EP458: A Really Unexpected Consideration for Solving Staffing Shortages That Impact Access and Care Quality That Is Based on a Ton of Evidence, With Komal Bajaj, MD

[00:00:01] EP458, A Really Unexpected Consideration for Solving Staffing Shortages That Impact Access and Care Quality That Is Based on a Ton of Evidence. Today I Speak with Dr. Komal Bajaj.

[00:00:23] American Healthcare Entrepreneurs and Executives You Want to Know, Talking, Relentlessly Seeking Value.

[00:00:32] Hi Tribe. I hope today finds you well enough. You know, whatever it is, whatever's going on, sometimes you just have to wake up in the morning and do what you need to do, left foot, right foot, breathe.

[00:00:43] And I'm hoping part of the day listening to this podcast is a good addition.

[00:00:48] So anyway, I am very happy to be with you discussing a topic that requires a lot of us to left foot, right foot, breathe. Staffing Shortages.

[00:00:56] And this staffing shortages just doesn't impact clinical leaders and also clinicians who are getting told to increase patient load or whatever to make up for staffing shortfalls.

[00:01:05] It also impacts plan sponsors who might be paying for what amounts to poor quality that results from a patient having to wait six months for an appointment while their cancer is progressing.

[00:01:15] And all of these things obviously impact patients and members. So staffing shortages and how good any given institution is at dealing with them or forestalling them is everybody in a community's business.

[00:01:28] I think it's a logical first instinct to throw money at the problem or focus on stuff like maybe, you know, mindfulness stuff.

[00:01:37] It's also an intuitive thing to do to talk about reducing administrative burden. And sure, all of these things produce some results. But yeah, not enough, obviously.

[00:01:47] Otherwise, we would not have rampant staffing shortages and 35 percent of doctors thinking of quitting clinical practice.

[00:01:52] So as many in other industries have largely figured out to solve the staffing problems, a big issue is always cultural alignment.

[00:02:00] Is a workplace aligned with the values of those who work there? I'm remembering my very first management class I ever took in college.

[00:02:08] So call this literally management 101 on attracting and retaining talent so good people are productive and don't leave and cause staffing shortages.

[00:02:17] Part of the cultural alignment piece is what do employees care about?

[00:02:22] Do they trust leadership to care about these same things?

[00:02:25] Because alignment of values enables people to show up with their hearts, not just their Hoka sneakers.

[00:02:32] And trust happens when our hearts feel connected to one another up and down the org chart.

[00:02:38] Sometimes I wonder whether having minimal staffing shortages could be, I don't know, some kind of like KPI for enlightened leadership.

[00:02:44] And there's a ton of variables, geographic desirability and all kinds of other variables.

[00:02:48] But if not just what is written on the walls, but what is actually going on in the halls aligns with the values of those working there.

[00:02:56] Yeah, I could see that there'd be a lot of great people looking to work there and not leave.

[00:03:01] And kudos to leadership for setting the tone that can make that happen.

[00:03:04] OK, what are the root causes of staffing shortages?

[00:03:07] Which, in the converse, are what's required to attract and retain docs and nurses and everybody else to prevent staffing shortages.

[00:03:15] This is, in fact, what I talk about today with Dr. Komal Bajaj.

[00:03:19] The first issue here is a breakdown of trust.

[00:03:22] There was a survey by Deloitte that Dr. Komal Bajaj talks about that revealed fewer than half, 45 percent, of frontline clinicians trust their organization's leadership to do what's right for patients.

[00:03:33] Even fewer, 23 percent, trust their leadership to do what's right for workers.

[00:03:39] Second requirement is an alignment of purpose and organizational goals, aligning that with the hopes and aspirations of employees.

[00:03:49] So how do you figure out what people's purpose is?

[00:03:52] Oh, right. You ask them. You listen to what they tell you.

[00:03:56] Exactly. It is so interesting what can be learned from asking the right questions.

[00:04:01] But what is discerned by listening likely won't be the answer anyone thought it would be.

[00:04:06] Because if it was the answer we all thought it would be, we probably wouldn't have some of the problems that we currently have right now with our clinical workforces.

[00:04:15] Right. And I'm going to pause for effect because there's a big, massive, unexpected reveal in this pod and it's coming up.

