Note: This transcript has been auto-generated and lightly edited for clarity. It may contain minor errors.

Welcome to the Sustainable Healthcare Healthcare Podcast. I’m your host from Green and Racing Group, and today I’m here with Michael Mojo from the Center for Sustainable Hospitals in the Danish region from the healthcare provider. Michael, you are working a lot with providing change management around sustainability at the hospitals and other places, working with clinicians.

Would you like to introduce yourself to our listeners? Yes, thank you and thanks for having me. My name is Michael, and originally I’m educated as a teacher, but I have a master’s degree in educational psychology and I’ve been working within the healthcare sector for almost 13 years, the first 10 years at our service provider, a regional department that provides all the linen and cleaning for most of the hospitals.

Providing education for most of our employees at that point. The last three or four years I’ve been working full-time with sustainability and I was fortunate enough to be part of the Center for Sustainable Hospitals back in 2021, when we were only three, but now we’ve grown to plus 25 people.

That’s been a rapid change and that’s actually allowed us to go from a startup to a more integrated part of the region’s government systems. That’s also provided me with a possibility to dive a little bit more into focusing on the competencies that are actually needed to drive this change.

In order to help facilitate all of this change management needed at the local sites. So a major part of my job is to go out to the hospitals and facilitate and meet with different kinds of groups. It could be leaders, it could be sustainability consultants or ambassadors from the local departments.

My job is to go out and help facilitate and see what is actually needed in order to drive these changes. Excellent, and interesting with your background as a teacher, which probably says a lot. For our listeners, what is the Center for Sustainable Hospitals and what is your goal?

The Center for Sustainable Hospital is part of Central Denmark region, and our aim is to help and facilitate achieving the goals set in our ambitious sustainability strategy, which was produced in 2020 and has a 10 year span and is about to be renewed now. Our aim is to go out and help the hospitals, both at a department level with the managers there, but also as a hospital as a whole, to counsel them in ways of achieving the potential they have.

But it could also be in facilitating helping in the procurement and the tenders that we do on medical equipment, but also producing totally new items, or facilitating the talks with the industry in order to change specific products into being more sustainable.

Exponentially undertold story, that sustainability is one of the fastest growing professions in healthcare across Europe. If you just look at the headcount, of course, because it started from zero, but that’s a very interesting point of view, because in one way we were actually employing a lot of people that could have been nurses instead.

That’s the way we’re very aware of. But a very high majority of the funding that we received is either given directly to us as a way of actually saving money in the long term, which we actually produce. But it could also be that we’ve achieved some funding from the EU or from external sources.

So actually, our budget is much higher than the budget that we receive from just our funds as being employed by Central Denmark region. When we started as a startup, most people were like, oh yeah, sustainability. That’s nice, that’s extra, that’s really good.

We had a lot of wind coming in our back in the beginning that allowed us to get a very big draft. But then suddenly most of the organizations within our own group, because we are 35,000 people employed here, most of the people at one point found out that we were actually very much interested in making these changes and that these changes profoundly changed the way they think or act around the work. Within the first one or two years, we had a lot of pushbacks because in the beginning we were nice and friendly and everything, but then they found out that we were actually very interested in profoundly changing some of the total basic dynamics of providing healthcare. That actually made us pause a little bit and make sure that we have a broader scope and a bigger mandate for these changes. Because people are on the other hand also much more interested in contributing, both because the decisions that we actually influence influence them in return, but also because the interest has actually grown quite a lot the last few years. That’s why we also need to grow because we need to manage so much more interest from different parts of people. We need to make sure that we pray in all the churches because if we have something that we need to have done, it’s not enough just to get the technical department or this department.

We need to go all the way around. Which is also one of the things about sustainability. It’s not just a quick fix in one end. It influences the whole food chain.

Anyone working with change management and healthcare could learn a lot from that. Really interesting as well that I understand you correctly, that sustainability has actually allowed you as a healthcare provider to tap into funding beyond what you’re getting to deliver the care and hospital services that you do, which is really interesting.

