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

The Moderating Effect of Environmental Uncertainty on New Product Development and Time Efficiency*

This empirical study examines the influence of environmental uncertainty on industrial product innovation. The present study addresses what is believed to be a shortcoming in the new product development literature and explores potential effects of environmental uncertainty on the development process, project organization, and on project timeliness with a sample of development projects in two countries, Canada and Australia. When looking at the combined sample of 182 completed projects, this study finds that the perceived market-related project environment has a direct and positive impact on time efficiency. Further, this research finds that a higher degree of technological uncertainty moderates the relationship between development process, project organization and time efficiency. Consequently, innovating companies may benefit by adapting some of their development approaches to different environmental conditions and to varying degrees of uncertainty. However, when examining country-specific effects, the results change quite significantly. In particular, the findings indicate that environmental uncertainty in the Canadian sample neither directly impacts time efficiency, nor does it have any moderating effect. Instead, technical proficiency in the development process, project team organization, and process compression appear to be viable strategies to increase time-efficient development. In contrast, the results of the Australian study suggest that perceived market and technological uncertainty impact time efficiency. In particular, under conditions of technological unpredictability, project team organization increases time efficiency, whereas process compression appears to decrease time-efficient product development. However, process compression seems to be a viable strategy in environments characterized by lower technological uncertainty. The results also point to the importance of disaggregating data when studying product development processes across countries

Perceived environmental uncertainty; PEU; REF 2014

NoAn important contribution to the literature on perceived environmental uncertainty (PEU) is Milliken’s distinction between state uncertainty, effect uncertainty, and response uncertainty. However, despite its appealing logic in capturing the types of uncertainty managers may experience as they seek to understand and respond to changes in an organization’s environment, there has been no full and rigorous psychometric development and testing of scales to measure the three constructs. Using a two-phase empirical study, this research seeks to develop and test such scales in terms of dimensionality, reliability, and validity (including nomological validity). The results suggest that managers do make a meaningful distinction between different types of uncertainty, that it is worthwhile measuring all three constructs (as they have differential impacts on outcome variables), and that there are linkages between them. Managerial contributions and implications for future research are also discussed