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

Abstract 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

Accountability in Street-Level Organizations Accountability in Street-Level Bureaucracies Brodkin

Abstract: The challenge of managing street-level discretion lies at the heart of the search for strategies of administrative oversight and control. How can management promote accountability without deadening responsiveness and undermining the application of professional judgment on which management also depends? This article reconsiders the problem of accountability from a street-level perspective. First, it reviews the literature on implementation, street-level bureaucracy, and new public management in order to raise questions about the limitations of current approaches to accountability, including new public management solutions that rely on performance measurement. Second, it makes the case for a street-level approach to accountability and illustrates how it can be used to reveal critical dimensions of organizational practice that are not captured by other means. Finally, issues of street-level practice are placed in broader perspective, as part of an on-going global search for ways to advance transparency and accountability in social provision. Keywords: accountability, performance measurement, public management, streetlevel bureaucracy Accountability is an essential requirement of public management in the democratic state. Yet, all too often, bureaucratic discretion is the nemesis of accountability. The challenge of managing street-level discretion lies at the heart of the continuing search for strategies of administrative oversight and control that can promote accountability without deadening responsiveness and undermining the application of professional judgment on which management also depends. In the case of social welfare agencies, where discretion is a necessary and even desirable part of the caseworker-client interaction, public managemen

Managing asylum: Street-Level Organizations and Refugee Crises

In 2015 the so-called “European refugee crisis” began to put advanced democratic states to the test. How would they manage millions of asylum-seekers living within their borders–in the state, but not yet of the state? This article interrogates what it means to manage asylum, focusing on street-level organizations at the interface between asylum-seekers and the state.</p

Accessing the Safety Net: Administrative Barriers to Public Benefits in Metropolitan Chicago

Accessing the Safety Net is a report of the Public Benefits Hotline Research Project. It presents a portrait of a year in the life of the public benefits system in metropolitan Chicago (Cook County) from the perspective of individuals trying to navigate within it. It analyzes the record of calls made to the Public Benefits Hotline by area residents reporting difficulties in obtaining access to benefits. It reveals systematic difficulties that Chicago-area residents have experienced in accessing safety-net programs. The record of calls also illuminates some of the rarely seen day-today realities of a complex administrative system at work