GoGREEN: REDUCING THE ENVIRONMENTAL IMPACT OF OPERATING THEATRES - A BEHAVIOURAL SCIENCE APPROACH

NHS contributes substantially to the UK's carbon footprint, accounting for 4% of England's total carbon footprint. Operating theatres are shown to be three to six times more energy-intensive than the rest of the hospital and a major contributor of waste. The aim of this research is to identify possibilities for behaviour change in UK hospitals to reduce the environmental impact of operating theatres practices.

Recent research and pro-environmental initiatives have proposed practical guidelines to minimise environmental impact in operating theatres such as reduction of anaesthetic gas (e.g., using local anaesthetic instead of general anaesthetic), rationalising surgical instruments (e.g., streamlining surgical instrument trays) and opting for reusable products and equipment (e.g., reusable gowns and tools instead of disposable ones). However, many of the proposed solutions overlook the behavioural factors that are crucial in the implementation process. This is evidence in practice, where sustainability champions in UK hospitals report on slow adoption of these and similar green surgery guidelines.

While surgeons and other theatre staff are aware and concerned about environmental waste and climate crisis, many report significant challenges in implementing pro-environmental behaviours in their practice, and there is a well-known gap between environmental intentions and pro-environmental behaviours of individuals. Therefore, understanding how theatre staff can be empowered to adopt green surgery procedures is critical for the net-zero transition of healthcare systems.

In this project, we will work closely with surgeons, other theatre staff and the broader stakeholders at Imperial NHS Trust hospitals to identify the most important facilitators of and barriers to the adoption of green surgery principles and practices in operating theatres. With these insights, we will co-design interventions for behaviour change for the surgery pathway with the highest plausible environmental benefits, and that can help to close the gap between environmental intentions and pro-environmental behaviour in operating theatres. We will employ insights of environmental psychology, behavioural science and human-centred design principles to propose a package of interventions that will be used to facilitate the implementation of environmental guidelines in surgery.

NHS contributes substantially to the UK's carbon footprint. Operating theatres (OTs) are shown to be three to six times more energy-intensive than the rest of the hospital and a major contributor of waste. Pro-environmental initiatives have proposed practical guidelines to minimise environmental impact in OTs such as reduction of anaesthetic gas, rationalising surgical instruments and opting for reusable products. However, many of the proposed environmental solutions overlook the behavioural factors that are crucial in the implementation process. This is evidenced in the low adoption of these and similar green surgery guidelines in practice.

The aim of this project is to empower theatre staff in the UK to reduce the environmental impact of surgery practices whilst ensuring patient safety. The work will be realised through three work packages in collaboration with Imperial NHS Trust hospitals, Centre for Sustainable Healthcare, Royal College of Surgeons and Imperial's Institute for Global Health Innovation, across one year, addressing the following objectives: 1. to establish evidence-based guidelines for green surgery by systematically reviewing current literature and guidelines for sustainable healthcare and green surgery. 2. to identify the barriers to and facilitators of implementing green surgery guidelines through a combination of survey (in the UK) and in-depth interviews with surgery stakeholders at Imperial Trust hospitals. 3. to co-design interventions for pro-environmental behaviour in the operating theatre or within the surgical pathway with stakeholders through iterative design workshops.

Guided by a participatory design approach, the project will use the Behaviour Change Wheel process (Michie et al., 2011), which includes the Capability Opportunity Motivation - Behaviour model (COM-B). This will enable an understanding of the underlying individual, social and contextual factors driving the targeted pro-environmental behaviours.