WORKFORCE WELLBEING & DEVELOPMENT
independently and the nurse needs to make an assessment of the patient to determine their level of independence.
“Let’s say a nurse says a patient needs a lot of assistance in mobilising, there is an algorithm to that and it says ‘if my patient needs a lot of assistance in moving then here is the equipment I’m going to use and this is how I’m going to do it’.
“It ensures for the patient, as well as the worker, that the way the patient is going to get the appropriate care is through an agreed- upon standard that embeds patient and worker safety all in one.”
Patient care and worker safety are therefore not separate things. Once organisations have got standards in place, and staff trained, reinforcement by management is the priority.
“When you have that package together and you’ve embedded it in the protocols of care you’ve achieved your goal.”
Food, waste and energy
As well as focusing on worker safety at Kaiser Permanente, Gerwig is the environmental officer and her book ‘Greening Health Care’ presents practical solutions for healthcare organisations and clinicians to improve their environments and the health of their communities.
We wanted to speak to Gerwig because although the US healthcare context is very different to the UK’s, worker safety, patient care and environmental impacts are all areas where lessons can still be learned.
Topics in her book include: making food services sustainable; managing hospital waste; and mitigating measures climate change
impacts.
On food, Gerwig said the focus tends to be nutrition and using food as part of a healing process, but there are also huge sustainability opportunities.
“In this context, we’re talking about the health of a much broader community. For example, we’re looking at procuring foods that are not grown using lots of pesticides or fertilisers.
“We’re interested in pushing the institutional food systems and progressing to a more sustainable system.”
Part of this, at Kaiser Permanente, has included sourcing food locally from farmers using few or no pesticides, and holding farmers’ markets held at hospitals.
Healthcare organisations, especially when they collaborate, have enormous purchasing power. “And by using this leverage, in the US, we’ve been able to buy food that is more environmentally friendly for our patients. That has been a wake-up call for all the collaborators. When we work together we’re much more successful.”
All hospitals, wherever they are in the world, buy huge amounts of food and energy, use a lot of water and generate a lot of waste.
Gerwig said taking action starts with an environmental impact assessment, then the prioritisation of actions. An organisation’s strategy will depend on local context and geography, “but the aim is the same”, she said.
“We’re striving for reducing carbon emissions and are targeting the same things. We’re looking at our supply chains, pharmaceuticals, food – and certainly we all have to keep the lights on.”
Carbon emissions
Everyone wants to cut fossil fuel use and there is a lot of work going into developing renewables. “What is interesting and what makes hospitals unique is that we’re 24/7 operations,” Gerwig said. “We use large quantities of energy throughout the day and that makes us a renewable partner for renewable energy opportunities. We should take advantage of that, and we should leverage that more than many hospitals do today.”
Kaiser Permanente is emitting 5% less carbon than in 2008 – despite opening new hospitals since then. “We’re using more energy, but it is cleaner. That is a lesson that can be taken globally,” said Gerwig. “We’ve done this by being more energy efficient, and making every electron count, through window shading and making sure that our buildings are properly commissioned so systems don’t work in contradiction to each other.
“That, coupled with greater use of renewables, [solar and wind, mostly] is how we’re doing that.”
Gerwig concluded that healthcare organisations should be at the cutting-edge of connecting environmental health to human health and demonstrating how the sector can address climate change, waste, food, water and chemicals – from a health perspective – that prevents disease in the future.
Kathy Gerwig FOR MORE INFORMATION
Proceeds from Gerwig’s book are going to Health Care Without Harm coalition. The book can be bought here: ukcatalogue.
oup.com/product/9780199385836.do
national health executive Nov/Dec 14 | 69
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