Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Thank you so much, Jasmine for that kind introduction and for the honor of joining you for this meeting today. I'm sorry, I couldn't have taken in the whole thing due to time differences, but I look forward to getting caught up on the recordings. So today, I have the pleasure of speaking to you about some of our research and implementation work in Vancouver. And I just wanna begin by acknowledging that I am speaking to you today from the traditional and unseeded territories of the coast, Salish peoples, which are the Mus the Squamish and the Slaver Tooth Nations. And we have uh a history, a long history of colonialism in Canada that we continue to grapple with. And so we have a practice as part of our commitment to indigenous reconciliation of, of always acknowledging that the lands on which we currently have the privilege of living, working and playing are not rightfully ours, but rather the ancestral and and rightful homes of our first nations colleagues. Now I have the unique privilege of inhabiting what I consider to be one of the most supportive ecosystems to advance work and sustainable health care. So I'm excited to share with you today work that we have done within the Planetary Health Care Lab at the University of British Columbia and at Vancouver Coastal Health. And I think you will see the strong links between research and implementation. So in 2021 we launched the Planetary Health Care Lab, bringing together thought leaders, experts from a number of disciplines. As you can see here to be able to really rigorously investigate the environmental impacts of health services, delivery and design appropriate behavioral and policy solutions. And we, we have, we're very fortunate to work in a living laboratory arrangement with Vancouver Coastal Health, which is the Health authority in which I practice clinically, which serves 1.2 million people in BC and encompasses 12 hospitals, a number of long term care facilities and lots of primary and community care. And thanks to our visionary Ceo Vivian Eop Pois, these are our four foundational pillars that must underpin everything we do within the organization. And as you can see, Planetary Health is one of those because Vivian understands that our health depends on healthy ecosystems. And so we formally recognize that we as a health system have a duty of care to nature, that we cannot in the process of caring for one patient today adversely affect the health of other patients, either current or future. And I wanted to just take a minute to talk about how we at VC H have action, this foundational pillar and this commitment to planetary health because every health system has gone about that a bit differently. And I think it's always informative to understand how uh different approaches to organizing. So we the first thing VC H did upon identifying this as a foundational pillar was rebrand one of our vice presidents as the VP of strategy innovation of Planetary Health. So it is formally within the portfolio of one of our senior leaders and she oversees this tripartite portfolio that includes both longstanding players in the sustainable health care space like public health and facilities and maintenance. So our public health team works primarily with our communities on climate adaptation and resilience. And our facilities and maintenance team does things like building energy management and waste management. But what we recognize was missing from this picture was bringing the sustainability lens to actual bedside clinical care delivery. And so we established what we call a sustainable clinical services team and we operate out of the Department of quality and patient safety. So as to formally recognize sustainability as a dimension of quality of care. So I was lucky to assume the role of medical Director of Planetary Health. And we now have this fledgling team and our mandate is to implement validated low carbon high quality care. Now, uh Jasmine mentioned Cascades in the introduction and if you're not familiar with Cascades, Canada, I highly recommend you check out their website. They have developed many implementation ready resources like these playbooks for organizational readiness assessment, and strategic planning for sustainability. And we followed these playbooks to develop our planetary health strategic plan to 2029 within which we worked from VC HS existing vision and values. And they made it easy for us because our vision was already healthy lives in healthy communities, which with an expanded view can easily bring in healthy ecosystems. And so we identified five areas of action to have impact in four different elements of sustainability, all working toward that goal of healthy lives in healthy communities. So the work my team does primarily falls within the s the service design and delivery and food and nutrition areas of action. And we use the planetary health care framework that we published a few years ago in Lancet Planetary Health as our organizing framework. And I think I'm not gonna spend any time on this today, but I just want you to understand that this framework includes both supply and demand side management to really encourage people to take a very comprehensive perspective of sustainability and not focus too much at the end of the line kind of waste bin. This framework can be distilled down to three general principles, prevention stewardship and decarbonization. And so the work I'm gonna show you now kind of falls across all three of those uh operating principles within the prevention space. There's obviously action outside the health sector in optimizing social determinants of health. But anything we do within the system that minimizes disease decreases. The incidence or severity of disease is a, is a climate mitigation strategy. And vaccines are probably the very best example of this. Our HPV vaccination rates have not recovered to pre pandemic levels, which I suspect is the case across many jurisdictions. And I give this example because a few years ago, we were undertaking a surgical systems redesign and working with each surgical service on among other things, developing sustainability goals. And in working with the gynecologic oncologists, they told me they wanted to focus on some sort of waste management strategy within theater. And I suggested that they actually focus on HPV vaccination rates. As the surgeons who treat cervical cancer and other HPV mediated disease, they could have their highest impact by trying to address our very suboptimal HPV vaccination rates. So I would encourage you to encourage your colleagues to take a similar kind of upstream big picture view and recognize where their greatest impact lies. Our second operating principle is the idea of matching health services to demand, which includes both structural and behavioral components. So things like ensuring adequate primary care services and access to those. And then from a provider perspective, ensuring that we're operating a appropriately and taking a stewardship lens to avoid both underuse and overuse of health services. A few years ago, we did a study looking at unnecessary blood work in our acute care surgical patients, which I think kind of demonstrates this operating principle really nicely. We recognize that unnecessary daily routine blood work in this patient population has cost to the patient, to the hospital and to the environment. And that those three things comprise the classical notion of a triple bottom line. So the first thing we did was decide what is appropriate blood work in this patient population. So we undertook a Delphi consensus process within the division of general surgery and established, for example, that patients who have an uncomplicated appendectomy or cholecystectomy do not need postoperative blood work. They're just gonna go home and we're not even gonna look at it. Then we looked at what was actually happening and showed that we were doing unnecessary blood work in 76% of our patients and we were able to quantify in really granular detail, the cost to the patients to the system in this very small sample population and the carbon cost of that care. And that brings us to the third operating principle of our framework, which is the idea that once you have optimized the health of your population, you've determined what care is necessary and appropriate, then you can really focus on dec carbonizing or de polluting that care and this is where we have infinite opportunity for innovation within clinic clinical services design. Now, I know that all of you will be familiar with the Desflurane story because this is one of the most widely known uh and celebrated kind of elements within the s sustainable health care space. And we like many others studied this. And in a old publication now showed that des the singular use of Desflurane was responsible for a tenfold difference in anesthetic emissions across the hospitals we studied. And of course, now many in many places, anesthetists have voluntarily shifted their practice patterns away from Desflurane. We showed that in British Columbia over a five year period and seven local hospitals, anesthetic emissions were reduced by two thirds just by virtue of voluntary practice change. And of course, now we're seeing more uh top down mandates and and Desflurane bans such as from NHS Scotland. But that brings me to kind of the next frontier in in reducing anesthetic emissions, which is can we avoid inhaled anesthetic agents altogether and avail ourselves of alternative strategies like regional anesthesia. So things like spinal anesthesia or peripheral nerves.