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

Habilidades gerenciais na administração de centros de desenvolvimento infantil na cidade de Tena, Equador

La gestión abarca el proceso administrativo, estrategia, y habilidades gerenciales, impulsando la eficacia y el rendimiento empresarial. El objetivo consistió en identificar las habilidades gerenciales indispensables para una eficiente gestión de los centros de desarrollo infantil en la ciudad de Tena, Ecuador. La metodología se caracterizó por ser cuantitativa, no experimental, alcance descriptivo, transversal y método analítico-sintético. La muestra fue de 30 Coordinadores. Se ocupó un cuestionario con una escala de Likert. Los resultados muestran la caracterización de Coordinadores que el 90% son mujeres, el 96,7% tienen tercer nivel educativo, el 43,3% con más de 10 años de experiencia y el 76,7% son Licenciados en Educación Inicial. Las habilidades gerenciales predominan en competencias competentes y avanzadas, pero áreas en desarrollo sugieren oportunidades. La gestión de centros de desarrollo infantil destaca experiencia (56,7% más de 6 años), alta competencia en planificación (60%), evaluación mixta en relaciones (53,3%) y competencia media-alta en políticas y bienestar (53,3%). Correlaciones entre habilidades gerenciales y gestión muestran que mayor competencia se relaciona con mejor gestión. Se concluye que, la aplicación de habilidades gerenciales en la gestión de centros de desarrollo infantil es esencial para garantizar la calidad de la educación y el cuidado brindado a los niños.Management encompasses the administrative process, strategy, and managerial skills, driving business efficiency and performance. The objective was to identify the managerial skills that are indispensable for the efficient management of child development centers in the city of Tena, Ecuador. The methodology was quantitative, non-experimental, descriptive, cross-sectional, and analytical-synthetic. The sample consisted of 30 Coordinators. The instrument utilized was a Likert-scale questionnaire. The results depict the characterization of Coordinators, with 90% being women, 96,7% holding a tertiary education degree, 43,3% possessing over 10 years of experience, and 76,7% being Licensed in Early Childhood Education. Managerial skills prevail with competent and advanced competencies, yet areas under development suggest opportunities. The management of child development centers highlights experience (56,7% with over 6 years), high competence in planning (60%), mixed evaluation in relationships (53,3%), and medium-high competence in policies and well-being (53,3%). Correlations between managerial skills and management reveal that higher competency relates to better management. It is concluded that the application of managerial skills in the management of Child Development Centers is essential to ensure the quality of education and care provided to children.A gestão abrange o processo administrativo, a estratégia e as habilidades gerenciais, impulsionando a eficiência e o desempenho dos negócios. O objetivo foi identificar as habilidades gerenciais indispensáveis para a gestão eficiente de centros de desenvolvimento infantil na cidade de Tena, Equador. A metodologia foi quantitativa, não experimental, descritiva, transversal e analítico-sintética. A amostra foi composta por 30 coordenadores. Foi utilizado um questionário com escala Likert. Os resultados mostram que 90% dos coordenadores são mulheres, 96,7% têm o terceiro grau completo, 43,3% têm mais de 10 anos de experiência e 76,7% são formados em educação infantil. As habilidades gerenciais predominam nas competências competentes e avançadas, mas as áreas em desenvolvimento sugerem oportunidades. A gestão de centros de desenvolvimento infantil destaca a experiência (56,7% mais de 6 anos), a alta competência em planejamento (60%), a avaliação mista em relacionamentos (53,3%) e a competência média-alta em política e bem-estar (53,3%). As correlações entre habilidades gerenciais e gerenciamento mostram que uma competência mais alta está relacionada a um melhor gerenciamento. Conclui-se que a aplicação de habilidades gerenciais na gestão de centros de desenvolvimento infantil é essencial para garantir a qualidade da educação e do cuidado oferecidos às crianças