Examining the uptake of low-carbon approaches within the healthcare sector: case studies from the National Health Service in England

The National Health Service (NHS) in the UK, is one of the largest organisations in Europe and indeed the world. It therefore has a significant ecological footprint. As a result there are key corporate, financial and environmental targets that the organisation is expected to meet as a means of reducing resource consumption. Using a case study approach, this manuscript examines best practice examples for the uptake of low-carbon strategies for energy conservation. These strategies included sustainable procurement, use of renewable energy technologies, supply chain management, use of building management systems, renegotiating energy contracts, undertaking energy audits, and behaviour change, to realise significant financial, as well as energy and carbon savings. A key focus was management of water resources, including the use of recycling and recovery of heat. The implications of the findings for building ecological and financial resilience within the organisation are also discussed

Strategic management of waste and resources in health and social care

The health and social care sector in the UK faces a number of overarching headwinds in the short and medium term. These include, but are not limited to the National Health Service (NHS) meeting efficiency savings, shifts in the point of provision of healthcare services, an ageing population, managing pandemics and epidemics, changes in the types of diseases and their patterns, stricter health and environmental compliance targets and the incorporation of technology into service delivery. However, two key issues currently dominate and look set to do so going forward in the coming months and years, namely, meeting large efficiency savings (Pym, 2016) and Brexit. These factors will not only have a significant impact upon the delivery of healthcare services, but also wider with respect to the delivery of the associated services (e.g. environmental management)

Understanding the perceptions, roles and interactions of stakeholder networks managing health-care waste: a case study of the Gaza Strip

The sustainable management of waste requires a holistic approach involving a range of stakeholders. What is often difficult is to understand the manner in which different networks, like information and interaction, are composed and work, and to enhance their effectiveness. Using social network analysis and stakeholder analysis of healthcare waste management stakeholders in the case study region of the Gaza Strip, this study aimed to understand and examine the manner in which the networks functioned. The Ministry of Health was found to be the most important stakeholder, followed by municipalities and solid waste management councils. Some international agencies were also mentioned, with specific roles, while other local institutions had a limited influence. Finally health-care facilities had a high interested in waste management, but were poorly informed and linked each other. The manner in which the network operated was complicated and influenced by differences in perception, sharing of information, access to finance and levels of awareness. In particular the lack of a clear legal framework generated various mistakes about roles and responsibilities in the system, and evidently regulation was not an effective driver for improvement. Finally stakeholders had different priorities according to the waste management phases they were involved into, however segregation at the source was identified as a key requirement. Areas for improving the effectiveness of the networks are suggested. The analysis utilized an innovative methodology, which involved a large number of stakeholders. Such an approach raised interest and awareness at different levels (public authorities, health providers, supporting actors, others), and stimulated the discussion about the adoption of specific policies, and the identification of the effective way forward

Costs associated with the management of waste from healthcare facilities: an analysis at national and site level

Given rising spend on the provision of healthcare services, the sustainable management of waste from healthcare facilities is increasingly becoming a focus as a means of reducing public health risks and financial costs. Using data on per capita healthcare spend at the national level, as well as a case study of a hospital in Italy, this study examined the relationship between trends in waste generation and the associated costs of managing the waste. At the national level, healthcare spend as a percentage of gross domestic product positively correlated with waste arisings. At the site level, waste generation and type were linked to department type and clinical performance, with the top three highest generating departments of hazardous healthcare waste being anaesthetics (5.96 kg day-1 bed-1), paediatric and intensive care (3.37 kg day-1 bed-1) and gastroenterology-digestive endoscopy (3.09 kg day-1 bed-1). Annual overall waste management costs were $US5,079,191, or approximately$US2.36 kg-1, with the management of the hazardous fraction of the waste being highest at $US3,707,939. In Italy, reduction in both waste arisings and the associated costs could be realised through various means, including improved waste segregation, and linking the TARI tax to waste generation

Understanding student engagement with social entrepreneurship: a case study of the University of Northampton

The development of skills for social enterprise is a key learning outcome in UK higher education. Using semi-structured interviews and questionnaires with students at the University of Northampton, this study aimed to examine the key factors that impacted upon student engagement with social entrepreneurship. The study showed that while levels of engagement were generally low, there were significant opportunities to improve these levels. A range of psycho-sociological factors (e.g. behavioural intentions, fears of debt, and awareness), as well as socio-demographic factors (e.g. gender), were found to have impacted upon student engagement with the concepts. Recommendations for increasing engagement including improving awareness, being mindful of terminology used, access to funding, and the need for greater cross-faculty working are suggested. While this is only a limited case study, the implications of the findings for wider UK HEIs such as provision of adequate funding and support, and the need to address key concerns such as student perceptions of links between grants and loans to debt, and limited awareness of social entrepreneurship, are also discussed

Collegiate Competition and the Propensity for Gender Bias

Since the dawn of time gender has played a starring role in human behavior. The behavioral implications of an individual’s sex have permeated research findings in a wide variety of academic disciplines. This preliminary investigation will explore the concept and definition of gender, gender bias, and gender stereotype on actions and conduct. Specifically, this inquiry will determine the scope and types of gender bias/stereotypes that exist in the business world with a primary concentration on the area of professional sales. The ultimate objective is to discover the type and level of influence a person’s gender contributes to evaluation, performance and judging in student sales competition

