Delivering sustainable healthcare in Scotland
What will help or hinder the shift to sustainable healthcare?
A team from the Scottish Clinical Leadership Fellowship Programme conducted an analysis to identify the barriers to designing and delivering sustainable healthcare in Scotland – and the things that will facilitate it. The research was published in the Future Healthcare Journal.
Identifying the barriers to sustainable healthcare
The team interviewed people who are involved in planning and delivering sustainable healthcare in NHS Scotland. After a process of analysis, they identified 12 key barriers to the delivery of sustainable healthcare, which were organised into four themes: lack of resource; resistance to change; complexity; and lack of leadership.
Interviewees spoke about ‘lack of resource’ in terms of money, time, and staffing. There can be upfront financial costs to making changes that enable more sustainable care – and it can be difficult to find the budget for these, even when they would ultimately save money. For example, a change from single-use to reusable equipment can save money over time, but the original purchase of something reusable will be more expensive than the single-use equivalent.
Lack of time was an issue both for staff attempting to make change – usually in addition to their job – and for people being asked to make changes. This presented as a type of resistance to change. Individuals and teams who are very stretched have little headspace to think about new ways of working and interviewees reported that the strain the workforce and the system is under is a barrier to change.
Resistance to change was also discussed in terms of staff lacking confidence to work with new equipment and of staff being cautious about the effectiveness or safety of proposed changes.
Healthcare systems are complex. Building a sustainable healthcare system from the ground up would be a difficult enough task, but to ‘retrofit’ an existing system is even more challenging. Interviewees identified complexity as a barrier, both of the system and of the climate and biodiversity crisis. Finding a way through evidence around carbon emissions or the impact of proposed changes were examples of complexities people felt were difficult.
Lack of leadership was reported as a barrier in particular because of staff changes – if one committed person is driving change in an area and they move on, that work can be lost. Similarly, without some oversight higher up, there is a risk of work being duplicated or good practice not being shared or spread.
Identifying what facilitates sustainable healthcare
In addition to barriers, the team also identified 12 facilitators of sustainable healthcare, which were also arranged into four themes: organisational vision; empowerment; resources; and collaboration.
Nationally, the vision for net-zero healthcare in Scotland by 2040 was seen as key in encouraging action. Clear organisational vision at a local level translated to planning, support and resources.
Personal values were seen as an important element of empowerment, driving actions in the work setting which in turn inspired and empowered others. The impact of effective actions was also seen as empowering. Networks of like-minded people were also seen as empowering and supporting action.
Unsurprisingly, resources were an important facilitator. This included having time for sustainability work built into roles, as well as educational resources, toolkits and checklists. Interviewees also discussed the co-benefit of sustainable healthcare work being a gain in resources. Reducing waste and optimising care often resulted in money and time being saved.
Finally, all interviewees mentioned the importance of collaborations, including networks within specialties and cross-disciplinary groups. Patients were also highlighted as being key to achieving change.
Recommendations
The team put together ten recommendations based on their analysis.
1. Communicate with the general public, NHS staff, and wider system partners on NHS Scotland's organisational vision for net-zero healthcare and the leading role each can play in attaining this ambition.
2. Organisations should make net-zero a priority with clear action plans, leadership, and accountability to accompany this.
3. Create a culture of empowerment that enables leadership among those with a climate interest.
4. Allocate human, economic and time resources to sustainable change efforts.
5. Consider environmental sustainability in all healthcare planning and procurement decisions.
6. Make carbon footprint calculations more accessible.
7. Develop a national repository of carbon footprint metrics.
8. Create and strengthen networks to facilitate shared learning, resources and good practice.
9. Promote multi-disciplinary and cross-organisational working.
10. Work with academics and industry to harness innovation.
They conclude that there is, “a role for everyone who is involved in the design and/or delivery of healthcare to play their part”.
Reference
Harpur A et al. The barriers and facilitators to the design and delivery of sustainable healthcare across NHS Scotland: A forcefield analysis. Future Healthcare Journal, 22:2, June 2024. https://doi.org/10.1016/j.fhj.2024.100135