Sustainability
involved, if there is to be any lasting effect on the Net Zero target.
Aboueid and colleagues reviewed the barriers and enablers of implementing environmentally sustainable practices in healthcare.7
They
surmised, from the current literature, that barriers and enablers relating to the individual were knowledge, skills and attitude. In relation to institutions, this included budget, strategy and readiness, and geographical issues related to infrastructure and awareness. Political factors were regulations and incentives and, finally, patient awareness and knowledge was also important. They highlighted that, for the healthcare sector to implement sustainable practices, it was important to map the complexities that these facilities had to contend with. Challenges also related to issues hanging over from the COVID-19 pandemic. It was noteworthy that, throughout their work, they found a theme of key importance which was a top-down approach in successfully implementing sustainable practices across an institution. An article said to be from the UK, but unidentifiable, showed that barriers to implementation of green initiatives in the theatre were lack of leadership, perceived infection risks, lack of data, concerns about increased workload, staff attitudes and resistance to change. The same issues might be related to any change in behaviours and practices – especially if it requires a considerable effort. However, enablers for individuals were
found to be engagement, motivation, perceived benefits and continuing professional education.7 Enablers for institutions were said to be a learning organisation, budget, resources, staff, transformational and supportive leadership, resilience, buy-in from key stakeholders, reporting and monitoring systems, performance systems, waste management system, resilience, internal protocols, dedicated personnel, learning from other hospitals, action alerts and policy statements. From this long list, it can be seen that the whole institution has to be on message and that support needs to exist across the board. A recurring theme was also found that the onus should not be on the health professionals, but on the institution they work in, to make a practice successful and that the hospital should empower environmentally sustainable practices to become second nature. Clinical practice guidelines also need to reflect sound environmental practice.
Education and training The surgical workforce needs to be supported in its educational needs by the addition of
theoretical knowledge on the environmental impacts of surgery and the principles of sustainable practice to support their ability to drive change.7 Online training is available through the Centre for Sustainable Healthcare, as well as NHS England. Useful resources are also available via the Greener NHS Knowledge hub on the Future NHS Collaboration Platform. The Intercollegiate Green Theatre List is a very helpful list of recommendations developed by four surgical Royal Colleges, separated into sections to reflect the surgical pathway, which could be used as a checklist for teams wishing to make progress along a more sustainable route.8 Clinical ideas for developing sustainable
theatre and surgical practices will be covered by the next in the series of articles.
References 1. Green Surgery – reducing the environmental impact of surgical care. 2023 Accessed at:
https://sustainablehealthcare.org.uk/ news/2023/11/csh-contributed-new-green- surgery-report-setting-groundwork-reducing- carbon-footprint
2. Health Care Without Harm. Health care’s climate footprint: climate-smart health care series green paper number one. 2019. Accessed at:
https://noharm-global.org/ sites/default/files/documents-files/5961/ HealthCaresClimateFootprint_092319.pdf
CSJ
3. ‘Green surgery report’, Brighton & Sussex Medical School, Centre for Sustainable Healthcare, and UK Health Alliance on Climate Change (2023). Green surgery: Reducing the environmental impact of surgical care. London: UKHACC.
https://ukhealthalliance.org/ sustainable-healthcare/green-surgery-report/
4. Ibid 5. Rizan C Reed M, Mortimer F et al 2020. Using surgical sustainability principles to improve planetary health and optimise surgical services following the COVID-19 pandemic. Accessed at:
https://publishing.rcseng.ac.uk/doi/ epdf/10.1308/rcsbull.2020.148
6. NHS England Net Zero Building Standard 2023. Accessed at NHS England. Accessed at: https://
www.england.nhs.uk/publication/nhs-net-zero- building-standard/
7. Aboueid S, Beyene M, and Nur T 2023, Barriers and enablers to implementing sustainable practices in healthcare: a scoping review and proposed roadmap. Accessed at:
https://journals.sagepub.com/doi/ epub/10.1177/08404704231183601
8. Royal College of Surgeons Edinburgh, Royal College of Surgeons England, Royal College of Physicians & Surgeons of Glasgow and Royal College of Surgeons in Ireland.2022. Green Theatre Checklist. Accessed at: https://www.
rcsed.ac.uk/professional-support-development- resources/environmental-sustainability-and- surgery/green-theatre-checklist
June 2024 I
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