Sustainable dentistry module 6: How-to guide: Embedding and measuring sustainability

Where do I begin?

Despite the best of intentions and enthusiasm, any effort to implement a new process can quickly fall by the wayside if you try to do too much too soon.

Progress is the goal, not short-term perfection

Planning is the first critical step. This includes developing and communicating your vision of sustainability, developing a practice plan or policy, and measuring and evaluating the changes.

6a. How to: Develop your sustainability vision

Why is it important?

In his TED talk, ‘Start with why’, Simon Sinek explains that people don’t buy in to what you do, but why you do it. Starting with ‘why’ engages people at a deeper level and purpose, and this is a powerful motivator and connector. 

Both your dental team and your patients need to understand the need for change and feel inspired to act.

6b. How to: Communicate your vision to staff and patients

What does sustainable practice look like?

Communicating your practice’s sustainability vision can increase awareness and support amongst your staff, patients, other dental practices and your local community.

To staff:

Take the time to articulate your reasons for implementing sustainability in your practice.

o This could be via a staff meeting or other communication channel. Invite feedback and listen to the ideas and concerns expressed. All staff and patients should be encouraged to share their values and solutions to support the practice in becoming more sustainable.

o Sustainability should be included in all staff induction packs, and reference to the sustainability vision and policy included within your practice handbook (see 6b – Developing a sustainability policy).

o Information could include information on the Top 10 Tips (see below), and general information on sustainability (e.g. carbon emissions of active travel, significant carbon emissions associated with dentistry). (See the resources section below.) With such a process, new staff are more likely to consider sustainability as an integral part of their role.

To patients:

Planning a communication strategy to your patients is important, however, avoid big splashes and announcements until you have some concrete achievements to speak of.

- It’s important that your sustainable practices align with your vision and can be demonstrated. Overrepresenting the extent to which a practice is environmentally friendly, sustainable or ethical is referred to as ‘greenwashing’.

- Create a plan to subtly but consistently drip feed messages into your channels that build an authentic picture of your vision for sustainable practice. This could include putting sustainability material within the waiting room or on the practice’s website or social media pages, highlighting the steps that the practice is taking and progress made.

Modelled example

Leila is an associate dentist, and currently is the practice lead for sustainability. She is developing a practice sustainability plan with help and input from her colleagues. After consultation, she has decided to include:

• A process to manage communications to staff raising awareness about the plan

• A process to encourage staff to share their ideas, suggestions, experiences on sustainability

• A process to collect feedback, ideas and offers from patients on sustainability

• A process for the practice to engage staff with an interest in / passion for sustainability

• A process to encourage patients and staff to travel sustainably

• A process to manage appointments more efficiently (minimise multiple visits, and group family appointments where possible)

• Processes to manage waste, energy and biodiversity

• A post regarding sustainability on Peer.org.au, with the view of developing a network of dental practices collaborating on sustainability

• A process for the practice to engage patients and visitors.

For each process, a staff member will be responsible for implementing and evaluating the associated actions. They used the relevant tips from this guide and decided how each could be best implemented in the context of the practice.

6c. How to: Develop a sustainability practice policy

Why is it important?

A formal sustainability plan with actions and outcome measures can signal that the practice is taking this agenda seriously and measuring progress.

What does sustainability practice look like?

A sustainability practice policy needs to be embedded into general management processes (such as routine staff meetings) to ensure that momentum is not lost as other issues arise.

Part of achieving this is trying to assist the team in thinking about sustainability not as a separate entity but as integral to successful everyday functioning of the dental practice, and to patients’ overall health.

Where do I begin?

1. Use the How To Guide to assess as a team where energy and carbon savings can be made.
   
   Before you can get to where you’re going (sustainability goals), you first need to know where you are. Undertaking a benchmarking exercise to understand your sustainability performance is vital. It helps you to see what you can actually measure, where you’re already doing well, where the gaps are and how your sustainability performance compares to other market participants. Use the Action items from the How To Guide to assess what changes can be made. 

2. Review the actions for these areas and discuss how they can be adapted for the size of your dental practice

Desmond Tutu once said, ‘there is only one way to eat an elephant, a bite at a time’. That’s how you have to think about sustainability planning for your business. Once you have a clear view of your sustainability performance, you’ll have a good idea of the areas where your business can have the most impact.

The reality is that you will have to balance different priorities and agendas and there will be tough choices between what you want to do and what you can afford to do as a business. Think about identifying three to five strategic priorities or pillars for your plan, keeping in mind these considerations. (3)

3. Put together a practice sustainability plan, with an emphasis on simple and achievable goals.

The policy needs to be practice specific and will contain an action plan with SMART targets. Make allocated staff members responsible for specific actions. The practice needs to consider the resources for implementing the plan. Sometimes these may require short-term financial investment for longer-term financial gains. See the real-life example below for inspiration.

Note: A practice sustainability policy or plan can be quite simple for a smaller practice, but a larger practice may require more complex documents. Although not currently a requirement for dental practices, voluntary sustainability accreditation may become available in the future. Check the website of the Australian Commission for Safety and Quality in Health Care for advice and updates.

4. Choose indicators to measure sustainable changes in your practice, both qualitative and quantitative.

See 6d. Measure and evaluate sustainable changes.