Michael, I wanted to ask you as well. For a lot of people in healthcare and in the private industry, from the suppliers, they had this feeling or they’re being told that this is somewhat also something nurses and doctors are doing. At the same time we will also sometimes be met with that. We are still just looking at the price and quality or clinical effects. So you are speaking to all these different departments. Could you give us a status on some of them, if we say leadership and clinicians and procurement?

What’s the status out there around sustainability? What are they thinking? What do they think about, what are they struggling with? What’s the motivation around it? I think generally when you meet clinicians and you talk about sustainability, one of the first things that comes up, if they haven’t dived deep into sustainability before is what about the hygiene?

Is this really hygienically safe? Is this okay? Because we actually changed from multiple use to single use because it was more hygienic. That was actually correct in some ways. For instance, with the textiles, it was necessary because we didn’t have the textiles at that time. But in other ways, there weren’t really that many good reasons to change in one way or the other.

But it also has to do with the way that we clean them or we actually remanufacture them from the parts. Once we get past this hygiene concern, because one of the first things we did in the Center for Sustainable Hospitals was actually employ a hygiene nurse because we need to have them very close.

There are a lot of things where we are focusing on places where hygiene and sustainability actually go very well together. For instance, with the use of non-sterile gloves, like the blue gloves, we use millions of them. There’s actually a heightened infection risk if you use way more gloves than you’re actually supposed to.

If you actually just follow the basic rules on how to use these, that means sometimes you have a conflict between hygiene and sustainability. Obviously if you need to clean things, you need to be very sure of the procedure to make sure that you actually can achieve the hygiene.

That’s an ongoing discussion and it’s not to say that it’s solved completely, but you have to take it case by case and you have to collaborate very closely with the suppliers. But for some of our products it’s actually a problem that we just use too much in non-smart ways. We actually have too many different warehouses where the products just go too old and then they expire on date, or we don’t use them often enough, or we use them incorrectly. Just by getting these basic principles into the talk, that helps a lot. One of the things I’ve noticed is that if I go around visiting different departments or sections and I gather up the people there, the first thing they say about sustainability is obviously the hygiene, but the next thing that comes up is, okay, we wanted to work with sustainability. Of course, we all have to work with it, but we are very much concerned that this is an extra added feature that comes on top, like extra requirements. We’re afraid that it’s going to impact negatively on the way that we have a good social place in our workplace. So we see it as a threat.

But when you talk a little bit further along with these people, they actually see that the sustainability agenda is much more a wholesome agenda that also takes into account many different factors. Like the choosing wisely campaign, from which most people actually just stop doing things in the healthcare system that are proven ineffectively.

Because if you do a little bit less, that will free up some time. Healthcare professionals are very often in lack of time and there are no strict budgets. So instead of changing a wound pad too often, you could go a little bit longer or just use a little bit less and do a little bit less.

That will actually free up a lot of the time that you need to do other things. Once the clinicians see that this is part of the sustainability agenda, that actually frees up a lot of their mind space and their incentives towards working with this. It’s many things, but I think that sustainability is something that we work on throughout the organization. It could be either IT or people working with AI in the government. And also in the procurement department, our Sustainability Center for Sustainable Hospital is part of the procurement department. One of the things that’s very interesting is that

The sustainability agenda has up until now been part of the quality. You’d have the price that factors in roughly 60%, and then you have all of the quality parameters, which could mean ergonomics or the feel of the product. In this case, it would mean that if it were sustainable or more sustainable or it could be recycled or remanufactured, it would gain some more points in the quality sector.

But the problem is that if you have something like price, it’s very easily comparable. But sustainability, it’s kind of hard to get sustainability to go from subjective parameters into objective parameters because how do you measure the carbon emission? How did you get to these numbers?

By comparing price, it’s much easier. But I think there’s a movement going on and a very big need and wish to actually move some of the sustainability parameters from a subjective point to an objective point. Because that will allow us to have a language that we can talk about and that will mean more fair competition.

