Health system sustainability and healthcare waste will be in the spotlight at an event in Sydney today (13 November), convened by the NHMRC Partnership Centre for Health System Sustainability.
It is a timely discussion, following a recent call by the International Society for Quality in Health Care (ISQua) for the health sector to reduce its climate footprint and to embed climate sustainability within its work to improve healthcare (as reported recently at Croakey and shown in the feature image).
Cutting the enormous waste from low-value care is an important strategy for reducing the health system’s carbon footprint, says Associate Professor Yvonne Zurynski from the Australian Institute of Health Innovation at Macquarie University and the Lead of the Coordinating Centre of the NHMRC Partnership Centre for Health System Sustainability.
Yvonne Zurynski writes:
At a gathering of more than 1,500 healthcare professionals from 80 countries last month, the International Society for Quality in Health Care (ISQua) issued a Statement on Sustainability in Health Care.
ISQua is committed to promoting climate sustainability and implementation of climate-friendly interventions in the health sector.
So, what does climate sustainability have to do with health system sustainability? Plenty!
The most respected of medical journals, The Lancet, reported in 2018 on the likely devastating impacts of climate change and weather extremes on the health of populations and therefore on health systems across the world.
Climate change is already resulting in increased transmission of infectious diseases such as dengue fever and malaria. It threatens food security through droughts, floods and destructive storms. Heatwaves are associated with reduced labour productivity. All having knock-on effects on physical and mental health.
Healthcare is one of the world’s largest industries—the National Health Service in the UK is the world’s 8th largest employer.
Addressing waste
As such, the healthcare industry has the power to make a significant reduction to its carbon footprint by choosing renewable energy sources, reducing single use plastic items and introducing recycling schemes.
By doing exactly this, Princess Alexandra Hospital in Brisbane reduced its landfill waste by 600,000 kilograms a year.
There are, however, other types of waste in the healthcare system.
We know that low-value care accounts for approximately 30 percent of all healthcare delivered to patients.
Put simply, low-value care is waste. It is care that has no discernible benefit to patients, but accounts for significant financial costs to health systems, patients and the broader community. It includes, needless tests and imaging, over-diagnosis and over-treatment – at best it’s wasteful, at worst, it’s harmful.
For example, approximately 40 percent of prostate cancers are over-diagnosed. These are cancers that cause no symptoms or ill-effects throughout life.
However, by over-screening and over-diagnosis, men might undergo treatment needlessly and may experience serious side-effects and reduced quality of life because of pain, erectile dysfunction and incontinence— not from the cancer, but from the treatment.
Value first
It seems that health systems have been tolerating wasteful low-value care at approximately 30 percent for the last 25 years. There aren’t too many industries that would abide this level of wasteful activity.
By tolerating low-value care, we inadvertently overburden the health system, limiting access to needed high-value care that provides real benefit to patients and communities.
The system already is threatened: by rapidly ageing populations (almost a quarter of all Australians will be over the age of 65 years by 2057); high rates of chronic disease (approximately 50 percent of Australians have a chronic health condition); ever proliferating new and expensive medical technologies—drugs, tests, medical equipment, imaging; more demanding health consumers; and an increasingly stressed health workforce.
More healthcare is not necessarily beneficial healthcare. And yet, our systems are designed to reward the volume of care delivered rather than the quality and appropriateness of care delivered.
You need only look at what we tend to measure when reporting health system outcomes—numbers of consultations, hospital admissions, emergency department presentations, operations performed, prescriptions written. This tells us about volume, not value.
Systems approaches
However, things are changing by taking a more systems-based approach and considering the health system for what it is—a complex adaptive system just like the ecosystem.
When introducing change into complex adaptive systems we need to understand how these systems work and ensure that the solutions being introduced are adaptable and resilient while taking account of the complexity and entrenched cultures that are intrinsic to healthcare systems.
It is heartening to see innovations being implemented through quality improvement programs, health consumer involvement in setting the health agenda, and a more defined focus on how we deliver care, rather than on how much care is delivered.
For example, by increasing the use of telehealth, digital health and apps, and empowering people to self-care we could immediately reduce carbon emissions through prevented travel, while at the same reducing wait times for face-to-face consultations.
There is no doubt that the health sector will need to adapt to climate change. It will need capacity to do this.
Cutting waste attributed to low-value care will free capacity and resources in an already stretched health system to enable it to respond to the new challenges that climate change will bring.
Strong leadership from the Australian Government, the health sector and health consumer groups is needed to develop, adopt and implement an integrated strategy on health, environment and climate change, as called for by ISQua.
• The NHMRC Partnership Centre for Health System Sustainability will hold a health system simulation to tackle low-value care on the afternoon of 13 November 2019 in Sydney.
• Yvonne Zurynski, Associate Professor of Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, and the Lead of the Coordinating Centre  of the NHMRC Partnership Centre for Health System Sustainability.
