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

First you have to get outside:reflections on the ecological location of qualitative fieldwork

Most methodology books do not explain how nature—or in the author’s case, heavy wet snow and swampy muskeg—can be an intrinsic part of a qualitative research design. Yet the author’s inability to make sense of the subarctic not only limited her preliminary qualitative analysis, but this lack of skill also nearly killed her. This article describes the author’s emergent belief that first-hand situated knowledge of the local ecology is an essential requirement of effective qualitative inquiry in social—ecological contexts. The author uses data from two ethnographic studies that were published in the Academy of Management Journal (2000) and Organization & Environment (2004) to illustrate this point. She discusses how the local ecology affected her qualitative research design in terms of access, type of data collected, and interpretation of local management practices. The author closes by calling for a renaturing of qualitative inquiry especially as it relates to research on sustainability