Staff at St Barts Hospital in London

UK Buildings rarely achieve their designed energy efficiency. Many organisations try to ensure their staff know how to best use their buildings, but the challenge is creating a permanent behavioural change. Operation TLC has embedded an energy-saving ethos into hospital culture by incentivising staff to ‘Turn off equipment, switch off Lights and Close doors’. The result: closed doors maintain privacy, lowered lights help patients sleep.

Improving patient care is the focus of this sophisticated behaviour change programme, first implemented at Barts Health NHS Trust in London, designed to help staff use hospital buildings as efficiently as possible. Operation TLC has embedded an energy-saving ethos into hospital culture by incentivising staff to ‘Turn off equipment, switch off Lights and Close doors’. The result: closed doors maintain privacy and lowered lights help patients sleep, while vital NHS funds are saved.

With a proven business case for action, there’s huge potential to roll out the model across the NHS, with accompanying benefits for patients, planet and the public purse.

“Operation TLC has delivered improved patient care at the core of our business whilst empowering our entire workforce to take action on energy usage and climate change. It has been a truly inspiring project and one I hope other NHS Trusts will be inspired to follow.”

Fiona Daly, Barts Health NHS Trust Environmental Manager

Impact

Phase one of Operation TLC ran from June 2012 to March 2013 in the two PFI hospitals within Barts Health NHS Trust, and phase two is running across all six Barts Health hospitals. Phase one gained the support of 35 out of 60 wards in the two targeted hospitals, and phase two will bring the remainder on board, as well as covering the other Barts Health hospitals.

Operation TLC has resulted in face-to-face interaction between GAP and about 2,500 Barts Health staff, with all 15,000 staff being reached by other forms of communication in use, and over 150 ‘champion’ staff recruited to promote the programme in their wards. Barts Health NHS Trust treats 1.4 million patients each year, all of whom will be benefitting to some degree from the impact of Operation TLC.

Social benefits

Each of the three Operation TLC actions has benefits for patients and for staff:

  • Turning equipment off when it is not required results in reduced noise levels and better temperature control, making the environment more comfortable for both patients and staff, and helping patients sleep better.
  • Turning lights out when not needed enables patients to sleep better at night and between 1pm and 3pm, when lights are dimmed and visitors only permitted in a separate room from the ward. An added benefit for staff is that the quiet periods in the afternoon allow time to catch up on administration.
  • Closing doors helps both patients and staff by lowering background noise, reducing accidental invasions of privacy, keeping rooms at the correct temperatures, and ensuring infection control measures work as designed.

Audits of staff behaviour and surveys of patients have been used to evaluate progress, and patients have responded positively to the changes resulting from Operation TLC, for example, the proportion of patients reporting disturbed sleep was 32% in TLC wards, compared to 46% in other wards.


Fiona Daly

Environmental benefits

GAP carried out a partial audit of the extent to which staff were carrying out the TLC actions, and combined this with energy modelling and metered energy use (where available) to estimate the energy savings delivered. The results so far are: 

– Audited 543 MWh electricity saved through switching off lights in staff and patient rooms. 

– Estimated 233 MWh electricity saved through switching off lights and appliances in patient areas. 

– Estimated 191 MWh electricity saved by switching off computers and lights in administration areas. 

– Estimated 297 MWh from one off actions like removing unused isolators. 

– Small amount of heat saved by keeping doors closed.

The total estimated savings are therefore 1,088 MWh/year electricity and 278 MWh/year gas, or 6.6% and 1% saving of what the energy use would have been in a ‘business as usual’ scenario. This represents a CO2 saving of over 500 tonnes/year.

Economic benefits

By reducing the Trust’s energy bills, more resources can be made available for investment in hospital services and improved patient care. The annual energy saving from the behaviour change aspects of the pilot programme was about £97,000, giving a payback of under one year. On top of this, additional annual savings of £200,000 were made due to removal of redundant equipment which enabled the cancellation of a costly maintenance contract.

How is energy-saving behaviour change encouraged?

GAP’s initial research with staff indicated that environmental issues were not a significant motivator for most of them; quality of patient care came top, followed by the working environment and saving money for the Trust. To identify opportunities for saving energy, GAP surveyed staff to find out how they were using the building, carried out audits of lights left on and doors left open in a selection of wards, and talked with staff to identify typical daily activities. This initial survey work also gave a baseline against which progress could be measured. Realising they needed to come up with a simple message to engage staff, GAP settled on “Give the building TLC and it will pay back and give patients and staff TLC in return.” The motivation for each of the TLC actions is:

  • Turn off: by turning off equipment that is not needed, the noise and temperature levels are reduced in wards, making them a more pleasant environment for patients and staff.
  • Lights out: by turning out unnecessary lights at night, and for a period after lunch, patients can get better quality sleep, and staff can use the quiet time to catch up on paperwork.
  • Close doors: closing doors reduces both noise and accidental invasions of privacy for patients, helping them sleep and feel more comfortable during their stay.

The actions taken as part of Operation TLC saved energy as well as benefitting patients. Turning lights off is an obvious saving, as is turning off equipment that is not in use, but the energy saving resulting from closing doors is related to the design of new hospitals. Wards are kept at different temperatures as required for treatment of patients, ranging from 18 to 26oC, so closing doors can reduce undesirable transfer of heated or cooled air into corridors. There are also wards kept at a slightly lower air pressure, to contain pathogens from contagious patients, and wards at higher air pressure to protect those with suppressed immune systems – keeping doors closed reduces the energy needed to maintain the required pressure difference.

Royal London Hospital new building

How much does it cost?

The first phase of Operation TLC cost about £90,000, mainly accounted for by the staff time required to deliver a face-to-face programme. This was paid by Barts Health, Skanska and GE, and funding for phase two has been secured from the Department of Health.

The future

GAP is already working with the Department of Health to roll Operation TLC out to the other hospitals in Barts Health NHS Trust as well as Frimley Park Hospital in Surrey. Furthermore, Barts Health and Skanksa have included phase three of Operation TLC in an Energy Performance Contract for the three non-PFI hospitals in the Trust, with a requirement for annual savings in excess of £60,000. The contract commits them to delivering energy savings for the Trust through technical and behavioural measures, and the resulting financial savings are used to pay the financier of the work, Sustainable Development Capital Ltd. GAP and Skanska are setting up a similar contract with Kent and Medway Partnership Trust.

GAP is also developing a platform tool to embed and scale sustainability in hospitals. 

The approach GAP has taken in designing Operation TLC, i.e. finding the right motivations for the organisation in which behaviour change is needed, is also applicable outside the health sector. Wider use of this approach could deliver significant energy and cost savings in many private and public organisations.