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Advancing Healthcare Sustainability at Mass General Brigham · Becker’s Healthcare - Clinical Leadership Podcast

0:00
Hi, everyone, and thank you for listening to
0:02
the Becker's Healthcare Podcast.
0:04
I'm Erica Carbajal, an editor with Becker's Hospital
0:08
Review.
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Joining me on today's podcast are doctor Winnie
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Armand, the associate director at the Mass General
0:14
Center for the Environment and Health, and doctor
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Greg Fury, medical director for climate and sustainability
0:21
at Brigham and Women's Hospital.
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Thank you both so much for joining me
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today. Thank you for having us. Yeah. Thank
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you. It's a pleasure. Yeah. I think it's
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it's a really great time for this discussion.
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I think sustainability is coming up more and
0:33
more. There's definitely energy growing around the topic
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when we're talking to hospital and health system
0:39
leaders. So
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can you start us off by
0:42
telling us a little bit about the big
0:44
picture here? I know the health care sector
0:47
contributes
0:47
around 9%
0:49
of US greenhouse gas emissions,
0:51
and we're starting to see more systems
0:54
be intentional here and start to take action.
0:57
So can you tell us a little bit
0:58
about when sustainability
1:01
actually first emerged as a strategic imperative
1:04
at Mass General Brigham, and what are some
1:06
of the most significant investments that the system
1:09
has made to date to reduce its environmental
1:11
footprint?
1:13
Sure. I'm I'm happy to take this one.
1:15
So
1:16
first of all, I think it's critical to
1:18
state that climate change is a public health
1:21
crisis. And at MGB, we feel that contributing
1:24
to a crisis that's taking a devastating toll
1:26
on human health is at direct odds with
1:28
our fundamental mission to promote health and well-being.
1:31
And as a a meter in sustainable health
1:33
care delivery,
1:34
we're committed to addressing climate change and its
1:36
threats to our community's health. So we've actually
1:39
been doing this work for decades. We've been
1:41
a meter in this space,
1:43
for a number of years now.
1:45
But I think what's important to note is
1:47
that the scope of that work has changed
1:50
over
1:51
time. So
1:52
going back twenty, twenty five years,
1:55
this work was largely
1:57
focused on energy. And full full transparency, that
2:00
was driven in large part by the financial
2:02
savings
2:03
that could be achieved through
2:05
energy conservation,
2:07
on-site renewable energy production,
2:09
and purchasing renewable energy.
2:12
But, during that entire time, we've recognized that
2:16
there was alignment not just with kind of
2:18
the financial piece of this, but also with,
2:20
as I mentioned, the public health implications that
2:23
we're do are reducing our impact on the
2:25
environment. So some of the
2:27
big investments that National Brigham has made over
2:31
the past twenty five years in this space,
2:32
particularly around energy,
2:34
have been, as I mentioned,
2:36
on
2:37
energy conservation.
2:39
This was largely through, what we've called our
2:41
strategic energy master plans,
2:43
one and two,
2:45
investments in on-site renewables. So a number of
2:48
our facilities
2:49
have rooftop solar.
2:51
More recently, we have been investing in kind
2:54
of off-site renewables through something called a virtual
2:57
power,
2:58
power purchase agreement.
3:00
Initially, we worked on purchasing renewable energy from
3:04
a wind farm in New Hampshire, and then
3:06
just and quite recently,
3:08
in collaboration with Harvard, MIT, and Apex Clean
3:12
Energy as as well as a few other
3:14
smaller players,
3:15
we established something called the consortium for climate
3:17
solutions,
3:18
which is basically
3:19
invested in two large scale renewable energy projects,
3:23
that will provide clean energy
3:25
equivalent to the NLU usage of about a
3:27
130,000
3:28
homes over fifteen years.
3:30
So for now twenty five years, mass general
3:33
Brigham has really made a concerted effort
3:35
to
3:36
address emissions associated with just energy,
3:40
consumption and has been really successful in that
3:42
space.
3:43
Moving forward, we're planning to continue doing this
3:45
work. We're actually just finishing up something that
3:47
we call the decarbonization
3:49
master plan. That's gonna be essentially a roadmap
3:51
for many of our facilities
3:53
to essentially,
3:55
decarbonize
3:56
and and eliminate emission remaining emissions associated with
3:59
our facilities.
