Medical Student Quality Improvement Projects on Environmental Sustainability and  Climate Change:

Five  Quality Improvement Projects

This document is  a template that any medical school can use to develop  medical student  quality improvement projects on topics of environmental sustainability and climate change.  It can be customized to suit needs of your school. Contact the author to obtain an editable Word file.

Contents:

I. Introduction & Objectives

II. Faculty Resources Available to Students and Coaches

III.  Online Resources for Students & Coaches

IV. Five Environmental Sustainability and Climate Change QI Projects for Medical Students

  1. Create an Environmental Sustainability Program in the Healthcare Unit
  2. Create an Energy Assessment and Management Plan
  3. Educate Patients and Staff on Environmental Sustainability
  4. Educate Patients and Staff on Climate Change & Health
  5. Create a Healthy Foods Program

V. Summary

VI. Author

I. Introduction & Objectives:

The impacts of climate change on health are growing and have received increased attention in the medical community as we understand how populations are being adversely affected.   There will be more frequent and more severe natural disasters such as wildfires, flooding, and extreme heat events.   There will be worsening air quality and changing patterns of infectious and  vector borne illnesses associated with rising temperatures and flooding.

The healthcare system in the United States has a large carbon footprint. In 2007, hospitals consumed 5.5% of total delivered energy in the US despite representing <1% of the buildings.  For example, in 2012, the fossils fuel burned to generate the energy consumed by the University of California at San Francisco resulted in emitting  150,000 tons of CO2—equivalent to 15 million gallons of gasoline.  In addition, the healthcare sector generates enormous amounts of waste from paper products, plastics,  single use devices, food, and inefficient water consumption.  Identifying areas of waste and ways to deliver healthcare in a more “green” fashion represent opportunities to save money, to decrease healthcare’s greenhouse  gas output of CO2, and to mitigate the adverse environmental & health impacts of healthcare delivery.

Environmental sustainability in healthcare practices has been identified as an important quality improvement goal by  most medical schools,  the American Medical Association, the American College of Physicians, and many other health professional organizations.  Most sustainability efforts to date have been directed at hospital facilities, with little work undertaken within the many outpatient clinics, offices, diagnostic centers, ambulatory surgical centers, and other facilities.  These other sites provide opportunities for  medical students during their outpatient clinical rotations  to make significant contributions with quality improvement projects.

In addition, medical schools and their affiliated professional colleagues  serve a large number of climate-vulnerable populations including children, the elderly, individuals with mobility and cognitive challenges, and those of lower socioeconomic status.  Physicians have an opportunity to share wise environmental sustainability concepts with their patients in order to lower their patients’ household costs and to decrease the community’s greenhouse gas footprint.  Physicians have as well responsibilities to educate patients about the risks posed by  climate change and to help them to be prepared for extreme weather nd other events.

Many medical school curricula include a requirement that all students participate in a longitudinal, inter-professional quality improvement  (QI) project embedded within a particular clinical rotation.   Environmental sustainability topics can be outstanding QI projects for health professional students, projects that allow the student to leave a lasting impression upon the institution.

Quality improvement projects involving environmental sustainability and  climate change can fulfill institutional environmental goals by:

  • improving sustainability practices in healthcare
  • reducing healthcare waste
  • educating outpatient staff and patients about how to adopt behaviors that are more “green” and more supportive of individual health
  • educating patients about the health impacts of climate warming
  • educating patients on environment-related topics such as food choice, transportation, recycling, and chemical usages that affect health
  • collaborating with patients to prepare for climate events
  • forging healthcare system processes that can adapt and respond to climate events

These quality improvement projects can fulfill institutional curriculum  goals as student:

  • learn the management structure and management processes of clinics, offices, and hospital units
  • develop skills of collaborating with many members of the healthcare team
  • participate in the important goal of improving healthcare sustainability and climate change preparedness
  • educate patients and interprofessional staff on topics of environmental sustainability
  • consider issues of health equity and disparity by addressing the education of climate-vulnerable patient populations
  • improve community health by optimizing the uses of resources
  • lower the greenhouse gas footprints of both the institution and the community.

II. Faculty Resources Available to Students and Coaches:

The following faculty have some expertise in climate warming and its health impacts, as well as sustainability practices for healthcare, and are available to help  generating project ideas, formulate management plans, identify useful resources, and assist with project outcomes assessment.

