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Sustainable Decision Making and Behaviour Change

This theme will use SUSTAIN to develop and evaluate carbon-reducing behaviour change interventions in a simulated perioperative environment, and understand their implications for the wider socio-technical context.

The Problem:

All technologies and interventions have behavioural implications within the surgical environment.

  • Across the NHS, there are a growing range of sustainability guidelines, policies and suggested practices aimed at reducing the carbon footprint of operating theatres [1], yet these are rarely fully embedded within surgical practice [2,3], and non-sustainable behaviours continue to be widely practiced.
  • Perioperative carbon-reducing behaviours (CRBs) such as opting for reusable gowns and rationalising surgical instrumentation (Theme 1) can conflict with established ways of working and cultural norms regarding infection control and efficiency [1], and are influenced by the physical surgical environment.

The Result:

The psychological mechanisms underpinning surgical CRBs remain unclear, limiting opportunities for widespread implementation of technologies and practices aimed at increasing surgical sustainability [4].

  • Where CRBs are studied, this often occurs in abstract experimental conditions devoid of surgical context; or, via studies that examine attitudes and behavioural intentions, but not the behaviours themselves.
  • There has been little consideration of human factors and decision making when deploying new sustainable technologies, raising questions about the optimal point for intervention [5].
  • Lack of stakeholder engagement can limit the uptake of high potential carbon-reducing innovations

The Potential:

  • We need to understand the dynamics and mechanisms underpinning CRBs in the surgical context, and ways that technologies can be embedded in the surgical context to enable routine CRBs.
  • Having access to an in silico (offline) environment with high ecological validity, will enable better understanding of behavioural drivers, alongside barriers and facilitators in the physical environment.
  • The multi-space characteristics of SUSTAIN (pre-mid-post-surgery environments) will enable study of the behavioural system, including who makes decisions, and where/when these occur.
  • SUSTAIN will enable the use of novel behavioural science methods such as eye tracking and video analysis.

 

References

[1] Almukhtar A, Batcup C, Bowman M, Winter-Beatty J, Leff D, Demirel P, et al. Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework. Int J Surg Lond Engl 2023;110:554–68. https://doi.org/10.1097/JS9.0000000000000829.
[2] Hassan LM, Shiu E, Shaw D. Who Says There is an Intention–Behaviour Gap? Assessing the Empirical Evidence of an Intention–Behaviour Gap in Ethical Consumption. J Bus Ethics 2016;136:219–36. https://doi.org/10.1007/s10551-014-2440-0.
[3] Zacher H, Rudolph CW, Katz IM. Employee Green Behavior as the Core of Environmentally Sustainable Organizations. Annu Rev Organ Psychol Organ Behav 2023;10:465–94. https://doi.org/10.1146/annurev-orgpsych-120920-050421.
[4] Unsworth KL, McNeill IM. Increasing pro-environmental behaviors by increasing self-concordance: Testing an intervention. J Appl Psychol 2017;102:88–103. https://doi.org/10.1037/apl0000155.
[5] Davis MC, Challenger R, Jayewardene DNW, Clegg CW. Advancing socio-technical systems thinking: A call for bravery. Appl Ergon 2014;45:171–80. https://doi.org/10.1016/j.apergo.2013.02.009.