Computer generated transcript

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

Now, my name is Jackie Gordon. And um, we're here for the breakout session of the, of the share conference. And the first up, we've got Rachel mclean from the Center for Sustainable Health Care to us about the Green Team competition evaluation. Um So Rachel, do you want to share your slides? We've got seven minutes for each presentation. If you want to write questions, please do write the questions in the chat um or save them for the end. It's completely up to you. Um And we'll be monitoring the, the chat and, um, and looking to see what's there. Um But, and we'll have a chat at the end after all of the sessions. So we'll have the five different presentations and then we'll have the chat at the end. So, um, welcome Rachel and uh I will come back, I'll, after six minutes, I'll turn my camera back on. So I'm going to turn my camera off now. Thank you. Can you see the slides? Ok. The slides look great. Yes, great. Um Hi, everyone. So my name is Rachel. I'm one of the SQ for sustainability and quality improvement program leads at Center for Sustainable health care. And so today, I'm going to be showing the outcomes of an external qualitative evaluation of our Green team competition program. So the evaluation was led by the University of Oxford, but unfortunately, um they weren't able to join us today. So I'm presenting on their behalf um because I am the lead of the Green Team program. So as a really quick background, the Green team competition is a clinical leadership and engagement program in which six teams from within the healthcare organization are supported to plan implement and measure the outcomes of a sustainable quality improvement project. They then present their learning and outcomes to an audience and judging panel of senior leadership from within their organization. Um And you've actually, if you, if you've been here through the full conference, we have heard from several of our 2023 green teams uh through the course of today. So the evaluation focused on four questions. So what are the goals of the competition? What has the impact been? What factors that affect, take up implementation and expansion and how much, how might these findings inform future competitions? And I'm gonna focus on questions three and four today just because we don't have time to get into everything. Um And so to evaluate this, all 37 project reports and data from the seven participating organizations in 2022 were reviewed and analyzed and a thematic analysis of interviews with 13 participants was undertaken and So these participants were from two NHS Trusts in England and one health board in Wales. Um So in terms of key findings for impact very quickly. So um the median an annual saving per organization was 99 tons of CO2 equivalent and 33,000 lbs. There are a range of social benefits which include things like saving enough time, improving efficiency of services, improving patient experiences of care. Um but the impacts the carbon cost and social as well as clinical vary significantly due to the diversity of projects that are completed and also their scale. So some projects take place on one ward, whereas others take place across the whole hospital organization. So in terms of take up implementation and spread, there were four key things that emerged through the evaluation and I'm gonna go through each of these in more detail. So the first was multiple benefits. So measuring and sharing the environmental social clinical and financial outcomes was very positively received by all participants, uh especially if a project could align to improving patient experience or clinical outcomes. So alongside this, there was a perception that if you only focus on environmental sustainability, you might limit the number of people who engage or hear about your work. And so this approach can support you to be more successful in, in bringing people on board and and having a wider impact. So the second theme was uh that engagement in the program fostered a sense of agency and was really empowering for staff. And I think this is a really important finding as often clinical staff want to make sustainable improvements, but they just really have no idea where to begin. And so the competition model provides tools for them to take action and that can be both the new ideas but also um to help them have a new way of framing long term problems and ideas that they might have had in the past differently, uh which helps them to take more ownership over how they can tackle these. Um It was also noted that clinical champions were a significant driving force. Um And I would say that any staff member who's joining the competition is a clinical champion for sustainability. Um But this can be a double edged sword um which brings us to uh the next point which is around challenge you local resources and buy in. Um So there is a burden on staff time. And so one of the participants commented that sustainability tends to be quite unsustainable in the NHS and you're reliant on very passionate people. Um And I know the majority of staff who join the competition and, and take part aren't given dedicated time or they're given very little dedicated time. Um So they're really going above and beyond to, to be able to make a difference and improve sustainability of their care. Um And I believe this is probably not only the case for the green team competition, but for the majority of clinically led sustainability initiatives across the NHS, uh the other challenge was around wider team buy in. So, while multiple benefits uh and the competition model can enhance wider engagement, it's it doesn't fix everything. Um And there are still going to be ongoing challenges with environmental sustainability being recognized by everyone as, as something that's um important and that needs prioritizing. And so one interviewee commented um that consultants in their team would skip sustainability of their meeting agendas. Uh And lastly, so there were also challenges uh regarding um ongoing longevity and spread of improvements. And so this could be due to a few factors, we've already discussed such as wider engagement, recognition of sustainability as a priority, um lengthy admin or approval processes or operational barriers. Um And it's also a challenge for teams to maintain momentum without having dedicated time and support. Um So, at the end of the Green Team competition, we have a showcase event where we see a lot of enthusiasm and a sense of building momentum. Teams are discussing what comes next um new ideas. Um But this is subsiding over time. And so one of the reasons for this might be that because our support from Center for Sustainable Health Care has come to an end. Um but also for the the leads within that posting organization, so which is often a sustainability manager. Um They don't necessarily have the capacity to provide ongoing support to those teams either. Um I don't think that these findings are too surprising to us. And we know that um spreading and scaling of quality improvement work is a widely recognized issue uh in quality improvement generally. Um And we also know that not having dedicated time alongside clinical and operational pressures is going to impact what clinical staff can realistically achieve um and how they can continue that momentum. So, in terms of recommendations, uh the evaluation suggests that the program projects and multiple benefits uh need to be communicated more broadly. So that's beyond the staff who actively participate in the competitions. Um So thinking about how we can reach staff across entire organizations, um how we can increase support given to clinical champions, um how we can improve post program communication and support