That I think will be very important for moving the manufacturing part of the process and all of the suppliers into this area because obviously they have a very reasonable doubt to go into this sector because how are our data being processed? How do we measure it, and what do our competitors actually give for numbers?

I can understand the resentment and I think that fairness is very important in this. We need to find ways of making it objective in a way.

More and more tender sustainability is becoming a separate third category besides pricing and quality. I personally think that’s very good. But what we are also seeing is that it’s implemented in very different ways, and that’s a challenge. So much to unpack in what you just said. Let me dial it back to the clinicians.

What I heard you say was that some of the hurdles you met initially was whether working with sustainability, for instance with hygiene or other things, is going to be a barrier for us to do our job, is going to reduce the quality of service that we can do. That was a concern from clinicians.

And then secondly, we are already understaffed and stressed. Is this going to mean more things we have to do because we really don’t have that time or personnel. Those are very valid concerns, but also you were able to, in a lot of cases, find ways where it didn’t have to be either or.

Could you speak about what you mentioned with Choose Wisely or anything? How have you worked with integrating sustainability into the work that they’re already doing? In many cases if you look at it from a care pathway perspective, and as I understood you, if you do the right thing medically, if you do the action or use the product that has a well-researched medical effect delivering a good health outcome, it will also be more

Sustainable, but many activities are being done that we are just doing out of habit or that doesn’t necessarily lead to better outcomes. How have you worked with that with clinicians and how’s that dialogue taking place? Well, the thing is the clinicians, we have different ways of approaching and engaging with them.

In some departments, the clinicians are like ambassadors and they contact us and they have some knowledge of the basic principles of circular economy, and we help them with the rest. We have made a catalog of ready to use things that actually can just be implemented straight away because, as we said before, we have prayed in all the churches.

We have made sure that everything from procurement, service, purchasing, technical department, all of these are ready to implement the changes. We have a lot of good cases where we have multiple use products instead of single use products, not like in the surgical field, but many things are actually also going through the sterile departments to be sterilized and sent back again.

We have a whole list of products that can be changed and are ready to be changed. In some ways it’s an easy fix because the products are very easily comparable and they just need to take it from one shelf instead of the other. So there’s a lot of easy wins this way. But also there’s a lot of things that are different.

Like if they use multiple use metal instruments, they have to make sure that all people that are actually working in the department learn that they should not be thrown out. They should actually be put aside. So there’s a lot of habits that need to be changed, but we have a good handle on these things and we work closely with the clinicians.

One thing that can be a little bit difficult is if we have a hook in the department and we have the management backing us up and we also have the ambassadors, that’s fairly good. But if we somehow don’t yet have had that very good talk with the management of the department, that can be very difficult because it’s kind of hard to go around as a single ambassador and trying to implement changes even though they are approved by other entities.

It’s kind of hard to implement if you do not have that backing. But this is not very different than all different kinds of changes that you need to do. It’s just that the sustainability agenda is in many ways a positive thing to come with and it’s kind of hard to actually negotiate or find out different ways to be opposed to it.

Well, basically we tend to use a two-pronged approach. We either go to the top management because we have a political mandate to actually implement these changes. We have a strategy we need to implement, and the top management of the region is actually very much in front of this, so sometimes we use that to put it on the agenda.

What we’ve made quite successfully within the last one and a half years is to do some sustainability agreements. That is basically where we have the catalog of proposed actions that you could take as a hospital. Some are mandatory, but a lot is optional. The idea is that the hospital chooses

What kind of activities they would like to be measured on within the next year, and to do a sort of sustainability agreement with the top management that the ones that actually run the whole of the region. The good thing about this is that they actually have a freedom of choice, but they also look down in their departments and see what is actually doable.

And then they also have to put measurable outcomes on each of these targets. Like saying, we need to remove 95% of the bedding paper. What is good about that is that we can actually see that some of the things that we like, for instance, if you go to a doctor or a nurse or you need to be checked up by a doctor, you have this bedding paper that goes underneath the place where you lie down and it’s basically not needed. Except for very few reasons you should use it, but only occasionally. 95% of the time it’s easily dispensable. You shouldn’t really use it. So that’s one of the best things not to use it.

