What can we do to improve sustainability and environmental impact in endoscopy?

As temperatures continue to rise, it seemed fitting to meet with Leigh on a sweltering summer day to discuss how sustainability and environmental responsibility affect the future of endoscopy.

Leigh has worked as an endoscopy nurse for numerous years and has been the sustainability lead at Northumbria Healthcare NHS Foundation Trust for the last 6 years.

Leigh described the COVID-19 pandemic as a key moment that prompted her to reflect on the amount of waste generated in endoscopy. Seeing the substantial amount of waste being produced by the PPE measures introduced during the pandemic motivated her to make changes, start conversations and reflect on how everyday practices were creating unnecessary waste. For Leigh, the first step towards change is a conversation.

What simple change can I make today to become more environmentally conscious?

Leigh highlighted how having open discussions with colleagues is the first step – this will remind everyone to start thinking about sustainability, to discuss ideas and collaborate on the small actionable changes that can be made straight away. She explained how having regular reminders or questions at each huddle or team brief were a great place to start. Leigh likes to ask at each huddle ‘what can we do to be more sustainable today?’. She said, ‘even if that's discussing how to be more conscious with waste management or waste disposal or reducing the amount of accessories that get opened. Or just thinking about, you know, do we really need to open this or can we be a little bit more conscious about what we do?’

She emphasised how having channels of communication where like-minded people can have these conversations is vital. She understands how it is difficult to get sustainability initiatives started as people are tired and under a lot of work pressure. These conversations allow the ideas to begin, for discussions and dialogue to open on what changes can be made. Within these conversations colleagues can reflect upon their own environmental impact in a non-judgemental space.

She also explained that a good first step is introducing visual cues such as posters, as they allow people to learn more about where to start. She acknowledged that the subject of sustainability can be overwhelming and we need to challenge the element of fear it brings. People fear getting things wrong and making a mistake. So visual cues are vital as they can educate and remind people, and ensure that they don’t feel scared to ask questions.

Another step anyone can take is becoming a green champion. Get in touch with the sustainability lead at your hospital, ask how you can get involved in sustainability initiatives and ask to join the green endoscopy working group.

Staff often feel they don’t have the time, what would you say to this?

Leigh explained that the most sustainable options are often also the most time- and cost-effective ones, ‘sometimes when you get into these things, actually there isn't any added burden of workload to them at all. It’s just that perceived burden.‘

Often you will discover solutions that are not just better for the planet but have a positive economic and health impact too. Leigh continued ‘The hardest thing is getting people to start doing it. And, you know, once you start seeing savings and reduction in what you’re ordering, it is really nice to see.’

Measuring the success of the initiatives brought in is vital and can be very uplifting. Audits are an excellent way to measure the success and any improvements made within the department. She said, ‘things like audit and research are often a barrier to nurses because it’s something that's often poorly understood. But you've got really good audit departments who actually do most of the work for you.’

Leigh recalled the time she photographed the waste before the initiative began and then took another photo of the waste afterwards and shared this with the team. Using visual cues and celebrating success can really bring home how much positive work is being done by the team and how each person can make a difference.

What initiatives have you have been involved in?

Leigh has been part of an initiative focused on reducing the number of dignity shorts used on her endoscopy ward. Dignity shorts are not recyclable and, even when labelled biodegradable, are not disposed of through biodegradable waste in most hospitals, meaning they still end up in landfill. Previously, dignity shorts were given to every patient on admission, but Leigh started a new initiative where patients were asked if they wanted to have dignity shorts. This has significantly reduced waste and been very successful.

Another example was the introduction of reusable baskets for patient’s belongings, which can be wiped down between each patient use rather than using plastic bags. Patients gave positive feedback on the use of baskets rather than bags, and following their success in the endoscopy department, several other hospital wards began to adopt them too.

Reviewing bin locations also proved successful in Leigh’s workplace. She explained how bin positioning influences whether people recycle: if the bins were too far away or in an area with less footfall, she found that people were more likely to put waste in the wrong bin, but once the position changed, waste management was improved significantly. Leigh emphasised that focusing on small things that have psychological impact are among the most effective changes you can make. Challenging psychological barriers is crucial, ‘It's all about behaviour. So challenging culture and behaviours, getting people to be motivated. A lot of people recycle at home, its important to translate those habits into doing them at work.’

Introducing a green endoscopy board has helped to create a more open communication about sustainability on her ward. This board displays posters and information on current projects to improve environmental impact on the ward. Leigh expanded on how having this board in an area where patients could see it helped to spark conversations about the environment with them as well. She believes that living a more eco conscious lifestyle should be encouraged among everyone, not just staff.

Another way to reduce plastic is to partner with charities that create bags for surgical drains from recycled materials.

On a larger scale, Leigh highlighted that we need to campaign for minimising single-use Items, waste segregation, digital transformation, energy efficiency and appropriate patient selection. She said, ‘The most wasteful endoscopy is the one that should never have been done.’

She explained that if you work in the NHS in England, you can contact the sustainability officer for your hospital, listed in the telephone directory, and ask them to suggest changes that can be made on your ward. These roles have been introduced as part of NHS Net Zero by 2040.

Small changes can make a huge difference, especially when made by lots of people. We can all play a role in campaigning for change and garnering feelings of hope. Feel empowered by the fact that you have control over your actions and where you spend your time will have an impact. Your changes can inspire others to act too.

Useful resources related to green endoscopy: