 Alright, so we have Linda and Bidanka today and they are going to talk about the Green Maternity Project, a midwife-led initiative to promote correct waste segregation on an Australian postnatal ward. So Professor Linda Swede is both a nurse and a midwife with a broad experience in clinical environments management and research. Linda is an inaugural chair in Midwifery in Deakin University and Western Health Partnership. Linda is a Flinders University Distinguished Scholar, a Fellow of the Australian and New Zealand Association of Health Professional Educators, and a lifetime member of the Australian College of Midwives. Linda has over 120 peer review publications, is a Deputy Editor of the International Journal Women and Birth, is a peer reviewer for numerous other international journals. Linda is passionate about midwifery profession and improving maternity care. Dr Bidanka Vasilevsky is a research Fellow at Deakin University School of Nursing and Midwifery and Western Health Partnership. Bidanka has a PhD in Neuropsychology and research experience in a range of health issues. She has a growing track record in pregnancy and women's health research with a focus on improving pregnancy outcomes of women experiencing disadvantage and women with obesity. Bidanka plays a key role in a broader research group aimed at reducing the rates of neurodevelopmental vulnerability in children experiencing disadvantage by identifying potential drivers for these outcomes during pregnancy. Through this work, she has successfully engaged with health organizations and community services that they are keen to improve the outcomes of women, children and families. Bidanka's research on Maternity Services Improvement has led to actionary changes in the delivery of care in maternity settings at local and national levels. Welcome and you can start your presentation now. Thank you so much Paola. Bidanka and I are delighted to be here today to present this project. But I want to say at the very outset, it wasn't our design or our idea, it was from a passionate group of midwives who worked on a postnatal ward at the hospital in which we work that came to us with a problem going, oh my gosh, we just don't do the right thing with all the waste that we have. And given the global warming and the climate change issues and the carbon emissions, we really think we could make a difference if we segregated our waste better. So that was the start of this small project and it is relatively a small project. It occurred on one postnatal ward in one tertiary hospital in Melbourne, Australia. The people that were the drivers of the project were declined to be present today for lots of reasons. So Bidanka and I, as their mentors and supporters, are presenting the work. But as you'll see from photos, that the other midwives did the bulk of the work for this project. We were just supporting and encouraging them along the way. So we called it the green maternity project. So green being everything's green, it's good, it's what's the right word, like environmentally friendly, as such. So we also worked with the hospital's waste management person or people. There was a couple of people that we got engaged in this project. When we were conceptualising it, we said we really think we can make a difference. If we do things, we want to do a few audits and manage and assess whether or not we're actually making a difference. This group of the hospital we work at, we're very fortunate. They offer a research grant every year. And this group, the green maternity team, was successful in winning the grant in a particular year. So that gave them $15,000 in order to pay additional staff hours to do the additional work that's required for this kind of research. So without that funding and support, this kind of work would not have been possible. So I acknowledge Jessica, Anna and Kira, and also Angelina, who was with us at the beginning, but moved places very soon after the commencement of the project. So as a background, the healthcare sector, as we know, is one of the leading contributors to waste production globally. There are publications that say we produce about 7% of the carbon emissions across the globe, just to satisfy the healthcare system. That's 7% in the sense of making the products required for healthcare, as well as the healthcare system's use of things that itself. We're situated in Melbourne, Victoria, in Australia. And it's estimated that our public health system's solid waste. Just what we dispose of is 42,000 tonnes a year, just of solid waste. And the way in which that solid waste is managed depends on the type of waste, whether it's clinical waste, general waste, contaminated waste, et cetera. And so segregating the type of waste makes a huge difference as well. We know that waste management in Victoria costs about $17 million, Australian dollars. And that's just in Victoria. So Victoria is one of one state in Australia. There are numerous states and territories. So 60% of that goes to treating disposal of clinical waste. So if you think $17 million a year, 60% of it is managing clinical waste. Do we actually segregate waste appropriately so that only clinical waste is in the clinical waste compartment, which costs us the most? Or are we actually putting general waste, which is really cheap to get rid of, in clinical waste inappropriately? So it does beg the question. And I get that this is a completely lifted field topic for most midwives, but it actually is really important. Waste production will continue to rise over the coming years. We understand that there's so much more use of single-use only products, packaging and wrapping and all that sort of stuff. So we need to think about those kinds of things. So what we know is that inaccurate waste segregation has been identified by as a problem for health care staff. There's numerous articles that say nurses and midwives, in particular, doctors true, doctors and enthetists, PCAs, do not put the right things in the right containers for the