CleanMed Europe Day2: Innovation, Technology, or Population Health, and PatientsIncluded

Day 2 was about changing models of care to support a more sustainable health care system, and the voice of the patient was heard, in the form of Andy Williamson (@BigBuzzard)

Innovation Conference, Technology Conference, or Population Health conference? Yes.

Today’s discussion was a lot less about carbon and more about new models of care, including ones that are technologically enabled, population centric, and innovative (of course).

I found myself wondering if I had wandered into a health information technology or quality conference, and then I realized I had not, because in order to reduce waste (and carbon emissions) the care models have to be changed. So, a conversation about advanced pulmonary rehabilitation programs, or texting mood status for the management of mental health is just as at home here as are a conversation about powdered versus gas-propelled inhalers.

In a way, this is as I predicted, a conference about the “H” in “Health Information Technology.”

I would even ask, what other type of get together would be as holistic to bring these things together (innovation, technology, population health) through a societal lens?

By definition, if health care emits carbon judiciously, it’s because it supports people in being healthy – too much carbon, too little, and people are less healthy. It’s simple. I like to say, “if the patients get sick, we go out of business.” It’s just as easy to say, “If the planet gets sick, then our patients get sick, and we go out of business.” This approach is more patient-centered, in my opinion, than a conference that focuses on EHR implementation or quality metrics.

Speaking of the Patient

This conference earns the PatientsIncluded badge, because of the contribution of Andy Williamson, who’s a renal transplant patient, and former student of Oxford University, as I found out.

From my very first presentation on environmental stewardship: the patients notice

I was delighted to meet Andy, who I quoted in my very first presentation on the topic of environmental stewardship, to illustrate that patients notice the waste that we in health care have gotten used to (see: My slides from presentation : #GreenHC – Healthy Environments, Healthy People | Ted Eytan, MD).

Patients Included

Andy took me on a tour of his Alma Mater, Merton College (what you’ll see in the photographs below) and told me about his patient journey and interest in improving the sustainability of health care. He wants to make sure that as a person with polycystic kidney disease, that the same kind of care he’s been given will be around for his daughter if it turns out she is similarly diagnosed. And, as he discussed on stage, sustainability is more than about carbon reduction, it’s about changing the model from “patient at doctor’s beck and call” to the other way around. I have to say I like the way Dr. Frances Mortimer put it, kind of powerfully:

Progress is being Made

The news was given by Sonia Roschnick of the Sustainable Development Unit (@SDUHealth) that the NHS is on track to reduce its carbon emissions by 10% by 2015.

Is sustainability this generation of physicians’ HIV?

My last observation here was something I was struck by in a session on physician leadership and medical education, co-led by fellow US physician Amy Collins, MD and Stefi Barna from the Centre for Sustainable Healthcare.

It was described that environmental stewardship gets very little attention in medical schools (worldwide) today, however when a lecture is given, the response has been, “Why didn’t anyone tell us about this, why isn’t anyone doing anything about this?”

This reminds me almost exactly of my generation of physicians’ experience with persons with HIV. When we discovered that our profession was dealing with its inability to understand the condition by deserting those who needed their help the most, and the physicians who did show leadership were persecuted by their colleagues for doing so, it left a permanent imprint. Let’s see what happens with this generation. If they became as determined from this experience as we did, we should see a lot of progress in the next 10 years :).

Thanks for the warm welcome

I’ve been warmly welcomed as a United States’ based physician and as a Permanente physician representing Kaiser Permanente, a health system with a visible position on climate, and where 100% of our patients can email their doctors  Hint, NHS, I know you can do it, too, you’ll be glad you did, trust us on this.


Great, informative, post, Ted. Almost as good as being there. Can you talk more about the role of patients in conferences, how to select and integrate them to make it valuable for all including the patient?


Great question!

A few things to say – I see this as a means, to an end, which is integrating patients into the design of the health system. Conference involvement is a way for leaders to experience this first hand.

I have a bit of a recipe that I use, which involves

(a) deciding that patients should be involved – any patient is better than no patient, don’t get distracted by “which kind of patient”
(b) I attend to safety, comfort, and fun, in that order, creating an agreement with the patient in advance about roles, wishes, guardrails
(c) At Kaiser Permanente we have a toolkit that’s been published for us to use that covers everything from confidentiality to reimbursement

At some point I should write a detailed post about this, you can see some of the results in this post:

It really does start with the right mental model. Sometimes people say, “This is complicated/difficult to do,” and yet when I ask them to reflect on how much difficulty/complexity they regularly tolerate in working with their colleagues, a sense of perspective usually prevails :).

Try it,


Ted Eytan, MD