Frederik: [00:00:00] Hello and welcome to the Sustainable Healthcare Podcast. My name is Frederik Dam van Deurs and I am one half of Care Pathway Consulting. We are a boutique management consulting company that helps turning sustainability strategies into actions. In reality. So whether that is in a hospital or in a manufacturing organization or a market facing commercial affiliate, that is all we do.

Maria: Thank you. And thank you for keeping the show going.

Frederik: You're welcome. It's also a little bit of a passion project because it's genuinely some of the most interesting conversations that we have — because we don't have to look at a budget or a project schema or anything of the like while we're executing, so we can just keep it curiosity driven, which is a bit rare in this world.

Maria: The accurate title now is I am Chief of Development, and I'm doing an industrial public PhD in collaboration with Copenhagen University, the Faculty of Health and Medical Sciences, at the department called the Globe Institute. So there you have it. So I'm Chief of Development and I'm a PhD student now. And instead of being leader of Center for Sustainable Hospitals, we have a fantastic woman leader called Melina [?], who is now leader of Center for Sustainable Hospitals.

Frederik: What's going on? The last time you were on the show, I think we were at that stage where — are they called surgical gowns? The reusable surgical gowns. You were just about to launch that. What has happened since then?

Maria: Yeah, that's [00:03:00] a specific dive into one of the many projects going on. And according to the surgical gowns, they are still not launched, because there were some problems with the delivery of the fabric and with the quality of the fabric that did not live up to the promises and the tests that the producers should have made, which we then repeated — which was good, 'cause it turned out it was not as good as intended. So we are still struggling, actually, finding the right fabric.

Frederik: I think this is a super interesting case to pick up because it sounds as if you're almost inclined to position it as an innovation project that didn't succeed. But at the same time, you're able to name all of these spill-off effects that have come from it with all of the other items that have been switched for reusable items. Do you think this was a vehicle that spurred all of that, or would that have happened without this surgical gown project?

Maria: It would not have happened without this project. But the project is not a surgical gown project. It is a multiple-use textiles product project. So we are looking at the single-use textiles being consumed within hospitals as a broad category of product, but the gowns are just a major consumable [00:06:00] product. We were using a lot of them, and obviously they fill up the bins a lot more than the hats.

Frederik: I think you can say that passion is good for kicking things off, but not so great at maintenance. And I think that's one of the key things that we have observed in sustainability in healthcare and recent developments — is that we are approaching a stage where we need to substitute heroes with systems. And we need to substitute passion with governance.

Maria: Yes, I can. And there's a thread from what we just ended up talking — 'cause the PhD I'm doing is in implementation science. That is the research field I'm doing it within. And the offset of me wanting to make the change from being leader of Center for Sustainable Hospitals — and having built that up throughout the years — and then becoming Chief of Development and industrial PhD student, because I think you asked me on a pre-call "why did you do that?" — because I was happy with the job I had, but the leadership task changed because our [00:10:00] organisation has matured. We now have sustainability contracts with each hospital unit. We have these yearly roles of reports and the contract being renewed, and it has become more heavy on the governance side than it used to be.

Frederik: Would you say you're looking for the characteristics of successful implementation?

Maria: That depends on what you mean with characteristics. The definition of a successful implementation will, of course, vary depending on which intervention we're talking about. A successful implementation is not always fully implementing 100% or fully phasing out something 100%. The success could be 50% or 75%.

Frederik: What is your point of view on that? I think the anthropologist in me would say that it's human behaviour and culture at the end of the day — that maybe would [00:18:00] be my conclusion, at least the key component as a blocker.

Maria: It is a very human problem. [00:20:00] And I actually think I also misled you and the listener a little bit. The purpose of my whole PhD and the overall problem statement and research question is: what can we do to make it better? What can we do to deal with these human factors?

Frederik: But it's a great chorus though.

Maria: It's a wonderful chorus. But we really need — if we want to deal with the problem we have in a rational way, or just a sensible way, meaningful way — then we need to get the pace up. And it's not just a matter of organisations meeting their own strategy. It's a matter of health for human people [00:21:00] in the future. And it's not in 200 years future, it's in a few years future.

Frederik: I think that's a really good point. The resilience argument is not a nice-to-have assignment. It's an [00:22:00] absolute must-fix if we would like to have healthcare services in the fairly near future.

