Trust embeds a waste management pathway aiming to implement appropriate disposal and recycling activities, resulting in purified clinical wastes and increased segregation compliance

Synopsis:

Barts Health NHS Trust’s Waste Management Team [a working partnership with Skanska’s Waste Contracted Management Service] wanted to reduce domestic and clinical waste quantities, increase recyclable waste and shrink our waste disposal costs at all levels of the Trust; but in doing so, to also improve waste segregation, through staff engagement at clinical, non-clinical, domestic and managerial levels, to heighten the waste compliance profile, thereby maximising all efforts in achieving this goal.

With the Waste Management Team’s [WMT] initial engagement and continued deployment of the waste auditing [and behavioural change] team’s expertise, we successfully implemented and continue to implement our project, with buy-in from Senior Trust Managers, FM Managers, waste portering and domestic teams and supervisors.

Our aim was to affect the behavioural change of the Trust workforce towards all forms of waste disposal, by highlighting greener waste processes, best practice waste disposal methods, including safer sharps waste management, staff buy-in, regular “coal face” training where needed, continual shared proven data detailing the cost benefits to the change process; all this, not at one hospital site, but five hospital sites and all satellite Trust estate buildings, where 15,000 Barts Health staff work, since Trust merger, back in 2012.

Challenges:

In 2012, Barts Health, became five hospitals; the embryonic Barts Health WMT was expected to contain the waste budget; so skilled tools from the appointed waste contracted management service at two hospitals, and a passion by the Waste Manager, now heading up Barts Health’s WMT, to merge and expand best practise waste management principles from a new overarching Trust waste management policy, was launched.

At merger, only two hospitals had converted the majority of its soft bagged infectious clinical waste over to the offensive waste stream - a ⅔rds cheaper disposal method. At three hospitals, no staff training or waste auditing at the point of disposal was undertaken. We deployed additional resource from the already proven waste behavioural change teams [Sust-N] at these hospital sites; in the process, obtaining lead clinical auditing methods, electronically mapping every clinical room,an’s contact details from their responsible area, so that all clinic rooms would be audited for conversion over to the offensive waste stream; and every month, the same room would be audited for best practice waste disposal methods, thereby educating staff at the point of disposal, to change behaviour, so that recyclable and household waste elements, do not become clinical waste items.

Outcomes:

All Trust hospitals would transfer over to the offensive waste stream; with a threshold set at 60% of all clinical waste, reclassified as offensive waste. A timeline plan was shared with Infection Control Team leads, including the assessment tool, showing how conversion would be met, through clinical assessment of infectious clinical waste to offensive waste for each clinical room / area. Implementation would then commence, by discussion, explanation and change, with procurement, domestic and clinical staff, at all levels.

The waste auditing team’s electronic monitoring devices recorded door codes, numbers of foot operated waste bins [all waste streams] in rooms and detailing clinical / domestic leads for areas. Conversion of clinical waste bins to offensive waste, by virtue of changing the clinical waste bag used, issuing new guidance, was recorded.

On return audits to areas, the team’s devices record correct bags used / contents of waste bins, identifying improving compliance. Once audited, electronic reports are sent to the areas clinical/domestic leads, sharing best / highlighting poor practices [addressed at the time] / actions taken/staff trained. Continual auditing has nurtured staff confidence/satisfaction, building collaborative teams, which has empowered better waste disposal practices/cost savings.

Spread:

Following the offensive waste rollout; scrutinising each months waste tonnage returns of offensive waste to validate change and cost reductions; continued efforts of our teams auditing interventions; purifying our clinical wastes at the point of disposal, so more recyclable and household wastes are correctly disposed of, we decided to apply for the newly created Carbon Trust Standard for reducing waste, back in 2014.

We had to submit 2 years’ worth of auditable waste data, including all waste tonnage totals, which is scrutinised by the Carbon Trust appointing their chosen independent assessors. We had to prove that we had reduced the Trusts total waste tonnages from 2012’s year, to 2014’s year.

We were the 1st NHS Trust in the UK to receive the Carbon Trust Standard for reducing waste, for which we received 2 years’ worth of National recognition and accreditation. We further decided to build upon our successes by holding the Trusts 1st and very own Barts Health Waste Awareness Day, in May 2015, so we could share our best practice principles in waste management compliance and demonstrate how we achieved this. The day was a huge success, with over 70 attendees and over 30 Trust representatives attending.

Value:

Since 2013’s project inception, to the end of December 2018, the waste audit team has:

•  Completed 560,650 bin audits.
•  Sent 32,200 waste audit reports, detailing all aspects of audit findings/actions.
• Including noisy foot pedal bin lids, which get repaired by site maintenance teams, via our audit observations - this intervention, further enhances the patient experience.
•  For every waste audit that’s completed, adds value to the cost savings we make and increased waste segregation compliance from 83.3% to 92.2% Trustwide, through continuing behavioural change.
• 12,082 staff have received dedicated waste behavioural change training. This adds value to the Trust when asked to provide evidence of training records / continual assessment of staffs waste compliance and awareness, following CQC visits.
•  Contributed in saving money to the value of £1.5 million, by implementing, sustaining and surpassing our 60% threshold, through reclassifying infectious waste to offensive waste. Barts Health’s [all sites] 2018’s percentages for these two clinical waste stream tonnages are:
• Offensive waste 71.2% [1741 tonnes]
• Infectious clinical waste 28.8% [703 tonnes]

Other “firsts”, including no waste to landfill/recycling initiatives!

• Revending machines
• Renal Revending machines
• Sustainable reuse & bulk waste prevention
• Recomed PVC recycling scheme participants

Involvement:

Without the well-earned recognition of our clinical, domestic and portering staff and their teams, our work is pointless. Maximising our teams’ auditing presence at the point of waste disposal improves rectifications, builds bridges when mistakes are made and supports relationships when improvement is necessary. These methods crystallise the change process.

It delivers positive, engaging, outcomes, which culminates in attaining our goal - driving best practice, higher compliance and valued savings in waste disposal practices. The pinnacle of the waste management team’s NHS calendar day, is Sustainability Day. On this day, we say our “big thank you” to staff helping us achieve our aims. Every year, we honour, both best improved staff team at each hospital site, and best overall staff team Trust winner in waste behavioural practice. We present them with framed award certificates, detailing why they won their award.

The winners from this annual event are subsequently highlighted on the Trusts Intranet news, for all to recognise and respect. We showcase, at very years Barts Health’s Open Day Event, our teams work, engaging with staff and the visiting public, on how we capture the Trust’s confidence and keep our local community’s environment, safe, through contained, best waste segregation practices.