Sustainability: Start Small, Think Big

As Lara Richer wrote in The Pathologist in 2020: “If healthcare were a country, it would be the fifth-largest polluter in the world.” And, there’s no getting away from it – laboratory practices are a major contributor to healthcare’s environmental impact.

Unfortunately, implementing changes to lab practices can be perceived as time-consuming and costly, with many overstretched managers feeling unable to commit resources and budget to such efforts.

Recognizing this, the Panel of National Pathology Leaders (PNPL) is developing an Environmental Management System (EMS) that will act as a framework to get labs started on the road to waste reduction. Developed by the PNPL’s Corporate Social Responsibility Focus Group, the overarching plan will encompass general lab operations, testing practices, energy consumption, and waste management. It will also lay out key performance indicators and encourage regular reporting to ensure progress tracking and accountability.

Moira Larsen, Physician Executive Director at MedStar Medical Group Pathology, is on the Board of Directors for PNPL and Chairs the Corporate Social Responsibility Focus Group. In conversation with The Pathologist, Larsen shared her experience of the small changes that can help in greening the lab – and why it’s so important to make them.

How did you become involved in developing the EMS framework?
 

I was approached by PNPL’s Corporate Social Responsibility Focus Group on the back of communications I had with them regarding sustainability and greening of the laboratory, based on the work of the MedStar Health system. They asked me if I would chair the focus group and share the work we’ve been doing at MedStar Health with other pathology departments to help them figure out where to start.

What is the problem with today’s pathology labs?
 

Part of the problem is the use of legacy equipment. A lot of laboratory equipment is designed to have a very long lifespan. That means labs might be using kit that is 20 or 30 years old and not designed to meet today’s energy efficiency requirements.

In this respect, when labs are asked to improve their sustainability, it raises concerns that they will have to replace all their old equipment, which would be very costly. 

How do you address those concerns?
 

I believe it's important to look at sustainability in the laboratory much as we look at a quality management program. We should develop a system that looks at all aspects of the laboratory and identifies where you can have an impact. Then labs can start with the small changes that are easily achievable with minimal expense. Once you get started on that journey, it becomes easier to add other activities and to justify the spending required to do some of the more expensive things.

What changes do you think that labs can reasonably make?
 

I would advise starting with the low-hanging fruit. For example, we all check the temperature of our refrigerators and freezers – that’s mandated by regulation. But do we check the seals to make sure that they are intact, allowing the machine to operate efficiently? An amendment to the daily monitoring protocol could identify a small energy-saving opportunity that is easy to implement. We maintain lab equipment in the interests of patient safety and quality of care, but it can also be a sustainability initiative. 

In terms of test utilization, reducing the amount or frequency of tests sent out to reference labs could result in less packing material used and fewer transport miles. Next, we could look at test methods. If you’re testing rationally, being careful about consumption of materials, less waste will be generated. 

Waste management is certainly an issue that labs have struggled with for a long time. Inevitably, the trash with the highest health risk is the most expensive – and environmentally damaging – to dispose of. However, it might be possible to reduce the volume of hazardous waste generated by reminding people of the category definitions. It might be as simple as placing a laminated sign by the trash that reminds people what not to put in hazardous waste, so that we don’t generate more than is necessary.

Another issue is energy use. Laboratory equipment tends to behave like an energy vampire, draining power even when it’s idle. Perhaps we could unplug equipment when it’s not in use. Maybe we could start to replace those 30-year-old appliances with new energy efficient models one by one, as we can afford to.

Next, labs could look at their supply chain. If you have two vendors to choose between, one 15 miles away and the other 150 miles away, and the price is the same, you could choose the closer one to reduce the distance materials need to travel.

Labs are also notoriously high water users. Simple changes like introducing low-flow valves into faucets could reduce water consumption. Similarly, fuel consumption for courier services could be greatly reduced by encouraging the use of electric vehicles or simply by combining trips.

Then there is the controlled storage of reagents, which is another draw on energy. Labs might be able to reduce the stockpile to minimize that need or, if not, to generate the power from green energy sources.

It’s important for labs to look at all these small areas and decide what can be reasonably adjusted right now, and what might have to be part of a more strategic plan for the organization.

Can you tell us more about what the PNPL’s Corporate Social Responsibility Focus Group is doing to guide labs in sustainability endeavors?
 

Based on the experience of the various members, the committee is planning to put together a toolkit that lays out the considerations for an environmental management system for labs. This approach suits laboratorians who tend to be detail- and process-oriented thinkers. 

I think it’s important when you propose such initiatives to include some easily obtainable steps and accessible starting points. It needs to be presented such that people in labs feel that they can own the process – and that they can start it.

There certainly are references already available for this. In fact, in 2023, The Pathologist ran a sustainability issue that was full of great suggestions; indeed, it was one of my formative documents in seeing the bigger picture of lab sustainability. But sometimes it’s just really helpful to have a framework. That’s what we’re trying to put together.

Our guidance will also include key performance indicators so that labs can objectively assess their progress in reducing their environmental impact. It will suggest ways of measuring fuel consumption of your courier service, equipment efficiency, and water consumption, for example. Comparing those data before and after implementing sustainability measures allows labs to track their impact and evidence their progress.

And, of course, the measures we recommend will form part of a lab’s corporate environmental responsibility. They will include test utilization, associate’s safety, and all the things that impact efficiency – all coming together to make a better laboratory. As a result, lab outputs will be of higher quality for the patients, the institution, and the environment. 

Interestingly, I have noticed that the younger generation of laboratory medicine professionals specifically ask, in recruitment interviews, about institutional policies on reduction of pollution and laboratory waste and so on. They ask about policies on ensuring equity in the community and increasing diversity in the workplace. In that respect, implementing sustainability policies goes beyond doing the right thing for the environment – it actually helps in attraction and retention of young talent that wants to be part of these efforts.

How can labs be accredited for their sustainability efforts?
 

Though that is not part of my committee’s remit, the Joint Commission here in the US, which accredits hospitals, has actually developed criteria for voluntary certification for sustainability in a hospital. It includes measures that will also affect other high-waste hospital functions, such as anesthesia and pharmacy. But there are items on that list that laboratories can participate in. Some of these areas fed into elements of the environmental management system that I’m helping to develop.

What’s the driver for creating the EMS? Is it something that labs are asking for?
 

PNPL commissioned the guidance based on feedback from their members and the lack of available information on this topic as it relates to pathology labs. The Corporate Social Responsibility Focus Group got into this work from a belief that it’s the right thing to do and because our associates across the entire health system believe it’s important and want to participate. Though some of the larger commercial labs have started addressing this issue, we want to provide guidelines for laboratories and pathology practices of all sizes and show that even small changes can have positive results.

What are the consequences of not greening labs?
 

Ultimately, being wasteful increases costs, whereas reducing waste saves money. There is definitely a cost implication to not making changes.

It might also impact staff retention. Social responsibility has great meaning to younger people joining the profession, and I’ve noticed that they want to be associated with an organization that demonstrates the right attitude. Keeping our heads in the sand might just exacerbate the shrinking pool of medical technologists and other professionals who want to work in the lab.

Efforts to green the lab and bring it more in alignment with conservation and environmental principles have many positive impacts. Such efforts help with patient safety standards, financial stewardship, and contributions to our local communities. And it’s important to stress that these initiatives don’t require huge financial outlays or complete revamps of your facilities. You start with what you can do, take those small wins, and use them to go to the next level. Make a plan, share it, and start on the pathway. We hope the PNPL’s toolkit will shift sustainability from some big, scary, audacious goal to something everyone can do.