III.   Online Resources for Students & Coaches

1. My Green Doctor:   This free, online program is an easy guide by which  offices and clinics can become environmentally sustainable and teach wise practices to colleagues and patients.   My Green Doctor is appropriate for any outpatient facility and hospital unit.  Medical students can work with clinic managers to implement My Green Doctor’s program.   Users learn how adding five minutes of “green team” business to each regular staff  meeting can lead to significant improvements in environmental practices that save money and help reduce greenhouse gases.  Each meeting is fully scripted so there is nothing for the organizer to study or prepare.  Offices receive a  waiting room certificate for registering and the Green Doctor Office Certificate upon completing the  program.  Patient and staff education are an important part of My Green Doctor, with scores of free brochures, posters, blogs and other teaching tips provided.  My Green Doctor is a project of fourteen health professional societies:  https://www.MyGreenDoctor.org/ .

2. Royal College of General Practitioners:  The College offers a free service, “Green Impact for Health”. This clear, detailed program guides medical practices towards environmental sustainability. It offers dozens of great ideas for changes to offices and has a useful scoring system with which a clinic can track its accomplishments: https://www.greenimpact.org.uk/giforhealth/.  Medical students can use “Green Impact for Health” to identify further Action Steps to introduce to clinics.

3.  American College of Physicians:  The ACP launched in 2017 its “Climate Change Toolkit”  (https://www.acponline.org/advocacy/advocacy-in-action/climate-change-toolkit) . The Toolkit includes ACP policies on climate change, practice management and many related topics.  There are terrific posters, facts sheets, and brochures for the office:

4. American Medical Association: A nice place to start reading is the AMA’s concise 3-page document, “Lower Costs By Going Green”: https://www.mygreendoctor.org/wp-content/uploads/2017/11/AMA-Lower-Costs-by-Going-Green-Practice-Management-PDF-Sack-2017-1.pdf . This directs students and managers to great resources for managing medical offices, clinics, and outpatient facilities.

5. Energy Star:  The Energy Star program (www.energystar.gov) of the US Environmental Protection Agency offers great ideas for saving money in medical offices and facilities by using less electricity.  There is a list of Energy Star-rated energy efficient products, energy saving tips for patients’  homes, and strategies that be adapted to healthcare offices.

6. British Medical Association:   The BMA offers ideas to health professional on saving energy and related environmental subjects:  https://www.bma.org.uk/connecting-doctors/search?q=%22sustainability-health-top-tips%22#serpq=%22sustainability-health-top-tips%22).  The documents  encourage professionals to tackle climate change and promote public health.  The topics include:

7. Pediatric Environmental Health Tools Kit:  The PEHTK ( https://www.psr.org/blog/resource/pediatric-environmental-health-toolkit/) is an outstanding, practical guide for health professional in offices and clinics.  It was written in large part at UCSF.  It brings attention to health hazards related to air, water, food and chemical products, and the risks to the whole family and medical office staff, not just children.  User-friendly on any mobile device or computer, the PEHTK is free, concise, and peer-reviewed by experts in the field.

8. Our medical school’s sustainability office/program:

(add information here)

 

IV. Five Environmental Sustainability and Climate Change QI Projects for Medical Students:

Each of these student QI projects can achieve impactful results in 8-10 hours.  The resources and educational materials needed are fully available from the resources listed above.   Where educational materials for patients will need to be printed, a cost estimate is provided.  Students and faculty coaches are welcome to consider other topics that may not be listed below.

 

  1. Create an Environmental Sustainability Program in the Healthcare Unit:

Students will use the My Green Doctor program (or an equivalent program from the Resources list), collaborating with the unit’s manager and colleagues, to create a durable Environmental Sustainability Program that will seek to qualify the unit for the Green Doctor Office certificate from My Green Doctor, or for an equivalent level of accomplishment.  Components of the project may include to:

  • assess the management processes of the unit in order to decide how best to offer an environmental sustainability program
  • assist the unit manager to use the “Meeting-by-Meeting Guide” at unit organizational meetings
  • assess baseline energy and water usage in an individual clinic or unit, and identify opportunities to decrease usage
  • assess baseline solid waste generation such as paper, contact isolation gowns, gloves, procedural tools
  • improve patient and staff education (e.g. safe medication disposal practices, energy savings, climate change awareness)
  • assess the outcome of the environmental sustainability program, identifying its strengths and weakness, as well as generalizability to similar units at the medical school
  1. Create an Energy Assessment and Management Plan:

Students will work directly with the managers of the healthcare unit to design and implement an energy management plan.