We went through two of our hospitals and actually removed 98% of the paper within a six month period. That’s 98% because we can measure it by the purchasing. We know exactly how much they actually went without. It is good.

But it’s one of the easy ones because you basically just have to go without. The thing I usually tell the clinicians, and I use this as a good example, is that if you go to the doctor and sit down on the chair and your body is bent in two places, but we do not clean the chair every time that you leave.

This is just a chair. It’s cleaned once a day, but not after every use. We don’t put any paper on it, but then suddenly when we position your body to a horizontal position, suddenly you’re very contagious. We need to put this very thin paper underneath you. But why? This is the but why question.

We need to ask as many times as possible. But the thing about the bedding paper is that in our own happy thoughts we thought, well, let’s just take the next hospital and do it. Because if they can do it in two hospitals, they can do it in the third, fourth, and fifth.

But then once we started, we had to do all of the same battles all over again. We received mails from angry doctors saying, here are six reasons why. So we felt as if we had to start all over again at a new hospital. This is one of the places where we used the sustainability agreements and said to the top management, and even the hospital directors say, well, if you can do it in this place, we can do it here.

Just give us some examples so we can get underway. So our basic goal now is to produce these new initiatives, have them tested and implemented fully at one place and then another, and then we can actually say it’s doable. But the thing about these things, it’s not just enough removing the bedding paper because then

Night nurse came and said, well, it must be a mistake. Or they have a substitute and they buy some new, so we actually have to go all the way through and remove it from the ordering system. Remove it from the storage place. You need to have everybody on board because people are just missing something.

So there’s a lot of basic change management. If you need to do something different, you have to make sure that everybody’s on board, even though it makes sense and it’s easy. You cannot underestimate the last people. You need to get everybody on board.

But also very interesting, just from a supplier perspective, that’s not very simple case. But nonetheless, you had a product here where at the end of the day, it wasn’t sustainable and it didn’t provide the clinical value or the health outcomes that were needed, and then overnight or six months at least, it meant that if that was your business of selling, that business was no more.

Of course I know you can’t extrapolate that to more complicated things like surgery equipment, but I still think it’s important to say that the stakes are probably being higher in the future for suppliers in terms of really ensuring health outcomes and sustainability.

Following on from that, you mentioned you’ve done collaborations with suppliers or industry to create new solutions or new ways of working. How have you worked with various suppliers to the hospital? We work closely with them in two different ways. We have the big tenders going through, where that’s the other part of our department, the purchasing department.

The big tenders go through, because sometimes we do tenders for all of the regions or region hospitals. These are the big things that go through and here it’s more of a long-term change. In these, we have a calendar and we try to implement some of the new things.

Like we have developed Nordic criteria for sustainable packaging. Every time we do a new tender, we make sure that we implement these new criteria for more sustainable packaging. We try to see, obviously as you said before, there’s a lot going on to see how we can either have sustainability as a third parameter or how we could implement it in different ways. That’s also one of the things we meet from our employees. Once they get over the first hurdle, which is whether this is hygienic enough, then they say, well, the suppliers should just give us better solutions. Why do they package this the way they do? But this is where education comes in. Basically what we actually started doing now is hold a mirror up saying, well, we could do all of the requirements we want to our suppliers. The problem is our use. It’s the way we use it. For instance, if you look at your cupboard, you have all of these products that are expired by date.

That’s where we actually lose things. We work closely with our colleagues because I have three or four colleagues that work in lifecycle analysis and products. I have a colleague also working with textiles where they work closely with the industry to try to do some new textiles that are not on the market yet, but will be able to shed moisture and be waterproof.

Ways to protect the employees, but also that do not contain polyfluorinated carbon like PFAS. That’s kind of hard to actually do. But that’s one of the things where we want to, because we have all of the prototypes for changing many of our single use gowns to multiple use.

