the sustainable clinician - medact · sustainable healthcare sustainability as a domain of quality...

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”)


EstatesClinical

Carbonfootprint– NHSEngland

Procured(pharmaceuticals,equipment,everythingelse)

Travel

Buildingenergyuse

Commissioned


NHScarbonfootprint– goodsandservicescarbonhotspots


Summaryofprogress

Sustainableclinicalpractice

Reducecarbonwithoutreducing

health

Reduceactivity

Prevention

Selfcare

Leanpathways

Reducecarbonintensity

Lowcarbonalternatives

Sustainableestates

Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11

Outcomeneeded

Secondarydrivers

Primarydriver

Primarydriver



Fiveyearforwardview

• ‘Gettingseriousaboutprevention’

• ‘Empoweringpatients’

• ‘Newcaremodels’


Reducecarbonwithoutreducing

health

Reduceactivity

Prevention

Selfcare

Leanpathways

Reducecarbonintensity

Lowcarbonalternatives

Sustainableestates

Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11


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


• Normalsalinebags,togetherwithprimingsetsanddrainagebags,replacedwithonlineinfusion

• Dressingpacksreplacedwithindividualitems

• IVinfusion>bolus(6,175antibioticdoses/yr)

• Introducedwastesegregation

Queen Margaret HospitalNHS Fife

Resourcemanagement(2)

Saving:£45,000/yr


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

http://networks.sustainablehealthcare.org.uk

http://sustainablehealthcare.org.ukfrances.mortimer@sustainablehealthcare.org.uk

the sustainable clinician - medact · sustainable healthcare sustainability as a domain of quality...

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