Sustainable health care: Simple efforts can reduce your practice’s carbon footprint

January 11, 2022 | Author: Guest post
4 MIN READ

By: Dr. Husein Moloo

In this article:

  • How a novel quality improvement (QI) project targeting fax machines led to reduced carbon emissions and cost savings
  • Dr. Moloo’s tips for QI projects that reduce carbon emissions in day-to-day practice

Although it’s widely acknowledged that climate change is a big threat to global health, the reverse is also true (and one of medicine’s biggest secrets): if global health care was a country, it would be the fifth biggest polluter on the planet.

The University of Ottawa, where I am interim director of planetary health, is learning to leverage a continuous quality improvement (CQI) approach to make our practice more environmentally sustainable.

We recently learned that even small changes can have big impacts on the environment — and the great part is that a lot of these projects are scalable and adaptable to your practice environment. Moreover, your effort can be logged for Section 3 Maintenance of Certification (MOC) credits.

Dr. Husein Moloo (submitted photo)

Case study: 21st century faxing

In my former role as vice chair of QI and patient safety for the Department of Surgery at the University of Ottawa, I was lucky to work with seven divisional QI leads. Every year, we united behind a common theme (most recently, to decrease our departmental carbon footprint).

My colleague, Humberto Vigil, MD, FRCSC, became our first carbon-reducing champion. He piloted a simple — but brilliant — project in the Department of Urology that you can mimic in your own places of work: making the switch from paper to electronic fax.

Some of the environmental benefits of this switch are

  • reduced carbon emissions,
  • less strain on trees/paper resources and
  • decreased energy outputs.

To make this change, Dr. Vigil’s team led some new onboarding processes with instructional videos to demonstrate what people would have to do differently. Afterwards, they engaged the divisional QI leads to spread the initiative across the department.

The result?

  • Departmental savings of $13,000 a year in paper and energy costs.
  • Almost 12,000 kg a year of carbon emissions saved from entering our atmosphere.

And now our entire department is e-faxing, which is fantastic!

Jump to how Dr. Moloo and colleagues claimed this work for MOC credit

My tips for QI projects that reduce emissions in day-to-day practice

My advice for anyone seeking to reduce their environmental footprint is to not limit your thinking and look for opportunities around you. Here are my top three tips.

View your practice habits through a planetary health lens

Thinking about the triple bottom line for QI, where environmental impact and social accountability is considered in addition to economic cost, is a simple way to start reframing all QI activities.

As a QI project, e-faxing seems less obvious than, for example, decreasing surgical site infections. However, when you start reframing your mindset in terms of planetary health, it becomes a very logical thing to do! (Of course, reframing QI initiatives like decreasing surgical site infections as something that helps the planet is also important).

Reduce without compromising care

The Choosing Wisely Canada (CWC) initiative has revealed the importance of reducing unnecessary procedures. Check their website for reduction/preventative measures relevant to your discipline and build a QI project around one of those measures. Remember, the less intensive and wasteful the care you provide, the smaller your carbon footprint!

Pilot an idea for a little while to see if it works

The initiatives we’ve successfully spread throughout our department were first trialed by one team, which optimized them through several Plan, Do, Study, Act (PDSA) cycles, making them easier for other divisions to adopt. You can also ask around — what are your colleagues doing? What ideas can you find in the QI literature? Are there strategies you can adopt or adapt?

It’s a sad fact that the industry tasked to protect global health is actually putting it at risk by contributing to the climate crisis. But, as health care professionals, we have the power to help reverse this trend. I hope our e-faxing story and the MOC guidance note (below) inspire you to be a sustainable health care champion in your own practice and report your own initiatives for Section 3 MOC credits.


Husein Moloo, MD, FRCSC, is an associate professor of surgery, program director for Colorectal Surgery and interim director of planetary health at the University of Ottawa.

MOC guidance note from the Royal College

Visit our Essential Guidance on Quality Improvement webpage for support to start reporting your own CQI projects!

How and where to claim credits

  • For this improvement project, Dr. Moloo, Dr. Vigil and their colleagues who worked on the e-faxing QI project can claim MOC credits under “Section 3: Practice Assessment.”
  • For the time spent on this project, Dr. Moloo claimed 6.5 hours, which equated to 19.5 hours within Section 3.
    • This includes five hours of meetings with various stakeholders, including the divisional QI leads, administrative assistants and other surgeons to learn and determine the QI process, information technology implications and how to collect metrics, as well as plan presentations.
    • It also included 1.5 hours of streamlining office workflows for assistants and surgeons while making the switch from paper to electronic faxing.
  • Project participants can also claim additional learning stimulated by this work under “Section 2: PLP” with sub-option “Addressing clinical or academic questions across the CanMEDS framework” for 2 credits/hour.

Estimated time to report in MAINPORT: 5 minutes

For more information

Planetary Health Care for Colorectal Surgeons: a useful framework for any physician, regardless of discipline, to work with when considering clinical issues and how they pertain to planetary health.

The Sustainability in Quality Improvement framework (SusQI): quality improvement, in its simplest form, used to be the equation of patient outcomes divided by financial cost. The SusQI approach reframes QI through the lens of a “triple bottom line” that includes environmental, social and financial costs.

Video: Leveraging Quality Improvement for Environmental Sustainability in Health Care: jointly produced by the universities of Ottawa and Toronto, show this video to your colleagues to raise awareness that optimizing carbon-safe care is a planetary health imperative.


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GARY BOTA | January 12, 2022
I will start by saying thank you for all of the work that you are doing to reduce GHG emissions from healthcare activities. However, it is important to point out to college members that the RCPS has recently signed a multi-year partnership agreement with RBC. RBC continues to pour billions into oil, gas, and coal. In particular, RBC pumped more than $208 billion into fossil fuels since the Paris climate agreement was signed. RBC remains the world’s 5th largest fossil fuel funder. Our college needs to use its relationship with RBC to demand that the bank divests from fossil fuels.
Royal College Communications | February 23, 2022
Hello Dr. Bota, thank you for your feedback. The Royal College’s multi-year partnership with the RBC was entered into with a great deal of goodwill to offer increased and tangible member benefits. Your feedback and concerns matter to us and have been shared with our executive leadership team who will consider them during their program review at the close of the Royal College-RBC strategic partnership.