correct waste segregation. So people probably don't understand that if you put something in a general bin, it's disposed of at a certain cost. If you put something in a clinical waste bin, it's disposed of probably at 100% of the general waste cost. So because of the requirements for safety and all that kind of stuff. So there's a huge cost inferential in this process, but there's also a huge end product inferential. So at least if you segregate correctly, we know it leads to improved waste management cost and decreased environmental cost. So sustainable health care practices are valued by staff, but not always enacted. So various factors inhibit effective waste segregation in hospital, things like high patient turnover, lack of time, staff habits, perception that all waste is clinical, which is not, as I said, clinical waste disposal is much more expensive than general waste disposal. And also inconvenient bin locations as a few examples. Health care staff report inadequate knowledge about how to actually segregate the waste appropriately. So what happens if we improve waste management? When tailored education is provided, knowledge about effective waste management increases, but so too do the behaviours. The behaviours of the everyday person on the ward can say, oh, actually, this IV line shouldn't be in this bin. It should be in that bin. This breast infant feeding bottle shouldn't be in this bin. It should be in that bin. So it's about educating the everyday person on the ward about the appropriateness of their waste segregation. So we know that interventions to support accurate waste segregation have been associated with reduced cost. Cost to the organisation reduced risk to staff and patients. If you put the right things in the right buckets, it actually reduces risk to staff and patients. And as we've explained, is that if you segregate waste and it's disposed of in its the best manner possible for the type of waste it is, we're going to decrease the environmental impact. So all of those things actually make a long-term difference. So our study aims, sorry, it's pulling at my slide, to understand the impact of a midwife-led intervention to improve waste segregation and management on staff knowledge and attitudes, volume, waste volume and waste management related costs. So our study, I'll explain a little bit more about the methodology shortly, but our study was a setting in the western suburbs of Melbourne in a new hospital called the Joan Kerner Women's and Children's Hospital. It's one of the largest maternity hospitals in Australia with over 6,500 births a year. We have two postnatal wards, level seven and eight of the building you can see in front of you for the lovely rainbow-coloured building. It's beautiful. And there's two postnatal wards, excuse me, servicing 32 beds. So the study was actually done just on one of those postnatal wards, not on both. So it was one postnatal ward. So it was led by a team of, we say two to five because it changed. It was a 12 month, little bit over 12 month project. And so midwives resigned and came and left and came and all that kind of thing. There was a core feud that we named on the first slide that retained throughout the entirety of the project, but there were others that were involved at certain points throughout. So what we would say is that across the course of the 12 months, there were 19 sustainability champions. So midwives put their hand up and said, we wanna make sure we do the right thing. We wanna make sure that our waste segregation is effective and appropriate. This occurred just after the start of COVID. So the intention was for monthly education sessions, but because of COVID and lack of face-to-face sessions, et cetera, they ended up being four education sessions over the 12 months. They were instructional posters and waste preparation and disposal posters posted within the ward about what goes in which bin. Put this in here, don't put this in there, that kind of stuff. And I think we've got some images coming up next. There were monthly newsletters, detailing key waste management strategies. So every month, the small midwifery team that were championing this project would put a piece into their staff email about this month, we're focusing on Ivy Lines. This month, we're focusing on Catheters. This month, we're focusing on other things. So every month, there was something about how best to segregate the waste of the topic of the day. There were incentives to promote engagement. So we did actually do monthly incentives of, plants, for example, and I think we used public transport vouchers, et cetera, as a way of, you know, they're always green things to promote people to be champions, to push the cause we were trying to achieve. So here you can see some of the examples of the posters and slides that they used. I know it's small in your screen, but basically they stickity-taped examples of things onto posters and said this goes in the red bin or this goes in the yellow bin or this goes in the green bin, depending on what it was. And then we had the amazing, oops, sorry, I've got two screens going, let me go here. Then we had the amazing people who did the audits. So our study design was a pre and post intervention with staff knowledge surveys. We used observational waste collection audits. So we did a waste collection of 24 hours of waste segregation in the personal award at the beginning. And then the subsequent for education sessions and the monthly newsletters went out and we did two more waste audits. And you can see here our absolute champion midwives and they are midwives. They're not, you know, not anything else. They are midwives that are absolutely passionate about this who did the waste audit. So for 24 hours of waste collection, they looked at each kind of bin and whether or not the waste that was in that bin was appropriate for its type or whether it should have been allocated to a different bin. They also weighed the waste of each bin. So Vedanka will explain shortly