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The Vitals
Gain insights about health, science, and wellness with this groundbreaking video podcast from the acclaimed Mount Sinai Health System. Showcasing Mount Sinai's most renowned doctors, researchers, medical experts, and patients, The Vitals explores what happens when the most respected minds in medicine meet at the same table.
The Vitals
Is Health Care Sustainable?
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
In this episode of The Vitals, we explore a question that sits at the intersection of medicine and the future of the planet: Can health care truly become sustainable?
Host and Neurosurgery Physician Assistant Leslie Schlachter is joined by a multidisciplinary team of Mount Sinai experts working across clinical care, energy and infrastructure, and supply chain operations. Together, they unpack how sustainability efforts are being integrated into one of the most resource-intensive industries in the world—healthcare.
From ambitious emissions reduction targets and energy-efficient hospital systems to waste management, procurement practices, and sustainable food programs, this conversation offers a behind-the-scenes look at how large health systems are rethinking their environmental impact.
Whether you’re in health care, policy, simply interested in climate solutions, this episode sheds light on how systemic change is happening—and what it will take to push it further.
Learn more about Mount Sinai’s sustainability practices here: https://www.mountsinai.org/about/sustain
🎧 Subscribe to The Vitals and explore more podcast programming from Mount Sinai for expert conversations on the biggest issues in medicine, research, and patient care: https://www.youtube.com/playlist?list=PLCT7BA-HcHliU8QIXyuk_74L_uH0gyKGt
00:00:00:05 - 00:00:16:34
Colin Barnett
We've all made great strides in reducing our emissions, and we all have a long ways to go to get, you know, to 50% by 2030. And, you know, net zero by 2050. But if you compare our emissions across to campuses, we're all within, you know, 5 or 10% of each other.
00:00:16:38 - 00:00:33:15
Leslie Schlacter
If there was like an end goal at 2030 and somebody's got to say that they're the most sustainable, I feel like that would be something to shoot for. We would probably want to win that.
00:00:33:19 - 00:00:57:06
Leslie Schlacter
Hi. Welcome back to The vitals. I'm your host, Leslie Schaffner, a physician assistant here at the Mount Sinai Hospital. And on this episode, we're discussing sustainability and climate change and their relation to health care, specifically how Mount Sinai sustainability initiatives are reshaping the future of health care from energy efficient infrastructure and waste reduction to sustainable food systems and supply chain innovation.
00:00:57:10 - 00:01:20:55
Leslie Schlacter
To discuss our initiatives, we're joined by Doctor Moy, Tren and Carlos and Colin from our supply chain and infrastructure and energy team, all of whom are sustainability and climate experts here at Mount Sinai. So you guys all do completely separate things, but towards the same goal right. Essentially. So you're an anesthesiologist. You work four days a week as an anesthesiologist here.
00:01:20:56 - 00:01:36:45
Leslie Schlacter
Correct? Correct. Okay. And then one day a week for sustainability. Correct. And you are energy and infrastructure and your supply chain. Correct. What does that mean to people outside of a hospital? Even in the hospital, I don't even really know what that means. What do you guys do?
00:01:36:50 - 00:01:52:34
Carlos Maceda
So from my perspective, I'm responsible or our team is responsible for the procurement and the delivery of all the supplies that go out throughout the medical center. So whether it's the stuff that you use, the robots that you use, we procure it to the supplies that are used in the actual cases.
00:01:52:39 - 00:02:04:32
Leslie Schlacter
Okay. So I, as a surgical PA, already have 100 questions. I'll put them on hold, kind of like when we use disposables and whatnot. And for you, you are energy and infrastructure. What does that mean?
00:02:04:37 - 00:02:12:25
Colin Barnett
So I'm responsible for Mount Sinai built environment, which includes our our buildings and the equipment inside of it, including the energy that we use.
00:02:12:30 - 00:02:26:10
Leslie Schlacter
So really like the building as a whole, all of the rooms and how like the electricity and how it functions is you and all the stuff that we generally use is you correct? Okay. And then where do you come in.
00:02:26:15 - 00:02:45:54
Dr. Muoi Trinh
So I'm the clinician in the room. And so my role is actually to try to bridge some of these gaps. And the silo. So we are the end users in the operating room. We take care of our patients as the clinician on the floors, in the ICUs, in the, the owners and outside the O.R. as well.
00:02:46:06 - 00:03:01:13
Dr. Muoi Trinh
So I kind of represent that and and trying to connect the supplies that we use, the energy we consume, and how we can actually decrease our carbon footprint clinically because we use a lot and we use it to take care of all our patients. This is why we're here.
00:03:01:26 - 00:03:07:52
Leslie Schlacter
How did you find this role? Like, did you just wake up one day and think, I want to be involved in this? Is this something you've always been passionate about?
00:03:07:57 - 00:03:29:42
Dr. Muoi Trinh
I've been passionate about sustainability for a while. But it just started off as something quite small, to be honest with you. So I started off just doing recycling in the operating room because I saw a need for it. So I was in the O.R., and I think, just like you, you've seen in the past in the operating room, we go through a tremendous amount of supplies.
00:03:29:47 - 00:03:53:37
Dr. Muoi Trinh
So I do open hearts, and so we open up a ton of packaging material, single use plastics, a lot of that. And before we even started an open heart case, I remember this very vividly. We'd already filled up three big canisters. I think they're like 30 gallon canisters with nothing but packaging materials. And the patient hadn't even entered the room yet.
00:03:53:42 - 00:04:14:35
Dr. Muoi Trinh
So that just speaks to the amount of waste we generate in hospitals. And so that's actually how I got started. I started learning more about, sustainability. And then I started a recycling program, a periodic recycling program on the third floor. And what would you do this? I would say probably on to 2019. Okay.
