9 minute read
How trainees can get involved in sustainability in surgery
Oliver Townsend and Karen Chui
When we think about the ever-changing nature of healthcare and transformation of services, it is easy to focus on demographic shifts, clinical breakthroughs and workforce transformation. However, there is another major factor which will change the nature and method of delivery of services in the future: the climate emergency. That the earth is warming up, potentially dangerously and irreversibly so, is widely accepted [1]. Equally accepted is the role of human activity as the main driver of this, driven by the release of greenhouse gases [1,2].
What does this matter for healthcare?
The WHO states that ‘climate change presents a fundamental threat to human health’ and threatens to undo decades of progress in improving health globally [3]. The healthcare industry is a major contributor of emissions and needs to actively contribute to the internationally agreed targets to reduce emissions to ‘net zero’ [4,5]. Globally, healthcare contributes more to emissions than aviation (5% vs. 2%) [5,6], which gives an important perspective on the scale of the task facing healthcare providers to tackle climate change.
Healthcare leaders and bodies in the UK are increasingly recognising the impact that climate change, and the action required to try to mitigate it, will have on healthcare provision. Government and NHS targets for net zero, in 2050 and 2040-2045 respectively [7,8], mean change has to happen. Consequently, work to reduce the environmental impact of healthcare services will only increase in both quantity and visibility. Within healthcare itself, surgery is one of the largest contributors to healthcare system emissions and contributes disproportionately to energy consumption and hospital waste [9,10]. Reducing theatre resource consumption, waste and carbon gas emissions will be essential, combined with redesigning the provision of services to minimise emissions associated with patient travel and the supply chain [7].
Why as a trainee?
Environmental changes in the workplace will have a greater impact on our careers than those nearer retirement. As trainees, many of our generation are more climate concerned [11], and are therefore well suited to be leaders in driving healthcare sustainability initiatives.
For trainees with an interest in sustainability, getting involved can achieve curriculum requirements for audit, research, and leadership/ management roles [12]. There are many opportunities to demonstrate experience desirable for consultant roles, such as engagement in change in the theatre environment, or leading a cost- and carbon-saving projects through reducing waste or disposables.
Furthermore, as rotating doctors, we are able to take best practice around with us. Trainees are therefore in a prime position to be leaders in sustainability practice and evoke change. As the consultants and surgical leaders of the future, we can be the change we want to see, and normalise climate consciousness in our everyday practice.
Furthermore, as rotating doctors, we are able to take best practice around with us. Trainees are therefore in a prime position to be leaders in sustainability practice and evoke change. As the consultants and surgical leaders of the future, we can be the change we want to see, and normalise climate consciousness in our everyday practice.
How to get involved
There are many ways trainees can get involved in sustainability in T&O, starting from the individual level through to leading institutional change.
Start with looking at your own, your colleagues’ and your department’s practice, and try to identify where changes are possible. Turning this into local audits can lead to significant change. Examples of this include ‘leaning’ of surgical trays to reduce sterilisation of unnecessary instruments, and substitution of disposable battery pulse lavage systems for rechargeable battery options. Both of these examples were presented at our BOTA x ORUK Sustainability in T&O Surgery Conference this year13, showing the change that trainees are already making (Figure 3). Although pandemic-related, advice during COVID-19 was for absorbable sutures to be used instead of clips or non-absorbable sutures, to reduce the need for clip removal (disposable kit required) or follow-up (patient journeys, clinician appointments), and this could be applied equally to the climate-conscious department [14]. The Intercollegiate Green Surgery Checklist (Figure 4) is a great starting point for change that can be implemented and audited [15].
Starting with easy wins will inspire others that change is possible, and to be more bold with the next project (and there is always a next project).
