Environmental sustainability in quality improvement: A starter guide for paediatric dentists
Year: 2022
Type: article
Abstract: The environmental crisis is the greatest challenge our planet is facing.1 As healthcare professionals, our aim is to improve the health of our patients and communities, but delivering healthcare services actually contributes to the detriment of the planet. Some of these environmental effects will negatively impact global human health, for example, air pollution, ozone depletion and climate change. In the UK, the National Health Service (NHS) was responsible for approximately 4% of national carbon emissions in 2014/15,2 and the NHS has pledged to become a ‘net zero’ carbon healthcare system.3 To deliver this goal, sustainability has to be a priority for the NHS. Working to improve the services and systems in which we work is a professional and ethical obligation as members of the paediatric dentistry team. One way to develop services is through a quality improvement project (QIP). An article in last year's Quality Improvement Briefing demonstrated the benefits of QIPs in paediatric dentistry.4 The aim of this article was to encourage the members of the paediatric dentistry team to carry out sustainability-focussed QIPs, providing some practical tips and examples, and to discuss how to incorporate sustainable principles into all service improvement projects. Environmental awareness is increasing; there is no shortage of ideas to make sustainable changes in our daily lives, personally and professionally. In fact, there are so many potential areas for improvement that the challenge lies in starting with something that is simple and achievable. Perhaps the most impactful areas to focus on are those that would be applicable to other services—not only paediatric dentistry but also other dental specialities, and other medical or healthcare services entirely. We will come back to this later. The Sustainability in Quality Improvement website (susQI.org) provides a plenty of open-access resources on carrying out a sustainable QI project and goes into detail far beyond the scope of this article.7 Their practical step-by-step guide on how to carry out your susQI project is very briefly summarised in Figure 1. Many of the principles in this guide are no different from any other QI activity and roughly equivalent to the plan-do-study-act (PDSA) design already adopted in QIPs. These SusQI steps were followed for a project carried out at the Eastman Dental Hospital on the use of surgical gloves vs exam gloves in 2021. Previously, one of our team had demonstrated that the carbon footprint for a pair of sterile surgical gloves was over 11 times higher than nonsterile examination gloves (measured in kg CO2e).8 Clinicians at our hospital have access to both types of gloves, with no protocol on which gloves to choose for which procedures. Therefore, the aim of this project was to reduce unnecessary surgical glove use and the associated environmental impact. In September 2021, a clinician questionnaire on current practice found that clinicians often chose surgical gloves under general anaesthetic (GA), regardless of whether the procedure is surgical or not. There were a few misconceptions—that surgical gloves should always be worn under GA, that simple dental extractions warranted surgical gloves and that immunocompromised patients warranted the use of surgical gloves. The infection control and prevention (IPC) team were consulted to discuss what gloves are appropriate for different types of dental procedures. With input from IPC, a new standard operating procedure (SOP) was implemented in December 2021 to reflect that surgical gloves should only be used for surgical procedures (those involving incisions, raising flaps, etc.). The clinician questionnaire was repeated in February 2022 and showed a 50% reduction in sterile glove use for nonsurgical GA procedures (eg, simple extractions and/or restorations of teeth, which make up 79% of the department's GA cases). The carbon footprint saving was calculated from this reduction, assuming 3 pairs of gloves are used per GA (consultant, junior and assistant), and the department has the capacity for approximately 90 cases per month; this resulted in a saving of 79.4 kg of CO2e per month, the equivalent of driving a typical passenger car 200 miles.8, 9 Although making a sustainable change within your own service is an achievement, the ultimate goal is a zero-carbon health service. An isolated QIP in one service is often the first step, but encouraging more services or specialties to make similar changes will result in more meaningful environmental impact savings. The only way to achieve this is to share ideas and projects between organisations. Sustainability QIPs, like any QIP for that matter, can be shared in a variety of ways within and beyond paediatric dentistry. In the UK, for example, there are many ways to share projects through the British Society of Paediatric Dentistry (BSPD); the Quality Improvement Briefing (QIB), branch meetings and conferences can all help spread the word among the paediatric dentistry community. Often, the results can be applied to other dental or medical specialties, and so, you could also present your project at QI events within your trust, or even submit your QIP to the Greener NHS, which produce a monthly bulletin and report case studies on its website. International conferences and events will help spread the ideas further.10 Supporting paediatric dentistry services and other healthcare services to make sustainable changes is challenging—it takes time, leadership and patience. QIPs are not the only way to embed sustainability within your service. Sustainability can (and should) always be considered whenever any type of change is proposed, from a simple audit to planning a complex business case. Take a simple project from last year's QIB as an example: Development of a Safeguarding Pathway in a Paediatric Dentistry Department by Cant & Tatham, 2021.11 This project introduced a vital new pathway for missed appointments. Without explicitly mentioning sustainability, the pathway they designed already lends itself to sustainable principles; notes are recorded electronically, no new paper forms were introduced, and the pathway streamlines care in order to prevent wasted appointments if they are not needed. Environmental principles can be applied when deciding how to implement a new pathway such as this. For example, creating electronic resources to train new staff as an alternative to an induction handbook, adapting electronic record and letter templates as an alternative to paper forms, or making an e-folder to keep reference documents and safeguarding logs as an alternative to a physical paper folder. Larger projects, such as business case planning, can also incorporate sustainable principles. At the Eastman Dental Hospital, for example, the joint orthodontic–paediatric dentistry clinic piloted virtual appointments over the last two years and is working to develop and expand the virtual multidisciplinary team model. Initially, clinical outcomes and patient feedback were evaluated and supported the development of the service. It is important to think about sustainability alongside clinical quality and cost-effectiveness, and therefore, we are now evaluating the environmental savings (reducing patient and staff travel into the hospital) by moving to this virtual format. As sustainability becomes an ever more important goal within the NHS, my experience so far has been that these projects are well-supported and encouraged at a trust level. The environmental impact of the paediatric dental services that we deliver cannot be ignored; we need to work together to make improvements. There are plenty of ideas and support available for clinicians who are interested in carrying out a sustainability QIP, but this article encourages all clinicians to incorporate sustainability into all aspects of clinical governance. The author declares no conflict of interest.
DOI: 10.1111/ipd.12908
Author: Alexandra Lyne
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,100
OpenAlex ID: W4295437663