00:04:14:40 - 00:04:38:04
Leslie Schlacter
So for all of you guys listening, when you think about going to the hospital, maybe being a surgical patient or seeing your provider, every time a patient goes into the operating room, we have to set up the tables for all the equipment for anesthesia and then everything for surgery. And all of the supplies that we use have to be sterile for the patient, which means they have to be wrapped in a wrapping and then covered in a plastic wrapping.
00:04:38:09 - 00:05:01:07
Leslie Schlacter
And typically, all of these supplies are some form of a plastic. And to open up everything, put it out and use it. It fills, I would say 530 gallon trash cans easily per case. And so you think about that. All the patients here in one day at Mount Sinai, all of the hospitals in our system, and then across the country just in one day, it's astronomical.
00:05:01:12 - 00:05:10:36
Leslie Schlacter
So knowing that, that's kind of what it looks like here from like just even a surgical perspective. But across the hospital, what's the mission of the sustainability program? Does it have a name?
00:05:10:40 - 00:05:20:57
Dr. Muoi Trinh
I think we're a sustain Mount Sinai. Right. Okay. And so mission, our mission is to try to decrease our carbon footprint from delivery of care.
00:05:21:01 - 00:05:23:30
Leslie Schlacter
Okay. And so far, how have you been doing that?
00:05:23:34 - 00:05:28:48
Dr. Muoi Trinh
Well, collectively, I think we're on target to 50% reduction by 2030.
00:05:28:53 - 00:05:33:43
Leslie Schlacter
What would you say have been the biggest moves that you've made so far? Like logistically what are you doing.
00:05:33:48 - 00:06:00:23
Colin Barnett
So we measure our carbon emissions in a couple different a couple different ways. We divide them into, scope one and two emissions, which are primarily energy related. And we've reduced that over the past two decades by 30%. How? First and most significant reduction was we eliminated all use of heating heating oil to heat our buildings, which, that's something we did 15 years ago, and that reduced our emissions significantly.
00:06:00:32 - 00:06:33:32
Colin Barnett
We've also grabbed a lot of low hanging fruit that that's in low hanging, energy efficiency projects like converting your lighting from older style fresh dancing contestant bulbs to, LEDs. Improving our Hvac system controls so that we can turn off the Hvac when, the spaces are unoccupied. We've installed advanced, real time energy management controls, which allow us to find anomalies in the way our systems operate so we can reduce, wastage, in that manner.
00:06:33:32 - 00:06:41:22
Colin Barnett
So those are kind of like the low hanging fruit that we that we've grabbed. And now we're looking at much more complex projects to get to the next 20%.
00:06:41:27 - 00:06:59:03
Leslie Schlacter
So if there was like an old house, let's say I lived in an old house, which I don't, I live in an apartment, but if I wanted to upgrade it to make it more efficient, I maybe would check my electrical, my plumbing, check my windows. I might need new windows. What? What are special things about a hospital that are just different than standard?
00:06:59:07 - 00:07:04:41
Leslie Schlacter
You know, I'm sure improving efficiency, especially energy wise, is very different for a major hospital.
00:07:04:46 - 00:07:24:16
Colin Barnett
Yeah, the concepts are the same, but we have added challenges. Being a hospital. So the first is that, in our office, for example, we require very large amounts of air to move through these rooms. And in the winter, that means we're moving, 20 air changes of our through and our that that means that the air that might be five degrees outside.
00:07:24:16 - 00:07:49:21
Colin Barnett
We have to heat to say 68 degrees, which requires an enormous amount of energy that's much different than your house, where the air changes might be 0 or 1. Right? But there are similarities too. So, for example, when we want to make a new building, we want to electrify it and make it more efficient. We use, heat pumps and variable refrigerant flow, cooling technology.
00:07:49:26 - 00:07:59:04
Colin Barnett
And this is not that dissimilar from installing a heat pump, in one of the rooms of your house that, to get to so you can turn off your or eliminate your gas boiler.
00:07:59:13 - 00:08:03:42
Leslie Schlacter
And you said, how many years has it taken you to get to where we are now from when you first started this?
00:08:03:46 - 00:08:12:20
Colin Barnett
We started in the late 2000. So we're, you know, we're in it's been about 15, 16, 17 years. And we still have we still have a long ways to go.
00:08:12:25 - 00:08:15:06
Leslie Schlacter
And I can imagine this is a very expensive project.
00:08:15:10 - 00:08:16:23
Colin Barnett
It is,
00:08:16:28 - 00:08:17:13
Leslie Schlacter
You know, do the right.
00:08:17:13 - 00:08:54:16
Colin Barnett
Thing. We try to we try to work on it, taking small steps. So, for example, recently we opened, new AI, Research building at three East 101. That building was a former nurses residence. We got renovated it, and we replaced the Hvac system as part of that much larger project. So it's much, generally much more palatable and realistic to, say 5% to, the total cost of a project and incorporate these sustainability measures than it is to say, hey, Doctor Carr, I need $2 billion to decarbonize our health system.
00:08:54:16 - 00:09:03:49
Colin Barnett
Like, you know, it's just not realistic, you know, financially or from any other perspective. So by tackling it on a building, by building our project by project basis is the still way to go.
00:09:03:54 - 00:09:16:56
Leslie Schlacter
Kind of like optimize as you go. That's right. Yeah. Yeah. And what about from the supply chain perspective. Is it like the same concept or can you tackle are you like going department to department or floor to floor. How does it work to.
00:09:17:08 - 00:09:35:08
Carlos Maceda
No it's it's more globally. So we're we're dependent on a lot of different things like use just using your example of all that packaging that gets opened up. Right. And so there are certain things that we could do. Like there are custom packs where you could put more stuff in there that are single, sterile, that don't have individual packaging.
00:09:35:13 - 00:09:54:54
Carlos Maceda
So the challenges with that is, is there are 30 different physicians that are using that. And everybody wants to use something different. Right? So those are the types of things that we kind of grapple with. But from our perspective, what we try to do is, is we're doing more reprocessing. So there are vendors that are now doing you buy a single sterile item, and they've gotten FDA approval to do reprocessing.
