11
Outcomeneeded
Secondarydrivers
Primarydriver
Primarydriver
CENTRE forSUSTAINABLEHEALTHCARE
Sustainableclinicalpractice
Reducecarbonwithoutreducing
health
Reduceactivity
Prevention
Selfcare
Leanpathways
Reducecarbonintensity
Lowcarbonalternatives
Sustainableestates
Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11
Outcomeneeded
Secondarydrivers
Primarydriver
Primarydriver
CENTRE forSUSTAINABLEHEALTHCARE
CENTRE forSUSTAINABLEHEALTHCARE
Fiveyearforwardview
• ‘Gettingseriousaboutprevention’
• ‘Empoweringpatients’
• ‘Newcaremodels’
Sustainableclinicalpractice
Reducecarbonwithoutreducing
health
Reduceactivity
Prevention
Selfcare
Leanpathways
Reducecarbonintensity
Lowcarbonalternatives
Sustainableestates
Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11
Sustainableclinicalpractice
Outcomeneeded
Secondarydrivers
Primarydriver
Primarydriver
Infrastructure&processCENTRE for
SUSTAINABLEHEALTHCARE
e.g.drypowderinhalers(1/18xcarbonofMDI)
Thesustainableclinician
Advocacy
Qualityimprovement
Resourcemanagement
Clinicalpractice
Academy of Medical Royal Colleges, 2014 (with CSH)
Clinicalpractice?
Dr.HughRayner
QueenMargaretHospitalRenalUnit,FifeGreenNurse:MaryThomson
2009
14,000dialysistreatmentsperyear– 2.9kgwasteeach
40.3tonnes /year
100%incineratedasclinicalwaste
Resourcemanagement
CENTRE forSUSTAINABLEHEALTHCARE
• Normalsalinebags,togetherwithprimingsetsanddrainagebags,replacedwithonlineinfusion
• Dressingpacksreplacedwithindividualitems
• IVinfusion>bolus(6,175antibioticdoses/yr)
• Introducedwastesegregation
Queen Margaret HospitalNHS Fife
Resourcemanagement(2)
Saving:£45,000/yr
CENTRE forSUSTAINABLEHEALTHCARE
SustainableQI
Mortimer, F.,insubmission 2016
SusQI:improvingpre-oppathwaysAprimarycareteamnoticedthatsomepatientswhowerereferredforhipand
kneereplacementswerebeingreferredbacktotheGPsurgeryafterpre-operativeassessmentatthelocalhospital.Thiswasbecauseparameters,such
asbloodpressure,wereeitheroutsidethetargetrangeorwerenotcommunicatedproperlyinthereferralinformation.Anauditrevealedthat1in
6patientsloopedthroughthesystem– 10/year.
Activity Outcome £’s CO2e Social
ExtraGPconsult [delaytosurgery]
£451 18kg2 Patient&carertime/stress
ExtraHospitalconsult
[delaytosurgery]
£1121 23kg2 Patient&carertime/stress(parking…)
Total (for 10loops) £1570 410kg
1. Unit CostsofHealthandCare,PSSRU,December2015.Availableat:http://www.pssru.ac.uk/project-pages/unit-costs/2015/index.php
2. Carbon Hotspotsupdate forthehealth andcaresectorinEngland2015,SustainableDevelopmentUnit, January2016.
CharlieKenward,SevernGPST3SustainabilityScholar2014-15
Advocacy
Advocacy
http://networks.sustainablehealthcare.org.uk
http://sustainablehealthcare.org.ukfrances.mortimer@sustainablehealthcare.org.uk
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