to optimize those longer term benefits and expansions. Um And lastly how we can consider integrating with existing um CSH programs. It and so to think about addressing these recommendations, there are some steps that we've started to make. So firstly, we prioritized enhancing our engagement with an involvement of quality improvement teams throughout the program. Um And so we've been doing that through our 2023 competitions and obviously moving forward. Um So the Green Team program uses quality improvement tools and and processes to implement projects. And it makes sense that long term this project support should be integrated into organizations, existing Q I processes and support structures. Um We're also um outcomes of the evaluation to organization leads. So sustainability and quality improvement teams before we even start competition. So they're more aware of some of these ongoing challenges. Um And they can start to think about how they might be able to reduce some of the barriers for staff and optimize outcomes long term from their competition. Um We're improving the mentoring that we provide to green teams during the competition on communicating specifically multiple benefits to their wider team to bring them on board with their improvement efforts. Um So when teams join us in the competition, we, we understand it's called green teams. Um they're often joining because they are really motivated by that environmental element and it's a key change driver for them. Um But focusing on this alone, when they speak with their wider team, they might miss opportunities to bring wider teams on board. Um We're considering incentives for staff to encourage ongoing collection of data and sharing of their learning. So things like writing um supporting them to write submissions to conferences or awards. Um And really key to that is continuing to encourage teams to, to highlight and target problems where they can have a positive impact uh in, in multiple ways, not only from an environmental perspective. Um And I'm aware of time, but so just lastly, we've got a link. Um Well, a QR code to the full evaluation if you'd like to read it and I'll put a link in the chat. Um You might need to move on to the, to the QR code so that people can grab it quickly. Thank you so much Rachel. That was really, it's really great. Um And um lots of things that we're that we're all interested in, in terms of scaling up and using the best for the um using sharing that best practice. So lots of good learning and questions I'm sure will come up from that. Thank you very much. So, now I'm going to move on to um Rory Gibson, who's joining us from the highlands and um uh is going to be talking about his um echo project echo. So I'll hand over to you Rory and once again, I'll come back after six minutes. Thank you. Great. Thank you so much. So, I'm hoping you can hear me and see the slides. OK. But my name is Rory Gibson. I'm a junior doctor working at the Highland Medical Education Center in NHS Highland, Scotland. And I'm delighted to be able to join you today at share 2024 with the presentation entitled using Project Echo to create a multiprofessional and multi sector online community of practice to improve understanding of health care sustainability. Written alongside my colleagues and corresponding authors from the Scottish Center for Project Echo it, Kirsty Bateson and Doctor Jeremy Kane. So, just going to start with a brief introduction of the project's aims. These were as the title suggests, to create an online community of practice for healthcare professionals and students about healthcare sustainability. With the aim of this being for professional and students across professions and different sectors of health and social care. And the way we would do this would be through the modality of case studies and subsequent discussion. And I'll explain more about the exact structure of what happens, particularly with projects echo shortly but just to provide some context um within Scotland and I guess the UK as well, there are numerous statutory and regulatory documents which I'm sure many people here will be familiar with requiring healthcare professionals and students to be familiar with sustainability in relation to healthcare. Whether that be the Scottish government's climate emergency and sustainability strategy outlining NHS Scotland's strategy to become a net zero health service by 2040 or for those of us working within a medical profession, there's a recently updated good medical practice stated medical professionals should practice sustainably where possible. And then for those working in medical education, there's the education for sustainable healthcare curriculum, detailing how students can be educated on this topic. And there are obviously many other strategies and documents out there detailing how other areas of health and social care will progress towards becoming sustainable organizations. However, whilst these documents and requirements requirements exist, I'm sure many people will empathize with the feeling that it can look at certain how as to how we're getting there with many people feeling that it's still those grassroots members of staff still advocating for and making the change. So creating that urgency. So as when I apply the cos eight step model of organizational change, I'm sure many people will feel that they are in this category here attempting to create that urgency. However, I and a team at the Scottish Center for Project Echo, who I'll tell you more about shortly, recognized that there was already fantastic work going on by members of staff in NHS Highland and beyond working towards a sustainable health service. And really what we needed was to bring these professionals and students together in a community of practice where we could celebrate these short term wins and share ideas and practice, generating new ideas and consolidating that knowledge and information. However, the context of NHS Highland means that doing so in person is rather challenging, namely because it is a large and rural area encompassing the a land mass, the size of Belgium. And additionally, it is flanked by the even more remote health boards of NHS in Highland and Chia Orkney and Shetland. So we decided to create an online community of practice using the virtual learning environment Project Echo. Project Echo stands for extension of community health care outcomes and is an online knowledge sharing platform using an evidence based methodology. The model originates from New Mexico in the States from the early two thousands before being transported across to the UK mainly via the hospice network. And it adopts a democratized all teach all learn approach to healthcare education, covering a wide range of topics. They operate out of hubs found throughout the world. And the structure of the sessions is one where rather than it being a standard webinar subject, experts are invited to talk for roughly 20 minutes on a case study relating to the topic of the session. But then it's the participants who take over in the latter portion of the session to have a facilitated discussion lasting roughly 45 minutes in relation to a problem case or question that they will have brought to the session. This being a critical aspect of it being a community of practice to create the curriculum. Often with project, ethical participants are given the opportunity to define it. However, we wanted to create a structured curriculum in accordance with Doctor Francis Mortimer's principles of sustainable healthcare, which I'm sure need no introduction here. Um So that participants got to ground it in both those upstream and downstream me measures towards a sustainable system. The curriculum therefore looked like this with the exception of an