00:09:54:54 - 00:10:12:59
Carlos Maceda
That's been going on for a while. We've expanded on that. Our part levels were try to get it, more accurate as much as we can so that we're not over ordering. So so our are things because they're not as expensive as the type of stuff that Colin is doing to do. Ours is more on a global basis than as opposed to, you know, department by.
00:10:12:59 - 00:10:14:58
Leslie Schlacter
Department, just like pure volume.
00:10:15:03 - 00:10:16:07
Carlos Maceda
Correct.
00:10:16:12 - 00:10:30:16
Leslie Schlacter
When decisions are made, I'm sure you can appreciate this from like a surgical perspective. When decisions are made for instruments like whether to have something that's disposable or not disposable. How much is sustainability thought about in that versus just pure cost?
00:10:30:21 - 00:10:48:43
Carlos Maceda
Well, actually, to be honest with you, the the number one decision of those types of things is usually with infection control. Okay. That's usually the first predominant because we you if you're going to be using something reusable as opposed to disposable, then you have to have the proper resources and speed. You have to make sure that all these things obviously are cleaned the proper way.
00:10:48:43 - 00:11:05:45
Carlos Maceda
And so that's a big part of it. I know one thing that is is is near and dear to Doctor Tran's heart is, disposable gowns versus reusable gowns. We used to use reusable gowns. We've gone to disposable infection control is not a big fan of going back to to, reusable. So it's those types of conversations that we.
00:11:05:48 - 00:11:08:42
Leslie Schlacter
What is your thought on that? What do you want?
00:11:08:47 - 00:11:34:03
Dr. Muoi Trinh
So, I'll be honest, what we were looking at wasn't actually, reusable gowns in the operating room. We're actually worth considering it as a potential trial in the ICU for patients or neonates that need some isolation. So it's not a sterile environment that we're thinking about at all. But it could also reduce the waste. I want to take it a step back a little further, because we're just like shooting questions here.
00:11:34:03 - 00:11:55:32
Dr. Muoi Trinh
And it's great. I love the combo, but I just wanted to bring it back a notch. Yes, we're working on various projects, but there's also a strategic plan here. It is not that we're just gun shotting everything. So in 2024, we actually, figured out where all our greenhouse gas emissions were coming from. So we completed a full inventory of our greenhouse gases.
00:11:55:37 - 00:12:14:15
Dr. Muoi Trinh
So now we kind of have a sense of hotspots. Yes. I'm so grateful for Colin and all his work. He's been doing phenomenal work to decrease scope one and two emissions. As he mentioned, these are energy related emissions. The bigger part of our emissions for our entire health system, though, comes from scope three, which is our supply chain.
00:12:14:29 - 00:12:40:36
Dr. Muoi Trinh
That includes our medications, our medical devices, our food, our waste employee travel. That's the bulk of our emissions that we're working on right now. And so we're trying to target this, these things as if it is feasible. So for instance, what we're been working on is some of the pharmaceutical agents. So my work in anesthesia has been trying to remove some of the most impactful medications.
00:12:40:40 - 00:13:10:48
Dr. Muoi Trinh
So for us in 2023, we actually had actually before this in 2021, we had a bunch of, QE projects that eventually what we did was we removed desk flooring entirely from formulary. It's one of the agents that we used to keep patients asleep, but it's 2500 times more efficient at trapping heat and CO2. We have a lot of other medications out there that are available to keep patients asleep that are equally safe, equally efficacious, but with much, much lower carbon footprint.
00:13:10:53 - 00:13:38:03
Dr. Muoi Trinh
And so this is the kind of stuff that we're talking about. We're talking about exchanging something that still gives us quality of care, keeps our patients safe, does what it's supposed to, but with a lower carbon footprint. And so that's one of the initiatives that we've worked on. And then the part is getting rid of waste. We discovered that our nitrous oxide, 90% of it of our purchased nitrous, was actually never reaching the patient because of the delivery system.
00:13:38:07 - 00:13:38:33
Dr. Muoi Trinh
So it's.
00:13:38:33 - 00:13:39:56
Leslie Schlacter
Big. How did that happen?
00:13:40:01 - 00:14:09:49
Dr. Muoi Trinh
So it's being piped, from, these large tanks, cryogenic tanks, and there's loss along the entire system due to the nature of nitrous oxide. So by removing these tanks and actually just delivering the nitrous oxide at the point of care, which in the operating room in tanks, smaller tanks, now we've eliminated over 90% of the waste. So these are the things that we're talking about that we're thinking about critically.
00:14:09:54 - 00:14:21:59
Dr. Muoi Trinh
From the clinical side. And then when we talk about supply chain, these are the things that we're actually interested in, in implementing, so that we can decrease our carbon emission or it's not actually being used and not being.
00:14:21:59 - 00:14:24:48
Leslie Schlacter
Actually evaluate our carbon footprint. Like, what does that look like?
00:14:24:54 - 00:14:50:52
Dr. Muoi Trinh
There are certain products that we understand the carbon emission, of that product specifically some medications. But in order to understand a carbon footprint, it is, looking at all the things that go into manufacturing of a product as well as use and then disposal of that product. So you have to do what's called a lifecycle assessment to really understand this or lifecycle inventory.
00:14:50:52 - 00:15:18:24
Dr. Muoi Trinh
This is another way of looking at cradle to grave emissions from a product. As you may understand now, given the amount of products out there, it's not exactly easy to get product specific carbon emission data for every little thing, every little drug that we use. So what's acceptable right now is what we're using as an input output. I guess cost based analysis of carbon emissions.
00:15:18:28 - 00:15:25:32
Dr. Muoi Trinh
So we use that to estimate the things that we didn't know about in 2024 when we were inventorying our greenhouse gas emissions.
00:15:25:37 - 00:15:34:40
Colin Barnett
Yes. In general, measuring the scope three emissions is much more difficult than, energy related scope 1 or 2 emissions, which we generally know exactly what our emissions are.
