Healthcare accounts for 7% of the total Dutch carbon footprint. The causes are complex and diverse, while the initiatives to reduce those CO2 emissions are often local and not always coherent. In order to get a bottom-up grip on the phenomenon of 'helping to green hospitals', Medical Delta and the LDE Centre for Sustainability started the Interdisciplinary Thesis Lab 'Sustainable Hospitals'. Nine master's students from various disciplines at the universities of Leiden, Delft, Rotterdam and Twente were presented with this problem and asked to write their master's thesis on this topic.
This unique interdisciplinary approach not only provides insight into each other's knowledge and skills, but also gives direction to the approach to greening healthcare from a broad scope. In addition to the individual observations, a joint position was formulated with a common conclusion on how to green healthcare; from awareness to action from on high.
Following the thesis lab, a round table meeting was organized led by university experts and stakeholders from various disciplines. The aim was to learn from each other and to find out what the students are calling for. Following this, there was a Medical Delta Café about the greening of hospitals.
Click here to watch the Medical Delta Café "Greening of hospitals - more thinking or more doing? (in Dutch)
Through the thesis lab, the nine master's students received bi-weekly lectures, excursions and meetings with stakeholders for five months, allowing them to exchange ideas with each other and with experts. This input was used to get them started on their master's theses.
"Making healthcare more sustainable is complex, with many different interests at play. How do you shape that process? That is what makes this thesis lab so special. Students from all sorts of backgrounds have thrown themselves into the same topic, found the common problems and formulated recommendations," says Prof. Dr. Frank Willem Jansen, president of Medical Delta. "In doing so, the students entered into a dialogue with practitioners: the scientists and healthcare providers in the hospital. With this, Medical Delta and LDE Centre for Sustainability are facilitating a concrete interdisciplinary approach to more sustainable care. There are separate initiatives everywhere in healthcare, but people do not always know where to find each other. Interdisciplinary collaborations are needed to green healthcare."
Click on the links below to download some of the 2022 theses:
Clinical Microbiology Laboratories’ Transition to a Sustainable Future - Yuanyuan (Alice) Wu
The effects of patient safety culture on employee green behavior - Anouk de Reeder
What steps should we take to green healthcare? Medical Delta and the LDE Center for Sustainability held a round table to discuss this question. Participants came from a variety of disciplines and positions inside and outside of healthcare: from nurses to student researchers at the RIVM (National Institute for Public Health and the Environment) to scientists in engineering and sustainability.
The nine master's students who participated in the thesis lab are conducting research into all kinds of aspects of greening in the hospital - from waste in the ICU to decision-making about greening in the healthcare sector. In addition to their own research, they also presented a joint conclusion as a common thread for the further greening of hospitals. Students Elaine van Ee and Anouk de Reeder named the obstacles that many students had encountered.
The healthcare sector is currently governed by short-term financial incentives rather than longer-term sustainable solutions. The hospital culture is inherently reluctant to embrace change - such as sustainable innovations. Healthcare executives must balance along the many societal interests, such as the right financial balance, patient safety, laws and regulations, and the environment. Barriers to greening hospital care therefore lie in the areas of legislation and regulation and in the social, financial and material realms, the students concluded.
The students came up with concrete advice in various areas. For example, working practices can change both inside and outside the hospital by rewarding sustainable behavior among all stakeholders. They also noted that those involved must adopt a more active attitude. This can be done by creating more awareness. An example of this is a photo exhibition about the amount of waste created in the emergency room. This exhibition is currently on display in the emergency room of the LUMC and, because of its success, will go on tour to other hospitals.
Hospitals should also take a critical look at unnecessary safety measures that generate a lot of waste or CO2. Or break habits that pollute the environment, such as medical imaging equipment that is left on all day, even when not in use. Another recommendation is to identify hotspots and set specific departmental targets. Sustainability should also be a regular part of medical education, so that healthcare professionals already think about this as students.
After the joint conclusion of the master students, experts presented their views. Dr. René Kleijn, senior lecturer at the Institute of Environmental Sciences (CML) of Leiden University, studies the life cycle of products. He always starts with this rule of thumb: less is better. Less material, fewer procedures and less energy is generally better for the environment. He advocated thinking in systems, rather than in individual parts and products. Sustainability is a complex issue involving all kinds of processes and users throughout the healthcare system. More transparency and collaboration is therefore badly needed, about the production and supply chains of materials and medicines.
Dr. ir. Jan-Carel Diehl, associate professor at the Faculty of Industrial Design at TU Delft, is researching the use of consumables in intensive care together with colleagues at teaching hospitals in Rotterdam and Leiden. How this can be done more sustainably was nicely illustrated using the ubiquitous disposable glove. A study into the entire 'product journey' of this glove, from factory to incinerator, showed that its use can be reduced by, among other things, adapting the packaging. At this point, often more than one glove comes out, so users throw many gloves away unused. Diehl also advocates looking at the sustainability challenges in the healthcare sector from different perspectives and bringing them together. Not just the environmental perspective, but also those of infection prevention, employees, suppliers and, for example, the infrastructure within a hospital. Again, interdisciplinary cooperation between all stakeholders is the key.
Sustainability should be a value that is given standard attention in healthcare, thinks Dr. Bas van Rijn, senior lecturer in gynecology at Erasmus MC. He conducts research on sustainability in his department. According to van Rijn, we should keep three things in mind that influence sustainability in healthcare. First of all, there is the care itself: some treatments, for example, have a higher impact on the environment than others. Then there is the influence of research and innovation that can lead to new, more sustainable solutions. And finally, the influence of health, including prevention, is important: healthy people may live more sustainably because they need less care. Van Rijn is increasingly getting questions from the current generation of patients about the environmental impact of treatments. They recognize the importance of sustainability.
How about sustainability in the operating room? Maelle Lustig, master's student in medicine and science intern in anesthesiology, and Hans Friedericy, anesthesiologist and PhD candidate at LUMC, researched it. Lustig examined the environmental impact of different types of surgery. One of the things she sees is that behavioral change can make a big impact. There is still a lot to gain, for example, in the area of waste separation in the operating room. Friedericy studied the OR's carbon footprint. One of the outcomes was that the type of gas used to anesthetize people makes a big difference to emissions. If healthcare professionals have a clear idea of which behaviors and treatments produce the least emissions, they can make conscious choices to reduce them.
The final presentation was by Lowik Pieters MSc and Martijn van Bodegraven MSc, researchers in the field of sustainability at the RIVM. RIVM contributes to scientific research which is important for the Green Deal Sustainable Care. A major challenge at the moment, according to them, is the lack of knowledge and data. For example, the calculation of the environmental footprint of Dutch healthcare is coarse-grained. It is insufficiently known what impact medicines exactly have on the environment and we still know too little about the interaction between sustainability, behavior and safety. Collecting all the data is currently time-consuming, because sustainability in healthcare is decentralized. A solution lies in a combination of a decentralized and more centralized approach to collecting validated data, for example in an independent knowledge base.
The round table made it clear that there is still much to be gained in many areas when it comes to making healthcare more sustainable. We are still in the phase of raising awareness, in which all those involved are slowly realizing that sustainability is important. In any case, to initiate the change to sustainability, it is important to get more collaboration in all layers of the healthcare sector, to provide more transparency about data and to do more research so that we have more knowledge about the environmental impact of healthcare operations. More education in sustainability - not just for students, but for anyone working in or with the healthcare sector - will help. Top-down steering will help drive these changes.