initial introductory session where we discussed health care, sustainability, its many definitions and the in sectional challenges of it. Um The subsequent sessions corresponded to a different principle where a guest speaker presented a case of how that principle had been applied in the local area. For example, the role of active health link workers in relation to health promotion or the House of Care model in relation to patient empowerment. The discussion afterwards, therefore, meant that participants could discuss how this principle itself could be applied in their own setting with the ideas of what they learned from the subject expert as for results. Well, we were delighted that over 60 participants, each numbers fluctuated for each session, but this was our peak. We additionally had representation from across Scotland and also across health and social care. The word Cloud gives you an idea of the different proce professions and sectors who attended. And I think it's really great to see how diverse the attendance was given that transgressive nature of increased inclusivity and the new ideas that can be generated from different backgrounds and perspectives. And this slide just gives you an example of some of the engagement that we saw in that introductory session. So you can see there were people from all over, from Thurzo to Loch ILP and over to the Highland and Gia. Um And I should point out that in other sessions, we then also had representation from Aberdeen, Glasgow and Lothian. And here you can also see all the different perspectives that people had to come to the session, whether that be professions or how they felt about sustainability as a topic. And so overall, the Project Echo Series had quite a favorable impact. We of course, can't know for sure whether or not to actually change their practice as a result. However, feedback certainly suggests that it was a highly useful and beneficial experience to er to participants. And I quite like this quote from one of the participants who said that the series helped them realize that sustainable healthcare is just good healthcare, which is something that I think we were striving to achieve anyway. And as for next steps, well, there's so much potential for what can be done with regards to sustainability in healthcare and Project Echo, there's a potential to run a series again, with a greater focus on different sectors we publicize to the curriculum could extend with more topics and examples of good sustainable care or project. The Project Echo model could be adopted in your own setting to launch a curriculum and on healthcare sustainability in your local area, which I'm very happy to be contacted about if that's something you're interested in. So, thank you very much for listening and here are some extra details and contact information if you'd like to get in touch. Lovely. Thank you very much, Rory. Thank you, Kirsty. There's lots of lots of good learning for us there. I think it's a really key thing to think that good healthcare is sustainable healthcare is just good healthcare. So, thank you very much. And now I'm going to go over to Fraser and Jack um who are going to be presenting about uh from the University of Dundee, also from Scotland. Um about using the double diamond model, you prefer green or toolkit. Thank you very much. Well, good afternoon, if you want. My name's um Fraser Bruce and I'm a design lecturer and researcher at the University of Dundee. And this is my colleague, Jack Fletcher, who is the innovation lead on the project also from the University of Dundee. And our presentation this afternoon is entitled using the double diamond process model to cosign a green war toolkit. And the, the project is in collaboration with other colleagues from across the university, as well as NHS Tayside in Dundee, including Chris Lim, Molly Stevenson and Vicky Tully. So design hopes on healthy organizations in place based ecosystems. Scotland is an HRC Future Observatory funded project, bringing together design l researchers and healthcare experts. It's led by the University of Strathclyde and the University of Dundee with collaborative partnerships with Harry at W University, a University of Dundee and the University of Edinburgh, as well as NHS Scotland in industry partners and public sector stakeholders. And design hopes ultimately aims to be an inter internationally recognized center of excellence supporting NHS Scotland's transition to net zero through design L thinking and innovation. The NHS Scotland's climate emergency and sustainability strategy was the starting point for the design hopes project. The report identified five strategic priority areas for NHS Scotland to, to support it in its transition to net zero. And these included buildings and architecture, sustainable care, sustainable travel, sustainable products and services and sustainable communities. The design hopes project is aligned around each of these themes. And today, we would like to just take this opportunity opportunity to, to share with you briefly the work so far on the Green War Toolkit which sits under the theme products and services. Our research is underpinned by the UK Design Council's double diamond process model. Um This involves successive and iterative divergent and convergent stages where the first diamond is about designing the right thing um understanding the problem space and reframing the problem. And the second diamond is about the designing the thing, right? So this is about designing whether it's a product service or new experience. And we are currently in relation to the Green board toolkit. We are currently operating in the second diamond, moving into the development stage of the project. So this presentation is very much still work in progress. Our early research began with a pop up installation at nine Well Hospital in Dundee to engage with healthcare professionals raise awareness and gather new leads. The pop up was more than a physical space. It was um a playful creative and interactive space allowing us to understand some of the barriers and challenges related to sustainable practices as well as generating some kind of early ideas and actions for the project. You know, early research, we found challenges in um pharmacy processes, medication management, staff behavior and equipment reuse. And we also discovered really some innovative ideas around visualizing waste management, addressing up skilling and training needs, as well as empowering NHS staff to drive behavioral change. So uh after the workshop, we had in nine miles in the corner space, I'd like to introduce the kind of title the working title we're on which is the Green Wards toolkit. So the project aimed for this green more toolkit aims to guide healthcare staff providing the knowledge, tools and resources to empower them in implementing new sustainable practices as a result in a capable and skilled workforce to provide more green healthcare systems. By conducting primary and secondary research, we aim to identify the most effective methods for providing the necessary resources and establishing measurable goals. This will help to guide and educate healthcare workers on integrating sustainability practices within their current clinical and nonclinical operations. So when researching into the different toolkits, we began to take note of the reoccurring themes that show up and are used to cover areas of sustainable action within the healthcare practices. These themes look more specifically into what activities the healthcare staff will be required to complete the potential themes on the left. Um Look more specifically into what uh activities in healthcare staff be required to complete. Um and how to be taken forward to define the activities are relevant in each one. On