4:00
It's not the only way we're kind of
4:02
thinking about this in relationship to our facilities.
4:05
We understand that not only is energy
4:08
our energy use really critical, but also just
4:12
the ability of our buildings to really be
4:14
resilient in the face of climate change. So
4:16
one of our buildings
4:17
at the Spalding Rehabilitation
4:19
Center in Boston
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It was really it's right on the water
4:23
on Boston Harbor, and it was designed to
4:25
basically take into account the fact that over
4:28
time, we're gonna be seeing increased flooding and
4:31
impacts from, climate change on that on that
4:34
particular
4:35
building, and so it's designed to be able
4:37
to withstand those types of,
4:39
of threats. We're also working on building a
4:42
new building at,
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at, actually, Winnie's institution,
4:46
Mass General Hospital.
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That's gonna be nearly a net zero building.
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So it's probably the most environmentally,
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sustainable building that MGB has ever embarked upon,
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and I think serves as a model for
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many health care institutions
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who are, considering
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building kind similar types of buildings that I
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would say align our goals of providing high
5:08
quality and excellent clinical care to our patients,
5:11
but also doing so in a way that
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has minimal environmental impact. And then the other
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thing I would just add is that I
5:16
mentioned, you know, those have been some of
5:18
the types of projects that we've been working
5:20
on for many years
5:22
now. But as I mentioned before, the breadth
5:24
of work has expanded beyond just energy and
5:26
real estate and into other quarters or of
5:29
our,
5:30
mission, like clinical care, research, and education. So
5:33
we have projects that are focused on reducing
5:36
emissions related to anesthesia care
5:39
from,
5:40
metered dose inhalers.
5:41
We have a lot of work going on
5:43
around single use device reprocessing, which allows us
5:46
to essentially
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buy back at a reduced price devices that
5:49
are labeled in single use, but which the
5:51
FDA actually allows us to,
5:54
have reprocessed by a third party and ensure
5:56
that they maintain their sterility
5:59
and their efficacy in in provide in clinical
6:02
care.
6:03
We have a project around greening our research
6:05
laboratories,
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and reducing emission and energy consumption and emissions
6:10
associated with research.
6:11
And I would say we're doing other things
6:13
to really ensure that employees and trainees really
6:16
begin to understand the critical connection between climate
6:19
change, human health, health care delivery, and our
6:21
role in driving those solutions.
6:24
So,
6:25
so I think, you know, this work really
6:26
started with energy, but it's expanded,
6:29
substantially over the past twenty years. And now
6:32
I think we're beginning to see
6:34
the same kind of approach to sustainability begin
6:36
to be visible and present in much of
6:39
the work that we're doing across MGB.
6:42
Yeah. Thank you, doctor. Very helpful to hear
6:45
of the context and overview of of that
6:46
evolution
6:47
that you mentioned.
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Doctor Armand, I know that employee engagement
6:52
is a big part of this work, and
6:54
we're seeing that increasingly
6:56
in different surveys.
6:57
One of the bigger ones is is four
6:59
and five clinicians have said that they want
7:01
their hospitals to address climate change, and they
7:03
see it aligned with their organization's
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mission to your point
7:07
earlier, doctor Furry, and that's according to a
7:09
2024
7:10
survey from the Commonwealth Fund. So what are
7:13
you seeing on this front from employees at
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Mass General Brigham? How are you gauging their
7:18
response
7:19
to some of the health systems work and
7:21
commitments around sustainability?
7:24
Yeah. Our employees have a very similar response,
7:26
so much of the the survey that you
7:28
mentioned.
7:29
It's clear that our employees also care about
7:32
climate change,
7:33
And most of them feel that we as
7:35
an institution
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should try to address this.
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And in fact, in 2023,
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Mass General Hospital offered education
7:44
on climate change and health care sustainability
7:47
as one of our biannual
7:49
quality incentive measures.
7:52
And while this training was optional, we had
7:54
over ninety
7:56
five percent of our clinicians,
7:59
do this optional training. So over 2,400
8:02
clinicians.
8:04
And we actually did survey them, and the
8:06
vast majority felt that the this type of
8:09
training was very relevant to both their personal
8:12
lives, but also
8:13
their clinical practice,
8:15
Because we do see how climate change is
8:17
affecting patients and how it can actually interfere
8:20
also with our health care delivery.