[00:04:21] Dr. Komal Bajaj did a huge survey and also references other huge surveys and came up with a purpose that has served to align health care workers across the country.

[00:04:31] And it is not what I would have guessed in a million years it would be.

[00:04:34] So spoiler alert, skip ahead like two minutes if you don't want me to ruin it for you.

[00:04:39] But here is a shared purpose that can align leadership and health care professionals around a shared mission.

[00:04:46] It's aligning around high quality, planet friendly care.

[00:04:51] Wait, what? Yeah, that was my reaction.

[00:04:53] But this is a very possible shared purpose for organizations across the country, not only along the coasts either, but also in the heartlands.

[00:05:03] Many studies and surveys show this to be true.

[00:05:05] So let's parse out what planet friendly care means because I didn't think about a bunch of this stuff initially.

[00:05:12] First, everybody, Americans across these 50 nifty United States, thinks about care in the context of the planet locally,

[00:05:19] making sure that local pollution isn't causing breast cancer and legions of kids with asthma.

[00:05:25] Also, since workers frequently live in the area they serve, it's also making sure their own water and air is not making they themselves sick.

[00:05:34] A lot of times this is also mirrored in findings on community health assessments, by the way.

[00:05:39] Lots of people are already talking and doing stuff about this whole making our community safe to live in by detoxifying the environment.

[00:05:47] But planet friendly or planet aware, maybe health care is also.

[00:05:51] So this is number two, making sure that supply chains aren't interrupted by like hurricanes.

[00:05:56] Third point here, besides number one, keeping track of environmental, social determinants of health and weather related supply chain problems.

[00:06:05] We also have curbing waste doing stuff like how do we reduce single use plastic in the OR that is getting put out on trays, not used and then chucked.

[00:06:14] And there's two issues with that.

[00:06:16] One is the landfill waste problem.

[00:06:18] But it's also extremely wastefully expensive for no reason.

[00:06:23] Like the hospital is spending money buying gear and then literally just throwing it away without using it.

[00:06:28] I could not think of a better definition of just like pure waste than this.

[00:06:32] A fourth, why there's alignment across the board here for why this matters.

[00:06:37] This planet friendly care matters.

[00:06:38] There's lots of federal, state and local grants available to serve these ends.

[00:06:42] So there's financially net positive reasons from the hospital standpoint to go in this direction, too.

[00:06:49] So, again, alignment and alignment builds trust.

[00:06:51] Trust leads to a workforce less prone to everybody leaving.

[00:06:55] I love this conversation with Dr. Coman Bajaj and it is chock full of really great research peppered with me saying, wait, what?

[00:07:03] A whole bunch of times.

[00:07:04] So please do listen to the show and go on the same learning journey that I did.

[00:07:08] My guest today, as I have said multiple times already, is Dr. Coman Bajaj.

[00:07:13] Dr. Bajaj is an OBGYN who serves as the chief quality officer for a couple of hospitals in the Bronx, New York, that are part of the municipal health system of New York.

[00:07:25] She also now serves as medical director of sustainability for the municipal health system, New York City Health and Hospitals.

[00:07:31] Oh, lastly, I want to give a shout out to Megan Antonelli and the Health Impact events that she runs.

[00:07:40] Originally, I had seen Dr. Coman Bajaj speak at one of those events.

[00:07:45] They are in New York City.

[00:07:47] There's actually another one coming up on January 22nd and 23rd, 2025.

[00:07:54] These events are for health care leaders.

[00:07:57] There's usually a lot of hospital execs and other executives who are there.

[00:08:02] This one in January, though, I'm just looking.

[00:08:04] You know who's going to be there?

[00:08:05] Chelsea Clinton.

[00:08:06] If you're looking for a reason to come to New York City, there you go.

[00:08:09] My name is Stacey Richter.

[00:08:10] This podcast is sponsored by Aventria Health Group.

[00:08:13] Coman Bajaj, MD.

[00:08:15] Welcome to Relentless Health Value.

[00:08:16] Thanks, Stacey.

[00:08:17] I'm a longtime fan of the podcast.

[00:08:19] So great to be here.

[00:08:20] If we're focusing today on staffing shortages, right, which you can't pick up any of the industry.

[00:08:28] I mean, you can't pick up USA Today.