5. Ensure your indicators are SMART

See the resource section for information on how to develop SMART goals.

6. Make some quick sustainability changes to build excitement and momentum

Real life example

Beaconsfield Dental, based in Victoria, Australia, is a progressive dental clinic committed to sustainability and caring for the community and the environment. A broad range of measures in all aspects of sustainability have been implemented in this clinic, including:

- solar power generation from 144 solar panels

- solar hot water

- rainwater collection (17,000L)

- 12 compost bins

- an Indigenous garden with native edibles

- a broad recycling program

- building design with energy-saving appliances and lighting

- environmental artwork

- a Tesla EV charger.

The Victorian-based practice developed a sustainable practice policy which includes the following sections:

- 1. Reduction of electricity consumption

- 2. Reduction of water consumption

- 3. Waste mitigation

- 4. Recycling

- 5. Organic matter

- 6. Garden

- 7. Staff and patient education

- 8. Biodegradable products

- 9. Electric car charger

- 10. Internet

- 11. Dental materials and consumables

- 12. The future (plans).

Beaconsfield Dental Awards:

- Winner 2022 Casey Business Awards Sustainability Category.

- Finalist 2022 Premier’s Sustainability Awards Sustainable Places and Destinations-Industry Leader

- Finalist 2019 Casey Cardinia Business Awards Health, Education and Well-being.

- Finalist 2018 Casey Cardinia Business Awards for Health, Education and Well-being.

- Winner 2018 Premier’s Sustainability Awards Health Category.

- Finalist 2019 Melbourne Awards for Sustainability

- Finalist 2018 Melbourne Awards for Sustainability.

- Finalist 2016 Premier’s Sustainability Awards

- Winner 2015, 2016, 2017 Casey Cardinia Business Awards for Sustainability and the Environment

6d. How to: Measure and evaluate sustainable changes

Why is it important?

Measuring

Embedding sustainability into a healthcare setting is a quality improvement process. An integral part of quality improvement is the use of measurement. Measurements could be used in the future for dental practices to benchmark their sustainability performance against their colleagues, and it is possible that sustainability metrics could also be used in future commissioning decisions.

Indicators recorded in order to measure sustainability within the dental practice should be SMART: Specific (the measure should quantify an important result, e.g. kWh of electricity), Measurable, Achievable, Relevant (i.e. related to sustainability), and Time specific (e.g. over one month, one year, etc).

Check out the other sections of this guide for ideas on measuring your efforts.

Many local councils and other government departments offer support and resources for managing sustainability. Look at your local council or state government website and find out what they offer.

Carbon Footprint

By collecting electricity and gas use (kWh), a sample of patient and staff travel, and procurement (purchases) information, a practice can capture a significant part of its carbon emissions. (4)

There are new tools emerging on the market to assist businesses to measure their carbon footprint. See the links below to learn more.

There are also many free programs offered by government to help businesses become more sustainable, reduce their carbon footprint and work towards net zero emissions. See the links below to learn more.

Evaluating

Evaluation is the process of assessing or determining the significance of an action. Many dental practices may wish to evaluate their sustainability indicators informally, e.g. comparing energy use, or waste use from one given period to another.

A more formal evaluation can be performed quantitatively (e.g. using data) or qualitatively (e.g. using non-data information such as descriptions of sustainability improvements).

Evaluation can either be process (how an outcome was achieved) or outcome based (the actual change, or how effective the program was in producing change).

Real life example

The ‘Green Impact audit tool’ for dental practices was developed by the postgraduate dental department of the University of Bristol in the UK and piloted in 2014–15, supported by the National Union of Students (NUS). It enrolled dental practices in the South West to implement sustainable changes using the tool, led by Foundation Dentists in their practices. Fifty practices were engaged, 42 of which submitted a toolkit and were audited remotely by trained students. Changes involving waste management and recycling, printing and photocopying, and energy awareness and use were made, and energy, carbon and financial savings were demonstrated.

Calculations to estimate the impact of the practices’ combined actions on both carbon reductions and financial savings were carried out using the Carbon Trust Empower Calculator. Through just two of the actions (printing double-sided and switching off lights and equipment) approximately £11,035 and 53 tonnes of carbon were saved.

Modelled example

Sonya is a dental practice owner. She has worked with her team to implement sustainable changes in the practice and wanted to evaluate the changes. She has created a template to evaluate the process and outcomes achieved, which will be used as part of a sustainability audit. Each dental team member in the practice will lead a part of the audit for each indicator:

References

1. Simpson, D.D. (2011) A framework for implementing sustainable oral health promotion interventions, Journal of Public Health Dentistry, 71(s1), pp. S84–S94.

2. Harford, S. et al. (2019) Sustainable dentistry how-to guide: Measuring and embedding sustainability, Centre for Sustainable Healthcare. (Accessed: 06 July 2023).

3. Burr, P. (2021) 5 steps to make a sustainability plan for your business, LinkedIn. (Accessed: 15 May 2023).

4. Dental Carbon emissions studies using DEFRA & SDU footprint figures: Duane B, Hyland J, Rowan JS, Archibald B. Taking a bite out of Scotland's dental carbon emissions in the transition to a low carbon future. Public Health 2012; 126(9): 770-777.