Last year, Region Skåne, along with it’s partner, the City of Malmö, completed the EU Life+ funded CLIRE (Climate Friendly Health and Care) project. The project had been running from 2010-2015 and its main objective was to show that healthcare, through various initiatives, can drastically reduce its climate footprint. To this end, they have produced a new guide called ‘Simple Steps to Reduce the Climate Impact of Healthcare’.
Speaking about the release of the guide, Kristina de Geer, Environmental Manager with Region Skåne said: ‘We have created a Guide that gives 4 simple steps to reduce climate impact from healthcare. We are delighted to share this Guide with other care providers and hope that you will find it useful and supportive of change too a climate smart health care system. In Region Skåne we continue to develop our work with the experience from the EU Life+ Climate Friendly Health and Care (CLIRE) project and we want to share good example with others.’
At the start of the CLIRE project, Region Skåne carried out two climate analyses of the Urology Clinic and the Clinical Hand Unit at SUS University Hospital in Malmö – one for the year 2010 and one for the 12-month period between September 2013 and August 2014. These two clinics were then used as examples in the guide for the work that has been done to reduce carbon emissions. The guide outlines a four-step process towards reducing the climate footprint of healthcare.
Step 1 – Mapping the Environmental Impact:
The first step of the four-step process involves ‘Mapping the Environmental Impact of a Clinic’ and details how data can be collected about the climate impact of different areas involved in healthcare: material consumption, energy consumption, transport, and food.
Hospitals consume huge quantities of materials, many of which are disposable and contribute significantly to carbon emissions. For example, in just one year, Region Skåne buys (among other products and materials) 47.8 million gloves 32 million paper towels, and 700 million syruinges for its activities. The use of materials was identified as the biggest contributor to CO2 emissions, especially the use of disposable materials.
In terms of energy use in healthcare, the energy consumption of medical equipment (such as X-ray machines, which represent 55% of the total energy consumption of medical equipment), other equipment directly related to healthcare (such as cleaning and sterilisation apparatus, monitors, etc.) as well as computer equipment, printers/copying machines, and TV sets are all taken into consideration.
Emissions from healthcare-related transport is broken down into four main categories: goods transport, commuting to work, work trips and patient transport, and is identified as another major contributor to carbon emissions.
Finally, food consumption is identified as producing one quarter of the emissions that affect the climate in Sweden. Along with the massive emissions of methane and nitrous oxide from meat production, about 80% of all arable land in Sweden is used to grow animal fodder. Given that the average Swedish person consumes 80kg of meat per year (weight including bones), and the large amount of food produced and consumed in hospitals, food is an important area for reducing GHG emissions.
As well as discussing the climate impact of these different areas of healthcare provision, the guide also provides calculation models for estimating the carbon footprint of these activities. Using these simple calculation models, healthcare facilities and hospitals can calculate their own climate impact from different activities.
Step 2 – Studying the Results and Identifying the Areas with the Greatest Impact:
The second step in the guide outlines the step after the mapping process is finished – studying the results to be able to identify the areas within your own clinic that have the greatest environmental impact. Taking the example of the Urology Clinic and the Clinical Hand Unit in Malmö, the results from that mapping process showed that the greatest climate impact was from the use of materials.
Examining these results leads us to step three of the guide, working to reduce the climate impact.
Step 3 – Working with Measures to Reduce Impact:
Step three of the guide details the practical steps that healthcare facilities and hospitals can take to reduce their climate impact, after the mapping and identifications phases of the previous steps.
Use of materials
In terms of the largest area of climate impact, materials, the guide outlines four areas that affect carbon dioxide emissions from material use:
- Choice of materials in the product
- Type of product (disposable or reusable)
- Unnecessary consumption
- Work methods
For example, in term of unnecessary consumption, the guide gives the example of examination gloves in Region Skåne, where 47 million gloves are used every year. These gloves were difficult to remove from their packaging and came in packages of 150, which were tightly packed. Often, when removing these gloves, some would fall to the floor and had to be thrown away without being used. A review of wastage carried out on two occasions in the two units showed that 6% of gloves fell out this way and were subsequently wasted.