[00:08:30] Forget about just the industry publications and not hear something about the crisis of staffing amongst physicians, amongst nursing, amongst support staff.

[00:08:40] How do you kind of quantify the scope of the issue here?

[00:08:45] Yeah, you know, you're absolutely right.

[00:08:47] You hear about staffing shortages in mainstream media.

[00:08:50] Most patients that you talk to across the country are aware of the staggering shortages that exist.

[00:08:57] And certainly, as you said, leaders every day are thinking about staffing shortages.

[00:09:02] And if you really sort of begin to look at the scope of shortage, you see a variety of numbers being thrown about.

[00:09:08] A recent 2024 Mercer report cited a shortage of 100,000 clinical healthcare workers, primarily nurses and allied health professionals by 2028, which is just around the corner.

[00:09:21] A report by the National Center for Health Workforce Analysis sheds more dire numbers.

[00:09:27] More than 300,000 registered nurses, 140,000 physicians, and 100,000 psychologists in the next 15 years.

[00:09:35] If you flip that and look at it from a patient perspective, there was an HHS report in 2013 that really approximated 102 million people in the United States.

[00:09:46] Wow, staggering numbers.

[00:09:47] Live in areas with a primary care professional shortage.

[00:09:52] If you put that into a mental health context, that number rises to 167 million.

[00:09:58] And so if you look at it from all vantage points, clearly there's a shortage that exists.

[00:10:04] And when you talk to, as you mentioned, healthcare leaders, hospital CEOs, the top challenge that they identify year over year is staffing shortages.

[00:10:14] Recapping what you were talking about, 100 plus million Americans, which is a third of the country, as you said, are potentially in the near term living in areas where they may not have a PCP, mental health services.

[00:10:31] And obviously, probably the numbers are even higher if you're looking for a specialist.

[00:10:34] So, you know, these are material.

[00:10:38] And you're having administrators who are saying, hey, this is our biggest challenge.

[00:10:44] And it not only impacts access, which is one thing that we're talking about, but it's also often cited as the reason why our operational budget was exceeded is because staffing shortages.

[00:10:55] And then we had to pay extra and we're doing all this crazy maneuvering to get appropriate or adequate staff.

[00:11:02] And this costs a lot of money.

[00:11:03] So you've got the access issues.

[00:11:05] You've got the budgetary problems that this creates.

[00:11:09] If I'm thinking about this as an administrator, what do I think the problem is?

[00:11:17] Yeah, you're right.

[00:11:18] I mean, health care worker shortages, as you said, has really a multi-pronged impact on costs, on quality of care, care experience, and in a vicious cycle, worsening those shortages.

[00:11:29] And so it's imperative to think about the root cause of the shortages because we really have to think differently about how we address shortages.

[00:11:39] And so in looking at the literature, talking with different leaders, there are some key standouts as to the root causes of shortage.

[00:11:47] The first, honestly, is a breakdown of trust.

[00:11:51] There was a survey by Deloitte that revealed that fewer than half, 45%, of frontline clinicians trust their organization's leadership to do what's right for patients.

[00:12:01] Even fewer, and this is like a real ouch, 23% trust their leadership to do what's right for workers.

[00:12:07] And so it's these two types of trust, do the right thing for patients, do the right thing for workers, that are really highly correlated with clinician burnout.

[00:12:18] And, you know, I think the topic of burnout itself, Stacey deserves a comment here because people will throw that word out a lot.

[00:12:25] The surgeon general describes burnout as a high degree of emotional exhaustion, cynicism, and a low sense of personal accomplishment at work.

[00:12:35] Those are very important characteristics when we're thinking about how do we address burnout.

[00:12:41] And in the United States, more than half of nurses and physicians are experiencing burnout.

[00:12:45] 60% of medical students and residents, and an interesting number, up to 75% of pharmacists are experiencing symptoms of burnout.

[00:12:55] We started out talking about staffing shortages, and then we kind of pivoted into, all right, what's the issue here?

[00:13:02] And trust has entered the building or a lack thereof.

[00:13:06] Maybe trust has not entered the building, and that's the problem.

