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

Do moral emotions make people responsible consumers ? ::a preliminary investigation of incidental guilt and shame

In nowadays consumption-based society, products (e.g. food and electronic products) are often thrown away before they are sufficiently used. The aversive consequence of such a lifestyle is becoming more alarming. There is an urgent need for a change in people’s consumption style. How can we make people correct their existing wasteful consumption behaviors and act responsibly? In fact, feelings very often can influence people’s behavior and judgments (Schwarz, 1990), even though the feelings are aroused by irrelevant sources - incidental emotion (Garg, Inman, & Mittal, 2005; Lerner & Keltner, 2000; Schwarz & Clore, 1983). Feelings of guilt and shame are known as moral emotions which are the guidance to ethical behaviors (Tangney, 1991, 2003). Although there is a significant overlapping between these two emotions, they also differ in several important aspects. One critical difference lies in the way the transgressor makes attributions (Niedenthal, Tangney, & Gavanski 1994). A transgressor who attributes the wrongdoing to a specific behavior (i.e. “I’ve done something bad”) is more likely to experience guilt while a transgressor who makes attribution to the global self (i.e. “I’m a terrible person”) is more likely to experience shame (Tracy & Robins, 2004). Given these fundamental differences, we speculate that a guilt-laden consumer is more likely to correct his or her wrongdoing (i.e. wastage) by taking reparative actions to minimize waste but a shame-laden consumer may possibly give up doing so. Findings from an experimental study (N=90) largely support this prediction. Undergraduate students who were made to feel shame were less likely to participate in a recycling campaign organized by the university than the students in the control condition. They reported a lower intention to use recycling facilities provided. On the other hand, participants who were made to feel guilt reported a marginally higher intention to participate in the campaign than the control participants. These preliminary findings suggest that emotional experience derived from other life domains might determine responsible consumption behaviors. Shame, which is commonly regarded as a moral emotion, may not necessarily make people more responsible consumers. The mechanism that underlies this effect may warrant further investigation

Customer Relationship Management and Firm Performance: The Mediating Role of Business Strategy

As managers and academics increasingly raise issues about the real value of CRM, the authors question its direct and unconditional performance effect. The study advances research on CRM by investigating the role of critical mechanisms underlying the CRM-performance link. Drawing from the sources → positions → performance framework, the authors build a research model in which two strategic postures of firms – differentiation and cost leadership – mediate the effect of CRM on firm performance. This investigation also contributes to the literature by drawing attention to the differential impact of CRM in diverse industry environments. The study analyzes data from in-depth field interviews and a large-scale, cross-industry survey, and results reveal that CRM does not affect firm performance directly. Rather, the CRM-performance link is fully mediated by differentiation and cost leadership. In addition, CRM’s impact on differentiation is greater when industry commoditization is high. Full text PDF available online