the right, we have zoomed in on the theme of waste. An example of an activity for this theme would be around how waste bins are clearly labeled and all staff must be reminded of the difference of the waste bins. So we continued the research looking into an in depth review of both healthcare toolkits such as green impact, as well as design focused examples such as diy development impact on you to understand key features which are different from the themes. So the key features of the toolkit examples we explored were through headings, the forms and synthesized down to the development of ideas in the next stages of the toolkit headings such as difficulty levels and navigation are examples of such features. So bringing both the toolkit features and themes together, we developed a journey map that dives deep into the whole process of a potential starting toolkit. I understand this looks like a lot is going on here. But the green word toolkit is very complex and needed. We needed to use the design L approaches to visualize the structure function and touch points of the concept. This journey map allowed us to explore staff actions, activity submissions and how the future impact is relayed back to the healthcare staff to summarize and show the journey map. Explains the front end through the green and blue street. Uh the green being, staff actions, what they must do to achieve sustainable activities and the blue being the interface and skeleton, whether that's the upper framework and finally the pink straight, which is the back end looking at the internal system that means the toolkit functions properly. Er so finally, the journey map allowed us to take the complex steps and formulate what key points. Both the front end and back end consist of using the icons to reinforce the ideas allowed for more visual representation. So er using this kind of step by step approach er for healthcare workers, they feel supported along the way. And finally, a back end example, specified need for the branding and color scheme remain consistent throughout. This is still a working prototype and a welcome some feedback in the comments section. And the final slide really is just to say that through the whole design hopes project um uses a theory of change model to describe the challenges, visions and input on and the resources as well as the relevant activities and output leading to the desire to kind of short term and middle term outcomes um and to be captured over the whole funding period of the project. So, thanks for listening. Well, thank you very much for, for your presentation. That's, that's great and um I hope that people will put their comments and and um and ideas and feedback. So a lot, a lot of information, very interesting. Thank you. So now we're going to move on to William Nash from um University Hospital of Sussex, going to be presenting on Plymouth and Health School Card. So I'll hand over to you William. Thanks very much. Um So, yeah, my name's er William Nash, I am a junior doctor down in Brighton, currently working at Worthing Hospital. Um and I am presenting to you on behalf of the er climate Health Scorecard Initiative. Um And yeah, my other co authors can be here today. So uh that's Emelia and Elena. Um So um I'm sorry, so today I'm just gonna talk to you about um some of the pilot data. Um We previously presented the Climate Health score card er last year at the share conference. Um But we're in the second iteration of it. Now, I'm gonna talk to you about the goal strategy methodology results, some feedback that we've got and some key messages um from the project as well. So the pilot data um was collected in 2021 and we presented it in the journal of climate change and health. We presented this uh last year at the share conference. So I'm here to um present the new findings for 2022 and 2023. Um So the main goal of the climate and health scorecard initiative is to support health organizations and moving towards a just healthy and sustainable world um at the rate and speed required to ensure a liveable climate for all. And the key really is to enable health professionals to know what kind of action is being taken by their organizations that they are members of. So to really facilitate um er to facilitate transparency like in the case of health report card. Um We're very much taking those principles and applying it to other healthcare organizations. So, the strategy um of the initiative is to create a framework of achievable yet ambitious climate actions and we score these across all domains which I'll talk about. Um And hopefully, this will facilitate um cross organizational learning. Um And I'll talk to you about some of the case studies um that we've learned about through doing this project, the progress is monitored. Um And we're hoping to do the score card B annally. Um So the questionnaire, um this is an example of what the questionnaire looks like. So the project itself started in 2019, 2020 at the time, I wasn't involved in the projects, but Eleanor and Emelia consulted a wide range of experts both within the Center for sustainable health care organizations like Med Act, um and also other clinicians and academics as well. Um And they generated a school car, er generated a questionnaire that's been um slowly improved over the years through an iterative process. Um So here's an example of some of the questions. So has your organization measured its present day carbon footprint and you get a mark out of um 0.5 for this. So we would send these questionnaires to all the organizations and we, it was all about building relationships with people within the organization to send this um questionnaire in and we would often get try to get supporting evidence for each of the questions as well. Um So the questionnaire itself was split into um four domains. So um internal operations, education and training, finance, and advocacy. So here's just some of the, some of the themes of the questions that we ask each organization. Um So I've highlighted some of the key ones I think. Um So we ask questions about where they supply their energy from, whether it's renewable. Um Do they incentivize low carbon travel? Do they have plant based food options, sustainable events, things like the climate adaptation plans and decarbonisation plans, we would ask for written evidence of those plans. So we're not just of, of course, we're relying on and then reporting this to us, but we, we very much try to get evidence where we can um in terms of education and training, which is absolutely central to the way that these organizations function. Um Do they embed complan health in the curricula? Um And do they promote climate literacy? Do they have fellowships? Do they teach about social and climate justice as part of their curriculum in finance? It's all about have they divested from fossil fuels and have they moved to ethical banks and insurers? And then actually, what do they do beyond the um the remit of their organization of the influence legislation? Are they memberships of the UK um hack um as well. So they're the four domains and these are the organizations that took part this round. So we have 19 organizations, quite a lot of Royal colleges, I think about 10 or 11 and then some other smaller organizations as well. Um It's also for anybody who's here, please just have a look at these and, and see whether your organization is involved here. There were lots of organizations that didn't take part and that's also um important to, to realize as well. Um How can we get more organizations um wanting to be more transparent um with, you know, the stuff that they're doing with regards to sustainability. Um So the results, I'm not really gonna go into loads of detail. They're all on the website and we will be publishing