Sustainability with Georgie Opie and Dr Tom Clemens

In this episode of the One Health Podcast Wellbeing Series, Dorian Broomhall gets to know Georgie Opie, Program Manager for Sustainability at the Royal Hobart Hospital and Dr Tom Clemens, Staff Specialist Paediatrician for the Tasmanian Community Paediatric Service.

Georgie and Tom speak about how the health of our planet is linked to the health of the community, and why this means sustainability should be important to those of us working for the Department.

They talk about aligning our work with our values in order to find satisfaction.

And they speak about recognising our own limits in fixing the word’s problems, looking after ourselves and about finding fulfilment in small actions.

Transcript

Dorian Broomhall:

Welcome to the One Health Podcast. This episode was recorded on the land of the palawa people. I acknowledge and pay respect to all Tasmanian Aboriginal people and to their deep history of storytelling. My name's Dorian Broomhall, and I'm the manager of Culture and Wellbeing for the Department of Health here in lutruwita, Tasmania. For this episode of the podcast, I got to know two people working in the sustainability space within health. Georgie Opie is the Programme Manager for Sustainability at the Royal Hobart Hospital, part of Hospital South. And Dr. Tom Clemens is a Staff Specialist Paediatrician for the Tasmanian Community Paediatric Service as well as Chair of the Hospital South Health Sustainability Taskforce, and the Deputy Chair of the Statewide Health Environmental Sustainability Committee.

In our conversation, we spoke about how the health and wellbeing of our planet is inextricably linked to the health and wellbeing of all of us and our children. We spoke about why those of us working in health should, therefore, care about sustainability. We speak about finding fulfilment in supporting the small actions that add up to big change, and we also talk about recognising that we can't fix every problem in the world and that we must also prioritise where we place our energy and look after ourselves first. We also speak about the importance of doing work that we find satisfying and that resonates with our own individual personal values as part of our sustainability as people. So let's get into it.

Georgie, would you mind just telling us a little bit about what you do and what brought you to what you do?

Georgie Opie:

Yeah, of course. So I am the sustainability manager for Hospital South. It's a very new role and Tom here is very key in getting that role up and running. My background is nursing. I was a post-anaesthetic care unit nurse for a long time and became very disillusioned with the amount of waste that we were producing. Had a bit of a crisis about it. I really struggled with my mental health and climate anxiety around it, then realised that you could study sustainability and that was a whole field of learning. Yeah, so basically got into it that way and managed to end up in a space where I get to combine my two fields of expertise and do eight hours of really meaningful work for me, which allows me to kind of frame my responsibility to doing good. I think it's really important. There's so many different battles that you can fight on a day-to-day basis and it's almost like picking one or two that you are prepared to fight and then still having time to switch off, so my way of doing that is through my work.

Dorian Broomhall:

Wow. It's funny, we've had quite a few conversations now, I think, since you started in this role. It's funny how such a simple question can bring out a whole bunch of stuff that I didn't know. I knew that you had a nursing background but I didn't know that you necessarily studied sustainability specifically and that that was a real driver for you, so that's really interesting. I will definitely come to that in a second. And Tom, welcome.

Dr Tom Clemens:

Thanks, Dorian. Yeah, so I'm Tom Clemens. I'm a general and community paediatrician and I'm Chair of the Health Sustainability Task Force for Hospital South, which has been a group that's been loosely together over more years that I've been involved. But we managed to get recognition for the committee as a subcommittee of the Quality Safety and Clinical Risk Committee in 2019. Part of the work that the committee did and some of the members was to develop business case for Georgie's role. Hospital sustainability officers or sustainability managers haven't been a thing in Tasmanian hospitals so far but they have been around in various guises in hospitals on the mainland and internationally.

Of the members of the committee who are all, let's say interested amateurs, none of us have experience in or qualifications in sustainability but we're obviously highly motivated to try to seek change, partly out of things like the crushing volume of waste that Georgie was buried under in PACU but partly driven by, I suppose, from my personal experience. I was seeing lots of kids and working on things for them, like making sure that they were fully immunised, making sure that their asthma was well managed, making sure that we did things for their health that were going to ensure their long-term wellbeing.

