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)

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

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

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

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

Multi-criteria assessment of the appropriateness of a cooking technology: a case study of the Logone Valley

The choice of fuel for cooking, particularly in rural areas, can lead to significant socio-economic and environmental impacts amongst households. Using the Logone Valley on the border between Chad and Cameroon as the case study region, this study sought to evaluate appropriate cooking technologies for the case study region. Several alternatives to traditional three-stone fire were evaluated, including the: ceramic stove, Centrafricain stove, parabolic solar cooker, biodigester, LPG stove, and mlc rice husk stove. Four main clusters were investigated, structuring quantifiable indicators for financial, environmental, social and health related impacts of the use of a certain energy technology. The findings suggest that the Centrafricain stove alone or in combination with the mlc stove, was the most appropriate cooking technology for use in the case study region. These technologies were more appropriate than the traditional cooking system of the three stone fire. The use of four clusters of criteria, within a weighted system, coupled with the views of users, experts and literature, as well as the scope of the criteria employed enabled a reliable and valid approach to understanding the most appropriate cooking technology to recommend

A critical review of a key waste strategy initiative in England: Zero Waste Places Projects 2008-2009

To help drive the required behaviour change for increased sustainable practice the Government in England launched a Zero Waste Places (ZWP) initiative to develop innovative and exemplary practice. By inviting places to bid for ZWP status, the successful applicants were then expected to become exemplars of good environmental practice on all waste issues. The ZWP programme commenced in October 2008 with the selection of 6 distinct places based upon an application by a partnership. The places ranged in size from the very small (one street of 201 properties) to a Region of England (5 million population). The funding was £70,258 and the mean was £11,709. The overall assessment suggests that the Local Authorities and their project partners rose to the challenge of zero waste and in most cases met or even exceeded their objectives (meeting at least 80% of aims and planned actions) and achieved high value for money in terms of Government funded initiatives. A Certificated Standard for ZWP was developed and is perceived as being both useful and valuable and it is hoped that it will spur a large number of new ZWP applications

Factors influencing corporate pro-environmental behaviour - a case study from the UK construction sector

The need for a more sustainable approach to the management of resources is a key focus for all stakeholders, including organisations. Using a range of qualitative and quantitative approaches within a UK case study construction company, this paper examines the key underlying factors impacting on corporate pro-environmental behaviour. The findings indicate that even though staff generally exhibited strong environmental attitudes and beliefs, these did not always translate into sustainable practices. Based on the findings, strategies on enhancing sustainable environmental management practices within organisations, particularly within the construction sector are also presented

Sustainability practices and lifestyle groups in a rapidly emerging economy: a case study of Chennai, India

The development of strategies to encourage more sustainable approaches to resource consumption is a key global challenge. This is particularly the case within rapidly developing countries such as India, due to rapid urbanisation, population growth and resource consumption. Using households in the Southeastern Indian city of Chennai as the case study, this study sought to examine the extent to which lifestyles could be categorised into groups and the role of the concepts of sustainability on these groups. Five lifestyle groups were identified, ranging from ‘dedicated environmentalists’, to non-environmentalist’. Conservation of electricity and water were key sustainability behaviours. Various key factors were found to impact upon the behaviours of individuals in these groups including perceived limitations in time, levels of awareness, as well as values. The implications of the findings for facilitating improved policies and practices are discussed