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So, we had a lot of feedback from
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these physicians that took the training that they
8:27
were very grateful for this education.
8:30
And they were also very grateful for the
8:32
steps that Mass General Brigham was taking. And,
8:35
you can actually refer to more details on
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that study if your audience is interested. It
8:39
was published our findings are published in the
8:41
JAMA network open
8:43
last year.
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So and the other thing I'll just mention
8:46
is that we are also trying to do
8:48
more education, not just within our own facility,
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but share the expertise that some of our
8:54
colleagues offer from Mass General Brigham.
8:57
So Greg and I are also launching a
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sustainability
9:00
course, called Pathways to Net Zero.
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It's coming up. It's a half day
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live virtual course on November 5.
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And as I mentioned, many of our colleagues,
9:10
leading experts across disciplines will be speaking. And
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it's designed to educate
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about creating a more sustainable
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healthcare system. And it's open to everybody,
9:21
staff,
9:22
executives, administrators, clinicians. And so, we do hope
9:24
you'll join us. But I also wanna mention
9:27
that it's just not Mass General Brigham is
9:29
paying attention to the staff,
9:31
and health care systems more broadly, but also
9:34
to our to our patients. We have a
9:35
number of initiatives that try to address
9:38
climate change and it's how it's affecting our
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own patients.
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So some of the initiatives I'll mention is
9:44
an AI tool that's, a project that's done
9:47
in collaboration with IBM.
9:49
And it's, to help identify our patients who
9:52
are most vulnerable
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to extreme heat and ensuring that they are
9:57
aware of the resources to help keep them
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safe.
10:00
And most recently, we just completed our community
10:03
health needs assessment, which is a survey conducted
10:06
across all of our Mass General Brigham hospitals.
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And we did, include,
10:12
investigations
10:13
to try to understand better how climate change
10:15
and pollution is affecting the communities that we
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serve.
10:19
Yeah. Thank you, doctor Aman. Well, that 95%
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on an optional training, that's impressive. It's good
10:24
to hear.
10:25
And I imagine there's, like, a a recruitment
10:27
and retention aspects to that too just, you
10:29
know, based on those survey numbers and being
10:32
able to to be directly involved
10:44
reducing the health systems environmental footprint so far?
10:47
Do you have any estimates on savings achieved
10:50
through these efforts or other measures and lenses
10:53
that you're you're trying to gauge, you know,
10:56
how big of an impact these efforts are
10:58
having?
10:59
Yeah. So
11:01
I think it may you may not be
11:03
surprised to hear based on what we've discussed
11:05
earlier that really kind of our work around
11:07
energy has been where we've achieved probably the
11:10
most savings.
11:11
I'll also say it's the easiest to quantify.
11:14
So,
11:15
we can directly measure our emissions from energy
11:19
consumption,
11:20
whereas
11:21
some of the other aspects of health care
11:23
sustainability are are can be more difficult to
11:25
quantify.
11:27
But in terms of our energy, so
11:30
I mentioned there, there are essentially three components
11:33
to achieving
11:35
reductions and emissions related to our energy consumption.
11:38
One is through, really through energy conservation.
11:42
And and then the other is through production
11:44
of renewable energy and purchasing renewable energy.
11:47
At this point in time, National Brigham
11:50
gets about 80%
11:52
of its electricity from renewable resources. So we've
11:54
invested heavily in in
11:57
in purchasing renewable energy. We would actually be
12:00
probably closer to a 100%
12:02
if we weren't locked into some longest term
12:04
contracts with certain, utility suppliers
12:07
that prevent us from being able to do
12:08
that. So we've made a commitment to this,
12:10
and that's had a really dramatic,
12:12
impact on reducing emissions from our electricity
12:16
consumption.
12:17
I mentioned before
12:18
our strategic energy master plans, which each of
12:22
which really kind of emphasize
12:24
those three kind of elements.