[00:13:09] What I'm inferring from what you're saying, if literally half of clinical workers do not believe their bosses, the administrators, are serving the best interests of patients and don't even think their bosses are serving them,

[00:13:25] then you wind up with staffing shortages because people are like, I don't want to work here, right?

[00:13:29] So, like, you can recruit as fast as you can recruit, but if the back door is as wide open as the front, you just get churn amongst the clinical staff, which then now everybody's disorganized, nobody knows what's going on.

[00:13:41] Like, you wind up with other issues on top of the whole trust issue.

[00:13:45] You wind up being not a great place to work, just exacerbating the whole shortage issue.

[00:13:52] Is that kind of the theme here?

[00:13:54] Yeah, you got it.

[00:13:55] I mean, it's sort of a terrible stew.

[00:13:57] What you're describing is really spot on.

[00:13:59] Healthcare workers have choice.

[00:14:01] And so, as we think about solutions to address the shortage crisis, we have to recruit great people that want to work at our organizations and also retain them and connect them back to sense of purpose, sense of trust.

[00:14:17] And it makes us think differently, right?

[00:14:19] I think we need to think differently about how we're going to approach this problem.

[00:14:22] So, if I'm thinking about how do I improve trust?

[00:14:25] Like, if trust, a lack or a lack thereof, is kind of a root cause there, and I'm thinking about, all right, well, how do I fix this authentically?

[00:14:34] If I'm thinking about what might be a successful way to create alignment or create the kind of relationship that should exist optimally between administrators and clinical teams, how do I think about that?

[00:14:46] If you take a step back and really look at, as you said, everyone's acknowledging that workforce shortage is a problem.

[00:14:55] And organizations are trying a whole lot of things to address it.

[00:15:06] Organizations are investing in all sorts of technologies to reduce administrative harm or administrative burden.

[00:15:13] And those tactics to improve compensation and mitigate some of the undesirable aspects of work definitely have merit.

[00:15:21] But the point here is that organizations cannot rely solely upon those sorts of efforts to create that trust, that loyalty that's needed for excellent health care.

[00:15:34] So, there's a survey, I think, that speaks to a lot of what you just brought up.

[00:15:38] So, this is from Prescani, hundreds of thousands of health care workers.

[00:15:42] And what they found was that pride in work and connection with colleagues are the strongest correlates for folks wanting to stay within a system.

[00:15:54] Agreement on these two statements.

[00:15:56] I would like to stay within the organization if a similar position was offered elsewhere.

[00:16:00] And I'd like to be working at this organization three years from now.

[00:16:04] And so, I think that as you're talking about trust building, what we're really talking about is this sense of alignment of purpose and carefully listening to not just what are employees' pain points, but also what are their hopes, what are their aspirations?

[00:16:25] And how can organizational goals and hopes and aspirations of employees be aligned?

[00:16:31] How you build trust is you create a feeling of alignment, connection with colleagues through that virtuous cycle.

[00:16:40] The organization not only improves its ability to work together and to trust each other, but then staffing shortages tend to decline because churn amongst the workers tends to decline.

[00:16:54] Without a doubt.

[00:16:55] Wow. And I think what's interesting is when we bring up trust, when we bring up loyalty, sometimes those words feel fluffy.

[00:17:02] But to exactly what you're saying, there is real hard return on investment from creating structures, creating opportunities for that alignment.

[00:17:14] You raise a really good point.

[00:17:15] And to a certain extent, I'm not blaming administrators here for having an immediate urgent problem and then trying to fix it in the most expedient way possible.

[00:17:28] But it creates this doom loop, not focusing on the big picture and opening up the aperture into the things that are really going to create the alignment in the team and the trust in the team and things that are actually going to align with the values of those who work there.

[00:17:46] It winds up doing potentially more harm than good.

[00:17:50] So if I'm thinking through then, and you said listening as part of this, you know, like really listening to find this alignment.

[00:17:56] You've done a lot of work actually listening.

[00:17:59] What have you heard across our health system?

[00:18:02] And certainly in connecting with other leaders across the country, really thinking about what are organizational goals?

[00:18:11] What are individuals caring about in their personal lives?

[00:18:15] What are the things that they're seeing in the media?

[00:18:17] You know, what are the things that give our health care workers anxiety or cause for pause?

[00:18:22] And one of the things that, to be honest, we've surprisingly landed on is this notion of together advancing high quality, planet-friendly care.

