Low-Carbon, High-Quality Care Collaborative

Case study submitted as part of Lancet Commission call for case studies.

Team members / location: Andrea Wnuk, Kate Meffen - British Columbia/Canada

Issue:  Clinical service delivery within the health system is a large consumer of energy, resources and a major producer of emissions and waste. In addition, MDIs release potent greenhouse gases when used and when disposed of incorrectly. Perioperative care has an oversized carbon footprint due to the use of inhaled anesthetic gases, the potential for unnecessary care, the reliance on single-use devices and improper waste disposal. Operating rooms, in particular, generate up to a third of their total hospital waste.

Intervention:  We used a spread collaborative model with two low-carbon clinical streams. One stream aims to build skills and capacity for in-patient and out-patient/primary care settings to implement low-carbon inhaler practices related to the management of asthma and COPD. A second stream is introducing environmentally conscious practices that improve efficiencies in the perioperative setting.

The collaborative includes a combination of virtual sessions and peer learning, coaching and mentorship, and local improvement actions with clinical teams from across the province of British Columbia engaged in the application of change ideas related to clinical practice, education, and person-centred care. We supported physicians with sessional fees and included Health Quality BC staff and resources to run the collaborative.

20 clinical teams - 10 working on sustainable perioperative clinical practices, and 10 working on climate-conscious inhaler practices have joined us to work towards reducing carbon emissions from these clinical practices. Teams started their quality improvement journey with us in January 2024 and will continue until November 2024.

Outcomes:  

• Environmental: We have an overall aim to reduce carbon emissions (CO2e) from clinical practices of participating teams in the Low-Carbon, High-Quality Care Collaborative by 10% by November 2024. In the sustainable perioperative stream, we have sustainability metrics that teams are working towards measuring reductions in carbon emissions from anesthetic gas use, unnecessary pre-op testing and from the transitions to regional and spinal anesthesia from general anesthesia. In the climate-conscious inhaler stream, teams are measuring reductions in carbon emissions from more appropriate prescribing on metered dose inhalers, reducing loss and waste of inhalers in acute care, and switching to low-carbon alternatives.
• Social: Patient and health care professional experience are both key indicators in the Low-Carbon, High-Quality Care Collaborative in both streams. Many teams are measuring patient experience, but also health care professional experience and engagement. One example, is a team working on initiating a OR Green Team - a team that will engage with OR staff around their ideas on how to reduce the environmental impact of care delivery in the perioperative space. They will complete a pre and post survey to measure the level of engagement and opportunities for improvement.
• financial: We haven’t done much work to quantify financial impact of the Low-Carbon, High-Quality Care Collaborative currently. However, we know many low-carbon, high-quality clinical practices have co-benefits. Most are better for the environment and also come at a lower financial cost.
• clinical: Patient Outcomes: Many of our Low-Carbon, High-Quality Care Collaborative teams have outcomes measures related to improving patient experience. Examples or our patient experience and outcome measures include:
  • Appropriateness: the percentage of patients prescribed an inhaler who have an objective diagnosis of asthma or COPD.
  • Effectiveness: The percentage of patients who can demonstrate good inhaler technique.
  • Effectiveness and Safety: The percentage of emergency department visits from asthma and COPD exacerbations.
  • Respect: The percentage of patients that indicate they experienced a high level of care.
• Population Outcomes: We don’t have a focus on population health, however, many of our teams are working on clinical practice changes that support better control of asthma and COPD by focusing on proper management of respiratory symptoms.

Key learning point: 

We saw success by front-loading the work by spending time engaging with clinical leaders in planetary health, assessing capacity to take on new work and meeting teams where they were at in their low-carbon journeys. Allowing teams to work at their own pace by providing a variety of supports and resources, has helped teams progress along the improvement journey. Also, helping teams to understand how to measure their impact has been a key to success. Being able to both see and communicate improvement via data is a key component to any improvement work.

Advice and recommendations to others looking to unite clinical teams under a common aim to reduce carbon emissions from clinical practices:

• Look for the early adopters and showcase their learnings and expertise.
• Connect those doing similar work to share challenges and opportunities.