that the outcomes of those audits but we measured them three times, pre-education, middle education at the end of education and the waste audit took account of 24 hours of waste collection. They were conducted by the same people at the same time. So the same, you know, so it was fairly consistent in the process of doing that waste audit. But yeah, anyway, you'll get to hear the amazing results we had. We also did a staff survey. So there was about 140 clinical staff on the postnatal awards at the time of the implementation of the study design. There were 59 nurses and midwives that completed the pre-intervention survey and that was about knowledge, knowledge of what items go into what kind of bin. So it was about their waste management knowledge and then post-intervention, there were 65 respondents. However, they're not the same group of people because in the hospital we work at the people that work on the postnatal award rotate. They rotate around different areas within the hospital and the study was only on the individual, one individual postnatal award. So we can't match the survey respondents but we can actually get a good sense of the knowledge, pre-intervention, post-intervention and for Duncan we'll talk more about that now. So I'm going to stop and pass over to for Duncan. Thanks, Linda. And great to be part of this presentation. Before I move on Linda, can you please drive the slides for me because I don't have the... Yep, thank you. So we'll go to... Paola, can you give the Duncan presenter access? Yep, it's done now. Yep, be done because you can see now the arrows are the border and you can... Beautiful. Yep, thank you. Okay, so these are the demographics of our survey participants. So I just want to state that there were a different group of participants pre-intervention and post-intervention. So this study was conducted smack bang at the beginning of the pandemic in 2020. So you can imagine that there was a lot of staff movement across the hospital. As Linda said, even within this project we had staff leave and then come back and at all different points. So it would have... If we had tried to capture those that were pre and post-intervention I imagine we would have had a really small sample and the results would have not been analysable. So for that reason we've got two different groups and as you can see the majority were under 35 years of age and most were midwives and nurses. However, in the post-intervention we had a doctor, some management staff and a registered undergraduate student of Midwifery complete the survey. Most were relatively new to the service so one to five years of practice. There were a few more with about six to ten years of practice and we also had a few that had been at the service for quite a while. We asked whether the participants had received waste management training when they first started at the service and only a very small number had had any waste management training when they were employed. So this question of the survey asked participants to nominate what the bins that are available on the postnatal ward relate to in terms of the type of waste that goes into it. So as you can see the red bin takes general waste and nearly all participants got that right around 90% both pre-intervention and post-intervention. For the blue bin, which is the recycling bin, again they had high amounts of participants who knew what that bin was. So there was no significant difference pre and post-intervention there and the same for the yellow bin that was referred to clinical waste and again most of the participants knew both pre and post-intervention what goes into that bin. So then we asked participants to tell us what specific items go into what bin. And the first item was a syringe used for IV or intravenous antibiotics and that goes into a sharps bin. And as you can see around 40 to 47% of participants got that right which both pre and post-intervention. So there was no difference there. A coffee cup goes into general waste around over 66% of participants got that correct. Again, there were no differences pre and post-intervention. The intravenous line goes into general waste and as you can see a lot of participants got that wrong. So about 30% got it right, both pre and post-intervention. Again, no differences but it showed that that was an area requiring intervention. So instructional posters about how to prepare IV lines for waste disposal was included along the course of intervention to help address that. Indwelling catheter goes into general waste so a lot of people did not know that. Again, no differences pre and post-intervention. Paper towel most knew that it goes into general waste and that the baby bottle goes into recycling around 70% got that correct. And as I said before, there were no significant differences between the groups pre and post-intervention. And again, that's likely because of a lot of the movement of the staff and they would have been exposed to the intervention at different time points across the year and they might have missed some focuses. So in that regard, it's limited but it did actually show our team what are the areas that they need to focus on to improve waste segregation on the ward. Okay, so then we asked participants to tell us perceived reasons for not segregating waste correctly. And most said that they didn't know what goes into what bin, time constraints, bin location, lack of interest in the effective waste disposal. And there were only a very small number of participants that felt that all staff segregate waste appropriately. And again, there were no significant differences there pre and post-intervention. Okay, then we asked participants to write their agreement on a number of statements related to waste management at the hospital in terms of regularly trying to reduce waste and practice recycling. Most participants agreed that they did make an effort to do that, both pre and post-intervention. Finding separating the waste into correct bins is easy and does not impact