12:27
And so most recently,
12:30
this is the strategic energy master plan that
12:32
we've been implementing
12:34
over the past four years has basically included
12:36
about a 122
12:37
energy
12:38
conservation projects,
12:40
and
12:41
that's essentially,
12:42
achieved an annual net emissions reduction of about
12:45
39,000,000
12:46
pounds of c o two. That's really kind
12:48
of the the same amount of emissions,
12:51
or same the emissions that would be generated
12:53
by about 15,000 cars driven for a year.
12:56
So really substantial savings. And I think what's
12:59
most impressive and perhaps most compelling
13:02
to, like, to,
13:03
leadership is the financial savings that are achieved
13:06
with that. So we've reduced our our energy
13:08
costs
13:10
annually by about $4,300,000
13:12
as a consequence of,
13:14
implementing these types of programs.
13:17
I did mention before that it's not we're
13:19
not just working in energy space.
13:22
For example, I mentioned anesthesia.
13:25
What we know is that many health systems
13:27
use nitrous ox nitrous oxide and in anesthesia,
13:31
many health systems use what's called a centralized
13:35
system. So there's a big tank, in one
13:37
location
13:38
that gets piped to the,
13:40
ORs and other places where we are using
13:43
nitrous oxide, and it turns out that those
13:45
systems
13:46
leak a lot. Like, 90% or more of
13:49
the nitrous oxide is just leaking in the
13:51
system.
13:52
And so, at one of our hospitals, we
13:54
have essentially
13:55
decommissioned that centralized system and moved to a
13:58
different way of supplying
13:59
nitrous oxide. So that's resulted in,
14:03
like, really, like, huge savings in the amount
14:05
of nitrous oxide that's being released into the
14:07
atmosphere.
14:08
And, similarly, there are other anesthetic gases that
14:11
have a big impact on the climate as
14:12
well. And through concerted efforts just to change
14:15
clinical practice, we've been able to dramatically reduce,
14:18
the amount of certainly the most potent greenhouse
14:21
gases,
14:22
that are also anesthetic gases in a really
14:24
meaningful way. There are other things that we're
14:26
working on that I think are having impact.
14:28
We have a very large reprogrammer
14:31
purchasing reprocess
14:32
single use devices as we talked about before.
14:35
And increasingly, we're working with our supply chain
14:37
partners to identify opportunities there to,
14:41
reduce emissions associated with our supply chain, which
14:44
we know is the largest single contributor to
14:46
our overall environmental footprint. And so that means
14:50
working with suppliers to identify products that,
14:53
that have a smaller environmental
14:55
footprint
14:56
that we can choose preferentially
14:58
over,
14:59
over alternatives.
15:00
The and then there I would say there
15:02
are other
15:04
aspects of this that are harder to quantify
15:06
and weren't necessarily
15:08
implemented specifically because they were seen as,
15:12
sustainability
15:13
strategies. But, certainly, for example,
15:15
the dramatic
15:16
shift to telehealth and virtual care that occurred
15:19
in the pandemic is associated with really substantial
15:22
savings in emissions.
15:24
We know that that patient and staff travel
15:27
to and from our facilities is a relatively
15:30
substantial contributor to our overall environmental footprint.
15:34
And so I think it emphasizes that there
15:36
these other ways in which
15:38
the rethinking the way we deliver clinical care
15:41
can can result in substantial,
15:44
emission
15:45
savings.
15:46
Yeah. Thank you, doctor Furey. Interesting to hear,
15:49
especially just around kind of that transition you
15:51
were mentioning from energy into the more clinical
15:54
space too and what's happening with,
15:56
the anesthesia gases. And I think we did
15:59
some coverage earlier this year too on more
16:01
health systems phasing out dust fluorine and that
16:03
being,
16:04
an impact that has
16:06
engaged a lot of clinicians have been engaged
16:08
with too. That leads me to to my
16:11
next question. I think sometimes it can be
16:14
easy for employees to feel a bit removed
16:17
from some of the work historically, especially when
16:19
when it's focused more on infrastructure energy.
16:23
So how does can you expand a little
16:25
bit on how sustainability
16:26
shows up on the ground in the day
16:28
to day experience, perhaps for clinicians and staff?
16:33
I'd be happy to answer that. And actually,
16:34
I feel like this is a wonderful segue
16:36
from the last conversation about how staff really
16:38
do care about this.