[00:18:34] Wait a second.

[00:18:34] Just interrupting.

[00:18:36] So you listen to a lot of health care workers across the board in search of this main theme that can drive this alignment, which can drive trust,

[00:18:47] which can make everyone feel collegial, you know, to kind of go through that cycle that we talked about authentically, right?

[00:18:54] And the cause, maybe we'd call it, that rose to the surface was advancing planet-friendly care.

[00:19:04] Yep.

[00:19:04] It was a surprise to me too.

[00:19:06] All right.

[00:19:06] So you identified this and I'm not, like no judgment here.

[00:19:09] I'm just surprised because it's not the first thing that would come to mind.

[00:19:14] Absolutely.

[00:19:14] Well, it harkens back to this idea of if we're going to address a chronic problem, we have to think differently.

[00:19:21] And so there were a few things in that sort of listening that I want to spotlight.

[00:19:26] The first is hundreds of organizations across the United States have signed, meaning their boards have approved it.

[00:19:34] This is an institutional priority, the Health and Human Services Health Sector Climate Pledge.

[00:19:40] What that is, is a public commitment to develop a climate resilience plan and achieve carbon neutrality by 2050.

[00:19:48] And even those organizations that may not have signed the pledge are by necessity developing structures and policies to mitigate the risks of climate events, both locally as well as areas that might be vital to supply chain.

[00:20:02] Example that's top of mind are the hurricanes in the Gulf, where healthcare delivery was certainly affected locally, as well as the national supply of IV solutions.

[00:20:13] So here's an area where there's a lot of work that's happening by commitment, by necessity.

[00:20:19] At the same time, the Commonwealth Fund surveyed a large group of healthcare workers across the United States.

[00:20:27] So across all different kinds of practice areas.

[00:20:30] And this is really cause for pause.

[00:20:33] Four of five clinicians surveyed believe that it's important for their hospital to address climate change and that doing so should be aligned with their organization's mission.

[00:20:44] Three of four feel that it's important for themselves to be involved in reducing environmental impact.

[00:20:51] And this is the kicker.

[00:20:53] This, Stacey, is directly relevant to our conversation today.

[00:20:56] Six of 10, so 60 percent, 60 percent of your workforce indicated that a prospective employer's policies and action on climate change would impact their decision to apply for a job.

[00:21:09] Wow.

[00:21:10] All right.

[00:21:10] I just want to underline a couple of things here.

[00:21:12] What ultimately this whole conversation is about, how are we engaging?

[00:21:17] How are we retaining?

[00:21:18] How are we building trust in an effort to really align across an organization in an effort to create the team?

[00:21:26] You know, put the team in teamwork.

[00:21:28] In doing so, mitigate some of these staffing shortages as a win-win, really.

[00:21:34] I think you put that brilliantly, that whatever we're currently doing, there's still staffing shortages.

[00:21:40] So maybe not working.

[00:21:42] Therefore, let's go out and listen, actually listen to people without judgment.

[00:21:47] Let's listen.

[00:21:47] Let's listen to what people are saying.

[00:21:49] And six out of 10, 60 percent said they wouldn't even go work for someplace that didn't have anything about the planet, anything about improving the sustainability of the health care that's being delivered in that workplace.

[00:22:05] I mean, that is striking.

[00:22:07] Absolutely.

[00:22:07] You know, and we're starting to see all different kinds of groups of health care workers coalescing to promote planet-friendly practices.

[00:22:16] There's a huge uptake in all these sorts of activities.

[00:22:19] Yeah.

[00:22:19] And I think it just underscores, like, this is exactly why you do research.

[00:22:23] This is exactly why you do surveys, because probably your first guess is what you tried and it didn't work, which is why you're doing the survey.

[00:22:29] So, OK, we have realized now that there is such a huge interest and really personal commitment that amongst health care workers today across the board, one of the values being expressed is this commitment to sustainable health care.

[00:22:47] What do you do with this information?

[00:22:49] It's really, really striking when people say the word climate, sometimes like people's heads veer into sort of a political kind of conversation.

[00:22:57] For most health care workers, right, it's in the title.

[00:23:00] When they're thinking about climate, they're thinking about health, their own health, the health of their family, the health of the communities they serve.