this in due course, but here's um the exam, um the results for the Royal Colleges and Faculties. So these are the big organizations which have um huge resource in terms of the amount of funding um that they bring in. Um and the, the amount of, um for example, investments that they make. Um So you've got er 11 Royal Colleges, so you've got the Faculty of Public Health and General Practitioners and Royal College of Pediatrics and Child Health at the top and then the breakdown of where they score their points. Um So that's the Royal Colleges and then we've got other smaller health organizations that do have premises and so they actually have buildings. Um So again, uh you've got the Royal Pharmaceutical Society at the top there. And then finally, these are smaller health organizations without premises and staff. So we didn't really want to lump them in with organizations that had premises. And so hopefully, as, as this, um, project develops and we'll get more smaller organ organizations taking part as well. And then what we've done this as well is write reports for each organization that we've sent to them, outlining actions that they have taken and actions that they haven't taken as part of the um centered around the questionnaire. Um And then quickly, and I haven't got much time but feedback, we got some quantitative feedback saying that lots of organizations reporting that it's really helping them, encouraging them to take climate action, developing their own organizations, climate strategy. And then here's some quotes, these are all on the website just about things that organizations that we've worked with that said it's really helping them uh as a template for change. Uh And here's some of the case studies which are also on the website for organizations that have done some really positive work. We can't take all the credit of course, but hopefully it's getting organizations thinking. Um So finally, just to say there's clearly pockets of positive climate action going um happening across um healthcare. But just to say that it's quite a poor response for only 19 organizations out of 66 that we actually went to. Um how do we democratize this process? Thinking about greater representation? And can we think about bringing the same process to NHS Trust as well? So great questions will and hopefully we'll have time to chat about that. Um at the end. Yeah, I think be put it in the chat already so people can go there and there are lots of things that we need to, that we definitely would be great for people to have got ideas about how to, to um bring that to other organizations in the chat later. So thank you very much, really interesting, great initiative. Um So next up, we have uh Sarah Briggs. Um and Sarah is going to be from the University of Rod, going to be talking to us about perceptions of UK public on the relationship between healthcare and the environment. So thank you, Sarah again, I will put my camera on in one minute before the end, right? Thank you very much. So, I'm presenting work done with a team at King's College, Miranda mcfarland and Gabby and Miranda is going to join for the panel discussion afterwards on some qualitative research we've been doing, looking at perceptions of the UK public on the relationship between health care and the environment. So by way of background, you'll know this already. Um The NHS is a global leader in sustainable health care. All of the devolved nations have made quite ambitious commitments around sustainability in the NHS. And this has been enshrined in the Health and Care Act of 2022. Um But despite this, we don't know very much about public perceptions and attitudes towards health care and the environment. The Health Foundation have conducted a survey which they repeated last year. Um looking at a broad level, some of this data, but we didn have much information beyond that, moving on. So the aim of our project was to understand the values, beliefs and experiences of members of the UK public pertaining to the intersection of the health system and its environmental impacts. In terms of methodology, we conducted 12 focus groups. Eight of these were in person and four online and there were 82 participants in these, you can see a breakdown of the demographics there. So the majority of participants were female. We have representation from across the UK. We had focus groups in England, Scotland and Wales and Northern Ireland. Participants joined online, excuse me. And of the data that was reported on ethnicity and socioeconomic status by 71 participants, we had a good range of socioeconomic status and then 30% of participants were not white British. Um We followed a focus group schedule which took participants through initially a mapping exercise of a health care experience and then thinking through the environmental impacts of that and then some questions and reflections on their own experiences of climate and health. And following that discussion prompted by some hypothetical headlines around a variety of topics. The data has been analyzed using in vivo. And we've used collaborative thematic analysis with deductive and inductive coding. So in terms of our key themes, we've got an awful lot of data, but I'm going to pick out some of the main points of interest. So participants, as you might imagine were a fairly engaged group, a lot of them knew quite a lot about the climate. But on the whole, they haven't thought about this in relation to health before And when we talked about it, they did want action on sustainability within health care. But they didn't see this as happening within individual health care encounters. And there were a number of reasons for this. Um Firstly, their environmental responsibility is already heavily moralized. And by that, we mean that people have a lot of sense of moral duty towards the environment and feelings of guilt and shame, which as this participant in the quote says, they didn't feel had a place in the G P's office. They also recognize that accessing healthcare involves a lot of patient labor. Already. There's a lot of effort with going to getting appointments and following through on their healthcare needs. And actually, they didn't have capacity to have the environment into that. They also felt that they didn't have agency to enact their own values with regard to the environment in a health care capacity. And they also felt it was slightly hypocritical, being asked to make sustainable choices in the context of their own health. When they could see multiple ways in which the NHS wasn't very sustainable. They also spoke well, the environmental issues that people spoke about are largely overshadowed by problems with accessing care. And participants recognized that poor patient care leads to wasted resources. And there was discussion of nostalgic discussion about how care had been in the past and how it should be in the future. Um There was a sense that improvements of care would have co benefits of benefit in the environment with comments, like if the system cared for me, it would be better for the environment. And there's a great quote here which encompasses quite a lot of these points. So this participant says a lot of people don't want to bother the doctors. So this sense that the NHS is already quite overwhelmed and they don't want to make the effort to go to that patient labor aspect, but they might be getting messages that if you've had particular symptoms, you ought to go and get checked out. So patients are doing that and they wouldn't be thinking about environmental impacts around seeking health care. And then the response of this was the second participant was that there's this sense that actually if you don't access care promptly and get good care, then actually you become more unwell and