We have the prototypes, we have all of the schematics. We have a lot lying ready, and they do it in Sweden already. What we need is a new textile that actually works. Once we find this, it will be a very rapid change towards a multiple use gown. That’s just one of the things where we work closely with the industry to do that. So you’re actually seeking out new solutions as well. Quite a few of our listeners, some are of course clinicians as well, but many listeners also work in the industry, in pharma or med tech companies. Some of these companies are trying to figure out, okay, we want to work with sustainability, or we have a new product that might be a bit more sustainable.

We want to create a partnership. What would your advice be for the people working in those companies? I assume you have to have this dialogue, whether that is with clinicians or dedicated sustainability people. This is a difficult question because if it’s a new product, there are two things important.

You need to make sure that it’s actually providing the value for the clinician. You need to have it tested with clinicians. That’s the first objective, is that it actually creates the value that you want for the clinician. Then when it comes to sustainability, like if you have product A that is much better than Product B which is on the market now.

I think it would be to contact the purchasing department, or us as a sustainability center, to help say, now this product is new in the market. It can provide this value. We work closely with many from the industry that actually gives us the materials lists of the product.

That way we can easily verify the specific carbon emission for that specific product. Then we can contact the clinicians and have it tested and see that this multiple use needs this cleaning process. We have very good data on the internal processes that are required to do this.

But we are very much in need of very active collaboration with the industry because obviously we need to move towards more multiple use. That’s one of the main things that we need the industry to do. And obviously it would be even better if we can help people from not going to the hospital.

But let’s start with that. They’re actually there now. We need to treat them. A lot of the things come down to: Can it be exchanged to a multiple use product? That’s one of the best things. If not, something that can easily be sterilized by us in our own sterile departments, then maybe it can be remanufactured or reprocessed somewhere in Europe or back at the industries production facility.

If not that, we’re also looking because some of the products are kind of hard to actually change because the logistics are very difficult. We’re also looking very much at how we can actually supplement some of the products or parts of the products with more sustainable parts that are easily recyclable or less intensive on land use or carbon emission.

So if you are in the industry and you have a product, you need to have it tested and make sure that clinicians say it’s good, but then contact somebody that can help you verify this specific case. What is actually new now is that three years ago, I would pretty much say that it would not be possible to come up with a solution that will actually cost more in a multiple use than a single use.

But that’s actually changing now. We can see that little by little we actually implement new solutions that are a little bit more expensive in this case, but provide much more value. That’s the good thing about the three bottom lines. Before, like five years ago, we would only have one bottom line saying this is the economic cost, and then we could put some lines in saying, but it’s also a little bit better in these ways. Now, with the three bottom lines and with the ability to actually give some very specific carbon emission outcomes, that actually factors in as well. That’s very interesting because our politicians are starting to ask now instead of saying, can we do this, does it cost extra?

The question now is: how much carbon emission would that actually give us, and how much would that cost? For instance, all of the buildings that are being built or rebuilt or remanufactured and all of the building departments, the building mass that we have, we decided that it should have the DNGB Gold certificate, which is a sustainability certificate for buildings.

That actually means it’s 15% more expensive. All the politicians say, well, that’s just the way it is. We’re seeing that because the readiness at the politician level is actually quite good. We’ve tried it a few times, going all the way up to the political level and saying, this product is a little bit more expensive, but we actually have much higher gain. We can remove the PFAS or we can remove all of these PVCs or whatever.

It’s a little bit extra cost. Every time we get a yes, so there is actually a change towards this, that it’s actually okay that your product’s a little bit more expensive, and that wasn’t there a few years ago. Definitely not. That’s a big change. Even in some healthcare systems.

It’s still that. We will pick the sustainable one if the cost is the same, but we are not willing to pay more. But that’s very interesting that you have made that point now, and we have multiple cases. It’s a key question for industry people. Are they willing to pay for it?

In most tenders, you would probably pick the more sustainable one now, and that’s the good thing about also having sustainability agreements because there they have carbon emissions. They need to reduce 25% of their carbon emission by the next three or four years. They have a very big number of carbon emission tons that they need to actually lower.