Health risks of solid waste management practices in rural Ghana: A semi-quantitative approach toward a solid waste safety plan

Inadequate solid waste management (SWM) can lead to environmental contamination and human health risks. The health risks from poor SWM can vary based on specific practices and exposure pathways. Thus, it is necessary to adequately understand the local context. This information, however, is rarely available in low-resource settings, particularly in rural areas. A solid waste safety plan could be helpful in these settings for gathering necessary data to assess and minimize health risks. As a step in developing such a tool, a semi-quantitative health risk analysis of SWM practices in nine Ghanaian rural villages was undertaken. Data on SWM in each village were collected through qualitative field observations and semi-structured interviews with local stakeholders. SWM-related health risks were assessed using the collected data, similar case studies in the scientific literature and dialogue among an assembled team of experts. The analysis identified context-specific practices and exposure pathways that may present the most substantial health risks as well as targeted solutions for mitigation risks. A risk assessment matrix was developed to quantify SWM risks as low, medium, high, or very high based on the likelihood and severity of identified hazards. The highest SWM risks were identified from dumpsites and uncontrolled burying of solid waste. More specifically, a very high or high risk of infectious and vector-borne diseases from SWM in the villages was identified, both in the disposal of solid waste in dumpsites and uncontrolled burying of solid waste. Additionally, a very high or high risk of inhalation, ingestion or dermal contact with contaminants was found in the disposal of solid waste in dumpsites, open burning of waste and reuse of waste from dumpsites as compost. The results demonstrate the potential value of a solid waste safety plan and a parsimonious approach to collect key local data to inform its contents

The utilisation of risk-based frameworks for managing healthcare waste: a case study of the National Health Service in London

The management of waste from healthcare facilities can potentially pose a significant risk. In the UK, there are a number of increasingly stringent pieces of legislation and policies to mitigate against these risks. Using the taxonomy of organisational change (Vuuren, 1998), this study evaluated the inherent risks within the reported practices and policies of 21 Acute Care Trusts within the National Health Service (NHS) in London, England. The most frequently occurring exposures involved contact with sharps, infectious agents and hazardous substances; personal injuries during waste handling; manual handling injuries; slips, trips and falls; and striking against or being struck during procedures. Approximately 65% of the reported exposures occurred within the wards and for this location, highly significant correlations were found between nurses and contact with sharps. The implications of these findings for risk management are also discussed

Exploring ‘pro-environmental’ actions through discarded materials in the home

The household is a crucial focus of both waste and wider environmental policy, being seen as a central site of socio -economic-environmental change, a space in which people may perform their civic responsibilities and where individual and wider imperatives are brought together. Yet policy makers have shown limited appreciation and understanding of what happens inside the home. So in contemporary waste policy, for example, households remain a ‘closed entity’ in which everyday routines and practices remain hidden. Increasingly, though, it is acknowledged by social scientists that the lived experiences of environmental and waste management in the home are significant issues requiring further study, but how we might go about trying to study them is proving a challenging question. Conventional pro-environmental behaviour research has often tended to study behaviours in ways abstracted from the social contexts in which these take place. This has prompted recent research involving repeat in-depth interviews with householders and more ethnographic approaches, the use of reflexive diaries and narrative methodologies. Curiously, however, there has been little research considering environmental management(s) in the home which has focussed on waste itself. This paper seeks to add to the discussion, by focusing on everyday processes within households, using a qualitative approach of ‘getting in the bin’ of households - that is, an interview approach which takes respondents’ discarded waste as a starting point from which we ask them to discuss the lived experience(s) and activities of everyday life. More broadly by developing insights from what has been termed a ‘realist governmentality’ perspective the paper seeks to offer a more nuanced and finely grained analysis of governing in situ, exploring the extent to which governmental ambitions in relation to waste are accommodated, resisted or [re]worked at the household level. The paper draws illustratively on case studies from a Leverhulme-funded research project based in Kingston-Upon-Thames, an outer London borough in the UK. The approach used a focus on the contents of household waste bins to develop a narrative approach driven by householders centred on stories about pro-environmental practice. The paper will deal with three elements of the research approach: texturing narratives of waste, generating narratives of recycling in practice, and producing narratives of understanding. The outcome is development of a more thoroughgoing understanding of how processes within the home shape waste governance, moving beyond treating the home as a closed entity

Recovering value from used medical instruments: a case study of laryngoscopes in England and Italy

The healthcare sector has a relevant environmental footprint because of the significant materials throughput, the hazardousness of certain wastes it generates and the energy intensive treatment necessary to manage them. Using semi-structured interviews carried out with stakeholders from hospitals in England and Italy, this study sought to understand how best to recover value from used laryngoscopes. The findings suggest that despite differences in the use of single use instruments and the presence of a dedicated waste management department, sites in both countries face similar challenges, including limited communication between procurement and waste management staff, staff engagement, and end markets. The implications of these challenges and strategies for overcoming them are discussed