Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Visitor satisfaction analysis as a tool for park managers: a review and case study

Visitor satisfaction has been an important area for leisure research since the 1960s and more recently for park management. A number of approaches have been adapted from consumer research including importance-performance analyses, gap analyses, threshold performance targets and overall satisfaction. This paper reviews these approaches with respect to park management. It then draws on focus group research with protected area agency staff to obtain their views on the usefulness and robustness of the analyses associated with these approaches. Yanchep National Park (Western Australia) was used as a case study, with the results from a recent visitor survey providing the data for satisfaction analyses. To provide a more accurate summary of the range in results, confidence intervals accompanied the results to illustrate the variation in responses. The analyses emphasize the importance for park managers of accessible, usable data on visitor satisfaction