Institutional Rhythms: Ideas and Opportunities for energy and mobility demand in the NHS.

Makena Lohr's picture

Dr. Stanley Blue from the University of Lancaster has been working with the DEMAND centre ( which studies the dynamics of energy, mobility and demand. He has been working at Blackpool, Airedale, and Leeds NHS Hospitals to understand more about how patterns of energy demand in hospitals are created and can be changed. 

 A large portion of hospitals’ typical carbon emissions come from energy and transport. However, these are often passed off by hospital managers as areas which they do not have control over and therefore dismissed in terms of sustainability improvements. Blue however reminds us that the “demand of energy, travel and goods is an outcome of everyday workings at the hospital”; he points out that processes and procedures will be the main driver of energy consumption and demand. These are the “institutional rhythms” which underpin the workings of a hospital; they are often hugely complex and require perfect synchronisation to work. Many are dependent on external factors- anything from catering deliveries to school holidays. Arising from these patterns are peaks and troughs in energy consumption. One way to reduce overall energy consumption is to smooth out these fluctuations by adjusting processes to minimise overuse at certain times. Blue argues that these “institutional rhythms” are an often overlooked, but are an essential part of making hospitals more sustainable.

Blue’s paper discusses two examples of where adjustments in hospital procedures can play a vital role in carbon emission reduction. 
Example 1: Delayed transfer of care is a significant problem faced by many hospitals- severely impacting on patient care, as well as incurring high financial and environmental costs. Discharge times are typically very concentrated between 3pm and 6pm. Blue suggests that reconfiguring processes could minimise this peak. Some potential interventions could include delaying ward rounds so that medications can be prepared overnight, speeding up paperwork by using IT, delegating authority away from clinicians so discharge sign off can be completed more quickly.

Example 2: Interventions in how to improve the sustainability of ambulance units often focus on improving vehicle efficiency. However, an alternative approach is to reduce the demand for these services, in particular trying to reduce congestion of ambulances around A&E entrances. One way to do this is to increase home based rapid medical relief services such as Home Frist. Another is to encourage a shift in professional boundaries between ambulance and hospital staff, for example specialist training for ambulance staff or job sharing options could be explored. 

Blue has shown how important timing, sequencing and the allocation of responsibility are in improving sustainability in complex institutions like hospitals.  He argues that we need to move to a much broader understanding of sustainability in order to improve patient care, as well as reduce the costs and carbon emissions of the NHS.  


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