[00:23:09] And oftentimes it's their personal stories.

[00:23:13] When it was a particularly hot day, I saw that my patients with hypertension were struggling.

[00:23:19] I noticed that I have a higher no-show rate on the days that there's poor air quality.

[00:23:23] All of a sudden, people are making those links to their own health and well-being as well as the delivery of health care itself.

[00:23:32] Right, like all the stuff coming out with microplastics, the particulates in the air and childhood asthma.

[00:23:39] Like, yeah, it's a thing.

[00:23:42] Without a doubt, it's that link.

[00:23:43] And what I think is also really important is the vast majority of health care workforce live near or within the communities that they serve.

[00:23:53] And so climate impacts, climate events, the quality of the water impacts everyone, workers, patients, leaders, which I think is, I think, partially why we're seeing the interest and the engagement that we're seeing.

[00:24:11] So what do you, when we're talking about engagement specifically, what does that engagement look like?

[00:24:17] Because it's one thing to just like, as they say, it's not what's written on the walls, it's what's done in the halls.

[00:24:21] So we can just write on the walls, we're committed to climate.

[00:24:24] I don't think that's probably going to do much.

[00:24:26] So what goes on in the halls that really creates the sense of alignment and trust?

[00:24:31] Well, I'll talk about the halls of New York City Health and Hospitals, which I'll tell you in discussions mirror some of what is happening in other halls across the country.

[00:24:42] So as mentioned, the largest municipal health system in the United States, we signed the Climate Pledge in 2022.

[00:24:48] And like a lot of organizations, the work around carbon emission reduction has been primarily led by facilities and operations, you know, efficiencies in energy, necessary upgrades to the actual halls.

[00:25:05] And at the same time, we realized very quickly that quality and safety functions, things like quality assurance, performance improvement, patient safety, the things that all organizations have some investment in because you have to.

[00:25:19] Those existing functions are important vehicles for engagement and at the same time can drive that institutional commitment to environmental sustainability and climate resilience.

[00:25:31] And so what do we start to do in the halls?

[00:25:33] The first was talk about it.

[00:25:35] I talked a lot about my own twins and how they impacted my thinking.

[00:25:40] People started sharing their own stories.

[00:25:42] Pretty soon we were having all these discussions about people's climate moment.

[00:25:46] And is this something that's formal or?

[00:25:48] Yeah, we did it in existing forums.

[00:25:52] So meetings and places and spaces that already existed, which I think is really important.

[00:25:57] You can bring some of these concepts into existing meetings.

[00:26:01] I remember, you know, some of our departments chose to have a grand round speaker on the topic of climate and health.

[00:26:07] And all of a sudden that was sort of energizing conversations about the impact of climate on health.

[00:26:13] One of the other really interesting areas, Stacey, is the community health needs assessment.

[00:26:18] So every health care delivery organization across the country has to do a community health needs assessment where you go out and you talk to people.

[00:26:25] And no surprise, but honestly, interesting to look at.

[00:26:31] Six of 10 of the top health risks that were perceived by our community were impacted directly by climate.

[00:26:38] So here you have something that health care workers are curious about, want to talk about, have their own personal stories to share.

[00:26:45] And at the same time, our community is talking about this really organizational commitment.

[00:26:51] So from what I'm understanding, there's a core group and you're meeting the people where they are because nobody wants to go to another meeting.

[00:26:58] So I think it's really smart what you're doing, not adding additional meetings on the calendar.

[00:27:03] But you're basically saying, look, there's a lot of dots to connect here to what you're already doing.

[00:27:08] Like, you know, you're talking about the community health assessments, population health, social determinants.

[00:27:12] Like all of these things are very intertwined.

[00:27:15] So if those within the organization start connecting those dots, then it actually does have a place.

[00:27:21] And it's not like this is a separate topic.

[00:27:23] It's it's folded into everything that's going on.

[00:27:26] You're encouraging people to think that through.

[00:27:28] I just want to highlight you mentioned taking it to where people are at.

[00:27:32] What we did was incorporate a climate lens into existing clinical priorities.

[00:27:38] And that is the key there.

[00:27:39] And that's where you move the conversation from supply chain facilities and operations into clinical care, which is the vast majority of emissions.

