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

Ethical Subjectivity and Politics in Organizations: A Case of Health Care Tendering.

This paper examines the relationship between ethics and politics in organizations with a specific focus on ethical subjectivity - that is, how people at work constitute themselves as subjects in relation to both their conduct and their sense of ethical responsibility to others. To investigate this we consider those ethics that were politically mobilized when five clinical partners tendered to buy out the medical practice in which they worked. We provide a detailed reading of a letter of complaint written by one of the partners and sent to their employer - a letter we consider to be a deliberate, political, ethically motivated and overt act of resistance. Drawing on the ethical philosophy of Emmanuel Levinas we argue that the practice of ethics is characterized by a tension where ethical commitments and realpolitik come crashing together. The implication we draw from this is that in organizations the ethical subject is always a political subject; the one who takes action in response to the call of the ethical demand. It is answering the call to political action by the ethical subject - a subject prepared to act in response to the experience of injustice while not resting easy on their own ethical righteousness - that provides an affirmative possibility for researching and theorizing ethics within a critical framework.21 page(s