In just two months, 1,446 gloves were dropped on the floor at the Urology Clinic featured in the guide. This corresponds to more than 13 packages of gloves, and about 25 kg CO2 eq. (CO2 equivalent). As a result, the possibility to take gloves out of their packaging one by one will be requirements made in the future procurement of gloves.
Another area identified in the guide in which improvements can be made in terms of reducing climate impact is changing work methods. With this in mind, the ‘LEAN’ system has been developed and implemented by a working group at SUS Malmö. This is a system in which departments can find a smarter work method that is better for all parties. Through the principles of ‘LEAN’, hospital/clinic employees aim to:
- Reduce wastefulness
- Make activities/flows more effective
- Free up value-creating time
Part of this system involves identifying the current patient flow with a view to improving it’s efficiency and effectiveness. By examining the patient flow of bladder cancer patient at the Urology Clinic (these patients make up 25% of all patients of the clinic), a working group was able to establish that the existing patient flow at the clinic took 80 days on average, from a referral arriving at the clinic to the patient receiving a diagnosis. The group identified that the ideal patient flow was about 45 days.
The working group then went about developing ways in which they could improve the patient flow and, to that end, established, amongst other initiatives, the ‘Haematuria Line’ - a direct call line that potential patients could call if they should they discover blood in their urine (haematuria).
Community nurses also work at the Urology Clinic at SUS and they drive about 50,000km per year when they are on duty. In 2013 they took care of 900 patients, generating 1,300 home calls. Of these home visits, 700 would otherwise have led to visits to the clinic or admission. The nurses who carry out these calls use two biogas and one ethanol-powered car, whose emissions are estimated at 0kg CO2. By carrying out these 700 home calls, the community nurses’ activities reduced CO2 emissions from transport by about 1000 tons that year.
In addition, the climate analysis carried out at the Clinical Hand Unit and Urology Clinic for the year 2010, each care intervention has a climate impact of about 41.7 kg CO2 eq. 700 fewer admissions/care visits would therefore reduce emissions by about 29 tons per year CO2 eq.
Increased energy efficiency
A number of measures were introduced to increase energy efficiency in both of thee clinics and reduce the use of heating energy and electricity, including:
- Installation of washbasin economy aerators. These increase the water speed while at the same time mixing with air during reduced flow, which in turn leads to 30 per cent lower water flow without reducing the rinsing effect.
- Replacement of old lighting fittings with new modern fittings with more energy-efficient light sources.
- Replacement of the light source in patient toilets from light bulbs to LED.
- Installation of motion detectors (lighting by presence).
- Computerisation of technical equipment, which enables steering for example ventilation plants.
- Replacement of old circulation pumps for warm and hot water with pressure controlled pumps which adapt pressure and flow to needs.
Through these measures, they have reduced the total energy consumption from 4,228MWh (year 2010) to 3,202MWh (year 2013). This is a reduction of 1,026MWh (24 per cent), of which approximately 545MWh was electricity consumption and 481MWh was heating. Calculated with the help of the emission factors for electricity and district heating, this means reduced greenhouse gas emissions by 38 tons CO2 eq for 2013 compared to 2010.
Step 4 – Evaluating the Results:
When evaluating the results and impact of this project, the guide suggests five simple questions that should be used when carrying out an evaluation:
- How did it look before we started the work?
- What changes have we made?
- What did we want to achieve with the changes?
- What have we achieved?
- What are the results of what we achieved?
Another important aspect of the evaluation process is examining what didn’t work in the process, and why.
With this fantastic step-by-step guide, the CLIRE project shows how simple steps can go a long way towards reducing the climate impact of healthcare. By following these simple steps, hospitals and healthcare facilities can take the lead in reducing their climate impact and protecting public health. The healthcare sector is a major consumer of resources and energy in Europe and needs to start reducing its impact on the environment and public health drastically. This guide shows how this can be done in a simple, effective way. As the guide concludes:
"To work with change processes is fun and develop- mental. When in addition you have the opportunity to analyse the good results, it often gives a kick that encourages you to move on to the next project, develop the next process, improve, renew."
Download the guide in full here.