Maximising environmental sustainability on the return to in-person conferencing: Report from a 2500-person anaesthesia meeting in Sydney,Australia

Abstract

The COVID-19 pandemic disrupted medical conferences, where restrictions on public gatherings resulted in the postponement or cancellation of in-person meetings. Virtual events emerged as a substitute, providing a mechanism for scientific collaboration and continuing medical education with the additional benefit of low environmental impact. However, digital events may not meet all the needs of delegates, such as professional networking and social connection. In this report, we describe the methods used to minimise the carbon footprint of the 2023 Australian and New Zealand College of Anaesthetists’ Annual Scientific Meeting, a conference with approximately 2000 in-person and 500 virtual delegates. A core group led the initiative, with all conference participants invited to contribute to this goal. A prospective prediction of carbon generation was undertaken, followed by the implementation of strategies to minimise and then measure the total carbon footprint of the event. Post-event calculations assessed the conference as better than carbon-neutral; however, delegate travel was not included in the analysis and therefore this result is tempered. Off-site workshops including virtual offerings were also not included in the analysis. We encourage medical conference organisers to collaborate with all stakeholders to embed low carbon-generation choices for their meetings where education, networking and social needs are also met.

Introduction

Healthcare delivery has a significant impact on the environment, responsible for 7% of Australia’s total carbon footprint ¹ and for 3–8% of New Zealand’s total greenhouse gas emissions. ² Environmental sustainability has been identified as a key issue for anaesthetists in many countries,^{3 –5} and in recent years there have been multiple initiatives to reduce the environmental impact of anaesthesia.^6,7

Healthcare conferences contribute to the environmental impact of medicine with carbon emissions, waste, and resource usage. Over recent years there has been a shift towards more sustainable conferencing, with guidance for meeting organisers coming from many sources, including medical colleges ⁸ and major international organisations. ⁹ Virtual conferences have been shown to generate up to 100 times fewer carbon dioxide emissions than in-person meetings. ¹⁰ During the COVID-19 pandemic, gathering restrictions saw virtual conferences flourish. However, despite their popularity, feelings of interpersonal connectedness that are necessary for well-functioning teams are negatively impacted by physical isolation, ¹¹ with significant loneliness and psychological distress reported in healthcare workers isolated from peers. ¹² Virtual meetings also have the additional challenges of requiring high-end technological prowess, timely access to technology support, time zone navigation, lack of social interaction and the blurring of work and home life.^13,14 Virtual medical conferences may also fail to facilitate scientific engagement and participation, with fewer abstract submissions when compared with in-person meetings. ¹⁵ Emergence from the COVID-19 pandemic has provided the opportunity to re-imagine the medical conference as a hybrid gathering, with both virtual and in-person components, to capitalise on the benefits and minimise the negatives of each format.

Here, the framework that was used for the recent post-COVID-19 return to an in-person meeting of anaesthetists and pain medicine physicians—the Australian and New Zealand College of Anaesthetists’ (ANZCA) Annual Scientific Meeting (ASM)—is described. The organisers aimed to maximise the interpersonal engagement and scientific connectedness that in-person conferencing allows, while minimising the environmental impact. The approach to this was systematic, led by a core sustainability team, and invited all participants to be involved. Post-event analysis was performed to inform future improvement. This manuscript is a supplementary piece to a corporate social responsibility report by the International Convention Centre (ICC) Sydney, which is provided as Supplementary material online. ¹⁶

Delivering a hybrid conference

The 2023 ASM consisted of a five-day program, comprising a total of 183 scientific, education and workshop sessions and 13 social activities. Over previous years, COVID-19 restrictions forced changes to the ANZCA ASMs: in 2020 (cancellation), 2021 (a hybrid meeting with limited in-person registrants) and 2022 (a virtual-only meeting). With the lifting of COVID-19 gathering restrictions the 2023 ASM was planned to return to an in-person conference. Delegate surveys from previous years indicated that virtual conferencing was preferred by some because of the environmental burden of travel, inability to access employment leave and ongoing caring responsibilities. Based on these survey results a virtual option was provided.