00:15:34:40 - 00:15:35:38
Leslie Schlacter
Because you can like look at that on the.
00:15:35:52 - 00:15:49:53
Colin Barnett
Utility meters. And we know generally how much carbon it takes or how much carbon is being emitted when they, you know, generate electricity upstage. So that's much more defined than, than the work that Carlos and Doctor Tran are doing.
00:15:49:53 - 00:15:52:30
Leslie Schlacter
What's the green team at Sinai?
00:15:52:35 - 00:16:20:50
Dr. Muoi Trinh
Sustainability started off as grass roots and so green. The green team basically embodies that still to this day. So it's basically a forum for all hospital employees to join if they choose to, so they can work on sustainability initiatives so they can join these meetings, bring in ideas, and we try to operationalize what we are able to and then we work with the team there, obviously with seven hospitals.
00:16:20:50 - 00:16:30:16
Dr. Muoi Trinh
So you can imagine that these meetings get really big. And so, what we try to do is break it down to smaller groups and work on smaller projects together.
00:16:30:21 - 00:16:32:07
Leslie Schlacter
Like a work study group, kind of.
00:16:32:07 - 00:16:32:53
Dr. Muoi Trinh
Yes.
00:16:32:58 - 00:16:40:04
Leslie Schlacter
So the green team kind of preceded this sustainability project. It kind of was like getting it going a little bit from the grassroots level.
00:16:40:04 - 00:16:42:13
Dr. Muoi Trinh
Yes, I would say.
00:16:42:18 - 00:16:46:36
Leslie Schlacter
How many people are on the sustainability project team?
00:16:46:40 - 00:16:58:21
Colin Barnett
I would say it's not really a defined team. We have a few key leaders that are involved at high level. We also have a sustainability committee that includes many of our.
00:16:58:26 - 00:16:59:28
Dr. Muoi Trinh
Leadership.
00:16:59:33 - 00:17:22:23
Colin Barnett
Executive leadership. I'm out Sinai, but there's there's many people, including, say, Pat Ortlieb from the food and nutrition team to, you know, we have an actual energy team that that works under our department that really gets into the nitty gritty. So it's a it's a pretty wide, wide group of employees who are most on the.
00:17:22:28 - 00:17:29:15
Leslie Schlacter
Mount Sinai was one of the first hospitals to sign the I think this is New York. CIF is that with NY stands for.
00:17:29:20 - 00:17:31:24
Dr. Muoi Trinh
Yes, a New York state insurance.
00:17:31:24 - 00:17:36:33
Leslie Schlacter
Fund. The Climate Action pledge. What is that? And like what is that what does that mean?
00:17:36:37 - 00:18:04:28
Dr. Muoi Trinh
So the New York State Insurance Fund Climate Action Pledge is actually really unique and innovative. Pledge. So, Sinai signed on to it in 2024. And basically what we're doing is we're pledging to decrease our emissions by a certain number. So 50% by 2030. And the aim is to achieve net zero by 2050. And what they've done is they've tied a financial incentive to climate action.
00:18:04:33 - 00:18:38:44
Dr. Muoi Trinh
What it's done for us as the health system, it's actually really accelerated our sustainability program by making a business case for environmental stewardship. And so, I talk about it a lot because I think it's so unique and it's so impactful. And it's also an example of how when we do the right things by our patient, by the community and for the environment and for our staff, it still makes business sense because we're still able to save money and there's a financial incentive behind it.
00:18:38:49 - 00:19:09:33
Dr. Muoi Trinh
It's also a real example where insurers and health care can actually partner to progress or to to work towards climate action. So it's a lot of the, commitments that we've made were very similar to other commitments. So one was to to complete our inventory of greenhouse gas emissions, which we did. And then every year to decrease our emissions, develop a strategic strategic plan and then, report on it annually on our progress.
00:19:09:37 - 00:19:16:12
Dr. Muoi Trinh
So that's things that we've done with other programs. But the thing that was different was that they tied it to $1 million.
00:19:16:17 - 00:19:25:30
Leslie Schlacter
That's nice. So if sustainability was a competition here in New York and all the New York hospitals were participating, who would be winning?
00:19:25:35 - 00:19:26:22
Carlos Maceda
Well.
00:19:26:27 - 00:19:27:08
Dr. Muoi Trinh
That's a tough question.
00:19:27:09 - 00:19:57:07
Colin Barnett
To be honest. I think most of the major hospitals are at kind of the same point in this journey. You know, we have, regular meetings with, with our colleagues at New York Presbyterian, NYU, Langan, MSK, Northwell, Monte. I could go on, but they all have, programs similar to ours. They have all invested, in energy efficiency.
00:19:57:12 - 00:20:13:52
Colin Barnett
We've all made great strides in reducing our emissions, and we all have a long ways to go to get, you know, to 50% by 2030. And, you know, net zero by 2050. But if you compare our emissions across the campuses, we're all within, you know, 5 or 10% of each other.
00:20:13:57 - 00:20:28:18
Leslie Schlacter
I'm just saying that, like, we're pretty competitive. If there was like an end goal at 2030 and somebody's got to say that they're the most sustainable, I feel like that would be something to shoot for. We would probably want to win that, right?
00:20:28:22 - 00:20:29:11
Colin Barnett
Of course. Yeah.
00:20:29:18 - 00:20:41:17
Leslie Schlacter
Okay. So then I just want to go back to the green team thing, because it seems like you said they brought ideas to you. What were some of the best green team ideas that they that they brought to you that you guys were not thinking of?
00:20:41:22 - 00:21:02:34
Dr. Muoi Trinh
So one of the things that we started was actually a virtual marketplace for, equipment office supplies. So the vintage of having a virtual virtual marketplace is that their products that people can't use. But if somebody else from the health system can use it, why not? And then it also decreases our carbon emission because we're not purchasing new.
00:21:02:43 - 00:21:04:19
Leslie Schlacter
Like give an example of something.