But, at the same time, I was very conscious that one of the biggest determinants of their long-term wellbeing is the health of the planet that we all inhabit and the ecosystems that we live in that we're entirely dependent on for our life support systems. And if part of the process of providing healthcare was resulting in degradation of those ecosystems on which they'll be reliant, it's like we're providing life support systems in the ICU but at the same time chucking all our rubbish into the ventilator or something like that, it just doesn't make sense. So yeah, there certainly seemed to be an opportunity here to do something that I was very passionate about but that also, hopefully, resulted in benefit for patients, if not directly then, and hopefully over their life course.

Dorian Broomhall:

So much there again, that's super interesting. I love your metaphors. Obviously, are very profound there but that idea that dealing with what's directly in front of us, no matter how significant that might be, remembering that there's also a long-term impact around the choices and the actions that we're making right now. So much of the work that we do in this organisation is what I call operational and rightly so, it's about delivering the stuff that's there. But if we don't have that strategic lens, that look to the future happening simultaneously, then you're quite right. Almost what's the point? What's the point of creating health and outcomes for people if the overarching thing is disappearing?

It's interesting to hear that this work, from your perspective, really only kicked off five years ago. Now I'm doing a bit of a deep dive into the work of Donella Meadows at the moment, who is one of the pioneers of systems thinking. One of her original books was in the '70s but was looking at sustainability from a systems thinking lens. That was where a lot of her ... And we're going back 50 years there, and we go to now and what we know and it's like, "Oh, we're just getting started with this work, which is kind of profound.

Dr Tom Clemens:

Yeah, and maybe a little worrying that we haven't been quick enough to take on some of this stuff I think. Yeah, I mean, certainly ... So I was lucky enough last year to receive a scholarship through the department to do a subject through Notre Dame University on health sustainability. One of the key components of that, in addition to exploring the health consequences of climate change and our contribution to it, was an element of systems thinking and I think that's a very valuable way of thinking about these things.

Partly, in my mind, it helps to give you a great lens for thinking about what are the potential points for change rather than necessarily tearing your hair out or getting frustrated or blaming somebody else. Thinking about where are the levers, where are the things that we can adjust? And we do have a lot of ... Particularly as doctors but even as nurses, people respect us. They value our judgement , they value our input on things, even things that are slightly outside our direct day-to-day expertise and so, I think talking about this stuff, thinking about it, trying to work out where things could change is definitely an important part of it.

Dorian Broomhall:

So link that, Georgie, to something that you shared at the very beginning there around being quite challenged when you were working at PACU with the amount of waste that you were generating. I suspect many people in our system are very well aware of these sorts of outcomes and going, "Oh my gosh. My wife's a nurse, I've got at least a dozen pair of single-use scissors at home that we try and keep using, but there's only so many pairs that we need." This is a certain reality of the system. Since you've been able to move into this new role, this sustainability role, what's that changed for your well-being at work?

Georgie Opie:

Yeah. Like I said before, it's allowed me to do the eight hours a day of caring and trying to make change and then go home and switch off so I'm like, "Cool, I've done my good job. I've done something that means something to me." But I think it's really common. There's so many clinicians, I think, who felt the same way, who have been engaged, in the end become disengaged because they're like, "We're not doing enough. There's not enough change happening." It's really hard to live ethically in our society. You can spend twice the amount on something that is not plastic wrapped or you can make decisions that feel right but they cost you inconvenience or time or money. It's a no-win situation sometimes. So yeah, giving me that framework to do my work and make the change for other people as well or help other people make that change and live a little bit more ethically, that's been really meaningful to me,

Dorian Broomhall:

I suppose, do you have any thoughts for those that are maybe struggling with that day-to-day? This could be for either of you who are going, "Wow. Sure, we live in a very lucky state from the fact of how our energy is created, sure, but there's still lots to think about there in terms of emissions and all the rest of it." What do you think we can do to reconcile some of those ethics?