then the impact on the health service. And with that, the environmental impacts are likely to be greater. In general. People wanted to know and have more information about climate and health and health care. They wanted this information both from their health providers. And there was a lot of referencing to national campaigns, perhaps reflective of recent campaigns around COVID. Um They want to be part of the conversation around sustainability in healthcare and they want to contribute to it. So this is one participant saying that they were part of patient participation group and actually, they were gonna take it back to them and wanted to talk about environmental impacts with them. And notably, and perhaps not surprisingly, there was a lot of mistrust and skepticism around the communication that they already get around the climate. But people did have trusted communicators. They tended to have particular news sources or particular individuals who they trusted in terms of communication. They also wanted this information before they became unwell. So not in the context of of seeking um healthcare acutely, they also referenced the role of digital in health care. There was recognition that this is widely used currently and will be more widely used in the future. And lots of talk about the use of apps and things like virtual care. People were aware of the environmental footprint of digital and that awareness came from both family and friends who might be working in the sector, but also coverage of this on TV and social media. Um And generally, the use of digital was framed in relation to gains in both health outcomes and in and in health efficiency, which they saw as ultimately benefitting the healthcare system in terms of sustainability. So, in conclusion, we've got a range of public perspectives that provide some really important insights into their priorities and concerns around sustainability in health care. And these need to be considered in the development of sustainable and resilient healthcare within the UK. Um These are our funders and to find it to our participants. Perfect your time, Sarah. Thank you so much. That's great. Um Really, really interesting. It's really good to know what um what the public feel about sustainable healthcare and how we can better communicate with them. And I think that that's been a theme that's come out through all the, the sessions you've had today is about communication. So maybe if everybody puts their cameras on now for the, the uh discussion and questions, um people have got questions and want to um put up their hands or um say something in the chat if you're not keen to say your hand, put up your hand, um I can't see any hands up. I don't know whether um Ben or Jasmine if you can see more clearly than I can. II have a, I have a question for everybody because I feel like there were, there was great um really great presentations. Thank you so much, everybody. But there seems to be a theme coming through about how we, how we um scale up the good practice and the sustainable work that's happening, how we include the workforce and the public in that. And I wonder if anybody's got any uh any thoughts about that or, or things that are that things they've noticed that themes that have come out from all of the sessions that we've had, the, the presentations that we've had that they would like to talk about or their own, their own learning, I think from um just from working on the plane health scorecard. And it's just, it sort of raises, it raises questions about, um of course, there's most healthcare professionals are part of some organization, some membership organization, depending on whether they're medical nursing, physio ot. And it's ultimately about who do these healthcare organizations represent. And although as part of the scorecard, we've been working with senior management teams within the organizations, actually, those organizations are primarily made up of members. And how is it that, how is it that sort of dynamic of the top down and the bottom up approach? How can members enact change in these organizations? Because we've very much been working, as I say with the sustainability directors of these organizations. And of course, they're very interested in how do they change an institution or an organization. But there's, I think there's, there's sort of a bit of a disconnect there because we're, I think, trying to influence things too much from the, from the top down. And I suppose through the climate health scorecard by making organizations more transparent. Hopefully it will encourage um members to um advocate for sustainability within their organizations. Um But yeah, I'd be interested to hear what other people thought of that. I think I would just add around spread and scale every organization and even one ward to the ward next to it in one hospital is really different. And so there are complexities to taking an idea that's happening in one place and implement it in another place. But at the same time, we don't have to be completely reinventing the wheel every time we want to make a change somewhere else. And I think there's maybe more we can do to promote and share the amazing work that's already happened, which is why events like today are are so beneficial. Um because there is so much out there already that we can learn from. Um that's maybe not always reaching the people who need to see that project or the work that's happening to be able to take the learning and, and implement something similar in their own service. I think, I think that's um there's a question, a question for Jack Fraser in the chat with, I don't know if you saw it saying um did using a focused model help the sustainable awareness and change? OK. Is that in terms of um the double diamond process model? Yes, I think so about your present come in. Yeah, it was just because your process of what you did looked very structured, it looked like you were following a model and you were monitoring what you were doing as you were going. And I just wondered if that really helped you improve the way that you were sharing ideas with colleagues that engage them. I just, oh, yeah. All of this is very much about how we engage other, isn't it? Yeah. Yeah. Yeah. Yeah. Yeah, absolutely. Thanks Debra. Yeah. Um I think this is what's really quite unique about our project. It's actually taking, it's, it's funded from the Apps and Humanities Research Council. So it's about using a design L innovation approach which is really quite different. So areas in NHS actually, you know, implement or come up with problems or, you know, address problems, come up with ideas and solutions and so on. And so we've been using the double diamond process model and that's just really a visual tool to understand the design process was important to note that, you know, you start off in the middle of the diamond and the problem could be really well, really well defined. So it's just a matter of then developing and implementing and delivering the solution. But if the challenges are we up against, you'll be really jumping back into the, the, you know, the, the first double diamond just to really understand that the, the problem space in the first place to even engage with some of our NHS staff colleagues. There's a sense that you might already have a solution in mind was about actually taking that step back and saying, you know, are we even addressing the right problem here? You know, and alongside that whole process model, we know we showed it clearly on the slide show. Well, there's a number of like methods like really structure of methods that we will use at different stages of that double diamond process model. So one of the ones, 11 of the ones that would really use, coming back to your point about