  • assess the management processes of the unit in order to decide how best to offer an energy management program
  • assess baseline energy and water usage in an individual clinic or unit, identify opportunities to decrease usage
  • assess what resources or guidance is available already at our medical school
  • together with the unit manager, create an energy management plan
  • educate the unit staff members and patients about the management plan and steps for implementation
  • assess the outcome of the management plan, identifying its strengths and weakness, as well as its generalizability to similar units at UCSF
  1. Educate Patients and Staff on Environmental Sustainability:

Students will create for the healthcare unit an environmental sustainability education program for  patients and staff.  Topics might include energy & water conservation, recycling, pharmaceuticals disposals, chemical uses, transportation choices and healthy foods.   This is intended to persist after completion of students’ work and to become an opportunity for students to make meaningful contribution to peoples’ lives and to community health.  Cost estimate: $300.

  • work with the unit manager to learn of opportunities for adding educational tools within the unit (e.g. brochures, handouts, posters, verbal teaching)
  • assess what topics of environmental sustainability might be appropriate for unit’s staff and patients. Consider cultural and socio-economic factors.
  • assess the quality and suitability of educational materials that are available from the Resources list above
  • prepare an education plan to present to the coach and unit manager for consideration
  • implement the plan
  • assess the outcome of the education plan, identifying its strengths and weakness, as well as its generalizability to similar units at UCSF
  1. Educate Patients and Staff on Climate Change & Health:

Students will create for the healthcare unit a climate change education program for patients and staff.   Topics could include explaining the basic concepts of climate science, explaining the health threats of climate change, offering opportunities for patients and staff to decrease their greenhouse gas footprints, and guiding patients on protecting themselves from the likely health threats of climate change in their community.  This education program is intended to persist after completion of students’ work and to become an opportunity for students to make meaningful contribution to the community’s climate change mitigation and to community health.  Cost estimate: $300.

  • work with the unit manager to learn of opportunities for adding educational tools within the unit (e.g. brochures, handouts, posters, verbal teaching).
  • assess what topics of environmental sustainability might be appropriate for unit’s staff and patients. Consider cultural and socio-economic factors.
  • assess the quality and suitability of educational materials that are available from the Resources list above.
  • prepare an education plan to present to the coach and unit manager for consideration
  • implement the plan
  • assess the outcome of the education plan, identifying its strengths and weakness, as well as its generalizability to similar units at UCSF
  1. Create a Healthy Foods Program:

Students will create a program for healthcare units to  foster the consumption by patients and staff of healthy foods:  healthy for people and healthy for the environment.   The plan will  be tailored to the health issues and needs of the  unit.  Topics may include evaluating what foods are available to the unit’s staff and patients, benefits of choosing organic and local foods, avoidance of red meats,  fish choices (e.g. risks of mercury consumptions to certain patient groups), environmental impacts of food choices, and healthy food preparation.  There will be a significant educational component.  Cost estimate:  $200.

  • work with the faculty coach to understand the unique nutritional patterns and needs of the patients cared for in the healthcare unit, including the cultural and socio-economic factors that may both contribute to food choices and promote both chronic disease and environmental degradation.
  • work with the unit manager or food service managers to learn what foods are provided within the unit
  • assess the quality and suitability of educational materials that are available from the Resources list above
  • prepare a plan for improving the food choices for staff and patients. Components of the plan might include working with foods service managers to recommend changes (e.g. eliminating red meat or increase local sourcing) and education.
  • implement the plan
  • assess the outcome of the plan, identifying its strengths and weakness, as well as its generalizability to similar units at UCSF

V. Summary:

Quality improvement projects on topics of environmental sustainability and climate change offer opportunities for students to understand management processes in healthcare units, to learn to work collaboratively  with staff members, and to  implement a management programs that will make a lasting impacts upon the healthcare unit, upon patient health, and upon community health outcomes.

VI. Author:

Todd L Sack, MD, FACP, Editor, https://www.MyGreenDoctor.org,  tsack8@gmail.com

Latest version:  September 2020

 

 

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