[00:27:50] What we use, how we prescribe it.

[00:27:53] And so, you know, the first place we started actually was the OR, the operating room, any procedure areas.

[00:27:59] There is so much waste and all of that waste is tagged to money.

[00:28:05] And so engaging staff, surgeons that were interested.

[00:28:09] We had a surgeon who said, you know what, I actually volunteer in my community around climate related activities.

[00:28:14] I never thought I could bring it into my day job.

[00:28:17] So like what's an example of something that someone did?

[00:28:19] So you were talking about waste in the OR.

[00:28:21] So like there's a lot of single use plastic.

[00:28:23] I'm just off the top of my head.

[00:28:25] Yeah.

[00:28:25] The lowest hanging fruit is individuals looking at their trays and their tray preferences.

[00:28:30] Sometimes those trays haven't been updated for a while.

[00:28:33] What you'll find is, oh, there were two sizes of bandage, but I never actually used that second size.

[00:28:38] Or, you know, I never used that third suture.

[00:28:41] And all of a sudden, the individuals themselves who are interested in engaging in this work found opportunities, which I think, again, is the key there.

[00:28:49] And then you get a sense of empowerment.

[00:28:52] Yeah.

[00:28:53] Honestly, Stacey, working on climate action is very agency building.

[00:28:57] And it goes back to our conversation at the very beginning, this aligned sense of purpose.

[00:29:01] And we're not saying don't use that single use plastic.

[00:29:05] If you need it to do safe care, great.

[00:29:08] But there, you know, 25% of health care is low value, meaning it has no benefit to the health of people.

[00:29:15] And so clearly there's tons of opportunity there.

[00:29:19] That is agency building and likely cost avoiding.

[00:29:24] We also rallied around personal behaviors.

[00:29:27] There was a huge sort of move to wanting to move to QR codes or virtual only documents or double sided printing.

[00:29:34] And that's like a really fun kind of win.

[00:29:37] People, again, feel like they have personal choice and that they can be involved in that way.

[00:29:42] And so, you know, what we're finding is that staff is really energized by seeing their impact beyond daily clinical processes because it relates to their patients and the broader community.

[00:29:52] It really helped reconnect folks to the sense of purpose.

[00:29:55] We've seen amazing manifestations of this increased workforce engagement, a camaraderie, sharing of stories, a decrease in climate anxiety.

[00:30:06] There's a very large health system who did a survey where they found that a quarter of their staff has climate anxiety.

[00:30:12] Workforce wellness is a component of burnout.

[00:30:15] If I was going to sum up what you said and thinking through this whole continuum, we started out talking about staffing shortages and one approach is just pay everybody more.

[00:30:24] But, you know, actually, it doesn't seem to be working out as well as hopes.

[00:30:29] So you got to start thinking different.

[00:30:31] And one thing that after listening to everybody you settled on because you heard it was let's figure out how to be more sustainable in the care that we're delivering.

[00:30:42] So deliver care in a climate friendly way.

[00:30:46] And the steps that you took there were to assemble this core team who was going to kind of lead the charge here.

[00:30:52] You definitely need that.

[00:30:53] But then help others realize how it connected with the missions of their different departments or what they were doing so that they could fold in this imperative as part of their ongoing work.

[00:31:07] So maybe they're going to be talking about it at a departmental meeting or etc.

[00:31:11] Now it becomes part of everybody's missions.

[00:31:13] It's disseminating and deploying across the entire organization.

[00:31:16] Now you've got stories to share, which really highlights individual empowerment, the agency that people have celebrating small triumphs.

[00:31:23] I mean, like all of this is part of team building.

[00:31:25] Actually, if you're even just thinking about this from an organizational standpoint, there's another win here that if you're throwing away the extra stuff that's on the tray, you know, not only is that just magnifying, amplifying the amount of waste from both money standpoint.

[00:31:41] It's also amplifying the number of amount of waste that's going into the landfill, right?

[00:31:45] Like, so there's just win-wins across the board.

[00:31:47] And then really kind of what this all wraps up into is teams that work together.

[00:31:53] It's kind of a connective tissue that then can underpin all of these different departments doing all kinds of different things.

[00:31:59] They can kind of share these triumphs that are an umbrella over the work that everybody's doing.

