Abstract
The healthcare sector has always paid attention to social and economic sustainability. Still, healthcare is a relevant industry with a high environmental impact. There is a call to include and consider environmental sustainability as a guiding principle for the healthcare sector of tomorrow. The United Kingdom, through its NHS and Royal Colleges, has taken the lead in studying the environmental impact and providing healthcare managers and staff with guidance and checklists. In addition to more sustainable buildings and greener operations, environmental sustainability principles should be embedded in clinical practices as well.
Starting from the recent literature and UK documents, a multidisciplinary group of scholars designed a Delphi questionnaire on the topic. Twenty-seven healthcare executives from Italy participated in the pilot study.
Results underline a topic that is gaining traction in healthcare. However, much work still needs to be done to effectively include environmental sustainability practices in hospitals and especially within the clinical community.
Policymakers, healthcare managers, scholars, and scientific societies should take the lead in defining new rules and processes, measuring, assessing, and reporting results, disseminating and sharing knowledge and best practices on the topic.
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FD and LC conceived the idea of the study; PP, FD, SD, MA, HB, StCa, SaCu, GG, GiMa, BR, AR, AV, and LC wrote the research protocol; AGA, GBo, GBr, GiCa, GaCa, AC, RC, TC, CC, GC, GD, CD, MFG, SL, IM, MM, GiMo, MCM, GioPa, GiuPa, SP, MP, LR, EMR, AS, PS, EAT, SV took care of data collection, FD, SD and LC took care of data analysis, FD wrote the first manuscript’s draft. All authors critically reviewed the manuscript and approved the latest version of the manuscript.
Appendix
Appendix
Delphi Protocol (English Version)
Section 0: Descriptive Statistics
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1.
What is your background?
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Business/management
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Law
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Clinical
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Other
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2.
What is your role?
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General Director
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Scientific Director
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Medical Director
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Administrative Director
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Physician/GP
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Manager
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Other
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3.
What is your gender?
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Male
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Female
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Prefer not to answer
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4.
What is your age group?
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Under 40
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41–50
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50–60
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Over 60
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5.
Do you agree to be an author in the scientific publication(s) reporting the Delphi results?
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Yes
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Section 1: Sustainability Acceptance and Change Management
Think of the clinical practice within your hospital/institution/health agency/organization. On a scale from 1 to 9, where 1 = strongly disagree and 9 = strongly agree, how would you rate the following statements? | Importance | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||
1 | Sustainability issues are particularly relevant in my hospital/institution/health agency/organization | |||||||||
2 | Green management should be a priority in all the industrial sectors | |||||||||
3 | Green management should be a priority in clinical practice | |||||||||
4 | Patients should be aware of the most sustainable clinical options when co-deciding with their physician | |||||||||
5 | Patients will appreciate greener clinical practices | |||||||||
6 | Hospitals and other stakeholders (e.g., financing institutions and governments) will appreciate greener clinical practices | |||||||||
7 | Patients will have more trust in greener clinical practices | |||||||||
8 | Grants and awards should prioritize greener clinical practices | |||||||||
9 | Greener clinical practices should be embedded into guidelines | |||||||||
10 | Greener clinical practices should be prioritized on the agenda of scientific societies | |||||||||
11 | Greener clinical practices should be prioritized on the agenda of healthcare top managers | |||||||||
12 | Greener clinical practices should be prioritized on the agenda of hospitals and other stakeholders (e.g., financing institutions and governments) | |||||||||
13 | Greener clinical practices should be preferred even if they are more expensive | |||||||||
14 | Technology can lead to more sustainable clinical practices | |||||||||
15 | Medical instruments should consider environmental efforts (e.g., limiting the use of energy, non-recyclable materials, and the creation of waste) and their end of lifecycle should be managed implementing recycling practices | |||||||||
16 | The end-of-life of clinical equipment should be managed by implementing recycling practices | |||||||||
17 | Non-technical skills can lead to more sustainable clinical practices | |||||||||
18 | Greener clinical practices should be properly reported | |||||||||
19 | Ratios and indexes connected to clinical practices should be calculated to measure and report sustainability in all medical department | |||||||||
