CHN Member Spotlight: Laurie Lalakea
Laurie Lalakea is the chief of otolaryngology at Santa Clara Valley Medical Center, and a wonderful climate and health advocate! Her healthcare sustainability efforts at her institution were highlighted by a local news channel (ABC7 News) - please see the 2:30 minute video below! Laurie was also featured as a climate champion in July 2023 by the Medical Society Consortium on Climate and Health.
Here’s her story:
Laurie Lalakea, MD
I first got the idea to reach out to leadership at Santa Clara Valley Healthcare in 2022, after learning that 8-10% of US GHG emissions come from health care. I heard from others at CHN about the HHS health sector climate pledge, and the example letter to leadership regarding the HHS pledge that Bill Pevec had drafted and shared. SCVH is a safety-net health system comprising 3 hospitals, over 1000 acute care beds, and 15 satellite clinics. Many of the patients we serve are already facing significant health disparities and are at increased risk for climate-related health harms. Given our patient base, I felt very strongly about advocating for our community, but our institution had no sustainability officer or plan or champion. Moreover, I had only just been introduced to climate and health at my first CHN meeting in Feb 2022, and felt that I had little experience or expertise to lend to this effort. I did not feel like a letter from me as an individual would be able to influence our administration, so my initial goal was to engage others at SCVH.
I reached out in June 2022 to my dept chair, and with her support, spoke with our medical staff president, Dr. Harry Morrison, who offered me the opportunity to give a short presentation to our medical staff leadership council (dept chairs) at our hospital and our 2 affiliated hospitals over last summer--my first ever climate presentations, only 4 months after joining CHN with no prior background in climate! While my early goal was to engage a handful of dept chairs, the Sept 2022 heatwave pushed climate change and climate resilience to the fore. Two of 3 of our SCVH hospitals had power outages, our ED was on diversion, and ICU patients had to be moved to areas of the hospital that still had power. These events resulted in an invitation from Dr. Morrison to present on climate and the pledge at the quarterly meeting of our entire medical staff, as well as hospital administrative leadership. Although I had hoped for a quick positive result, administrative leadership showed no interest in signing the pledge, and suggested that the county of Santa Clara Office of Sustainability was likely doing all that was needed.
Dr. Morrison's ongoing support was hugely helpful, especially given his influential medical staff leadership role. We met together with members of the county Office of Sustainability--while they had an ambitious Sustainability Master Plan for the County as a whole, they confirmed that hospital and clinic operations, especially scope 3, were outside of their purview.
To make a compelling case to administration for the pledge, we needed to show strong support from our medical staff. So together with Dr. Morrison, I customized Bill Pevec's draft letter for our institution, with the idea of sharing it widely with our medical staff as a climate petition, to allow those interested to sign on to the letter prior to sending it to administrative leadership. Dr. Morrison agreed to send out a blast email request to our medical staff, with a link to a Google form I had set up to gather names. The first 100 signatures were easy--but how many people read blast emails? The remaining signatures took a grassroots advocacy effort. I reached out personally to each dept chair, to ask if they would be willing to resend the link to their members on my behalf. I spoke with individuals who had previously expressed interest with a request for them to reach out to their networks. I let people know I would be delighted to receive a verbal 'yes,' or paper signatures. We ultimately got to 360+ signatures!
We sent the letter to our administrators in February 2023 with the list of all those who had signed the petition and waited for a response. Over the course of the spring, I had built some comfort and expertise in climate presentations, by offering to give Grand Rounds at my institution and at Stanford (CHN members Brenda Nuyen, Bill Pevec, and Knox Kelly were extremely helpful in sharing materials with me). I also reached out to our county Public Health department to explore areas of mutual interest around climate resilience. So when we were offered a meeting with administrative leadership in late April, I felt more ready to speak and advocate knowledgeably about climate, and Dr. Morrison graciously allowed me to take the lead in creating a slide deck for that meeting.
When preparing, I used advice that Bill Pevec had previously shared, to focus on WHY administration should engage in climate action, and in particular, WHAT WAS IN IT FOR THEM. I reached out to a handful of individuals who had expressed the most interest and support in prior months for their input and editing. Of course the presentation included some background on the climate crisis as a health crisis, the healthcare's large carbon footprint, the existential threat that climate change poses for us all, the urgent need for action, and our moral obligation as health providers to do no harm. But I included 'hooks' for SCVH in particular:
Concordance with stated organization priorities (equity, better health for all, address disparities, quality/safety, value and cost-effectiveness)
Potential significant cost-savings associated with many sustainability initiatives, and avoiding costs from facility shutdowns related to power outages, etc
Possibility of TJC environmental metrics
Support of County Office of Sustainability (themselves supported by County board of supervisors), as engagement of SCVH would be essential for County to reach its own goals
Support of the Dept. of Public Health
Facility disaster plan will of necessity include climate resilience plan
Employee wellness and development. 360+ signatures indicate that employees feel strongly about this, and training employees about sustainability and resilience will be essential to preparing for the future of climate change, and for the health of our patient community
Suggestions for next steps, including resources available for help, such as Practice Greenhealth, the Office of Climate Change and Health Equity (OCCHE)
The stated goal of the April presentation was to have SCVH commit to the federal health sector climate pledge, but given prior lack of interest from administration, we would have been pleased to at least get a commitment to continue the conversation and to target more modest goals. Our leadership is dedicated to the mission of better health for all of our community, but we are a safety-net institution, with resource constraints. That our enterprise CEO, Mr. Paul Lorenz, had the vision and courage to appoint an executive lead and move forward with the pledge at the conclusion of our meeting was beyond gratifying, and is an incredible win for our entire patient community.
In the weeks following SCVH's signing of the pledge, I have let our administration know that I am willing to help in any way that I can as this process moves forward. It has been very meaningful to share resources with the new executive lead for climate (Dr. Jennifer Tong), discuss next steps, meet jointly with Public Health and the County Office of Sustainability, draft project lists and suggest QI projects (for example reduce use of metered dose inhalers), help to launch an OR Green Team, and assist with drafting the press release to media. It is so exciting that local ABC7 picked up this story, and that the message about climate change and healthcare sustainability is getting a wider audience!
Beyond goals at SCVH, I am also working on launching a climate and sustainability group within Stanford's Dept. of Otolaryngology, in the hope of further amplifying the importance of healthcare decarbonization. I am also hoping to build support within our national Otolaryngology society to begin to engage in this work.
I am so grateful to CHN for starting me on this path, for contributing to my climate education during monthly meetings (Bill Pevec's sustainability talk was awesome!), links and resources on the CHN website and newsletters, and for sharing the initial climate pledge draft letter. Many thanks as well to CHN members including Bill Pevec, Brenda Nuyen, and Knox Kelly who were so generous with their time and materials to help support this effort! All of this is truly a huge win for the CHN team, as it never would have been possible without your inspiration and leadership!!!