[00:32:06] Stacey, I mean, you just said it so profoundly.

[00:32:08] Acknowledging the fact that, listen, short-term margins and pressures can sometimes make it incredibly hard to commit to long-term investments.

[00:32:18] But the point here is in exactly what you said, there are opportunities already all over the place that are not just margin-preserving.

[00:32:27] They are also synergistic with healthcare workforce experience.

[00:32:33] And so for those that are listening, I'd encourage you to learn yourself and provide opportunities for individuals to learn about, you know, climate and health.

[00:32:42] This also includes there are a ton of local, state and federal funding mechanisms, including the Inflation Reduction Act, that are pouring billions of dollars into this work to really make it easier.

[00:32:55] I also think that, you know, all organizations are already doing something, as I mentioned, by pledge or by necessity.

[00:33:02] Share what's already happening.

[00:33:03] I have no doubt that people in your organization will be interested in wanting to know more, right?

[00:33:11] And it's a source of pride.

[00:33:13] And as you highlighted before, you know, if you lean on existing structures, quality and safety activities, capacity building programs, arts and wellness programs, you can throw in elements of sustainability there.

[00:33:26] I'm also very heartened to think about leveraging and continue to leverage existing vendor relationships, which I didn't mention.

[00:33:33] You know, all of the EHRs are working on building sustainability-related dashboards.

[00:33:39] There's a lot of existing synergies there.

[00:33:42] And it's sort of like what you said, we got to think differently, right?

[00:33:45] And that's really the call to action.

[00:33:47] Call to action, think differently, use it as a approach to drive empowerment and agency and team building and trust.

[00:33:55] Is there anything I neglected to ask you that you would like to mention here?

[00:34:00] I think acknowledging that this was a sort of a surprising path.

[00:34:03] And I just want to double click on the fact that I came to this as a chief quality officer, a very sort of scripted.

[00:34:10] There's clear KPIs with that role.

[00:34:13] And I have no doubt as this continues to evolve and we continue, as you said, go back to research, learn more.

[00:34:20] We will continue to find really interesting and novel ways that engagement of healthcare workers thinking about high quality planet friendly care will show up.

[00:34:30] Yeah. And, you know, kudos to healthcare workers across the country, I'm just going to say, who are connecting the dots between quality and what's going on in the community relative to the environment that one lives in.

[00:34:41] Right. Like this just really echoes all of the research that says 20 percent of outcomes are driven in clinic.

[00:34:47] Eighty percent is what goes on outside.

[00:34:48] And the environment is a big bit of that.

[00:34:51] It's heartening that this is so appreciated and recognized.

[00:34:55] Yeah. And like there's a lesson maybe for administrators who are a little bit removed a lot of times from lessons of this ilk.

[00:35:02] Dr. Kamal Bajaj, is there any place that people could go if they're interested in more information about this?

[00:35:07] So there are a ton of resources that have been developed and are in development because of the engagement around this work.

[00:35:17] First, I would go to the Office of Climate Change and Health Equity.

[00:35:20] There's a lot there about the Inflation Reduction Act, how to access that funding and also a whole host of climate related resources, including forecasting how climate might impact your area.

[00:35:34] I'd also like to turn to the Agency for Healthcare Research and Quality, which has a primer on decarbonization, you know, sort of some early steps.

[00:35:44] And then really look to the literature.

[00:35:46] There are more and more evidence based exemplars that are being published daily.

[00:35:53] Really, like I look at the Lancet Commission.

[00:35:55] I look at the New England Journal, you know, really top tier journals.

[00:35:59] And so the learnings are building.

[00:36:02] I'd encourage you to tap into some of that that already exists and will be coming down the pipe soon.

[00:36:07] And we will link to as much of that as possible in the show notes.

[00:36:11] Dr. Kamal Bajaj, thank you so much for being on Relentless Health Value today.

[00:36:15] Thanks, Stacey.

[00:36:16] Hi, this is Cynthia Fisher, PatientRightsAdvocate.org.

[00:36:20] We subscribe to Stacey's podcast and we've learned so much with all the incredible individuals she interviews on healthcare and the opportunities to affect change for the better.

[00:36:35] I suggest everyone listen to these great podcasts so well informed for all of us engaged in healthcare.