00:21:04:24 - 00:21:08:58
Dr. Muoi Trinh
So for instance like a chair. Oh no. You don't have to buy a chair like.
00:21:08:58 - 00:21:15:00
Leslie Schlacter
A warehouse where you can just like get what you need. That's really nice. Yeah. What's another one.
00:21:15:05 - 00:21:27:10
Dr. Muoi Trinh
One of the employees wanted to carpool. And so we have seven hospitals. So you can imagine that's a little complex trying to create a carpooling program. But we're trying we're we're figuring it out.
00:21:27:10 - 00:21:30:36
Leslie Schlacter
Right now like carpooling outside of just the shuttle that we already have like a separate.
00:21:30:36 - 00:21:37:07
Dr. Muoi Trinh
System. Yes, we're talking from home there. You know, somebody was on Long Island, and they're looking for somebody else on Long Island that.
00:21:37:12 - 00:21:38:49
Carlos Maceda
I think already has one.
00:21:38:54 - 00:21:43:13
Dr. Muoi Trinh
I think it got taken down during Covid maybe though. So that's why we're trying to starting it back up.
00:21:43:17 - 00:21:43:48
Carlos Maceda
Okay.
00:21:43:53 - 00:21:56:31
Leslie Schlacter
That's why you need like somebody from every department talking in a room. So you're not like doubling the efforts. Yeah. What about what about from like, your standpoint, from big energy? What we're like, some of the best ideas or is that not really a grassroots thing?
00:21:56:40 - 00:22:19:58
Colin Barnett
We have some pretty big ideas, about where we want to go with sustainability. So, one of the kind of leading edge technologies is heat recovery. So that's taking our, you know, waste heat from, this room, for example, which is probably warmer. Warmer than we like it to be and using it to, to heat our building instead of just exhausting it to the atmosphere.
00:22:19:58 - 00:22:21:34
Leslie Schlacter
To go into the hours where we're cold.
00:22:21:39 - 00:22:43:17
Colin Barnett
That's exactly right. So, that's we're already doing that. We have a great project going on at the Hess, data center, where we're collecting heat from, our supercomputers, if you will, that the that the, the school of Medicine uses for, for research. And we're going to use that, heat to heat the house building all year round.
00:22:43:31 - 00:23:04:08
Colin Barnett
So, it's good because we can use this, this heat recovery chiller to cool the computers. And it's also good because we'll going to burn less, natural gas in our boilers because we won't have to use, natural gas to heat this building anymore. So that's kind of the kind of the cutting edge. It it's just a matter of, these projects take a lot of energy.
00:23:04:08 - 00:23:11:04
Colin Barnett
They take a lot of, resources, and they take a lot of a lot of capital. So we just have to tackle them, you know, one at a time.
00:23:11:16 - 00:23:16:45
Leslie Schlacter
Do you participate in all new builds across the system, or do you have people at other sites?
00:23:16:49 - 00:23:39:36
Colin Barnett
Yeah, we look at things from a system wide perspective. So generally when we're, you know, renovating, a unit or renovating an entire building or building a new building, our team is involved working with the architects and engineers and the clinicians and our and our business team to incorporate, sustainability features into these projects.
00:23:39:41 - 00:23:57:34
Leslie Schlacter
So let's just take an example. My neuro critical care team is on KCC nine, and we were just booted out again over to Annenberg eight. And they're going to spend the next couple of years building and changing the unit. Is that just like standard build or is there sustainability thought that's going into that.
00:23:57:39 - 00:24:27:03
Colin Barnett
Yeah. So that's part of our Tisch cancer Center project where, the health system is investing in this, older 1950s era building. And we're going to convert it into a modern, 72 bed, cancer hospital, including the the neurosurgical ICU and the cardiac ICU. And as part of that project, we're going to replace the old uninsulated masonry facade with a brand new curtain wall, which will be much more energy efficient.
00:24:27:16 - 00:24:48:41
Colin Barnett
It will be a much better environment for our patients, much more comfortable, much, much better light. And we're also incorporating other features like we're replacing the, you know, 100% outside air handlers with brand new air handlers that have energy recovery features. So, so that project, which is, you know, not it's not a it's not a sustainability project.
00:24:48:41 - 00:25:00:42
Colin Barnett
It's a project, to provide more, cancer care to our patients. But we've incorporated the sustainability manager into that project so we don't have sustainability forward. That's right. Right.
00:25:00:46 - 00:25:13:01
Leslie Schlacter
Do you like going back to Covid times? I remember, like, we had to think about, like how we were ventilating and all of those things is that that's also built into it. Kind of the things that we learned through Covid.
00:25:13:06 - 00:25:34:28
Colin Barnett
Yeah, to some extent. I mean, one of the things that we learned in Covid is that is that a very high level of filtration, it's very protective of our employees and staff. So, when Covid first hit, there was a tendency was like, oh, well, we need 100% outside air. We can't recirculate any air. Well, after some studies, we found that that's not really true.
00:25:34:28 - 00:26:00:07
Colin Barnett
Like, you can achieve, your infection prevention goals by using high levels of filtration. So we're, implementing that throughout, throughout these projects. And we're also, you know, we designed these systems with as much flexibility as possible. But to be honest, there's only so much if it's a if it's 98 degrees in the summer and 90% humidity. Well, I can't, you know, treat 100% outside air and distribute that throughout the hospital.
00:26:00:07 - 00:26:05:10
Colin Barnett
We won't we just can't do that same thing in the winter. And it's initially not necessary either.
00:26:05:15 - 00:26:18:36
Leslie Schlacter
A lot of the projects that you guys are talking about when we say sustainability is like for the better of the world, the climate, but how do these all of these actions better? The patient, better for the actual patient in their care?
00:26:18:41 - 00:26:57:18
Colin Barnett
Well, the simplest example is that is, you know, eliminating the, burning of, of heating oil in our building. That eliminates a lot of particulates, a lot of other, source, other kinds of air pollution for our patients that live, say, right, right outside of our or right downwind of our hospital building. So that's a that's a very simplistic approach but or example but but that that can be applied on a much a much broader scale when we reduce our burning of even cleaner natural natural gas, we reduce the, emissions, out of our facilities.