Beyond this, there is a multitude of more formal roles available. From positions on national committees, such as BOTA (Sustainability and Workforce Representative), to national sustainability fellowships, such as the Chief Sustainability Officer’s Clinical Fellowship Scheme with the Faculty of Medical Leadership and Management (FMLM) or the National Joint Registry (NJR) and BOA Sustainability Fellow, which allow trainees to effect organisational change [16,17]. Finally, there are numerous organisations which offer training and research opportunities, with courses and grants available for sustainability projects. The Centre for Sustainable Healthcare offers a variety of training opportunities [18], as well as a network of engaged peers and experts who can offer advice and support with sustainability projects. ORUK and BOA also provide grants and funding for research.
BOTA work
The great thing is that trainees are already involved. BOTA and ASiT have published Sustainability in Surgery statements and are working towards integrating these fully throughout their organisational activity [19]. The BOTA Sustainability and Workforce Representative organises the annual ‘Sustainability in T&O Surgery Conference’ which is growing each year [13]. This year, the conference involved 250 attendees from around the globe, with speakers from RCS England and the BOA, as well as discussions with industry partners Stryker, Johnson & Johnson and Smith & Nephew on green practice in the supply chain.
Following this, BOTA has incorporated as many sustainable measures into our Annual Congress in November to reduce our carbon footprint. There is still a lot we can do, but we’ve made a start by making our events more green and influencing organisations we interact with. BOTA represents an important trainee voice and strives to use our involvement with important stakeholders to advocate the sustainability agenda.
Personal life
Climate change work is not the sole responsibility of the government, industry and employers. The impact of any individual’s actions may be limited in the global context, but collectively we can make significant change. Within our personal lives, there are many ways we can be more sustainable and greener. We are not here to preach, and there will certainly be aspects listed here where these authors are not saints! No one is perfect, and change does not have to be immediate or ‘all or nothing’. Individually, it is about trying to make positive changes in habits and practice where possible.
‘Reduce, reuse, recycle’ is far from a new motto, and it is as relevant now as it ever has been. Indeed, it underpins the action needed at organisational level to achieve net zero in much the same way it can be used by individuals. On a personal level, both at work and outside, simple actions like turning off idle devices and lights reduces energy consumption, whilst choosing items or products with less bulky or eco packaging reduces waste for disposal. Reusable shopping bags are now commonplace, whereas using one’s own coffee cup or reusable cutlery is less common but no less impactful. Taking a bottle for refilling with water saves an often-virgin plastic bottle from landfill, with many reusable bottles also having thermal properties. Recycling involves separating the component parts of an individual package into what is recyclable or not and putting the waste in the correct bin. Many items we purchase, or have finished with, can form part of a more circular economy; after all, one man’s trash is another man’s treasure. Sites like Vinted for clothes, and eBay for everything else, allow items to be resold and often saves money (or generates it if you are a seller).
To reduce, reuse and recycle, NHS Green have added ‘Replace’ [20]. This is to guide staff to consider replacing individual car journeys to work with alternative means, such as public transport, walking or cycling, and lift sharing. The cycle to work scheme is an easy and cost- effective way to get a new bike, with bikes paid for in monthly instalments from your payslip taken out of pre-tax income [21]. Although typically structured over 12 months, which can be tricky for rotating trainees, it is possible through discussion with HR and payroll for this to be done over as little as six months. If considering public transport, combining this with a folding bike, can make door-to-door green travel more flexible and time efficient. Once open to alternative transport, it becomes easier to consider it outside of the commute. Taking time to explore which regular journeys you make by car could instead be made by bus or train often yields surprising results and be cost saving. This, coupled with calculating your private vehicle’s actual cost per mile to run, can make switching from driving to taking the train or bus a no brainer; evening out return train fares are a little-known gem offering cheap day returns for the afternoon and evening, as are capped evening bus fares.
Summary
The time is now to get involved in green and sustainability practice. Start with a few small changes to your own life and to your personal practice, then start with simple audits and changes at your workplace. Consider bigger roles such as the BOTA Sustainability and Workforce Representative role, or national sustainability fellowship roles. There is something for everyone, and we need everyone to do their bit.
References
References can be found online at www.boa.ac.uk/publications/JTO.