The provision of a high-quality virtual meeting over several days, with multiple concurrent sessions, comes with logistical challenges and significant costs. A hybrid (i.e. in-person plus virtual) meeting carries the organisational and financial burden of both methods of delivery. To constrain costs and ensure quality, only the whole-of-conference plenary sessions were streamed in real-time to virtual delegates (559 in total). All other scientific sessions were produced for online viewing after the meeting and made available for viewing to all registrants from one week after the event for a year. In order to improve engagement for virtual delegates, six virtual workshops were provided. They included a Can’t Intubate, Can’t Oxygenate workshop where participants had airway equipment posted to them in preparation for the session, modelled on a previously described workshop. ¹⁷ Recognising the value of environmental education for our delegates, there were six scientific and workshop sessions on the topic of environmental sustainability, of a total of 21 sessions addressing the broader definition of sustainability, which includes human and social health (such as diversity, equity and inclusion) as well as ecological health.

Although most presentations were delivered live and in-person, several international speakers elected to contribute virtually (13 of 175 presentations). To safeguard against disruptions in live transmission and to minimise time zone challenges, virtual presentations were pre-recorded by a production company and played to a live audience. This allowed for near-seamless integration of online presenters into sessions. Virtual speakers were available through a video connection for a live discussion with other in-person panellists and the audience at the end of each session.

Venue

When selecting the ICC Sydney as the meeting venue, considerations included capacity, cost and proximity to public transport and accommodation options. Emphasis was also placed on the environmental credentials of the venue and the willingness to achieve shared sustainability goals. The ICC Sydney met these criteria, being part of the first Green Precinct in the world to be awarded six stars under the Green Building Council of Australia’s Green Star Communities certification. Key sustainability elements of the venue include rainwater collection from the roof (providing all the irrigation demands and 63% of toilet flushing demands); the largest photovoltaic array in any Australian central business district, producing 545 MWh/year (enough to power 100 homes, and providing for 5% of the baseline energy for the building); and highly efficient energy, water and waste facilities. ¹⁸

In partnership with the ICC Sydney, which utilised carbon estimator tools developed by the Exhibition and Event Association Australasia, a sustainability action plan was created, including a baseline assessment of the projected carbon footprint of all elements of the meeting. ¹⁶ Pre- and post-event carbon footprint analyses took into consideration the event duration and size, food and beverage arrangements, estimated energy consumption, waste generation, and staging. This allowed for informed decision-making to minimise the environmental impact of each element of the meeting.

Catering

The conference included morning tea, lunch and afternoon tea for the 1995 in-person delegates. Where possible, ingredients were sourced locally and prepared in-house to minimise transport costs. Low carbon-impact menu options were selected, including one vegetarian day (‘meat-free Monday’). Post-event analysis demonstrated a saving of 62 tonnes of carbon dioxide equivalent (t CO₂e) compared with typical catering for similar events. ¹⁶

All meals and drinks were served on reusable dinnerware. Participants were encouraged to bring their own reusable coffee cups and water bottles. We did not supply single-use plastic water bottles, saving an estimated 14,600 of them. ¹⁶ Washing and water stations were provided for delegates to clean and fill their cups and bottles.

Low-environmental impact communication

Minimisation of printing

No registration brochures, handbooks or pocket programs were printed. Instead, conference information was provided on a digital platform via the ANZCA website and on a mobile app. The app also provided an interactive platform to engage with other delegates, healthcare industry representatives, and with chairs and speakers during sessions.

Promotional merchandise was avoided, instead using existing digital channels. The one exception was the commissioning of branded cloth operating theatre hats, meant to encourage the wearing of reusable theatre attire by anaesthetists, rather than using the disposable theatre hats provided by hospitals. Hats were made in Australia and contained a tag with a QR code linking to a newly curated ANZCA library guide containing evidence in favour of cloth hat use in operating theatres. This guide also included tips to assist delegates with making the sometimes-resisted change to reusable hats in their hospitals. ⁸

At the venue, digital signage was employed where possible, which had the added advantage of up-to-date accuracy. One exception was two large fabric wayfinding banners which were recycled into mattress fillers. Furthermore, scientific posters were displayed in an electronic-only format, obviating the need for presenters to produce and transport a printed poster.

Name badges and speaker gifts

Although eliminating delegate name badges was considered, it was considered that name badges would help delegates make and re-establish connections after a four-year conference hiatus. The components of name badges were chosen to balance environmental impact and the need to fulfil ticketing, identification and security functions. Dedicated recycling stations for them were provided for waste separation and recycling. Implementing this waste stream is estimated to have diverted at least 1520 lanyards from landfill. ¹⁶ In order to reinforce our commitment to the broader issue of human and social sustainability, a donation of AUD10,000 was made to Lifebox ANZ in lieu of physical speaker gifts. This donation was used to purchase 40 pulse oximeters for use in Laos (personal correspondence).