16:40
Many of our staff do feel very passionate
16:42
about this issue, and they really want to
16:44
be involved
16:46
in sustainability efforts on a day to day
16:48
level. So, I'd love to share some examples
16:52
from across the different departments, some stories that
16:55
have been,
16:57
I think, really powerful and
16:59
very impactful.
17:01
For example, we did have a recent surgery
17:04
resident who spearheaded an initiative
17:07
called watching our waste. And it was a
17:09
project aimed to minimize the contamination
17:12
of regulated medical waste, which many people think
17:16
of as red bag waste. It's waste that
17:18
is potentially infectious. And so it has to
17:20
be treated differently.
17:22
And so, because of that, it's much more
17:24
costly financially,
17:25
but also has a much larger,
17:28
emissions footprint,
17:29
up to five to 10 times more on
17:31
both fronts. So, that was, something that, one
17:35
of our surgical residents
17:44
waste.
17:46
Our environmental
17:47
services team paired up with our perioperative
17:51
team and tried to work on repurposing
17:55
or upcycling our Blu wrap.
17:57
So Blu wrap is that very tough plastic
18:01
wrapping that is used to protect
18:04
surgical instruments and help keep them sterile.
18:07
When they're in landfill, they essentially do not
18:09
degrade. And this plastic wrap generates about 7%
18:13
of our hospital waste.
18:15
So they were able to work together, environmental
18:19
services, with the clinical teams to try to
18:21
use a third party vendor and
18:24
divert this blue wrap where it's upcycled into
18:27
things like bags
18:29
and other types of,
18:31
of, actual
18:32
products.
18:35
Our nutrition food services team has also done
18:38
a number of things. They they are at
18:41
Mass General. They serve a lot of meals.
18:43
Our hospital kitchen
18:45
serves more than 30,000
18:47
meals a day. That's our staff, our patients,
18:50
and their families.
18:52
So in the years,
18:54
in most recent years, there have been growing
18:56
numbers of plant based meal options.
18:59
Our chicken has been antibiotic free for quite
19:02
some time. And the cafeteria
19:04
diverts the food waste
19:06
into a composting that is then actually converted
19:09
to energy
19:10
through an anaerobic digestion process.
19:14
And I'll make one more story I'll just
19:16
share which is actually just happening right now
19:18
because it's flu season coming up.
19:21
Our occupational
19:22
health services is,
19:25
leading a campaign to educate staff on both
19:29
proper hand hygiene before giving vaccines,
19:32
but also
19:33
proper decisions about glove use because
19:36
the gloves are not required for most routine
19:40
vaccines.
19:41
And we use a lot of gloves. So
19:42
in our hospital in one year, we in
19:44
our system in one year, we had about
19:46
184,000,000
19:48
gloves,
19:49
exam gloves that were used. And so,
19:52
you can see from these stories from clinical
19:54
departments to nonclinical departments, people are working together,
19:57
collaborating
19:58
on, initiatives that make a difference on a
20:01
day to day basis.
20:03
Yeah. Thanks for help painting that picture. Helpful
20:05
examples to hear.
20:06
Well, to close us out, I would love
20:08
to hear just some advice,
20:11
from each of you. I think, obviously, you
20:13
both know no shortage of immediate
20:15
tangible issues that health systems are navigating right
20:18
now, whether it's related to financial pressure, staffing
20:21
shortages,
20:22
navigating all of the shifting policies.
20:25
What advice might you give to colleagues at
20:27
hospitals and health systems that are in the
20:30
infancy of their sustainability
20:32
journey, particularly when it comes to getting the
20:35
ear of their executive peers who might not
20:38
be seeing climate as a tangible or urgent
20:40
issue?
20:42
I'm happy to start with a couple thoughts.
20:44
I think one of the main messages to
20:47
repeat over and over again is that sustainability
20:49
is really aligned with our mission in the
20:52
health care sector,
20:54
because climate change does have very dire consequences
20:58
for public health.
20:59
And sustainability
21:00
actually will strengthen our operational resilience over time.
21:04
So I think it's, it's not I think
21:07
it shouldn't be thought of as a burden
21:09
or cost, but really something that we
21:12
as an imperative and it is aligned with
21:13
our mission. And
21:16
as a follow-up to that,
21:17
that many of the initiatives actually offer return
21:20
on investment because it's cutting
21:22
waste and cost and it becomes more efficient.
