Hospitals exist to support people’s health, but they’re also large emitters of greenhouse gases. That’s why Southern Cross Healthcare is on a mission to cut waste anywhere it can.

The last thing on most people’s minds when they go to hospital, either sick themselves or to visit a loved one, is the impact that healthcare might have on climate change. But despite the obvious good that hospitals do and the necessary care they provide, they’re also responsible for producing significant amounts of waste and carbon emissions. It’s estimated that hospital-based healthcare generates between 3 and 8% of New Zealand’s total greenhouse gases. 

Hospital and surgical equipment come with significant safety and sterilisation requirements to ensure the protection of patients. But that commitment to safety has meant products are very often single use or secured in plastic packaging.

In 2017, just after New Zealand had banned single-use supermarket plastic bags, Oliver Hunt was looking for a master’s project when he realised healthcare waste must be a problem on the same level. That project became Medsalv, his company that takes used single-use medical devices from hospitals around New Zealand and re-manufactures them so they can be safely used again.

He realised the waste produced by surgeries mostly goes unseen. With over 330,000 surgeries per year around the country, hospital waste often finds its way into landfills.

“Every time a person goes in for a surgery there are a tremendous number of products used, things like surgical drapes and instruments, scrubs and aprons worn by medical teams, and implants come in huge amounts of packaging,” he says.

For Southern Cross Healthcare, whose network comprises 10 wholly-owned and several joint-venture hospitals nationwide, modifying their facilities and practices to address their environmental impact is a critical mission. In 2020, the not-for-profit healthcare provider produced its first Sustainability Strategic Plan. It outlines the organisation’s commitment to sustainable healthcare to ensure it remains fit for present and future New Zealanders. 

“We’re serious about delivering sustainable patient-centred care while reducing our impact on the environment. We see we have a responsibility to take action and do our part ,” says chief of strategy Tracey Barron.

“Benchmarking the breadth and scale of our environmental footprint is a starting point to help us gain insight into the impact that our actions and operations have on the environment, as well as enabling the setting of targets and measuring progress.”

Southern Cross Healthcare is aware of the dichotomy of existing to help people be healthier while also contributing to the unhealthiness of the environment we live in. 

“We know we’re not 100 percent perfect at this stage,” says Barron. “There are lots of things that we can do, but what the strategic plan has done is make sustainability part of our DNA and guide how we move forward.” 

The plan includes practical goals with real targets, and a core focus on seven sectors: waste reduction, energy and water efficiency, sustainable procurement, sustainable transport, energy efficient building, medical gases, and employee engagement and empowerment. 

Southern Cross Healthcare employees across the hospital network have been a critical force in helping to deliver the organisation’s mission. Gerda du Preez, general manager at Auckland’s Brightside Hospital, has seen her team members embrace the sustainability change. 

“It started with a couple of passionate staff members when I worked at the Auckland Surgical Centre [another Southern Cross hospital]. They’d bring me articles on how we could minimise waste in the hospital environment,” she says. “We were really excited and started changing small things and we realised that it made a difference.”

One of the early steps was to bring in a company called We Compost, which advised them to start composting paper hand towels – an important item across hospitals. They installed clear signage on the bins and noticed immediate changes. 

“Within the first month of doing that, we realised 50kgs of hand towels that would have gone to landfill were now being composted,” du Preez says.

Every hospital within the Southern Cross Healthcare network has its own Green Team, which work to fulfil the goals of the Sustainability Strategic Plan. These teams are also leading ongoing innovation and are empowered to start more grassroots initiatives. 

“Everybody’s gradually becoming more and more aware of the environment and the impact of things that we do,” says du Preez. “We make sure that when we implement changes, we do one thing at a time and educate the teams properly. Because I think if you take off and try and do everything in one go, you won’t get anything done properly.”

The environmental impact of hospitals can be hard to see. Only 5% of the anaesthetic used in operations is metabolised by the body. The rest – which is made up of Nitrous Oxide (N2O) and other harmful substances such as desflurane – is expelled into the atmosphere, where the molecules will take more than 100 years to disappear and are more destructive, individually, than carbon dioxide. Charles Harsono, an anaesthetic technician at Southern Cross Christchurch Hospital, has become passionate about the reduction of N2O in a hospital environment and its impact on ozone depletion.

This month, Harsono will present his research which explains how reducing the rate of N2O used in each daily machine check – a standard procedure where a hospital’s anaesthetic technician checks the content of gases is correct – will “reduce our carbon footprint, and hopefully make a difference for the planet”. According to Harsono the reduction would create a 43% decrease in the total amount of N2O used. Southern Cross Christchurch Hospital has already made the N2O changes he suggests, and the effectiveness of the initiative will be used as a case study for the wider Southern Cross Healthcare network. 

Harsono was inspired to make these changes by his personal journey to a more sustainable lifestyle. He says it’s as simple as healthcare suppliers and clients applying their existing values and practices to a different environment. 

“I think patients should be aware that there will be an environmental cost of their hospital care and procedures,” he says. “As an anaesthetic technician, I recognised the contribution of my daily practice to our healthcare system to climate change. Rather than ignoring my role as part of the wider anaesthesia and theatre team, I looked for ways to reduce my own carbon footprint in my workplace and every day.”

This simple but innovative thinking is at the centre of Southern Cross Healthcare’s strategy. When Covid-19 first hit last year, it made procurement of some medical supplies difficult. 

“It was really difficult to get some of the PPE equipment,” says Barron. “One of our staff members worked with a team at Auckland University to develop a face shield which was essential for theatre staff during surgery. It’s able to be sterilised and reused, so it reduced costs and enabled New Zealand production.” 

Southern Cross Healthcare works with Medsalv to ensure other single-use products, such as compression calf sleeves that assist in blood clot prevention, are now reprocessed. Medsalv works with Southern Cross hospitals nationwide to collect and remanufacture them. They’re then moved them back into circulation in coordination with Obex, a medical technology organisation.

“We inspect the sleeves and they are subjected to functional testing to make sure that they do their job, we have a unique identifier that we put on them, and once clean, they get sent back to the hospital to be used again. Our goal is to do that as many times as possible without compromising the integrity or safety of the device,” says Medsalv’s Hunt.

“The reduction in carbon emissions is considerable given that when you remanufacture a product you don’t have to find and refine the materials. We use clean energy and every step of our process has been picked over by a fine-tooth comb from both a safety and a sustainability standpoint.”

Southern Cross has examined other practices to reduce waste across its healthcare services. Projects like a sustainable collection system for surgical fluids and the adoption of reusable sharps containers have reduced the amount of plastics sent to landfill across its wholly-owned hospitals. 

The soon-to-be opened Southern Cross Central Lakes Hospital Queenstown (a joint venture partnership with Central Lakes Trust) features green and healthy building design, with integrated sustainable energy systems, a warm roof and careful consideration given to creating an environment that has a positive impact on patient wellness. In Christchurch, meanwhile, they’re in the final stages of replacing the hospital’s old diesel boilers.

A significant achievement was getting Toitū Envirocare certification for Southern Cross Healthcare. The third-party organisation has 400 New Zealand businesses on its books, and holds businesses accountable to their sustainability goals. The certification saw a commitment to reduce their carbon emissions by 6% within five years of their date of certification in 2020. 

“It was a very proud moment and sets a benchmark for us to be able to monitor our change over time,” says Barron. 

The momentum for change has come from employees themselves, says du Preez. Simple shifts in behaviour have set the tone for systemic change in the way the organisation operates. When recycling and waste reduction became a regular conversation at Brightside Hospital, she says it became “everybody’s mission to do it and do it well”.