Every time we do something like this, we can actually produce results. Like the anesthetic gases that you use are very high on climate because they have a high climate impact, and they’re called laughing gases as well in English. You use that for birth. We are actually trying to figure out now exactly how much could actually be saved in carbon emission by actually investing this amount of money in it. That doesn’t come with any economic positive outcome. This is just basically an expense. But given that we actually save so much on carbon emission, it’s a thing that they’re actually willing to consider.

Obviously it’s not like the green choice is by far the easiest choice every time. It’s just that we have a language now. We have a way of actually producing documents that will have the politicians say, with an ease of mind, well, let’s go this way instead. We didn’t have that a few years ago.

We’ve got some new tools in the box that help us and help the organization do these more green choices, which is very new for us. It’s very positive. Quick plug, I think it’s episode 69 of the Sustainable Healthcare Podcast, which is about anesthetic acids and switching to oxygen.

Michael, we have to round off, but this is super exciting. We covered a lot, but there’s so much more. Parting ways, if you had to sum up what really works change management wise in your experience in terms of getting clinicians, administrative people and other hospital personnel on board with the green transition, what are the key learnings?

I think one of the key learnings, the thing that we focus on now is that we have 35,000 people. About 1000 are totally dedicated, they have bought everything and they’re working on it, but we still have at least 85% of my coworkers in this big company that actually want the green transition.

They want to do it and they do it somewhat in their private life, but they have a very hard time seeing just how exactly they’re supposed to do it in their job life. They have this sort of work-life green balance that is a little bit off because they have to run really fast in their spare time to do a lot of these efforts as a private consumer in order to alleviate all of the pain that they inadvertently cause when they’re actually working. Because just by producing healthcare for the patients that come in, they actually make the world a little bit worse every day. So basically what really works is my main objective for the next two years in my work life: to help transition and make people think that sustainability can be a part of their work scope, not something they do in their spare time. They need to take that motivation and bring it into their job. Then basically, I think we need to make sure that if 85% of the people understand four basic principles of circular economy, I think we’re good.

Because you don’t need to know all of these specifics. It’s not really that hard if you just know a few basic principles that will help you navigate. Can you share those four as a service to the listeners? Yeah, I think we have divided it into three things: use less, use longer, and use greener.

Use less in any way. If we need to collect it, that’s avoid waste. Just see if you can go without the product or just lower the need. If you cannot lower the need, then lower consumption. If you move into use longer, try to see if you can keep your existing product working as long as possible and use before new, then comes the change to multiple use products. But the least alternative, which is also good but not nearly as good as the others, is to choose the greener alternative.

Try to see if you can find one. For all of these, once you’re finished using it, you should make sure that you can collect it and use it again. Disassemble it for next time use. That’s the thing. So use less, use longer, and use greener. I didn’t really invent this. It’s something that we’re working with throughout all the regions, but getting that operationalized and getting it into a way that we can actually communicate it and help people remember it and actually have that at the back of their mind while working, that’s something that’s really going to help. Because sustainability doesn’t have to be that complicated to begin with.

That’s one of the key obstacles, that people think that it’s very complicated. But actually if you just look at ways of using less, using longer, and using greener, that’s coming a long way. That’s the main objective for the work that I have to do for the next few years.

I love that focus and just to emphasize that they are in prioritized order. So really, start with use less. It’s something that we see a lot also from the manufacturers. The most sustainable patient is the one that doesn’t get sick. But if we can’t do that, then at least have it with as little intensive care as possible.

And then also on a product level, the less you can use the product, the better. Thank you so much Michael and keep up the good work. I can really recommend looking at the website for Center for Sustainable Hospitals. There’s a lot of really cool cases and you can just click translate in your browser and it should come out in English too.

Thank you very much. This was the Sustainable Healthcare Podcast. If you liked it, please share with a friend. Hear episodes on Spotify and Apple. Thanks for listening.