on time management. Most participants agreed to that to some extent but not as strongly with the previous statement. So that demonstrates that time was an issue. I'm concerned about the impact our organization has on landfill and the carbon footprint and most agreed with that statement. I would attend a training session to increase my knowledge of waste segregation. So there was some significant differences there. So pre-intervention, the majority of staff strongly agreed that they would attend training, whereas that dropped to agree post-intervention and that could be because of the pressures of the pandemic and the clinical priorities made waste segregation less of a priority and gave them less time to attend to any education because of that. We are doing enough in maternity services to minimize waste and most disagreed or strongly disagreed with that statement and same with the idea that the organization is proactive in addressing waste management. However, there was a significant change over time, more agreed post-intervention and we think that may be because of the greater visibility of the green maternity initiative across the ward. So people seeing the posters and the midwife champions around might have made them feel that the organization was starting to be more proactive about waste management as a result of that. So this is the really fantastic outcome. It's, this is the data from the observational audits of waste on the wards across the course of the intervention. So as you can see in January, the orange bar relates to clinical waste. So there was 15.7 kilos of clinical waste in January. That dropped down to 8.4 in July, so almost half. And then by the end of the intervention, the clinical waste dropped to 3.2 kilos. So that's one-fifth of the amount that was being produced at baseline, which is a huge impact. In terms of the other waste streams, so general waste and recyclable waste, there was not much of a difference between January and July. But the key aspect, oh sorry, I was looking at the wrong bar. So yeah, so in terms of general and recyclable waste, not much difference between January and July, but if we look in December, there was an increase in recyclables, which again is showing that there's been better waste segregation. So we want more of the waste to go in recyclables, and some going into general, but the least we want in clinical waste, and that's what has occurred over the course of the intervention, which is fantastic. So in terms of the cost impact, the cost of managing, so yes, I can hear you. Yeah, kind of. It's not about wanting less clinical waste per se, it's about appropriateness of the segregation, because what we're doing is we're putting too much inappropriate stuff into clinical waste that's costing the health service an awful lot more money than it should because it's been inappropriately segregated. So what we've proven is correct segregation completely reduces stuff. Sorry, back to you for Duncan. No problem, and yes, you remind me that. So the overall volume of waste did not change over the course of the intervention, and you would expect, we probably expected that there might have been more by the end because of COVID and greater mask wearing and all these additional single use items, you would expect that the volume of waste overall would have increased, but the volume did not, but the segregation was actually better. So there was a reduction in what was being put in the clinical bins as opposed to the others, which related in the cost reduction. So from January to July, the cost decreased by 30.4%. So we can't actually give you the values because the organization has a contract with the waste provider and they're not allowed to express that information. So we can only tell you by what proportion the cost reduced. And however, when we compare the cost from January to December, the cost reduced to about 50%, which is a significant cost saving to the hospitals. And you can imagine if this was rolled out across all the clinical wards on the hospital, that would amount to a large amount of money in terms of cost savings. And the major cost savings were related to that reduction in clinical waste because that is the most expensive to treat. And in terms of an environmental perspective, reducing clinical waste also reduces the environmental impact the most significantly because the stuff to treat clinical waste is so much more environmentally harmful than the other waste streams. So here are some comments that came out of the surveys. So some of the things that staff identified as issues. So one staff member said, my biggest issue with correct waste management is the layer of the ward itself. Because it is so long end to end, some days I am running back and forth and if the correct bin is not available, I can't afford the time or energy it takes to locate the correct bin. I know it sounds lazy, but the extra steps just add up. I would truly recycle more if I didn't have to go looking for the correct bins, locate scissors before cutting my IV bag. And then another staff member said, as a staff member, I find myself so conscious at home to reduce waste, but personally I struggle at work due to the huge workload and lack of desire from other staff members. We're so overworked, waste reduction is one of the last things on my mind. And a lot of midwives said that they want a culture of environmentally friendly midwives and that's what the Green Maternity Initiative really achieved. It showed that midwives are environmentally responsible and really want to make a difference within their work. But in order to do that, they need support from the organisation. So as Linda said, this was a very minimally funded project and it resulted in a really low cost in terms from the organisation in terms of big benefits for improving waste segregation and the costs to the service and the environment. And some staff indicated, or most staff indicated a key thing that they wanted more of was education to remind staff of segregation