Georgie Opie:

I think there's a couple of things. One thing I really noticed when I was on the floor was my thought cycle was, "Oh, I could make that change or I could push for that change." And then I would think, "Well, what's the point? It's not going to last, it's not embedded, it's not integrated." So moving to this role I was like, "Great, I can make change that will be embedded, integrated top down." But now, from where I sit, I see all those small changes and they really add up. It maybe doesn't feel like it day-to-day, but they do, they really add up. A lot of the work I do is basically supporting people who are doing the good work.

Dorian Broomhall:

Absolutely.

Georgie Opie:

It's not directly coming from me. That, I think, is really key, recognising that the little things do make a difference and also recognising where your responsibility lies. So you can try and change the world or you can try and protest gender violence or you can try and protest the war in Gaza. There's so many different things that you can try and fight, but recognising that you only have so much bandwidth and it's okay to take time to focus on yourself and go, "No, I'm going to turn the news off. I'm going to just focus on my family, my fitness, my wellbeing." Just put some boundaries in place around that and make sure that you pick and choose where you spend that energy.

Dr Tom Clemens:

Not only is it okay but it's necessary. It's essential to being able to continue to do what you do. You have to be able to look after and nurture yourself as well. And I think, for me, that's a big part of this is being able to do work that aligns with your values. I think there's a kind of moral hazard for people coming to work each day. We all do our best at home to switch off the lights or to drive less or walk more or whatever and separate our waste into things that can be recycled, but I think there's a risk to people. If they come to work and they feel disempowered, they've asked several times for this to be changed or whatever. They feel it's out of their control, they just have to chuck those single-use scissors back in the sharps bin because there's no other kind of solution to it.

One of the things that really motivates me is this kind of sense that we're not doing a very good job yet. I think it's improving but we're not doing a very good job yet of counting the true cost of things. So we're quite good in the health services at identifying where there may be cost savings to some extent, not always, but to some extent. But the thing that really appeals to me about sustainability is the three pillars, the so-called triple bottom line of sustainability. So we're looking at not just the environmental sustainability but also the social and financial sustainability of the things that we do.

And I think that's where it really links to wellbeing for me is that not only are we ... Sustainability definitely has a lens to the long-term environmental safety, and I think that's really important, but I think it's also really important for us as individuals to be able to be doing work that we find satisfying, that aligns with our values rather than coming to work and feeling like we have to do things in a way that undermines the way we would like to do them. I think that's exhausting, that leads to burnout, that leads to staff turnover, which then increases the stress on the system.

Georgie Opie:

And that's all sustainability in itself, people sustaining themselves, the inputs ...

Dr Tom Clemens:

Yeah, absolutely.

Georgie Opie:

Equaling the outputs.

Dorian Broomhall:

Yeah, I think that there's something to be said for both of you in the choices that you've made and the work that you do for realising that you get some meaning out of this. And for you, Tom, doing it adjacent to your core role as paediatrician, to realise that that is actually sustaining you by feeling like you're contributing and making those choices. We talk a lot about people who do work off the site of their desks, that's the metaphor, right? Sometimes that site of the desk work is actually the work that you get even more meaning from doing, and that perhaps is why people continue to choose to do it, right?

Dr Tom Clemens:

Yeah, absolutely.

Dorian Broomhall:

Georgie, I love that you had the frame of, I didn't realise the importance of the small things until I was able to get up and have that sort of view. How do you think that we help people to realise that their choices matter?

Georgie Opie:

That's a tough one. I think closing the loop, making it visible, making those processes visible. This is the cost of that action in emissions, and money, and time, and your wellbeing. I don't know how we necessarily do it in the health system better, but transparency and communication just seems to be the basis of everything. There are so many people that care, but they don't know that anyone else cares and they don't know that what they're doing means something to someone until we all start getting in a room and saying, "Oh yeah, I did that. I had that conversation with someone else." Yeah, it's breaking down those silos somehow in this kind of universal conversation that we're all having.

Dr Tom Clemens:

Yeah. Celebrating the small wins I think is important too. I think we all feel like, I certainly do, that we're not doing enough, that things aren't moving fast enough, things aren't changing at the pace that's required, and certainly the data on climate change would bear that out. But I think, at the same time, that can lead, and we see this commonly in children and young people, that leads to a sense of apathy or disengagement, and I think that in itself is a hazard for people as well. So being able to celebrate the things that we have achieved but still acknowledging that it's not enough yet.

