In this section
@article{Almukhtar:2026,
author = {Almukhtar, A and Batcup, C and Jagannath, S and Leff, D and Porat, T and Judah, G and Demirel, P},
journal = {Annals of Surgery Open},
title = {Understanding sustainability in operating theatres: an ethnographic study to determine drivers of unsustainable behaviours},
url = {https://journals.lww.com/aosopen/fulltext/2026/03000/understanding_sustainability_in_operating.6.aspx},
year = {2026}
}
TY - JOUR
AB - BackgroundClimate change is the biggest threat to human health. Paradoxically, the healthcare sector is a major contributor to climate change, and operating theatres are among the highest sources of emissions. Unsustainable practices are actions that compromise environmental, social, and financial sustainability, leading to unnecessary resource use, avoidable harm to the wider population, and reduced ability to provide effective healthcare in the future. Drivers of unsustainable practices and barriers to sustainability in practice (a top priority identified by the James Lind Alliance Priority Setting Partnership) are unexplored, hindering interventions which can help meet net-zero targets within healthcare. We conducted the first known ethnographic study to investigate behaviours related to sustainability in operating theatres, and their influences on those behaviours to inform the design of effective behaviour change interventions.MethodsNon-participant ethnographic observations with opportunistic discussions in elective general surgical operating theatres were conducted between June and December 2023 at two university hospitals in Central London. Data were collected until saturation using a template developed during the initial observations. Inductive thematic analysis was conducted, with sub-themes (influences) deductively mapped to the Theoretical Domains Framework (TDF).ResultsTwenty-six procedures were observed (42 hours). Unsustainable behaviours included: (i) unnecessary and inappropriate glove use, potentially compromising safety (average 8-10 pairs per operation), (ii) incorrect waste disposal, (iii) unnecessary package opening, and (iv) energy waste. Thematic analysis generated 6 themes and 16 influences (mapped to 9 TDF domains). Key themes were that sustainable practices are “infrequent and inconsistent” due to limited awareness (Knowledge) and low environmental concerns (Memory, Attention and Decision Processes). Unsustainable behaviours we
AU - Almukhtar,A
AU - Batcup,C
AU - Jagannath,S
AU - Leff,D
AU - Porat,T
AU - Judah,G
AU - Demirel,P
PY - 2026///
SN - 2691-3593
TI - Understanding sustainability in operating theatres: an ethnographic study to determine drivers of unsustainable behaviours
T2 - Annals of Surgery Open
UR - https://journals.lww.com/aosopen/fulltext/2026/03000/understanding_sustainability_in_operating.6.aspx
ER -
Dyson School of Design Engineering
Imperial College London
25 Exhibition Road
South Kensington
London
SW7 2DB
design.engineering@imperial.ac.uk
Tel: +44 (0) 20 7594 8888