Organizing Climate Action to Advance Quality, Patient Safety, and Staff Wellness

A recent Commonwealth Fund survey of health care workers found that 80 percent of clinicians believe it is important for their hospital to address climate change, with the majority affirming the importance of reducing their environmental impact both at home and work. Furthermore, 60 percent of those surveyed indicated a prospective employer’s policies and actions on climate change would impact their decision to pursue employment at the organization. These findings stand in stark contrast to data indicating that health care delivery itself accounts for 8 to 10 percent of greenhouse gas emissions in the United States. 

Increasingly, health care institutions are addressing this troubling irony. A wide range of  health care institutions have signed the Health and Human Services Climate Pledge, which aims for carbon neutrality by 2050. Legislative efforts such as the Inflation Reduction Act in the US offer opportunities to advance resilient and renewable infrastructure.  There is growing legislation across the globe to support structural changes towards climate resiliency and decarbonization. 

At the grassroots level, health care workers are organizing themselves to promote planet-friendly practices. To decrease the health care industry’s impact on the climate, are there ways to synergistically connect these people-powered efforts to organizational decarbonization strategies? 

In our experience (as documented in Integrating Environmental Sustainability into the Quality and Safety Agenda: Early Lessons Learned), quality and safety functions can help drive institutional environmental sustainability and climate resilience. Additionally, promoting climate action can be a key strategy to simultaneously link and advance health care quality, patient safety, and staff wellness. By incorporating a climate perspective into existing quality and safety processes, we have a greater understanding about the impact of and mitigation strategies toward inequities related to health care delivery, climate, and health. Moreover, staff are energized by seeing their improvement work having an impact beyond daily clinical processes, especially as it relates to their patients and the broader community.

Organizing efforts have been largely organic. Driven by what they identify as the most urgent needs in patient care, staff have built collective power to create sustainable change with others who share values and experiences. As a result of incorporating climate action into a quality and safety agenda, we have seen real-world manifestations of increased workforce engagement that include: 1) camaraderie and sharing stories on ways to decrease their household carbon footprint; 2) decrease in climate anxiety; 3) reconnection to sense of purpose; and 4) pride and increase interest in participating in institutional climate action and quality efforts. 

As quality and safety professionals from New York City Health + Hospitals/Jacobi/North Central Bronx who are completing a Climate Health Organizing Fellowship with support from a professional coach and organizer, we recognize that the principles of community organizing align well with performance improvement principles and the IHI Psychology of Change Framework. We are learning that successful organizing for environmental sustainability within health systems builds upon the following principles:

• Long-term change is nested. It is easy to think of environmental sustainability as lofty, high-level, and unachievable. But if we think of change as nested, we can walk backwards from that goal and turn it into a series of smaller campaigns that solve manageable, yet impactful subsets of the larger issue. Like Plan-Do-Study-Act (PDSA) cycles, these incremental efforts can lead to compounded change over time.
• Campaigns build people power. A campaign is a timed and concentrated change effort with periodic peaks to build new thresholds of capacity. Building capacity is an essential part of harnessing people power; the bigger the group becomes the more power it holds. Teams invest in people power up front and then take intentional steps for that power to multiply over time to achieve a collective goal at the end of the campaign. Like transformation tools used in performance improvement, campaigns also build power and courage to help activate people’s agency for change.
• Leading change requires relational leadership. Organizing is people-focused and people-led. Campaign leadership often starts out small with a core team focusing on something urgent to them. Through relationship building tools like 1:1 conversation, storytelling, and coaching, leadership structures become interdependent and distributed to demonstrate people power and the ability to create collective, large-scale change. For people-driven change, performance improvement needs relational leadership, especially in co-designing strategies and solutions. 

As climate change impacts health care in undeniable ways, taking action requires coordinated and organized efforts with people that understand change is possible and have the agency to make change. Fortunately, the foundations of organizing should feel like familiar territory for quality and safety teams, especially when leveraging their improvement work for effective and impactful climate-related work. Utilizing performance improvement infrastructure, alongside an organizing framework, ultimately makes climate action attainable and less daunting, which can advance health care quality, safety, and workforce wellness as a whole. 

These authors are four of the many people catalyzing planet-friendly change in NYC and beyond:

Lara Musser, DO, is the Deputy Chief Quality Officer at New York City Health + Hospital/Jacobi/North Central Bronx.

Tanvi Girotra, MPP, is the Principal & Founder of Enable Consulting, Trainer & Coach, Climate Health Organizing Fellowship.

Cjloe Vinoya-Chung, MPH, is the Associate Director, New York City Health + Hospitals/Jacobi/North Central Bronx.

Komal Bajaj, MD, MS-HPEd, is the Chief Quality Officer at NYC Health + Hospitals/Jacobi/North Central Bronx and Medical Director of Sustainability for NYC Health + Hospitals.

Photo by Zephyr18