And I think, for me, it's been that balance between the kind of bottom up, which is the way our committee initially formed was from people, clinicians who were frustrated at having to throw things out that they thought could be used again or frustrated at systems that didn't seem to acknowledge the potential impact and the consequences or the costs from a climate environmental perspective. But I've been impressed, I suppose is the word, by the receptivity from further up. I think it is hard. We all deal with that difficulty of you can't just do long-term planning. You've got to deliver that operational stuff. You've got to do acute care because there's no way you can shut the doors, you can't tell the ambulances to go elsewhere.

We've got to be able to provide that stuff, but unless we have a long-term vision for how to provide that in a way that maximises the value from a health point of view and minimises the negative consequences from an environmental or a financial point of view, if you don't have that lens on it you just end up just keeping on churning. You end up being the ambulance at the bottom of the hill and not altering what's happening upstream. That's where I love working with children. If we can make small incremental changes in their lives, in their well-being, then we can hopefully see substantial changes in their trajectory. And even though we might only alter the trajectory by one degree, over time that opens up a potential benefit that we all reap the benefits from.

Dorian Broomhall:

Let's do the magic wand thing, right? Instead of big picture let's do the visionary. I think that it's really important to note the link between well-being at work, sustainability at work, value in your job, meaning at work, all of these things, and I think this idea of environmental sustainability being sort of a key driver and a key link to that. I don't think there's many people around now happy to be challenged, but I really don't think there's many people around now who are still nay saying about this and saying, "Oh no, this isn't important." As you point out, Georgie, where do we place our attention, there's so much.

So if we took that vision then that we wanted to be known as the health service in the world, that was the greenest health service, and that people wanted to come and work here and be here because actually that's a motivator for them, and they want to contribute to that, and they want to be a part of that. I believe that would be true for many brilliant people right across the world who'd go, "Yep, I want to be there." Removing barriers right now, just thinking vision, what would we do? What could we do? Where would we start?

Georgie Opie:

You want me to take that one?

Dr Tom Clemens:

I mean, I think you hit the nail on the head when talking about removing barriers because I think actually that is one of the biggest things that we can work towards is somebody has a good idea or has an experience in a health service elsewhere. There sometimes feels like there's too many obstacles in the way to at least trying that idea. We don't have to roll it out expensively across the whole service in every single case but being able to say, "Oh yeah, that's a good idea." Let's be receptive to change because change is happening all the time anyway, and let's head the change in the direction we want it to go rather than just hanging on for the ride.

So I reckon that's a huge part and I think, yeah, it's not always clear where the barriers are, and some of them require a fair bit of systems understanding or complicated accommodations of different competing benefits, those sort of things. But one of the beautiful things about sustainability is the kind of win-wins. We can achieve both environmental savings, reduce our carbon footprint, and deliver better quality care and reduce the cost. There are a number of things where we can do that, that don't cost the earth literally or figuratively and deliver what they call in the climate change space co-benefits, so benefits of acting on climate change that also result in better health and well-being, that also result in financial savings.

Encouraging cycling or walking to work is a really simple, no-brainer, but when we have tried to do that there are things ... No one's deliberately putting obstacles in the way but there are barriers, so one of them is space. If you want to encourage cycling, then you have to have somewhere for people to park their bikes. We have got a reasonable space at the moment in the forecourt on Liverpool Street but it certainly has its problems. It's limited. It's often full these days, which is great. But being able to encourage active transport also increases people's productivity, increases their well-being. It makes it less likely for them to both be absent but also to show up at work unwell or whatever, so there's lots of potential, additional benefits as well as the carbon reductions for people not sitting in their cars driving.

Dorian Broomhall:

Not to mention not becoming consumers of our service as well, so.

Dr Tom Clemens:

Exactly right.

Dorian Broomhall:

Yeah, have a part in that too.

Dr Tom Clemens:

Yeah, absolutely.

Dorian Broomhall:

What do you think, Georgie?

