Energy efficiency and better patient care

In a pilot project at Barts Health NHS Trust, Global Action Plan – in partnership with Skanska and GE – has explored how hospital staff can be convinced and assisted to adopt energy saving measures. We have demonstrated that the more energy efficient wards show improved patient experience, with better sleep and privacy. The results could transform energy efficiency campaigns across the NHS.
    
For people seeking to cut energy consumption across the NHS, this is an exciting outcome. Our pilot project showed that frontline staff will change their actions to achieve their core goal – improving the patient experience. Taking energy saving actions on the wards creates a better hospital for patients, or a “healing environment” as described by Dr Steve Ryan, the Medical Director of Barts Heath. If nurses care about patient experience, and patient experience is improved by energy efficiency, we can get nurses to care about energy efficiency.

Significant Savings
The pilot programme ran in a quarter of Barts Health’s estate and achieved a one-year payback, saving £105,000 per annum and 800 tonnes CO2. We identified a total of six per cent energy savings available when the pilot is rolled out across the whole estate. If replicated throughout the NHS, similar programmes could deliver £35m in savings.

Barts Health and its three partners took on the challenge of this project because they knew that a typical energy efficiency campaign was unlikely to succeed. We wanted energy efficiency actions to become part of “business as usual”, which meant proving that energy efficient operations are better for hospitals.

What interests your audience?
Typically, energy-saving messages have been based on a request for staff to take action to save their organisation money, or to reduce their impact on the planet, with messages like “Turn the light off, save a polar bear!“ and “Unplug the photocopier and save us £1,000 per year.”
    
The problem with these campaigns is that while many staff agree that saving the NHS money and reducing environmental impact is important, these factors cannot compete with the desire to give patients the best care in hospitals. If a nurse came to work primarily to save the NHS money, he or she would be in the procurement office, not a hospital ward. It’s not that frontline staff don’t care about the planet, but just that they care about something else even more.
    
Global Action Plan, as an environmental charity, has for the last 20 years been helping organisations prove that achieving a lower environmental impact has much wider benefit, and is actually better for us. For any change to be “better for us” it must appeal to our existing desires.
    
In a hospital where staff care about patient recovery, we can suggest that they dim the lights during the day and maintain the temperature settings to help patients get better sleep. This shifts the dynamic to giving staff a helping hand to achieve their existing ambitions, which is a much more effective route to change.

As patient care is a uniting factor across NHS frontline staff, this approach should be replicable across the NHS. If you have the ambition to make an NHS Trust more energy efficient, what practical steps make up a patient care-focused engagement programme?

Programme Design
The programme had three stages. The first was scope; understanding the people in the organisation, the motivators and barriers to change and the actions they can take that will make a difference. The second step was action; making messages compelling, getting out there and talking to people, recruiting key influencers who share your ambition and listening to peoples’ reactions. The third step was to evaluate; continually reviewing the success of interventions, measuring impact and celebrating successes.
    
In the scoping phase we first determined what frontline staff could do that would make a material difference to the Trust’s energy bill. In the new world-class Royal London Hospital, individual rooms are set at different temperatures and the air is exchanged up to 10 times per hour in each room. This made the action of closing doors important to help the heating, cooling and air exchange system work efficiently. Lighting could be controlled by staff as could much of the equipment. But how did these environmental actions help staff achieve great patient care? Firstly, discussions with clinicians highlighted that good quality sleep is very important for patient recovery.

Where patients may be disorientated through illness or recovering from operations, it is also much safer for patients to stay in their rooms. When treating immunosuppressed patients or highly infectious illnesses, isolation is important. Our three actions – turning off lights and unused equipment and closing doors – do help patient sleep, improve safety, care and privacy.

Operation TLC
The best campaigns have a snappy identity. We needed one that led with a message about patients, and highlighted the three actions that help improve patient care. Giving the building a dose of tender loving care means that it looks after your patients – so we came up with the name Operation TLC, which in our case also stood for the three actions – Turn off, Lights out and Close Doors. We knew from our scoping phase that some staff were already taking energy efficiency actions. We reinforced why their existing actions were great for patients, and helped colleagues follow their lead.
    
The ethic of teamwork is strong on the wards and staff like to be rewarded as teams. We provided treats for teams where at least one team member was photographed doing a TLC action. With those photographs we produced small leaflets tailored to each ward. This intervention utilised a number of recognised social science and behaviour change techniques – social norming, self‑efficacy and positive reinforcement.

We asked volunteers, matrons and ward leads to champion the initiative, and then provided many reminders such as branded pens (nurses always have a pen on them), one-off events at the hospital entrances and screensavers on PCs. The screensavers featured senior members of staff, such as the medical director, or estates director, endorsing the campaign.

Getting Feedback
Global Action Plan’s engagement experts made 100 visits throughout the four-month campaign, to hear people’s reactions first hand, to thank them, to answer questions and to spread good practice. For example, when some wards heard that other wards dimmed their lights each afternoon to help patients sleep, we helped them find the lighting controls in their new hospital. Finally, the evaluation stage measured the impact of the campaign through ward‑walk audits, energy metering data, patient surveys and qualitative conversations with ward leads and champions. We used so many different measurement methods so that we could tell whether change had occurred, if it was down to staff changing their actions and whether patients gained benefit.

Lessons Learnt
What is our main lesson from the pilot? If you understand what people in any workplace are trying to achieve, and your energy efficiency suggestions help them reach their aims, you’ll be a help, not a hindrance.
    
So where next? What’s beyond the hospital door? As well as Operation TLC continuing throughout the trust, Barts Health has seen the potential to combine environmental and health ambitions in its East London community. We’re supporting Barts Health on two further programmes that help prevent patients needing hospital treatment and lower environmental impacts.
    
In one project, we will enable clinicians to recommend free insulation and boiler replacement for vulnerable patients suffering in cold homes. Another project will utilise the reach of the Trust to address traffic problems and improve air pollution which causes 4,300 premature deaths across London each year. More on this wider community health and sustainability agenda will be published in Health Business in October.

Further information
www.globalactionplan.org.uk