00:26:57:23 - 00:27:00:43
Colin Barnett
That, that potentially impact some of our patients and our employees.
00:27:00:50 - 00:27:20:12
Dr. Muoi Trinh
So I think also there so there are direct effects and there are also indirect effects. Right. So the direct effects are much easier to see. Right. Air pollution, heat right. Extreme weather events. Right. And so you see those immediate effects. So with extreme heat you can have asthma COPD heart failure exacerbations. That's very direct. And you can see it.
00:27:20:16 - 00:27:50:16
Dr. Muoi Trinh
But there are also indirect effects right. So with I mean we're very lucky if we live in New York City. And so we haven't really had this. But other states such as Texas or Florida, they have hurricanes and floods. Right. And during that process, yes, hospital facilities are affected by it. And it's not just the patients in the hospital that need to be transferred out immediately, but it's also what happens afterwards because those areas, they can actually take care of their patients there.
00:27:50:21 - 00:28:20:00
Dr. Muoi Trinh
Right? The the hospital facilities are not 100% functional. And so they're actually their communities don't have access basically. And so that's part of the work with sustainability is making sure that we're resilient, that we can bounce back and we can take care of our patients even when these things happen. But moreover, if you're reading the literature, you're seeing, an increase in number of reports and studies out there with nano plastics and microplastics getting into our bodies.
00:28:20:00 - 00:28:41:13
Dr. Muoi Trinh
Right? So plastics, they break down into smaller particles, but they never completely disintegrate. They're getting into our food chain or water and we're drinking it. We're consuming it. And one of the studies from 2024, in the New England Journal of Medicine looked at carotid plaques. So basically you can have formation of plaques in your carotid artery, which is the artery that brings splits your brain.
00:28:41:18 - 00:28:56:58
Dr. Muoi Trinh
And these were patients who didn't have symptoms. They came in and had them removed. When you looked at it under the microscope, the patients with nano plastics and microplastics had a four and a half times higher incidence of MI, stroke and death. So there are associations.
00:28:56:58 - 00:28:59:33
Leslie Schlacter
Creating vessel wall damage just from being in there.
00:28:59:34 - 00:29:24:49
Dr. Muoi Trinh
I think it was more an association study. We don't know exactly what the mechanism is, but it's affecting us. Right? Long term and indirect ways that we are not seeing. And certainly there are studies looking at plastics and placental tissues and heat shock proteins. So, so I think that it does impact human health. And we need to be thinking more globally and long term.
00:29:24:54 - 00:29:41:33
Leslie Schlacter
So it's kind of like what you were saying before about when I asked you about disposables versus reusables, and you had said it's an infection control thing, but it also like that's that's acutely but it also long term could be on the flip side, unhealthy for the patient long term possibly. Well, that would.
00:29:41:33 - 00:29:51:07
Carlos Maceda
Be I mean those are those are studies that would have to be done. But yeah, I mean the all of those things, you know, cost is definitely not the only factor that we consider when we're making these decisions.
00:29:51:12 - 00:30:02:53
Leslie Schlacter
So how does the hospital work when it comes to like actually buying all these products? Is it just based on like what our typical use rate is? How do we share with other hospitals? Is there like a reusing program.
00:30:02:58 - 00:30:28:37
Carlos Maceda
From a sustainability perspective? One of the things that we've been trying to do more is, is when you when you use the example of, sharing with other hospitals is, is to donate more. We just closed by. Right, right. And so one of the things that we're doing there is, is we've brought in not only organizations like Sophia that then they, take that, take the supplies and the and the equipment that we give them, and they take it to other countries.
00:30:28:44 - 00:30:48:03
Carlos Maceda
But we've brought in other hospitals that we partner with for them to get supplies, like the chairs and things of that nature that we're going to throw out so that we don't put it into the landfills. So we've been doing more and more of that. We even actually have partnered with an organization that because not too many people will take expired products, but we have 1 or 2 organizations that will.
00:30:48:18 - 00:31:01:12
Carlos Maceda
And so we've been partnering with them so that even even products that's expired, that you can't donate or another hospital can't use, they'll take it and way they're able to to use it. And so, we've been trying to do those types of things as well.
00:31:01:17 - 00:31:22:31
Leslie Schlacter
When you look like item per item. And this is kind of like a good both of you question. If you were to look at cost of a disposable one time, use throwing it away and compare that to a reusable. That has to go through speed and chemicals emissions for that. Something kind of obvious and basic to you guys.
00:31:22:40 - 00:31:29:01
Leslie Schlacter
How do you compare that side by side? Forget about infection control. How do you make that decision?
00:31:29:06 - 00:31:47:03
Carlos Maceda
Or from from our perspective I mean that that's a that's an easy enough analysis, right? Because let's say the reusable item is $1,000 and the disposable is $20. All right. So you start there. And then from there you start building on, well, what are all those other costs that you just mentioned that equal up to that right now.
00:31:47:04 - 00:32:03:34
Carlos Maceda
And how many times can you reprocess the thousand dollar one. So those are the types of analysis that you do from a financial perspective. And then you get which one makes the most sense. And then you start on top of that. If it's if it's pretty close, then you start adding on sustainability and everything else that goes a long way.
00:32:03:34 - 00:32:09:49
Leslie Schlacter
How often are we doing that for the majority of the products that we use, like reassessing what the best option is?
00:32:09:54 - 00:32:31:03
Carlos Maceda
Well, I mean, I would say that, the more reprocessing that we're looking at are things that have FDA clearance because then you also have legal implications if you're like, first of all, when when you talk about instrumentation, there are certain things that obviously like a la la LMA or things of that nature that you could look at disposable versus reprocessed, right.
