Sustainability
national SSD networks and suppliers. The project team gathered qualitative data from SSD managers and quantitative data from Public Health Scotland to identify surgical specialties that are likely to have the greatest impact on SSDs’ capacity and the environment. Using the data received, the project team was
able to prioritise high-impact specialties and procedures. The specialties identified through this scoping work were: Orthopaedics, Ophthalmology, General Surgery, Obstetrics and Gynaecology, and Plastic and Reconstructive Surgery. The team designed a suite of helpful
resources, including a simple, easy-to-use toolkit with implementation guidance for local departments to adopt to their specialty, allowing clinical teams to audit, review and streamline tray sets within their surgical specialty. The project team will present these innovative resources at future clinical delivery groups and plan for national roll-out of the work. It is hoped that this clinically-led approach will help to engage and ensure buy-in from clinical teams across NHS Scotland. The success of the project will depend on both clinical and SSD colleagues working collaboratively to embed the changes at both local and national levels.
Resources The toolkit is designed to be user-friendly, easily implemented and repeatable. The primary data collection tool is hosted on an excel workbook. The intelligently structured workbook allows clinicians to individually audit how frequently they use each instrument, ranging from: always used, often used, rarely used (<20%), never used. All data collected is automatically populated
onto a response sheet, enabling clinicians to quickly identify instruments that are not being used within their surgical sets for a specific procedure, thereby facilitating streamlining discussions. After the streamlined surgical set is agreed, results can be populated on to the outcome report, which automatically calculates the clinical team’s carbon savings per procedure. To support the toolkit, a user guide and other associated resources are available on a dedicated SharePoint site, accessible to all NHS Scotland staff.
What’s next The NGTP project team will leverage the extensive clinical networks established by the Centre for Sustainable Delivery to engage with every surgical specialty across NHS Scotland. These clinical networks, known as Specialty Delivery Groups, are established to support, innovate and develop high-quality services across NHS Scotland. The groups are multidisciplinary and have representation from
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all staffing groups. The project team intends to establish a network of enthusiastic and supportive colleagues to help deliver the work. Each specialty will have a colleague appointed as the lean tray steward, whose role will be to support the reporting and collation of work undertaken and to publicise and celebrate successes through the nationally available SharePoint site. To support local implementation, the lean
tray steward will coordinate with local boards to identify lean tray champions. These individuals will lead the work on the ground and report feedback and results to the lean tray stewards. Once the concept has been trialled and
refined within the identified surgical specialties, the team will make the resources available to the wider surgical specialties. The approach aims to empower local clinical teams to adopt the resources to make meaningful changes within their work environment. The purpose of utilising the SharePoint platform is to ensure the resources are readily available and kept up to date. Due to features such as access control, document management and sharing, the team aims to automate the project reporting to manage the potentially data-intensive process. This will ensure results are captured and provide assurance to the NGTP team that the implementation strategy is effective. Additionally, this web-based feature will allow for collaboration, giving colleagues the chance to learn and identify best practices from similar pieces of work conducted across the country. CSJ
References 1. NHS Scotland. Climate Emergency & Sustainability Strategy 2022-2026. Available from:
https://www.gov.scot/publications/nhs- scotland-climate-emergency-sustainability- strategy-2022-2026/documents/
2. Public Health Scotland Data. Data from PHS Discovery Site. Accessed 16/04/2024
3. Rizan, C., Lillywhite, R., Reed, M., & Bhutta, M. F. . Minimising carbon and financial costs of
steam sterilisation and packaging of reusable surgical instruments. The British Journal of Surgery, 2022, 109(2), 200–210. Accessed Feb 2025. Available at:
https://doi.org/10.1093/bjs/ znab406
4. Health Facilities Scotland. NSS. [Online]. Accessed 2024.
https://www.nss.nhs.scot/ browse/health-facilities/health-facilities- publications-and-guidance
5. Clinical Guidelines, Section 8.8, of the EW edition of Standards and Recommendations for Safe Perioperative Practice published by the Association for Perioperative Practice. March 2022. Available at:
https://www.afpp.org.uk/ wp-content/uploads/Standards-Collection- Use-and-Handling-of-Surgical-Instruments.pdf
6. Stockert E. Up to 75% of items on surgical trays are not used across many specialties. J Surg Educ. 2014;71(4):595-9.
7. Van Meter, A. Use of surgical instruments on standard surgical trays. J Clin Surg. 2016;33(2):120-5.
8. Asansino, M. Percentage of instruments utilized on surgical trays. Surg Sci. 2013;4(1):15-9.
9. Implementing Lean Surgical Trays. National Green Theatre Programme. Published online July 2024.
About the authors
Ms Lydia Robb MBChB, MRCSed, MMEd is a Plastic Surgery Trainee within NHS Scotland, currently on a year- long sabbatical to pursue the prestigious Scottish Clinical
Leadership Fellowship. During her fellowship, Lydia has been embedded within the Centre for Sustainable Delivery, where she primarily contributes to the National Green Theatres Programme. Her work focuses on driving sustainability initiatives within healthcare, with a particular emphasis on reducing the environmental impact of surgical practices.
Mr Steven Chawk is a Project Manager who has worked with the National Green Theatres Programme since its inception in early 2023. He has helped to bring clinicians, experts and
professionals together to develop actionable strategies that reduce carbon emissions across NHS Scotland.
Senalfred -
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