CONTINUING PROFESSIONAL DEVELOPMENT
Four principles of sustainable clinical practice
From: Dr Frances Mortimer, ‘The Sustainable Physician’, Clinical Medicine 2010, Vol 10, No 2: 110–11
The Campaign for Greener Healthcare has identified four principles which underpin sustainable clinical practice. These are:
1. Disease prevention and health promotion. All clinicians should be involved in prevention. Through broader advocacy and in individual patient care, specialties should aim to tackle underlying causes of disease – the social, economic and environmental determinants of health. Where possible, interventions should capture environmental co-benefits of healthy lifestyles, such as the improvements in air quality and carbon emissions from a shift to active travel.
2. Patient education and empowerment. To reduce disease progression and pre- empt complications, many patients could be empowered to take on a greater role in the management of their own health and healthcare. Informed patients are also well placed to improve the co-ordination between clinical teams and reduce misunderstandings or duplication.
3. Lean service delivery. Improving clinical decision-making in the selection and targeting of interventions will reduce lower value activities and their associated environmental impacts. Specialties can support this by describing the relevant patient pathways and providing clear, evidence- based guidance. Even where clinical input is of high value, a greater use of online records, email and telephone can reduce travel emissions by moving information in place of patients, staff and laboratory samples. Further efficiencies can follow from better integration of specialist services, such as diabetes, cardiovascular and renal care, which have a common patient base.
4. Preferential use of treatment options and medical technologies with lower environmental impact. Inclusion of sustainability measures in the evaluation of medical technologies will allow service planners, clinicians and patients to choose clinically effective treatments with the best environmental profile and will encourage their further development.
Figure 2 - NHS England CO2
8 reduction measures e baseline to 2020 with
Step 2 – Clear practical benefits
A low-carbon health service will be better at preventing illness, give greater responsi- bility to patients in managing their health, be leaner in service design & delivery and low carbon technologies. Healthcare staff should learn to communicate effectively using teleconferencing, telemedicine and home-use diagnostics. Nursing patients in the community may require different skills from nursing patients on the ward
Step 3 - Sustainable delivery of training
How we deliver training is as important as what we train. Sustainability is a way of do- ing things and its principles are most effec- tively understood and embedded when they are modelled as practices and behaviours.
Commissioners should look for train- ing that models ways of doing things that minimise environmental impact, allows for multiple learning modes and takes advan- tage of technological innovations already present in our daily lives.
For example, at present, consultants gain CPD points for attending conferences but not for watching a recording of the confer- ence, which would save time, money and travel.
Sustainable training models allow face-to- face networking opportunities to coexist
with e-learning and web conferencing. Above all, sustainable training models demonstrate that sustainability and quality are compatible by the choices they make in five key areas: transport, catering, venue, equipment, and involving delegates.
1. Transport
The distance to training and available modes of transport determine the time, expense and carbon footprint of learning. Trainers should:
• Inform attendees of their commitment to sustainable transport and explain why it is important, using pre-conference emails/literature/website;
• Choose a location with good public trans- port links and provide comprehensive travel information including pedestrian and cycle routes from bus and train sta- tions at the top of the travel instructions sheet;
• Use tools, such as an online carbon cal- culator (see ‘L’EcoComparateur’ provid- ed by the French train company SNCF);
• Collect information from participants on how they travelled to the event to raise awareness and help plan future training events.
2. Catering
The carbon footprint of food and tableware is determined by its production, storage, transport and disposal.
Continues > national health executive May/Jun 11 | 43
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