of waste and what needs to be in clinical waste versus general and recycling. Updates and refreshers and also what impact this has on the environment so they can understand the overall impact that they're having with what they're doing with their waste not only in terms of saving costs for the hospital. So in conclusion, the finance suggested that some targeted education about what items go into what bin is needed and that was really reflected in the pre-post intervention surveys where there were certain items that many of the staff still did not know what goes where. So targeting strategies to that would be helpful. The surveys from the comments from the surveys showed that the instructional signage was really valued. They really liked the signage above the bins. So when they were in front of the bins, they knew exactly what to do and what goes where. Around the bins also tools were provided such as scissors to help cut IV lines and et cetera and dispose of them correctly and ensuring each bin has access to those tools was also noted as important. Increasing visibility of the sustainability initiative was a motivator for behavior change, particularly having the midwife champions who were demonstrating best practice and really motivating staff to do the right thing was really important. So I will leave it there. Thank you so much for your time. I hope we will be able to answer some questions. We'd like to thank the Western Health Foundation who provided funding for this project and the passionate midwives who really drove this work and got it up and running and made such an impact on the ward. And there are contact details if you want to follow us. I'd also like to acknowledge Shane Crow who's Executive Director of Nursing and Midwifery. I think he actually funded the project, but that's okay. There's no drama because we're all the same-same. But the issues from what we've experienced like producing a 50% improvement created a substantial cost saving for one ward in one hospital across a place that's got 20 wards is extraordinary if you think about the way in which it could be expanded, but it requires champions. And a couple of those midwives that were on that champion group have moved to new roles. And what we understand is some of the practices have gone back to the old. So we need to think about ways about how we can sustain these kinds of changes because it benefits everybody. Thank you so much, Linda and Vidanka. It was a great presentation. So we have some comments from the audience. So someone says it's a passionate presentation. There is also a comment about, it's an important topic. I'm also interested in comparison of waste between home birth settings and hospital birth settings we'll need to compare physiological versus started perhaps a research project for someone. So... Thanks, Carrie-Ann. That comment, I did read it while Vidanka was talking. The service that we work at does have a publicly funded home birth service. And it is something we could potentially look at. But I'm not sure we have the volume to make a grand explanation or difference. But nevertheless, it's still very important. So we have another comment that says, great work. I would like to see that cost saving invested into actually reducing waste. We had one of the, oh gosh, I don't know. Vidanka, do you know what Carlos's role was? What's his professional role in the organization? So it was one of the waste management managers was a part of our team and he supervised the waste audits to make sure they were done correctly, appropriately, without minimising risk to the staff, to the midwives that did it. Yeah, Carlos was a sustainability coordinator or sort of the effect. And the organization as a whole has a number of strategies to try and reduce waste. But there's always more that can be done. And I agree, Laura, the cost savings do need to go into actually reducing waste. And that is a strategy of the hospital that we're working with in terms of their strategic plan. But it takes a lot of effort and commitment. And as this study showed, if we can fund just a small amount of time for clinicians to actually do this appropriately, it makes a big impact. So that's the message we need to be driving home to healthcare organizations is put in a bit of money into your staff and it'll pay you back in a big way. A big way. And it's not just paying you back, it's paying back the whole community because it's reducing climate change and all those sorts of things. So I absolutely agree with Juncker. A little bit of cost value in getting changed champions to get the waste segregation correct makes a huge difference in the cost to the organization but the benefit to the community. So this is a really odd ball, you know, midwifery presentation. You know, it's not something you would probably expect to see or hear at VITM. But seriously, we're presenting on behalf of an absolute passionate group of midwives that could see that they could make a difference in just the everyday things they did. And, Okay, just, Sorry. Yeah, just want to say one last thing. We have submitted this paper for publication and we're hoping that it will be published soon. So if you're interested in finding the full findings, follow us on Twitter or email us and we can keep you up updated once it is officially published. Thank you, Vidanka. We have a last comment and Carrie and sis, thank you for your work and more environmentally friendly products will be good for the future too. Completely agree. All this single use stuff is just crazy for our future. Just crazy. We need to clearly rethink a whole range of things around healthcare products and how we use them. And I've been reading a lot of work saying, maybe we need to go back to old ways of reusable items. So, you know, things that can be rewashed and reused rather than focusing on the single use stuff which are convenient and easy, but in terms of the effects of the environment will have a significant effect on all of us and we need to reduce that.