The Future of the Quality Movement – The Health Care Blog

By MARIE DUNN

A little more than 20 years ago, the IOM report To Err is Human catalyzed the profession around the realization that our health care system was killing around 98,000 people a year from medical error. I am part of a generation of professionals that learned to adopt systems thinking; to measure, monitor, and improve; and to ultimately improve quality of care. 

Today, we face a different set of challenges. Health care is in the midst of a global pandemic, a reckoning with systemic racism, not to mention the great resignation. But also, we face a climate crisis. Are these things connected? Is there something we all can do? The answer is undoubtedly yes, and I write to advocate for climate change to be included on this list of strategic and moral imperatives for health care leaders everywhere. 

Why is that?

• Even today, the health care industry’s contribution in emissions to climate change is killing people. In 2018, greenhouse gas emissions from the health care industry alone resulted in the loss of 388,000 disability adjusted life years.
• The impacts of climate change on health are inextricably connected to issues of systemic racism. For example, communities that were red-lined (racist housing policy that led to systematic underinvestment) experience higher temperatures than communities that were not, and higher temperatures take lives.
• Climate change makes conditions more favorable for the spread of some infectious disease, including pandemics, but also illnesses like Lyme and waterborne illnesses that have significant impacts on health.

As the world shifts, it’s time for health care leaders to develop a new set of strategic priorities that address the health system’s need for preparation and resilience in this landscape. 

So with that context, what can you do to effect change?

First, get up to speed on the intersections of health and climate. The information is out there, so dedicate some time to consuming it. Health Care without Harm is the leading non-profit in the US focused on this topic, with many great resources to draw from. I have learned tremendously from publications like The Lancet’s Countdown on climate change and health issues and the books Environmedics and All We Can Save. 

Reading is important, but don’t let it be your only action. Here are some steps to take.

Take a look at how climate intersects with your organization’s strategic plan and embed measures that link your organization’s success to its work on climate change. There are two primary ways your organization can demonstrate its efforts to impact climate change. 

One set of actions is to mitigate emissions. This might look like efforts to switch to renewable energy, review your organization’s investment portfolio, and most importantly in health care, reduce emissions coming from the supply chain. 

The other set of actions relate to adaptation. In short, since climate change is already happening, this is about creating a set of strategies that help your community—however, you define that community (local, regional, national)—more effectively respond to the impacts of climate change that exist today and will get worse in the future.

It’s nearly impossible to maintain progress on an initiative without a way to measure progress, so this means it’s important to incorporate measures related to climate into your organization’s strategic plan. On the mitigation front, this might look like striving to become a net-zero institution (Kaiser in the US and the NHS are leaders on this journey). On the adaptation front, maybe your organization picks a few measures from the recent Lancet Climate change and health report that are relevant to your community and tracks efforts and progress. 

Help people make connections between climate and existing strategic projects and skills. 

Too often, climate change feels far away from and unrelated to the pressing problems at hand. Also in a moment of big problems, there might be fear that we can’t turn away from something as big as the Covid-19 response. I am not advocating that we turn away from these near-term imperatives, but I do believe we need to add a climate-conscious lens. Make the links to show that by doing the hard work we’re already doing, with a climate lens, we can have even more impact. For example:

• Are you having conversations about social determinants of health? Link these conversations to climate–climate change is a social determinant of health. 
• Are you trying to improve your supply chain? As many organizations consider the effectiveness of their supply chains in the wake of a pandemic, this is the moment to add a sustainability lens. As the world becomes more emissions conscious, so will health care. Health care organizations wield tremendous purchasing power that can be used to positive ends here. It’s easy to think that being sustainable might always be more expensive. But there’s a lot of waste in health care, so efforts to reduce have the chance to not only reduce emissions but reduce costs. 
• Are you having conversations about value-based payment? There is readily available information on heat waves and air quality, and these environmental conditions have real impacts on human health. Review the CDC’s assessment of regional impacts of climate change on health. Is there a way to systematically add some indicators related to heat, air quality, or other relevant factors to your care management program program, with a set of related interventions, so you can better help your communities adapt? 

Look for your community. 

I don’t consider myself a climate change expert, and I am guessing you might not be either. 

But as health care professionals, we have a lot to bring to the table on the conversation about climate, in the same way that we have a lot to learn from folks who are working in other domains. What I do know is that no single person will solve this challenge, and that finding community is important.

Here are some ideas:

• Involve your supply chain and finance teams. Often behind the scenes, these teams will play a pivotal role in helping your organization move forward. 
• Take advantage of existing infrastructure. The CDC has invested in capacity for climate and health in a number of states through its BRACE program. Look to see what might exist in your community to draw on and build from.
• Reach out to your partners in public health or health care delivery. Health care delivery systems and public health have complimentary roles to play. Braiding resources and initiatives will help communities go further together.
• Seed funding to community-based organizations. As in so many health care efforts, community-based organizations play a critical role. These are likely not new relationships, but relationships already in place through other initiatives. Community-based organizations by their nature run on small budgets. Think about ways to flow resources into these organizations to secure them as partners and align your efforts in approaching them around topics like VBP, climate, and other efforts. Look for ways for them to lead in approaching the communities they serve.
• Build on your community data resources (HIEs, etc). Many community-based data programs are in the process of re-envisioning their future. Can these organizations be community resources to provide a data set or service that no single organization can provide where it comes to a topic like climate change?

Lead with small tests of change. 

When faced with the Institute of Medicine’s staggering assessment of error in medicine, we led with conviction, small tests of change, and systems thinking. This topic is gaining momentum, with institutions like the National Academies and HHS stating their intent to take action. However, the market forces are not in place as of yet to put climate change on the agenda of every health care organization. This is where your voice, conviction, and action matter. Chances are that there is something small you can do today to help effect change in your organization and build momentum. Small tests of change make a big difference.

Marie Dunn, MS, is a public health professional and long-time health executive working at the intersection of analytics, population health, and climate.