21:25
So actually, there are multiple
21:27
benefits with, many of these initiatives.
21:30
And then the last thing I'll say and
21:32
I'll pass it over to Greg, is to
21:34
just really
21:35
start with easy wins,
21:38
things that are low cost or staff led,
21:41
but also share those success stories because I
21:43
think that really does propel
21:46
the culture and the excitement
21:49
and the the acceptance of of, these types
21:52
of initiatives.
21:53
I agree with everything that Winnie just said.
21:56
I I will build upon it a little
21:58
bit, I think, and then come back to
22:01
this idea of confronting all of these pressures
22:03
simultaneously.
22:05
And
22:06
I think to follow-up what Winnie said, it's
22:08
it
22:10
In many situations,
22:12
sustainability initiatives are aligned with our other priorities.
22:16
So I talked a lot about how,
22:19
our investments in energy,
22:22
conservation and using renewable energy
22:25
have really resulted in substantial cost savings.
22:28
And so, similarly,
22:30
when we buy reprocessed goods, not only is
22:33
that reducing the environmental impact of the products
22:35
that we're using, but it's also saving us
22:37
money. So there are a lot of financial
22:39
opportunities,
22:41
to be had
22:43
as they relate to sustainability initiatives. That's not
22:45
true for everything, but it's a if for
22:48
health system that are just getting started with
22:49
it, there's a that can be a really
22:52
compelling argument.
22:53
I also think it aligns with other types
22:55
of priorities. A big one is just quality.
22:58
So everything we do in medicine is associated
23:00
with some sort of environmental impact. So for
23:03
systems who are interested in
23:06
also kind of reducing low value care,
23:09
bringing the sustainability perspective into it aligns closely
23:12
with that. Right? So if we can reduce
23:14
the amount of health care services that we're
23:16
delivering that are having minimal
23:18
minimal benefit for our patients, not only does
23:20
that save money, but it also eliminates avoidable
23:23
environmental harm. I think resiliency is another great
23:26
example. So during the pandemic,
23:28
we have about 13 kind of hospitals,
23:31
that are part of our network.
23:33
At the beginning of the pandemic,
23:35
and still today,
23:37
12 of those 13 hospitals were using
23:41
single use disposable
23:42
isolation gowns for contact precautions.
23:46
The pandemic hit, and as I'm sure most
23:48
people remember, there was a dramatic
23:50
increase in the demand for,
23:53
PPE.
23:54
It was really hard to meet that. Our
23:56
one hospital that had never switched to using
23:59
disposable gowns and was just using
24:01
laundable
24:02
isolation gowns
24:04
just weathered that storm without any problem. And
24:06
so,
24:08
many sustainable solutions are also kind of resiliency
24:11
strategies, and
24:13
I think that's an important message, particularly as
24:15
increasingly we were confronted with,
24:18
these these challenges to either our supply chain,
24:21
or other kind of resilience or other challenges
24:24
to our resilience.
24:26
And then I think Wendy's kind of already
24:28
alluded to this, but the alignment with just
24:30
kind of
24:31
workforce morale, we hear a lot about burnout
24:33
in the workplace. This is an issue that
24:35
people care about, and I think working for
24:37
an institution
24:38
that they know also prioritizes this
24:42
is,
24:42
is really helpful for workforce retention.
24:46
So
24:46
I think, you know,
24:48
there there are a number of different ways
24:50
in which health systems can really begin to
24:52
to begin their sustainability journey, but many of
24:55
them do not need to be in direct
24:56
opposition to other institutional
24:59
priorities.
25:01
Yeah. I think really interesting point just around
25:03
the resiliency strategy piece too. It sounds like
25:07
awareness is a key part of of this
25:08
work and educating,
25:10
peers and leaders as well.
25:13
Well, doctor Armond and doctor Furey, thank you
25:15
both so much for joining me for this
25:18
conversation today.
25:19
Thank you so much for having us. I
25:21
appreciate it. Yeah. Thank you. That was really
25:23
fun. I appreciate your time.
25:25
Yeah. And listeners, thank you for tuning in.
25:28
To access more episodes of the Becker's healthcare
25:32
podcast, please visit the podcast page on our
25:35
website at beckershospitalreview.com.
25:38
Thanks, everyone.