Planetary health

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Sustainability is a core component of high-quality care, and the need to incorporate a “green lens” and embed environmental sustainability into quality improvement efforts has never been more evident.

Be it through reducing low-value, carbon-intensive care, selecting more climate-friendly medication options when clinically appropriate, training and educating the workforce toward environmental sustainability and resource stewardship, or adopting reusables in lieu of disposables, there are myriad approaches to advancing high-quality, low-carbon, and sustainable health systems.

As you work on quality improvement initiatives, it’s important that you integrate a focus on environmental sustainability and climate stewardship in your indicators.

This tile was developed in collaboration with CASCADES (Creating a Sustainable Canadian Health System in a Climate Crisis), PEACH (Partnerships for Environmental Action by Communities within Healthcare systems), and The Canadian Coalition for Green Health Care. CASCADES is a pan-Canadian initiative that strengthens the capacity of the healthcare community across Canada to transition towards, high-quality, low-carbon, sustainable and climate resilient care. CASCADES is funded by funded by Environment and Climate Change Canada. PEACH’s mission is to cultivate and sustain partnerships across health care facilities in Ontario to support climate action. PEACH is supported through Planetary Health and the Department of Family Medicine at McMaster University. The Canadian Coalition for Green Health Care is a national organization that has been working for 25 years on developing green health policies and practices.

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Key Resources:

Journal article: Planetary health care: a framework for sustainable health systems
CASCADES’ playbook: Training for Better Health Outcomes: Integrating Sustainability into Healthcare Quality Improvement Education
Journal article: Bringing Environmental Sustainability into the Quality Agenda: Time to Act on Reducing Health Care Pollution and Waste (Sherman and Singh, 2023)
Journal article: Identifying opportunities for greenhouse has reductions and cost savings in hospitals: A knowledge translation tree
Canadian Coalition for Green Health Care (CCGHC) Guidebook: Climate emergency jumpstart kit: an implementation guide to streamline you climate journey
Greenhouse Gas Equivalencies Calculator
CCGHC “Green Pages”, a database of Canadian resources related to sustainability and health care

Change Ideas

Medication optimization

Eliminate use of desflurane as an anesthetic agent
CASCADES’ playbook: Sustainable Perioperative Care Playbook
CASCADES’ YouTube video: Sustainable Perioperative Care- Eliminate Desflurane at North York General Hospital
CASCADES’ project charter: Eliminate desflurane
Journal article: Developing a quality improvement project to tackle the desflurane problem
Indicator examples
% of total anesthetic agents purchased that is sevoflurane (desired direction:↑)
% of total anesthetic agents purchased that is desflurane (desired direction:↓)
% of patients who were given a non-desflurane anesthesia (desired direction:↑)
% of staff educated about environmentally friendly gasses (desired direction:↑)
Follow the sustainable prescribing pathway for inhalers
CASCADES’ playbook: Climate Conscious Inhaler Prescribing in Inpatient Care
CASCADES’ playbook: Climate Conscious Inhaler Prescribing in Outpatient Care
CASCADES’ collaborative: Climate Conscious Inhaler Prescribing Collaborative
CASCADES’ course: Climate Conscious Inhalers Prescribing Course
PEACH toolkit: Options for sustainable prescribing
Indicator examples
# of existing prescriptions that were switched from MDIs to DPIs (per reporting period) (desired direction:↑)
# of new prescriptions for metered dose inhalers (MDIs) (per reporting period) (desired direction:↓)
# of new prescriptions for dry powder inhalers (DPIs) (per reporting period) (desired direction:↑)
Indicator examples
% of patients using inhalers with a confirmed diagnosis of asthma or chronic obstructive pulmonary disease (COPD) (desired direction:↑)
% of patients using inhalers with well-controlled disease (desired direction:↑)
# of existing prescriptions that were switched from MDIs to DPIs (per reporting period) (desired direction:↑)
# of new prescriptions for metered dose inhalers (MDIs) (per reporting period) (desired direction:↓)
# of new prescriptions for dry powder inhalers (DPIs) (per reporting period) (desired direction:↑)
% of patients using inhalers with observed proper technique (desired direction:↑)
% of patients using inhalers instructed on proper disposal methods (return to pharmacy) (desired direction:↑)
# of inhalers prescribed per visit (for acute care) (desired direction:↓)

Food infrastructure

Implement plant-forward menus
CASCADES’ Playbook: Food Infrastructures for Planetary Health
Journal article: Food is medicine: actions to integrate food and nutrition into healthcare
The Planetary Health Diet - EAT Forum
PEACH Guidebook: Sustainable health care food system: Business case and implementation guide
Coolfood Pledge: resources that help organizations commit and achieve science-based targets to reduce climate impacts of food
Indicator examples
% of plant-forward meal options for patients relative to all meal options (desired direction:↑)
% of plant-forward meal options for visitors and staff relative to all meal options (desired direction:↑)
% of patients counselled on the health benefits of plant-forward diets (desired direction:↑)

Health workforce preparedness

Build internal capacity
CASCADES’ course (~20 min- asynchronous): Orientation to Sustainable Health Systems
CASCADES’ course (~ 90 min- asynchronous): Introduction to Sustainable Health Systems
CASCADES’ course (4 hours, synchronous course): Fundamentals of Sustainable Health Systems
CCGHC Green Office Challenge: Comprehensive health care environmental performance benchmarking tool
CCGHC toolkit: Green Office Toolkit
CCHGC Green Team Project: How to start a green team
CCGHC Project: Preparing Canada’s Health Care Buildings for Net-Zero
CCGHC Environmental Stewardship Guidebooks: Guidebooks for sustainable psychiatry, radiotherapy, rheumatology, cardiology, intensive care and more
CCGHC and PEACH working groups and networking hubs
Indicator examples
% of staff educated on resilient, low carbon and sustainable health systems (desired direction:↑)
% of staff that completed CASCADES' Introduction to sustainable health systems learning module (desired direction:↑)

Leadership and governance

Engage senior leadership and enable governance structures for sustainability reporting
CASCADES’ playbook: Organizational Readiness Playbook
Interior Health’s Roadmap: Climate Change and Sustainability Roadmap 2023–2028
Vancouver Coastal Health’s Planetary Health Strategy: Vancouver Coastal Health Planetary Health Strategy 2024-2029
Fraser Health’s Planetary Health Strategy: Fraser Health Planetary Health Strategy 2023-2028
NHS England’s roadmap: Delivering a net zero health service | National Health Service
CCGHC Program: Healthy Capital: Sustainable Investment for Hospital Foundations
PEACH and CCGHC Care Guidebook: Environmental Stewardship: An implementation guide for boards, executive leaders, and clinical staff: Meeting hospital standards and beyond
Indicator examples
Has sustainability been formally integrated into one or more leadership roles? (Y/N)
# of leadership roles with a formal sustainability component (desired direction:↑)
% increase of leadership roles embedding sustainability as a formal component and responsibility (desired direction:↑)

Reusables

Replace single-use items with reusables where appropriate
CASCADES’ playbook: Sustainable Perioperative Care Playbook
CASCADES’ playbook: A reusables first approach to healthcare procurement
Circular Clinical Care: Reducing single-use plastics in health care
PPE-mSup Reducing Health Care-Related PPE and Medical Single Use Plastic Waste Through Circular Economy Principles
PEACH and CCGHC guidebook: Environmental Stewardship in the intensive care unit: A roadmap to more sustainable practice
Indicator examples
Has your organization launched, progressed, or sustained initiatives to replace single-use items with reusables (e.g., isolation gowns, incontinence pads, anesthesia equipment, reusable bags) within the last year? (Y/N)