00:32:31:03 - 00:32:47:28
Carlos Maceda
So, so those are types of things. But then you have to start looking at and we do look at those and we we go through value analysis. And we've looked at those things a lot of times is the amount of resources that are needed to be able to do that in a speedy compared to them having to be able to re sterilize all of the products that they need for the O.
00:32:47:33 - 00:33:03:31
Carlos Maceda
Right. So for the o r. So those are the types of things we look at. But but a lot of times there's not like thousands of items out there that you could say I could do one or the other. And so we have to do this massive look at, more of what we're trying to do is things that have an FDA clearance.
00:33:03:36 - 00:33:09:57
Carlos Maceda
EPA is a big area. So like EPA has like ablation catheters and things that nature is electrophysiology. Sorry I apologize.
00:33:09:57 - 00:33:13:32
Leslie Schlacter
So electrification speed is sterile processing department.
00:33:13:37 - 00:33:32:25
Carlos Maceda
Thank you. And so there are ablation catheters and ice catheters that you can reprocess. Right. And so that's where we're focusing a lot more on is being able to get those purchased because they have 510 K clearance. And not only do they save money for the organization, but obviously from a sustainability perspective it also works as well.
00:33:32:31 - 00:33:43:33
Leslie Schlacter
So kind of like the lower the you want to find sometimes a lower hanging fruit, although it might be easy, it doesn't make big energy changes. So you want to focus on the bigger energy change.
00:33:43:33 - 00:34:06:00
Dr. Muoi Trinh
So I'll give you an example. Actually about reusables in single use. This is actually a project that Colin knows about because I've been working on it for a little bit, and that's the laryngoscope. So we know the carbon footprint from the laryngoscope, the disposable one is much, much higher because of the other manufacturing that goes into making a single use, single patient use the Rega scope versus the.
00:34:06:00 - 00:34:07:17
Leslie Schlacter
Reusable use laryngoscope.
00:34:07:24 - 00:34:08:24
Dr. Muoi Trinh
That's all we have.
00:34:08:29 - 00:34:09:01
Leslie Schlacter
Those are single.
00:34:09:01 - 00:34:13:30
Dr. Muoi Trinh
Use. They're all single use. They get thrown out. That's terrible. Tremendous memory loss.
00:34:13:30 - 00:34:15:51
Leslie Schlacter
Very not single. You see.
00:34:15:55 - 00:34:38:33
Dr. Muoi Trinh
No. They're single use. Oh man. They cannot be reprocessed. They cannot be recycled. They they just go straight in the trash. That's there. So, so, you know, we're evaluating a reusable handle which decreases the carbon emission from the handle by about 20 fold. And so, so we can do that kind of analysis and then extrapolate to cost benefit analysis.
00:34:38:38 - 00:35:08:04
Dr. Muoi Trinh
And you'll see that eventually when you look at the when you, extrapolate that to a year, two years, three years, assuming that you don't have lost along the way that there's going to be a few hundred thousand dollars, a few hundred thousand dollars, actually, when we did the math cost savings. And then obviously you also have to get it through infection prevention, and we have to work within the team and within the health system to be able to to make the workflow, be something that the health system can sustain.
00:35:08:09 - 00:35:17:58
Leslie Schlacter
Wow, I'm so shook by that, by like the lingering go scope being single use. Yeah. Because they I mean, they look they're they look very expensive. There's batteries in them.
00:35:17:58 - 00:35:20:01
Dr. Muoi Trinh
Clearly the batteries get thrown out.
00:35:20:06 - 00:35:24:33
Leslie Schlacter
Yeah. Oh that's too bad. What's another example of something like that.
00:35:24:37 - 00:35:35:33
Dr. Muoi Trinh
This is something that we recently did was the noninvasive cuff. I'm sure Carlos was involved in that too. There's a single use, single patient use noninvasive cuffs. They get thrown out after the patient like.
00:35:35:33 - 00:35:36:00
Leslie Schlacter
A blood pressure.
00:35:36:00 - 00:36:01:50
Dr. Muoi Trinh
Cuff. Correct. Okay. And then we, And then due to supply chain shortages and other things, we ended up switching over to Reusables. So the manufacturing from the reusable and reusing it more than once with patients ends up actually being much, much lower carbon footprint than throwing out. So if you are able to reuse the the noninvasive cuff for ten patients, you're actually saving yourself ten noninvasive cuffs that are being thrown out after each patient.
00:36:01:55 - 00:36:18:45
Leslie Schlacter
So when I'm on Amazon and I'm ordering packages, there's always an option that says like, do you want everything as soon as possible or do you want a lower carbon footprint, everything to come in one order, even if that's later? Are there options like that with our deliveries for things here at Mount Sinai? So there's like less trucks delivering things.
00:36:18:50 - 00:36:39:09
Carlos Maceda
So what we normally do is, is for all our general med surge supplies, we, we get, we have a prime distributor, kind of like an Amazon. They're called Medline, and we get all of our med surge deliveries from them. It's still a lot of deliveries. I mean, we get at Mount Sinai Hospital, we get four trucks at night that comes delivered for all the supplies that we use.
00:36:39:09 - 00:36:53:48
Carlos Maceda
And that happens five days a week. And then UPS delivers twice, and Fedex delivers twice. So we get like four deliveries a day from that. So one of the things that we're trying to do is look at how we can consolidate even further, to try to get less of those trucks to come in.
00:36:53:52 - 00:37:08:02
Leslie Schlacter
So had. So I would imagine you have to like in order to do that. You're kind of functioning at power levels on the floor to reduce waste on the floor. How is that supply chain community communicated on what's needed to replace and how that gets back to how many trucks.
00:37:08:02 - 00:37:38:30
Carlos Maceda
So there's a there's a whole host of people behind the scenes that are looking at all that data. I mean, when you look at the stuff that we're ordering, it's over a million lines of data a year of what we're ordering. And so we have now at Mount Sinai Hospital places that instead of delivering five days a week, we actually now have the data we're delivering three days a week to, okay, so we're doing things like that, but that requires a lot of resources that are looking at all this data of all these different lines that we're ordering, because you can have a power level of like 50 for a particular widget.