Maria: It really depends on where they're sitting, actually. The first step would of course be to explore your own organisation and find out if there is some sort of organisational structure around the area of sustainability. 'Cause it might be there and you just need to find it — and then jump on that wagon. And if it's not there, then you need to start building it up.

Frederik: Basically the point that I would play back to you now is: start with exploring where your organisation is.

Maria: Yes.

Frederik: Ask your peers or your management: what are we doing on sustainability? [00:27:00] And let that kind of guide your first explorative stage. Maybe snowball a little bit.

Maria: Yeah, absolutely. And say, "do you know who's doing something on this?" And then having those informal conversations. And if nothing is happening, then move on to the next stage and start doing something.

Frederik: Yes, that is visible and achievable in a way. And don't worry too much about the optimal journey to take, but start moving. And then if you start walking, and you could have taken a bike later on — you can always regret the first mile you walked, if you bike the rest. Maybe it got you where the bike was parked.

Maria: Exactly. Maybe that was the first mile. To sustain that metaphor.

Frederik: What was that network called again?

Maria: Global Green and Healthy Hospital — GGHH. And Health Care Without Harm hosts it.

Frederik: Nice. Thanks. I'll pop that in the show notes. Is that something you can subscribe to as a listener or join that group?

Maria: Yeah. There's a newsletter and it's free to become a member. You have to describe your motivation and your organisation and stuff. And then we at the board approves new members, and we are not strict. We love having new members who want something about this. And it's also a conversation to have with your department saying, "should we be [00:29:00] a member of this club?" Getting access to a lot of knowledge and a lot of network, and it's free.

Frederik: Makes a lot of sense. Thanks a lot for plugging that, and we'll make sure that stays relevant in the show notes as well.

Maria: That's a good question. I've never worked in the private sector myself. I'm definitely not an expert.

Frederik: That's a very honest disclaimer.

Maria: And I have had, of course, a lot of conversations with private sector people and collaboration. And in general, I have a sense that the med tech industry and the pharma industry, of course, wants to make this change as well. They're not stupid people. They understand what's going on. They see it too. But of course, they have a different type of organisation [00:30:00] than a public healthcare system, obviously.

Frederik: It makes a lot of sense. And I think what we see a lot in our work is when we start working strategically inside the organisations, sustainability can never be the driving argument, because that is not part of the business logic. So oftentimes it is much more powerful if it ends up being the last argument on the long list of arguments — where we're increasing speed, we are reducing cost, we're increasing resilience, we are doing all of these amazing things. And by the way, as a final note, also the right thing to do, morally speaking.

Maria: Yes. It's still okay. So flipping the script a little bit. But I really think it's a balance. And I struggle with it myself sometimes when I try to adapt to the audience in order to push the change, I think is needed. 'Cause we should always improve the quality of the conversations we have in the healthcare system across sectors. And we should improve the [00:36:00] quality of our perspective — or we should deepen the perspective that we operate from, all of us as human beings, no matter in which sector you are employed.

Frederik: In *Harry Potter and the Methods of Rationality* — it's a fan fiction that's written by a rationalist that I really enjoy reading, and I give a huge plug, it's available for free [00:39:00] online — Harry Potter in this world is a rational individual. And he says: "what is true is already so." And I think that sentence is just something I lean on in our scope of work. With so many reasons to look at the world with a complete lack of optimism.

Maria: I think a couple of two things. The first thing is that I have seen a lot of change happen in the last five, six years within the healthcare system. Going from when [00:40:00] I started in this area, there was barely anything in my feed on LinkedIn according to this subject. And it was not just the algorithm, 'cause there were very few hits when I Googled whatever was going on.

Frederik: Okay, there's so many good guys out there. We are gonna make it. It's gonna be good. I think that's a very hard note to beat with anything. I'll just say thank you so much for coming on the show, Maria.

Maria: And thank you for inviting me.

Frederik: To you, dear listener, thanks a lot for listening in. You've been listening to an episode of the Sustainable Healthcare Podcast. Our guest today has been Maria Gaden. And I just wanna thank you for listening in. Please subscribe to the podcast. Give us a rating, give us a share to someone who should listen to it. And let us know if there's anything you liked or disliked about the show, or if there's anyone you [00:42:00] would like for us to invite as a guest on the show. We always deeply appreciate that kind of feedback from you. Thank you so much for listening.