Leadership, advocacy, and engagement in healthcare sustainability
An interview with GASP co-founder Jonny Groome
Greener Anaesthesia & Sustainability Project (GASP) is a multidisciplinary group working to reduce the environmental impact of healthcare. The grassroots organisation consists of over 50 volunteers from all over the world looking to implement change through education, improvement, advocacy, and consulting. This year the organisation won the BMJ Environmental and Climate Action Team of the Year award and held their first international conference. Keppel Health Review has spoken to co-founder Jonny Groome about his journey in establishing GASP and finding success in healthcare leadership as an early career starter.
KHR: Can you tell us how GASP came about?
Jonny Groome: Four years ago, myself and another anaesthetic trainee were embarking on a project to try and reduce healthcare-related plastics. We realized that, as trainees that are rotated continuously between various hospitals and departments, it's difficult to maintain a project and so we felt the need to create a network. The initial intention for this network was to see this project through to its completion; however, it grew into a platform for the growth and spread of many other projects also looking to reduce the environmental impact of healthcare.
Image credit: Jonny Groome from GASP
How did you bring people together and expand from working within one hospital trust, to a multi-site, multidisciplinary network?
When we started to consider scaling up these projects to other hospital trusts, we realized the importance of making our network multi-disciplinary. A lot of these sustainable healthcare projects can't be done just on commissions. They require external advice and support from senior management, from healthcare estates, and from nursing staff to name a few. In order to have sustainable growth within GASP and enable other projects to flourish, we needed to have a really broad range of professionals on board. Many professionals were focused on reducing healthcare waste. In fact, a lot of people tend to start their sustainable healthcare journey looking at waste because it's something that's measurable and catches the eye. Additionally, the environmental impact of plastics was becoming more and more pervasive in public discourse with the abundance of groundbreaking documentaries such as A Plastic Ocean. These professionals were already starting their own projects and we felt it was important not to ‘reinvent the wheel’, but to bring them on board and offer our support. We then shifted into other areas and kickstarted the movement of trying to reduce the carbon footprint arising from anaesthetic gases.
I understand that you were a junior doctor in your first year of registrar training when you started GASP. How did your position as a junior impact your ability to initiate projects within the hierarchies that exist in day-to-day clinical practice?
Image credit: Unsplash
It’s really difficult! It’s challenging as a group of junior doctors to tell your seniors that the work they do on a daily basis has some unintended harmful effects on the planet, and that they could be mitigated if they were to change the clinical practice that they have cultivated over many years. You are very much speaking to people that you would normally learn from, but the way that we dealt with this was by bringing them on board. Our mantra within the organization is that we never tell people what to do, we just give them information and help them to make the right decisions. That seemed to really help with the power dynamic.
How did you navigate those difficult scenarios where you wanted to inspire some change amongst senior staff but felt that you might be stepping on their toes?
Stakeholder buy-in from senior management teams was quite challenging; however, our initial projects were largely around reducing healthcare-related waste. This was a non-threatening project that made sense amongst the consultant body and one that most were trying to engage with. It was a good point from which to pivot. When we moved into clinical decision-making domains, however, such as advocating for changes in which anaesthetic gases to use, we really started to face challenges and had to adopt a much gentler approach. We did often find pushback from certain consultants, but we responded by politely citing the current evidence and allowing them to make their own decisions—patient safety always must be the highest priority.
You have mentioned using best available evidence to empower decision-making and starting off with projects that do not encroach on practitioner autonomy as some of your tactics. Can you provide examples of any other strategies you found effective in engagement and advocacy?
When you're trying to enact change within a certain setting, it is important that you tailor your actions to the specific group you are looking to influence. Delivering a presentation to a consultant body—who are often more focused on data—is going to be very different to delivering a presentation to allied health professionals or nurses. The latter group want to see how it may impact the day-to-day running of their theatres, for example, or their wards.
For instance, one of our projects around introducing a new waste stream in operating theatres involved extra work for portering staff, extra work for nursing staff, and quite a bit of education. We adapted our communication strategy to these teams accordingly. First, we observed how information was normally given to them and found that it was commonplace to see overworked, tired nursing staff being told what they need to do for that day and with little information as to why they need to do it. So, we came up with the concept of guerilla teaching sessions. Guerilla teaching sessions are five-minute presentations. Three-quarters of slides explain why we need to enact change (the emotive reasons behind sustainable healthcare) and the final quarter would be looking at the change itself. We would ask staff members if they had five minutes to spare in their own working environment and tried to make it a pleasant learning experience for them. We found that that was a much more effective way of doing things than just giving people a list of demands.
Another key benefit of having a multidisciplinary network is receiving advice on how to approach certain areas of the hospital that many of us don’t usually work in. Often, they can provide us strategies in how to engage these groups and ultimately get these projects off the ground.
In a world where the topic of the climate crisis is so ubiquitous and disengagement is almost inevitable, how do you maintain the interest of your target audience?
I think it's about variation. It's important that we maintain an element of shock and awe to the fact that this is a very daunting task that we have, but also to the impacts of the climate crisis from a public health perspective. It’s also important to recognize our roles as healthcare professionals, a trusted profession still to this day, and use our voice to start demanding more change. It must be a key part of our role, as it would be with any other public health measure like advocating for healthier diets or smoking cessation.
Image credit: Unsplash
In the UK, many National Health Service (NHS) trusts are struggling financially and have competing priorities when it comes to improving the quality of care and meeting national standards of practice. How do we engage these trusts whose resources are likely to be limited?
When it comes to costs, a lot of the projects that we implement are actually cost-saving. Changes in the choice of anaesthetic gases and diverting waste from expensive management streams to a cheaper recycling one both have the co-benefit of being cost-effective. Now, if you're looking at what an NHS trust should be focusing on, given that some trusts are under more pressure than others, then the pandemic has proven to be a very interesting learning opportunity. It seemed quite inappropriate initially, when the pandemic started, to be talking about the environment. However, we started to realize quite quickly that some of the COVID-19 containment strategies that were already being undertaken in hospitals also had positive environmental impacts. For example, the use of telemedicine reduced the number of healthcare-related road journeys. GASP have set aside time to measure those impacts and promote these changes as an ongoing way of promoting sustainable change in our healthcare system.
Image credit: Unsplash
“Some of the COVID-19 containment strategies that were already being undertaken in hospitals also had positive environmental impacts. For example, the use of telemedicine reduced the number of healthcare-related road journeys.”
Finally, what advice would you give to the new graduates and emerging professionals who are reading this interview and looking to start their own sustainability projects or organizations from scratch?
Collaboration is key and the time to start is now; don't think this has to be something you can’t do until you are in a clinical role or in a more senior role. You will probably find you have more knowledge than the people that you think are senior to you. It's all about finding allies within the field. Those who share similar interests and goals and will help you in your mission towards achieving a net zero healthcare system.
More information about GASP and ways to get involved can be found on their website.