Room utilisation, waste production and healthcare industry

By using smarter scheduling, room utilisation efficiency was improved, allowing for a reduction in the use of floor space by 1600 m², thereby reducing total energy requirements. The entire event produced 2.54 t of waste, with a landfill diversion rate of 62%. The healthcare industry supported the conference with 47 exhibitors in the trade and catering hall. By establishing sustainability criteria for exhibitors including the elimination of typical non-sustainable signage, only 0.78 t of the total waste generated originated from the healthcare industry, with a landfill diversion rate of 31%. ¹⁶

Carbon footprint

The ICC Sydney worked with the Exhibition and Event Association of Australasia to estimate the carbon footprint of the event. All greenhouse gas sources from the venue were included in the assessment. This included transport of items, average utility use, food consumption and waste management. ¹⁶ The carbon cost of workshops held off-site, including the virtual workshops, was not included in the footprint estimation.

In the pre-event planning phase, it was predicted that with typical choices the conference would have a total carbon footprint of 369.03 t CO₂e. Post-event analysis indicated that with the adjustments in catering, waste, and room use, the total carbon footprint of the meeting was reduced by 136.18 t CO₂e to an estimated 232.85 t CO₂e. Although not achieved through carbon reduction efforts by the organisers, the carbon footprint of the meeting was offset by delegates, who were offered the option to purchase carbon credits with their event registration at a cost of AUD2 per day. Forty-three percent of delegates chose to offset the carbon cost of their attendance at the conference in this way, totalling 301.75 t CO₂e. With the inclusion of these carbon credits, the final carbon footprint of the on-site meeting itself was –68.89 t CO₂e. While this appears to represent a better than net zero carbon result, it does not include delegate travel and accommodation.

Travel: the ‘Jumbo’ (jet) in the room

Delegates and faculty travelled from across New South Wales (NSW), Australia, New Zealand and the rest of the world to attend the meeting in Sydney. Although registration addresses were collected, no data on travel and accommodation were available for the 1995 in-person delegates. Participants were encouraged to carbon-offset flights with their carrier, and flights booked via the ANZCA travel provider are offset annually.

However, due to limited information available, it was not possible to make an accurate assessment of the total carbon cost of travel to the meeting. Nonetheless, some estimates can be made that at least give an impression about this cost. The largest delegate cohort from beyond NSW travelled from neighbouring Victoria (356 delegates). Flights for this group are estimated to have generated approximately 50 t CO₂e, assuming all flew from Melbourne to Sydney, in economy class, and without carbon offsets. Further afield, flights for the 207 delegates from New Zealand would have generated approximately 60 t CO₂e, and those for the 14 UK delegates an estimated 30 t CO₂e. ¹⁹ Obviously, this impact further increases when a travel class higher than economy is selected as the number of passengers is not maximised for the space available. It is therefore easy to understand that the impact of travel negates the majority of the 68.89 t CO₂e saved over the rest of the conference, and that efforts to decrease the carbon footprint are meaningful, but small compared with the impact of travel.

Future improvements

Although the meeting elements directly under the organisers’ control were reasonably well covered by our analysis, an accurate assessment of the carbon cost of travel was the most impactful omission. Future conference organisers should consider accounting for this and encouraging their delegates to travel lightly.

A point of contention was the use of plastic pockets for the delegates’ name badges. Despite rigorous negotiations, this could not be overcome owing to several logistical barriers. As a compromise, the plastic was treated to enhance biodegradation. In the future, further discussions with registration providers and industry could provide a creative solution to this.

Whilst the use of venue floor space was reduced from our initial plan, methods of energy minimisation such as more efficient air conditioning temperatures and automatic shutdown of air conditioning and lighting in unused areas could have been further explored.

Conclusion

The environmental impact of an in-person medical conference was reduced by the use of a systematic team-based approach where lower-impact choices were made in all stages of planning and delivery. We believe that the use of such an approach can minimise environmental impact while still fulfilling delegate needs such as personal connection, scientific collaboration and education, which can be difficult to achieve online.

Supplemental Material

sj-pdf-1-aic-10.1177_0310057X241264576 - Supplemental material for Maximising environmental sustainability on the return to in-person conferencing: Report from a 2500-person anaesthesia meeting in Sydney, Australia

Supplemental material, sj-pdf-1-aic-10.1177_0310057X241264576 for Maximising environmental sustainability on the return to in-person conferencing: Report from a 2500-person anaesthesia meeting in Sydney, Australia by Fran Lalor, Shanel L Cameron, Tanya Selak and Stefan JM Dieleman in Anaesthesia and Intensive Care