How Ophthalmologists Can Decarbonize Eye Care: A Review of Existing Sustainability Strategies and Steps Ophthalmologists Can Take.

TOPIC: Understanding approaches to sustainability in cataract surgery and their risks and benefits. CLINICAL RELEVANCE: In the United States, health care is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability. METHODS: We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons. RESULTS: Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single-use supplies to reusables or implementing a hub-and-spoke-style operating room setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks. CONCLUSIONS: Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Weathering the Storm: How Superstorm Sandy Shaped the Response to COVID-19.

Catastrophic weather, like a pandemic, can wreak havoc on hospital operations. NYU Langone Health in New York City has experienced the extremes of both phenomena. In 2012, Superstorm Sandy severely damaged the system's core facilities, disabled operations, and forced the evacuation of more than 220 patients to other health systems. In 2020, the arrival of the novel coronavirus severely disrupted operations again-but this time, we were better prepared. Our experience in dealing with Superstorm Sandy taught us critical lessons that supported our readiness for COVID-19. Those lessons can be summed up as preparation, organization, and innovation.

Compliance and High Reliability in a Complex Healthcare Organization.

When considering the impact of regulation on healthcare, visualize a spider's web. The spider weaves sections together to create the whole, with each fiber adding to the structure to support its success or lead to its failure. Each section is dependent on the others, and all must be aligned to maintain the structure. Outside forces can cause a shift in the web's fragile equilibrium.The interdependence of the sections of the spider's web is similar to the way hospital departments and services work together. An organization's structure must be shaped to support its mission and vision. At the same time, the business of healthcare requires the development and achievement of operational objectives and financial performance goals. Establishing a culture that is flexible enough to permit creativity, provide resiliency, and manage complexity as the organization grows is fundamental to success. An organization must address each of these factors while maintaining stability, carrying out its mission, and fostering improvement.Nature's order maintains the spider's web. Likewise, regulation can strengthen healthcare organizations by initiating disruptive changes that can support efforts to achieve and sustain high reliability in the delivery of care. To that end, leadership must be willing to provide the necessary vision and resources.