00:37:38:34 - 00:37:49:25
Carlos Maceda
And then you look and you see that you're ordering ten a day, so that you might just then reduce the part level and maybe not order as often so that that is constantly being done to try to reduce all of that.
00:37:49:30 - 00:37:59:31
Leslie Schlacter
And then what about things like working with the technology department? I can imagine we print a lot. I wish we didn't, but we print a lot. How do we optimize so that we don't waste paper?
00:37:59:36 - 00:38:19:33
Carlos Maceda
So we're going to what's called eventually, in 2026 actually we're going to what's called pull printing. So instead of you just printing everything to the printer, you'll have your badge and you send something to the printer. And until you take your badge, it won't print, because what you'll find is a lot of times people print stuff, then they forget that they printed and they don't even get it and it's still left in the printer.
00:38:19:33 - 00:38:34:06
Carlos Maceda
So those are the types of things that we're doing. We're looking at consolidating printers, having a better policy, instead of saying everybody in their office has a printer, there's a general printer that's outside your office. And because you're doing pull print, it's still secure. And so those are the types of things that we're looking at doing there.
00:38:34:06 - 00:38:48:49
Leslie Schlacter
So I when I used to work in urology, any time I place an order for anything or close to know like the after visit summary in any like MRI, anything I ordered would just go automatically to the printer, but most of the time I never give it to the patients like they do. They call and get their appointments.
00:38:48:54 - 00:39:01:57
Leslie Schlacter
When I moved up here to neurosurgery, I had that part of my epic turned off so that nothing prints out anymore for me. I wonder how many people out there are just printing endlessly and have no idea to random printers.
00:39:01:57 - 00:39:13:14
Carlos Maceda
That's a really good point. I mean, and I can't speak for DDP because they obviously do their their own things. They might have they might have already done that for all I know, but that's definitely a good question to ask them. So I appreciate you bringing that up. Yeah.
00:39:13:19 - 00:39:35:34
Leslie Schlacter
So there's kind of like the supplies, there's the energy, the infrastructure. And you're kind of like intermediary for a lot of these things. You brought up food before that's like probably a whole separate conversation is like how food gets in here and waste and all of that. But one more thing I'm just kind of curious about is clinical waste, right?
00:39:35:34 - 00:39:56:35
Leslie Schlacter
A lot of times we have protocols for how we order things, whether it be post-op blood tests, scans, note writing, smart phrases, a lot of stuff just gets done in order. That's not necessary. Is there in a temporal department working on that form of waste? Because that would that's like my carbon footprint. My emotional carbon footprint.
00:39:56:40 - 00:40:24:27
Dr. Muoi Trinh
Yes. So as you can imagine, just kind of like the way Carlos alluded to, there's so many things, so many items, so many medical devices, you know, syringes. I'm I'm sure, I wish there were reusables for a lot of the other things. There really aren't for a lot of equipment and supplies that we have. But in terms of clinical waste, I think the best thing, unfortunately, because there's so many different departments divisions, it's hard to be able to hone in on everything.
00:40:24:27 - 00:40:44:57
Dr. Muoi Trinh
Right? So in some sense, what we really need, what we really want is actually specialists in those areas to tell us what they need or to take up the leadership spot in there. Maybe somebody in urology can show us where they're wasting, right, and where they can actually trim and decrease their carbon emission from. That's part of.
00:40:45:01 - 00:41:03:54
Leslie Schlacter
The protocols that people do. When you ask them why, they're like, I don't know. It's just what we do. Like, especially down in radiology, those machines probably run a lot of extra sequences that just aren't needed. What's one thing that you guys have been a part of? Something. It can be something small or big that you are most proud of so far in this sustainability mission, whoever wants to go first.
00:41:03:59 - 00:41:19:52
Colin Barnett
Well, I'll jump in. You know, I mentioned that that has, data center project, we we got a $2 million award from, from the state to support that project. So that offset a significant portion of that of that cost. And, I think that'll be a big success for us on it.
00:41:19:57 - 00:41:21:38
Leslie Schlacter
Well, congratulations for that.
00:41:21:43 - 00:41:44:01
Dr. Muoi Trinh
Yeah. Okay. I would say that, in terms of sustainability in our journey, so part of my journey is actually quite personal. You know, one of the things that we talk about with sustainability, why we do what we do, and part of it is that what I want to do is be able to leave behind a more habitable world for my daughter.
00:41:44:06 - 00:42:06:43
Dr. Muoi Trinh
So one of the things that she came home with when she was eight was, mom, you know, the polar ice caps are melting. What happens in the, you know, downtown if it's flooded? And so what I wanted to talk to her about and let her know is that. Yes, this is a problem. Yes, climate change is a problem and global warming is an issue, but also that you can do something about it, that she has agency.
00:42:06:55 - 00:42:21:12
Dr. Muoi Trinh
And I think that's what I'm proud of most, I guess in this journey, in this work, is that we've made something of the work, with this team. Really, we couldn't have done it with all without all the people that were together. Now she's 11, so.
00:42:21:12 - 00:42:25:55
Leslie Schlacter
She should come intern here. Yeah, yeah. What about you, Carlo?
00:42:26:00 - 00:42:42:51
Carlos Maceda
I would say the biggest project that is one that we're still working on, which is? We're working to what our prime distributor to to develop our own warehouse, which will allow us to do a lot of this consolidation and give us a lot more, of flexibility to the some of the things that we're going to do. So I'm hoping that that'll get completed in 26.
00:42:42:55 - 00:42:45:39
Leslie Schlacter
Thank you. Thank you guys so much for being here. I appreciate it. Thank you.
00:42:45:41 - 00:42:46:24
Dr. Muoi Trinh
Thanks for having us.
00:42:46:35 - 00:42:52:33
Leslie Schlacter
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