engagement, communication was this pop up installation. So it's really interesting in seeing any probably in any hospital setting. Um A lot, lots of things are communicated visually and things like pop ups or just all these stands, they just pop up, but they're quite um isolated and just kind of sit there and people just tend to like walk past them. So this pop up installation, we ran a number of times and it was really speculative. It was about had lots of interactive features, really conversation starters. Um And it was just a completely different way to actually kind of engage people around the net zero challenges. And yeah, and a lot of the feedback and um innovative ideas, you know, it was fantastic to see just people really engaging with that sort of kind of pop up exhibition stand and it's something we then use continue to use and other projects as well. So, yeah, So the process model structured, it does look like it's structured but unbelievably complex and ambiguous for the use of the design tool helps to kind of give that structure. And yeah, I always just say it's about being um getting comfortable being uncomfortable with that process model. That's the key thing, you know. Thank you. That's uh it's, it's really, it's really good to go back to back to not to think that we've got solutions, isn't it? But without, without going back to, are we addressing the right quick, I suppose. And Sarah, I wondered if you had some thoughts about that just coming from a point of view of how, how a public engagement and public um understanding. Yeah, I don't, I think Miranda has joined as well. It is also part of the project. I might mom. Do you want to take that or, or? Uh Oh, yeah. Um, the discussions as part of the session were around. Um I think the few quotes that we shared earlier, stainability tends to be quite unsustainable and then that sustainable healthcare is really just good healthcare. Um I think the public's perspect it was very much that they didn't consider healthcare to be something that was that they were willing to compromise on rather than framing this discussion in terms of tradeoffs. Um They talked much more about co benefits and they viewed improving efficiency and reducing avoidable waste as a sort of um something that, that was also beneficial to their health outcomes. So they, they mentioned things like getting access to healthcare, but then also having capacity within healthcare to adequately address their health concerns. Um And I suppose the other sort of big theme that's run through a lot of the different um discussions today has been around time and time pressure. And I think it's, it would be interesting to think a little bit, a little more, I suppose about whether we're responding to, um you know, the need to be efficient in, in order to relieve pressure or the need to be efficient in order to be more sustainable. And what the scope is that we're considering when we do that. Um because the, the way that the public kind of framed it was much broader, I think they, as much as their sort of first frustration was um not being able to get appointments in primary care settings. They also understood the sort of knock on effects um that could happen from not receiving adequate care at the outset. Um So I don't know whether you've got anything to add, but that was my very similar. I think a lot of it is around um you know, actually good quality care that patient centered in the medicine session earlier. Actually, um you know, they were talking about reduced tablet burden for patients and these things that actually improve patients experience of health care, but also improve um staff experience of health care and the idea that we need to, um I think, talk about the other benefits of these syndromes approach more, you know, the, and talking about expanding the reach to a broader range of people. Actually, if you can sell the fact that this makes life better for patients and for um the staff member, actually, that's, that's a real win. Um And, and um the public saw those, you know, dual benefits of addressing this. So are you saying that the public do, do see that completely? That's completely. Yeah. And II think it's something and that's it. I mean, it's been a big thing in the, in the, um, in the news this week about dental, about Children and dental health, isn't it about then? That's the biggest reason they're admitted to hospital, which obviously, from our point of view, has an enormous carbon footprint from the family's point of view is, is really traumatic for the child and is, and is a huge from the NHS point of view, huge use of resources. But if we can think about early intervention prevention, all those kind of things, I think that that's something that everybody can understand, everybody can understand the benefits of that. And we don't have to frame it in one area or another. We can say this is just better care as we can. And actually was mentioned a lot by members of the public in the focus group as well. I didn't cover it in the talks, there wasn't enough time. That was another recurrence. The was this idea of providing good health rather than addressing ill health? It's really key. Sorry, Miranda. Do you want to say something? Well, in terms of prevention, they also sort of questioned whether that was located purely within the remit of the NHS or whether, you know, they kind of were curious about what role public health should play. Um And I think because public health isn't a service that the public tend to directly engage with in the same way as the NHS, there was sort of less awareness about what, what public health kind of remit was that was certainly raised. Um, I think a few people questioned whether or not, you know, the role of the NHS is in sort of healthy lifestyle guidance or keeping people healthy. So there was a, I suppose a concern raised that you may be medicalizing health as opposed to addressing ill health within the NHS. Does that make sense? Um And, and Rory, I was wondering if I could ask you about with your, with the project that, um, sharing across a wide area for the best practice and whether and going back to what Rachel's point about even the next ward can have different challenges, how much people could, could share best practice or how much, how much it is transferrable in terms of what you found within, within your area. Yeah, absolutely. I guess that is the notion of, of project echo, sorry, being a community of practice was for people to bring their own kind of be familiarized with a principle or um an example of excellence, I guess, and to see how that could be applied within our setting, and it almost became a sort of a uh a task force as amongst, as, as opposed to anything else rather than this webinar. So it was really great to kind of see people kind of troubleshoot for each other and kind of across very different contexts. You know, we had community hospitals out in the outer hebrides versus kind of, well, what we would consider in a city in Inverness. Um So it's a very different context and challenges, but, you know, everyone's familiar with what it's like to deliver rural care work in NHS Highland. So it was, it was interesting to see how those, how those ideas could be spread. And that, that generally is ethos of project echo that participants will gain knowledge in that in that area that expertise um and then bring that to their community. So it was, and it's great to kind of hear of how that's been done as well. Um And I was interested that, that you, that it's uh multidisciplinary as well and does that in that includes the like it departments and uh and the um people in hr and thinking about workforce development and all those things as well. Yeah, no, great point. Actually, I guess our intention was for the