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 doctor Winnie
Armand, the associate director at the Mass General
Center for the Environment and Health, and doctor
Greg Fury, medical director for climate and sustainability
at Brigham and Women's Hospital.
Thank you both so much for joining me
today. Thank you for having us. Yeah. Thank
you. It's a pleasure. Yeah. I think it's
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 health care sector
contributes
around 9%
of US greenhouse gas emissions,
and we're starting to see more systems
be intentional here and start to take action.
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?
Sure. I'm 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 a meter in sustainable health
care 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 meter 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 twenty, twenty five years,
this work was largely
focused on energy. And full 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 that
we're do are reducing our impact on the
environment. So some of the
big investments that National Brigham has made over
the past twenty five 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,
one and two,
investments in on-site renewables. So a number of
our facilities
have rooftop solar.
More recently, we have been investing in kind
of off-site renewables through something called a virtual
power,
power purchase agreement.
Initially, we worked on purchasing renewable energy from
a wind farm in New Hampshire, and then
just and quite recently,
in collaboration with Harvard, MIT, and Apex Clean
Energy as as well as a few other
smaller players,
we established something called the consortium for climate
solutions,
which is basically
invested in two large scale renewable energy projects,
that will provide clean energy
equivalent to the NLU usage of about a
130,000
homes over fifteen years.
So for now twenty five 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 planning to continue doing this
work. We're actually just finishing up something that
we call the decarbonization
master plan. That's gonna be essentially a roadmap
for many of our facilities
to essentially,
decarbonize
and and eliminate emission 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
It 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 gonna 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,
of threats. We're also working on building a
new building at,
at, actually, Winnie's institution,
Mass General Hospital.
That's gonna be nearly a net zero building.
So it's probably 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 similar types of buildings that I
would say align our goals of providing high
quality and excellent clinical care to our patients,
but also doing so in a way that
has minimal environmental impact. And then the other
thing I would just add is that I
mentioned, you know, 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 quarters or 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 in provide in 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 connection between climate
change, human health, health care delivery, and our
role in driving those solutions.
So,
so I think, you know, this work really
started with energy, but it's expanded,
substantially over the past twenty 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.
Yeah. Thank you, doctor. Very helpful to hear
of the context and overview of of that
evolution
that you mentioned.
Doctor 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 is four
and 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, doctor Furry, and that's according 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 systems work and
commitments around sustainability?
Yeah. Our employees have a very similar response,
so much of the 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 health care sustainability
as one of our biannual
quality incentive measures.
And while this training was optional, we had
over ninety
five percent of our clinicians,
do this optional training. So over 2,400
clinicians.
And we actually did survey them, and the
vast majority felt that the 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 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 5.
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 wanna mention
that it's just not Mass General Brigham is
paying attention to the staff,
and health care systems more broadly, but also
to our to our patients. We have a
number of initiatives that try to address
climate change and it's 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.
Yeah. Thank you, doctor Aman. Well, that 95%
on an optional training, that's impressive. It's good
to hear.
And I imagine there's, like, a a recruitment
and retention aspects to that too just, you
know, based on those survey numbers and being
able to to be directly involved
reducing the health systems environmental footprint so far?
Do you have any estimates on savings achieved
through these efforts or other measures and lenses
that you're you're trying to gauge, you know,
how big of an impact these efforts are
having?
Yeah. So
I think it may you may not be
surprised to hear based on what we've 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 health care
sustainability are are can be more difficult to
quantify.
But in terms of our energy, so
I mentioned there, there are essentially three components
to achieving
reductions and emissions related to our energy consumption.
One is through, really through energy conservation.
And and then the other is through production
of renewable energy and purchasing renewable energy.
At this point in time, National Brigham
gets about 80%
of its electricity from renewable resources. So we've
invested heavily in in
in purchasing renewable energy. We would actually be
probably closer to a 100%
if we weren't locked into some longest 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 is the strategic energy master plan that
we've been implementing
over the past four years has basically included
about a 122
energy
conservation projects,
and
that's essentially,
achieved an annual net emissions reduction of about
39,000,000
pounds of c o two. That's really kind
of the the same amount of emissions,
or same 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 our energy
costs
annually by about $4,300,000
as a consequence of,
implementing these types of programs.
I did mention before that it's not we're
not just working in energy space.
For example, I mentioned anesthesia.
What we know is that many health systems
use nitrous ox 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,
like, 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 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 impact.
We have a very large reprogrammer
purchasing reprocess
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,
that have a smaller environmental
footprint
that we can choose preferentially
over,
over alternatives.
The and then there 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 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
these other ways in which
the rethinking the way we deliver clinical care
can can result in substantial,
emission
savings.
Yeah. Thank you, doctor 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 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
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?
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
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. So, that was, something that, one
of our surgical residents
waste.
Our environmental
services team paired up with our perioperative
team and tried to work on repurposing
or upcycling our Blu wrap.
So Blu 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,
of, actual
products.
Our nutrition food services team has also done
a number of things. They they are 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,
in 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, we in
our system in one year, we had about
184,000,000
gloves,
exam gloves that were used. And so,
you can see from these stories from clinical
departments to nonclinical departments, people are working together,
collaborating
on, initiatives that make a difference on a
day to day basis.
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?
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.
So I think it's, it's not I think
it shouldn't be thought of as a burden
or cost, but really something that we
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 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 the acceptance of of, these types
of initiatives.
I agree with everything that Winnie just said.
I I will build upon it a little
bit, I think, and then come 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 it's a if for
health system that are just getting started with
it, there's a 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 health care services that we're
delivering that are having minimal
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
laundable
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 resilience.
And then I think Wendy'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 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.
Yeah. I think really interesting point just around
the resiliency strategy piece too. It sounds like
awareness is a key part of of this
work and educating,
peers and leaders as well.
Well, doctor Armond and doctor Furey, thank you
both so much for joining me for this
conversation today.
Thank you so much for having us. I
appreciate it. Yeah. Thank you. That was really
fun. I appreciate your time.
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 beckershospitalreview.com.
Thanks, everyone.