Georgie Opie:

I think a lot of it comes back to consumption, unfortunately. The way we consume resources in our own lives and as organisations, it's that hangover from planned obsolescence. Things are built to not work with other systems and built to degrade, and the new things that are shiny and cheap and no one values them because they're cheap. You've got your grandmother's dresser, which has lasted a hundred years, but then you could buy the same things for $20. So changing that relationship with consumption and realising that anything you do consume you have a responsibility too. So that goes back to manufacturers and producers too. I don't think anything should be made in the world that hasn't got a plan of how it's going to be unmade responsibly.

It needs to be full life cycle so, even in my own life anything I buy, I buy only secondhand and I think, "Do I want to own this? Do I want to be responsible for it? Do I want to move house with it? Do I have somewhere to store it? Do I want to maintain it? It sounds like a lot of decisions but it actually makes it a lot easier for me. So yeah, changing that consumption, especially in healthcare, we just buy things to solve problems rather than actually looking at the horizon. Like, "What is the problem? Why is the problem there? Can we change the system rather than to buy a new toy or piece of equipment to solve it?"

Dorian Broomhall:

Yeah, so I think that both of your perspectives there, there's a beautiful combination of individual choice and agency that anybody can make decisions every day. What purchasing decisions you make at any level of the organisation, whether you're bringing a cute cup for a coffee. It's simple things like that right through to if you've got a budget or you go through a procurement process or what are the other things that we can look at there? There's work afoot to even change some of those processes so it's like big system changes there and there's that individual agency, which is so important to remember. I think that we can become entirely disempowered when we think about wellbeing. "Oh, well my roster is what it is and so therefore my life's going to be crap." It's like, "Well, okay, that's a challenging cause effect relationship to live with. How do we find different ways to go?"

"Well, that's the boundary by which it's been set. Could it be different? I would love it if it was and it's not right now, so what are the other things that I can do? What is it that I can influence and control?" Actually placing more attention on that I think would be helpful.

Thank you both so much for joining me for this conversation. I love your perspectives of linking meaning at work from being not always just what we do with our day-to-day. I'm really grateful that you've taken the time to share with them, to share with everybody about this as we consider wellbeing in a slightly different way. So thank you so much.

Georgie Opie:

Thank you.

Dr Tom Clemens:

Thanks, Dorian.

Dorian Broomhall:

This conversation with Georgie and Tom was really a different conversation compared to the others that we've done in this series on wellbeing. What I thought was really interesting listening back is how these patterns apply to ourselves. So we're talking about this idea of sustainability within the healthcare industry, the choices that we make today, in an effort to do good for what might be happening today but also might inadvertently do harm in the future through something like climate change and our contributions to that through the choices that we make. I think that's really fascinating to abstract that upper level and think about that in terms of the health and wellbeing choices we make for ourselves.

We might make choices today that aren't necessarily doing any harm and we might even perceive that they're actually doing us good in some ways in the short term, but we're not necessarily thinking about what that means for us in 20 years. The choices that we make today, of course, have a massive impact downstream and adding up perhaps a bunch of useful choices or positive choices with that long-term in mind can really make a massive difference in terms of what our long-term health and sustainability might be. The conversation didn't really specifically link to the pillars that we talk about, but I have to say that it's quite interesting as we think about the leverage points for sustainability and how we can move into a different direction or a more sustainable direction in the healthcare industries through some of those small choices that also really resonates with this idea of the six pillars.

Those choices that we make, those individual leverage points that we might be able to identify, the changes that might not seem all that big yet when you add them all up over a sustained period of time can make a profound, profound impact. The choices that we make today could be what actually keeps us out of somewhere like the hospital in 20 years time, depending on what might happen our lives. I think that taking that long-term view, much like we need to take for it with sustainability, realising that the actions that we make today have that impact in the future, that's quite profound and certainly something that I'm walking away thinking about after listening back to that conversation.

So thank you to Dr. Tom Clemens and Georgie Opie for taking the time to speak with us, and thanks to you for listening. I hope, like me, you found something useful in the conversation that you can take away and apply to your own work and life. Join me again for our next episode when I speak with psychotherapist and neuro-leadership consultant, Dr. Polly McGee, about self-regulation.