Meet the team: Seaside Surgical Sustainability
ENT Research Fellow (BSUH), Sustainable Surgery Fellow (CSH)
Brighton and Sussex University Hospitals NHS Trust, Centre for Sustainable Healthcare
- England - Kent Surrey Sussex
- Mr Mahmood Bhutta
- Dr Rachel Stancliffe
- Dr Frances Mortimer
- Dr Tim Chevassut
Sustainability should be considered a domain of quality in healthcare. Sustainable value considers patient and population outcomes against environmental, social and economic costs.(1) Sustainable value may be maximized by applying the principles of sustainable clinical practice: prevention, patient empowerment and self-care, lean service delivery and use of low carbon alternatives.
Anthropogenic climate change is the ‘greatest threat to global health in the 21st century’.(3) The NHS contributes a quarter of all UK public sector carbon dioxide emissions(4), amounting to 22.8 million tonnes per year.(5) Medical instruments alone account for 10% of this.(6) Around a third of all NHS hospital admissions are for surgical care, resulting in over 10 million procedures per annum.(7) Operating theatres are six times more energy-intense than the wider hospital(8) and responsible for 21-30% of total hospital waste.(9)
The NHS is currently facing a deficit of £800 million, with a £20 billion funding gap predicted over the next five years.(9) Surgery accounts for £4.5 billion/year of NHS spend(10) with running costs for an operating theatre estimated at £1200/hour.(11)
Previous literature examining the sustainability of surgery has been done in very specific areas, focusing on individual operations or instruments, rather than tackling surgery on a broad scale. Studies have frequently focused on financial rather than environmental or social impacts. Studies have found:
• 13% of disposable items opened for neurosurgical procedures were discarded without use(12)
• 90% of pre-operative set-up waste in otolaryngology procedures was recyclable(8)
• Optimisation can eliminate an average of 60% of instruments per surgical tray(13)
This project will partner with the UK Centre for Sustainable Healthcare (CSH). This grant application is for research conducted by the first UK Surgical Sustainability Fellow (CR).
Our research will:
a) Quantify the carbon, financial and social costs of surgical services
b) Identify opportunities for improving the sustainable value of surgical services
c) Assess potential drivers and perceived barriers for adoption of sustainable practice within surgery
We will evaluate the environmental sustainability of national surgical services in England using a hybrid approach, combining ‘top down’ environmental input-output modelling with ‘bottom up’ life cycle assessment.(14) This will be used to identify carbon hotspots and areas of greatest carbon consumption within surgery. We will evaluate social sustainability through considering the impact of surgery on the quality of life of patients, staff, carers and communities involved in the surgical supply chain. The latter will include an evaluation of the risk of labour rights abuses.
The national study will be used to inform a granular study focusing on carbon hotspots identified and conducted across 2 hospital sites (Brighton and Worthing). Lean service delivery is a principle of sustainable clinical practice (2) and lean management principles will be applied to tackle hotspots. We anticipate these will be studied within the context of the most common elective hospital operations in the NHS:(1)
• Hip arthroplasty
• Knee arthroplasty
• Surgery for Dupuytren’s contracture
The granular study will again use hybrid carbon footprinting methodology, here integrating value stream mapping. This involves documentation and analysis of the stages of an operation from start-to-end and the products used in that process, including gowns, drapes, sutures, and surgical instruments alongside consumables. The frequency of use of individual surgical instruments can be mapped with a Pareto chart. We will consider the environmental, financial and social impact of leaning surgical services.
Our recommendations will be informed by the above analysis alongside a systematic review of published literature. This will identify potential areas for change, including opportunities to minimise use of consumable products, reduce waste and recycle. For example this may include:
• Use of reusable, fair trade surgical devices, gowns and drapes, or reprocessing of single use devices
• Streamlining instrument trays
Surgeons have a unique position of influence within the operating theatre. The final stage of our research will include semi-structured questionnaires and interviews with key surgical opinion makers. This will identify personal and contextual factors surrounding adoption of sustainable surgery, including potential drivers (environmental, social or financial factors) and perceived barriers.
What is the benefit
• Patients will benefit from sustainable leaning of surgical care, designed to optimise use of limited resources to deliver patient outcomes (sustainable value).
• The NHS will benefit from the reduction in wasteful activity and meeting carbon and financial commitments.
• Healthcare staff will benefit from engaging in service improvement and resource stewardship.
Benefits for the Q community
• This project offers to showcase Q’s commitment to healthcare sustainability.
• We seek to engage with Q members to increase awareness of sustainability challenges within the NHS and the relationship of quality, value and sustainability.
• We will actively engage with Q members and enable them to become involved in improving sustainability within their local trusts, including through Special Interest Groups and Randomised Coffee Trials.
How you can contribute
- • We would love to hear what is being done in your local area to improve sustainability in operating theatres?
- • What are your own thoughts and attitudes towards sustainability within a healthcare setting?
- • Who do you think should be responsible for ensuring the financial and ecological sustainability of NHS operating theatres?
- • What is the best way to disseminate the findings of this study, to optimise the spread and scale of sustainability recommendations?
Q poster (PDF, 11MB)
This is a great project because…
The team have presented detailed and compelling evidence of the opportunity for change. We like the focus on environmental and financial costs and how lean could be applied in this context. There is strong academic input which should help with the evaluation but also a good practice focus.
By the time of the event we encourage the project team to think more about…
Although the research focus is a strength of the project we would like to see further engagement with evidence and experience of implementing lean projects.