Green Surgery Report: Barriers and Facilitators to Implementation

Section Highlights

Surveys indicate the majority of the public are concerned about climate change and support NHS net zero carbon ambitions.

Many surgical teams are motivated to improve sustainability but perceived barriers to change include lack of awareness, lack of information, feeling disempowered, financial costs, lack of time, inadequate facilities or resources, and lack of leadership and guidance.

Surgeons may look to Surgical Colleges, and specialty associations for guidance. Bottom-up leadership may be facilitated by sustainability champions and networks.

Sustainability is now a GMC mandated core outcome for undergraduates.

Few resources are available for postgraduate training e.g. the SusQI model enables sustainability to be integrated into Quality Improvement teaching and the Royal College of Anaesthetists has integrated sustainability into curricula and examinations.

Infection prevention and control policy and practice is often perceived as a barrier to sustainability. More consistent and permissive policy is needed, without compromising safety.

The medical supply chain is globalised, complex and fragmented, posing a challenge to enacting change to favour sustainability.
Transition to sustainable models of surgical care requires appropriate supporting policy and infrastructure, including physical facilities and financial models.

Section Recommendations

(1) Bolster top-down sustainability leadership

(2) Foster bottom-up sustainability leadership

(3) Develop surgical sustainability networks

(4) Develop effective education in sustainable surgery

(5) Provide support for those experiencing eco-anxiety

(6) Address infection prevention and control (IPC) concerns

(7) Coordinate international action relating to supply chains

(8) Develop policies and infrastructure that supports transition to sustainable surgery

Case Studies

Facilitating Inter-Departmental Sustainability Innovation

Ontario Surgical QI Network

Peer Education for Surgical Waste Management

_{*** Note: Outcomes data from case studies have not been verified and some financial and greenhouse gas emission figures are based on projections.}