community of practice to very much be open to anyone working in health and social care because, you know, it was our thoughts, we believe that sustainable change can only happen if you incorporate all sectors and all professions. Um and generally having that diversity of thoughts and ideas could hopefully generate new ideas or new exciting ideas. We unfortunately didn't get anyone from those departments that you mentioned. Like hr and II guess we did get people come from the likes of the States, but I guess the States are already very familiar with the sustainability agenda, but that's a very good point in terms of kind of potentially targeting those um those aspects of, of the health service in the future. I see on the line, I don't know whether Ky had any experience of people from other departments or those departments be using Project Echo for other topics and how that's worked out, but she's there. She might not be here at the moment. I was just trying to orientate myself with the controls. And so um yes, in terms of um running Echo alongside other other subjects or other specialisms, we, we sometimes do get people from other departments. Um It really depends on the topic. So um to, to give you an example, um I think it was probably about a year ago now we ran um Echo Sessions um alongside um NHS education for Scotland and Health Improvement, Scotland looking at adverse events, um, and what they wanted to do was share their, their learning from the research that they've been conducting for two years and to why, um, you know, adverse events end up in litigation. Um, and, and you know, what can we learn about how we treat patients and families before it gets to that stage? Basically. So for, so to give you an example for, for an Echo program like that, we had people from different departments because it, it affected everyone from the practitioners who were actually, you know, dealing face to face with patients, to policy makers, to quality improvement advisors, to hr advisors as well. Um So that's a, that's a really good example of where Echo can incorporate, you know, people from other areas. Um all working towards the same goal and uh funnily enough. Well, um Rory saying, you know, obviously the, the focus for the sustainability Echo was um you know, healthcare practitioners. Um for instance, we, we did have one or two people in each R that dipped in and out it because they wanted to, to, you know, um basically participate in it for their own learning um particularly because we're working in a, a healthcare environment um in terms of um you know, the people who, who work in it. Um that was a, that was an interesting one as well because I'm AAA digital practitioner and I found it quite interesting because I have my own questions um about sustainability and where digital practice fits with that because when you work in a not for profit organization, um and you are looking at sustainable digital practice, there's, there's going to be, there's going to be an implication for that somewhere else in what you do. Um And so yes, so I can give you that perspective from, from that point of view, but I hope that kind of answers it. So it depends on the subject. But I think it's generally when it's subjects where we're looking at, you know, service provision, that's when um Echo has the, the opportunity to bring in people from other departments and, and get that that whole provision perspective. Um When we're, we're talking about healthcare and healthcare practice and improving um clinical practice for patients, then yes, it does become then very targeted to health and social care. Thank. Thank you very much. Good to hear. Good to hear that, that um that viewpoint from a, from a digital point of view. But um and I guess, I guess uh thinking about projects that I've been involved with where we've had, it's been about information like giving information on the web sites and that kind of thing and bringing in it people so that we can make sure that the right information is out there or that we change the pro perform when people are admitted so that they're getting asked the right questions initially so that there's not problems further down the line that those, that's when it's really helpful to have people who know how to, to um to do those things as well, you know. So it's, it's clinical and, and I working together as well. So, um yeah, really, really helpful, useful. Thank you. Um I was also interested, so William thinking about the, the um the climate health initiative um for whether the workforce development is part of that as well. So when you're looking at, when the I um when you're looking at the uh climate health report card, do they, is that about how, how people's I know education is involved? But is it about ongoing education as well as initial education? And yeah. So within, within the internal operations, there's a number of questions where we ask organizations, what about, do you have um members within the organization that are paid, who have time and, and money set aside to work on climate related things? So that that was, was one thing we also had a question on um do the senior management teams, do they have a policy where they take into account sustainability and all of their decision making? Which I think quite interesting. And then there was a question, do they have climate working groups within the organization? Um So they were, they were the ones related to kind of the internal operations of some of the structures going on within healthcare organizations. But I think we probably do miss, we do miss more of the granularity of what it's like for ordinary members to work within those organizations. Um I think in terms of the education side of things we had questions related to do you have mandatory training courses to promote climate literacy amongst all your members? Um And there was some, some really good um some organizations who had um courses that all members had to, to take. Um Of course, some of them are a bit disengaged because some of them could get the point by just saying we give um there's a e-learning for health module that we give to new starters. How much of that actually engages people? I don't know. Um But yeah, so and, and then also um we tried to get as much evidence as we could um around our organizations teaching their members or, or even teaching the public about the some broader issues. So not just about um the science of climate change, but also about social justice and climate justice. Um and the intersection between inequality and, and of course, it makes sense that maybe the Royal College of GPS and Pediatricians and psychiatrists are doing that more than surgeons. I don't think we were surprised by that. Um But I think what, just by asking the questions to these organizations, we're trying to overcome a little bit of the institutional inertia that goes on and just trying to get people within the organization thinking about these things perhaps for the first time. I mean, there's clearly, there's some people within the big world colleges who are very passionate, very enthusiastic. Um, but we're also trying to hopefully get a little bit of healthy competition going amongst the, I think, I think it's been, I've realized that we've come to the end of that, you know, it's, it's been really such great presentations. Thank you, everybody who's been involved really. And thank you for your discussion afterwards as well. I'm looking forward to looking at through it all again, I think, hopefully, um and hopefully that, that we have done a bit of that kind of sharing of best practice and sharing of knowledge and understanding, which has been, she's always really useful. So, thank you very much, everybody. OK. Thank you. OK, buh-bye. Thank you. Thank you.