20 | Changing clinical practices can lead to fewer issues than traditional practices | |||||||||
21 | Greener management of clinical practice can lead to better medical outcomes | |||||||||
22 | Clinicians should be educated about environmental issues and outcomes connected with clinical activities and choices | |||||||||
23 | Patients should be educated about environmental issues and outcomes connected with clinical activities and choices | |||||||||
24 | It would be important to introduce sustainability practices also in procurement, selecting more sustainable products and suppliers | |||||||||
25 | The end of lifecycle of products sourced from external suppliers should be managed implementing recycling practices | |||||||||
26 | Governments should incentivize greener clinical practices | |||||||||
Section 2: Sustainability Habits in Clinical Practice
Think of the clinical practice within your hospital/institution/health agency/organization. On a scale from 1 to 9, where 1 = strongly disagree and 9 = strongly agree, how would you rate the following statements? Please note that all the elements should be rated according to your knowledge | Importance | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||
1 | I have a clear understanding and picture about greener clinical practices adopted my hospital/institution | |||||||||
2 | My hospital/institution promotes greener clinical practices in general terms | |||||||||
3 | My hospital/institution uses reusable textiles (including theater hats, sterile gowns, patient drapes, and trolley covers) | |||||||||
4 | My hospital/institution endorses the reduction of water and energy consumption | |||||||||
5 | My hospital/institution installed several automatic or pedal-controlled water taps | |||||||||
6 | My hospital/institution recommends avoiding clinically unnecessary interventions (e.g., antibiotics, catheterization, histological examinations) | |||||||||
7 | My hospital/institution recommends the creation of clinical preference lists for each operation—separate essential vs. optional items to have ready on side | |||||||||
8 | My hospital/institution recommends avoiding the use of single-use surgical packs | |||||||||
9 | My hospital/institution recommends opening only those sets that are needed and, when they are needed, by integrating supplementary items into sets | |||||||||
10 | My hospital/institution recommends avoiding all unnecessary equipment (e.g., swabs, single-use gloves) | |||||||||
11 | My hospital/institution recommends opting for reusables, hybrid, or remanufactured equipment instead of single-use (e.g., diathermy, gallipots, kidney-dishes, light handles, quivers, staplers, energy devices) | |||||||||
12 | My hospital/institution recommends switching to low-carbon alternatives (e.g., skin sutures vs. clips, loose prep in gallipots) | |||||||||
13 | My hospital/institution recommends recycling or using lowest carbon-appropriate waste streams as appropriate | |||||||||
14 | My hospital/institution recommends using domestic or recycling waste streams for all packaging | |||||||||
15 | My hospital/institution recommends arranging metals/battery collection where possible | |||||||||
16 | My hospital/institution recommends that damaged reusable equipment is repaired, encouraging active maintenance | |||||||||
17 | My hospital/institution recommends powering off lights, computers, ventilation, AGSS, and temperature control when the theater is empty | |||||||||
18 | My hospital/institution is supplied by firms adopting sustainable practices | |||||||||
19 | My hospital/institution employs sustainable “inputs” (e.g., from renewable sources, and/or made of biodegradable materials, and/or coming from recycling processes) | |||||||||
20 | My hospital/institution accurately measures operating room sterile supply waste | |||||||||
21 | My hospital/institution uses more leased equipment | |||||||||
22 | My hospital/institution shares equipment with other hospitals/institutions | |||||||||
23 | My hospital/institution encourages equipment to be shared among different clinical departments | |||||||||
Think of the clinical practice within your hospital/institution/health agency/organization. Which of the following tools should be used to promote sustainability/greener clinical practices? | Importance | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||
1 | Billboards | |||||||||
2 | Leaflets | |||||||||
3 | Newsletters | |||||||||
4 | Websites | |||||||||
5 | Corporate reports | |||||||||
6 | Multidisciplinary Green Teams | |||||||||
7 | Invitation to attend specific training courses | |||||||||
8 | Invitation to report best practices at congresses or events | |||||||||
9 | Illuminated signs and meters (e.g., reporting energy consumption or other data) | |||||||||
10 | Digital solutions (e.g., APPs, sensors, smart grid, …) | |||||||||
Accordingly to your knowledge and/or perception, what is the tangible impact of greener clinical practice WITHIN your hospital/institution? On a scale from 1 to 9, where 1 = low, and 9 = remarkable, how would you rate the following statements? Please note that all the elements should be rated according to your knowledge | Importance | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | ||
1 | Positive contribution for the environment | |||||||||
2 | More engagement of the patient | |||||||||
3 | Cost reduction | |||||||||
4 | Better quality of care | |||||||||
5 | My personal commitment | |||||||||
6 | Reputation of the hospital/institution | |||||||||
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Dal Mas, F. et al. (2023). Towards the Healthcare of the Future. A Delphi Consensus on Environmental Sustainability Issues. In: Martellucci, J., Dal Mas, F. (eds) Towards the Future of Surgery. New Paradigms in Healthcare. Springer, Cham. https://doi.org/10.1007/978-3-031-47623-5_15
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