The priority setting process
Stage 1: Establishing the Greener Operations PSP
A steering group was established to co-ordinate the PSP and implement its activity, assisted by a James Lind Alliance (JLA) adviser. Partner organisations and groups were identified to help promote the PSPs activities.
Stage 2: Gathering uncertainties
Surveys were conducted to gather uncertainties about sustainable peri-operative practice. These surveys were sent to patients, carers and healthcare professionals and the broader public by steering group members, with the assistance of partner organisations.
Stage 3: Data processing
PSP surveys were analysed and processed, in order to end up with questions that could then be used by researchers. Similar responses were combined, and those questions outside of the scope of the PSP were removed.
Stage 4: Interim priority setting
The long list of questions generated from the surveys was reduced to a shorter list. To do this, further surveys were sent out, asking stakeholders to prioritise these questions based on their own experience. This led to a shorter list of 20 to 30 questions, that were discussed at the final prioritisation workshop.
Stage 5: Final priority setting
At the final prioritisation workshop different parties with different perspectives had the opportunity to discuss their ideas, enabling a decision to be made to encompass all experiences. This led to the agreement of the Top 10 research priorities.
Stage 6: Publishing the Top 10
The Top 10 has been published on the JLA website and publicised to potential researchers and research funders. Methods used to communicate these results included websites, partner networks, academic journals and social media.
Our survey
During Stage 2 of our PSP, we asked healthcare professionals, patients, their carers and members of the public to tell us what questions they felt needed to be answered by research. We received close to 2000 questions to be answered, and this led to the creation of a list of 60 important questions.
In Stage 4 of our PSP, people were invited to select their most important questions from the 60 important questions. The top 25 questions that were chosen were then discussed at the final priority setting workshop in June 2022, to determine the Top 10 priorities.
Results
Results
The Top 10 research priorities to make operations greener are:
- How can more sustainable reusable equipment safely be used during and around the time of an operation?
- How can healthcare organisations more sustainably procure (obtain) medicines, equipment and items used during and around the time of an operation?
- How can healthcare professionals who deliver care during and around the time of an operation be encouraged to adopt sustainable actions in practice?
- Can more efficient use of operating theatres and associated practices reduce the environmental impact of operations?
- How can the amount of waste generated during and around the time of an operation be minimised?
- How do we measure and compare the short- and long-term environmental impacts of surgical and non-surgical treatments for the same condition?
- What is the environmental impact of different anaesthetic techniques (e.g. different types of general, regional and local anaesthesia) used for the same operation?
- How should the environmental impact of an operation be weighed against its clinical outcomes and financial costs?
- How can environmental sustainability be incorporated into the organisational management of operating theatres?
- What are the most sustainable form of effective infection prevention and control used around the time of an operation (e.g. PPE, drapes, clean air ventilation)?
Our Steering Group
Our steering group
Our Steering Group was made up of people who could collectively represent all areas affected by peri-operative practice. The process was assisted by a JLA Advisor.
Project Leads
- Dr Cliff Shelton
Cliff is a Consultant Anaesthetist at Wythenshawe Hospital and Senior Clinical Lecturer in Anaesthesia at Lancaster University. As well as trying to practice sustainably as a clinician, he has a particular interest in sustainable healthcare education on a postgraduate and undergraduate level and supervises two sustainable healthcare fellows in the North West School of Anaesthesia.
- Mr David Jones
David is working part-time as Medical Examiner at Wythenshawe Hospital. He retired as a Consultant General and Colorectal Surgeon in 2020. He is the President of Manchester Medical Society (2020-21). He has extensive experience in surgical education and professional affairs in healthcare.
James Lind Alliance Adviser and Chair of the Steering Group
- Dr Jonathan Gower
Jonathan spent many years as a biomedical researcher before moving into research management. He joined the NIHR in 2007, establishing the Comprehensive Clinical Research Network which involved setting up 25 regional research networks and overseeing the delivery of a large portfolio of research studies across 24 clinical specialties. Most recently he was the Assistant Specialty Cluster Lead for Cancer, Surgery and Oral & Dental Health in the NIHR Clinical Research Network. With over 25 years of experience networking with charities, the public and private sectors, Jonathan is passionate about improving the access of patients, their carers and the public to research which makes a real impact on people’s lives.
Patient and carer representatives
- Mr Bob Evans
Bob is a retired local authority director who has served as a lay committee member at the Royal College of Anaesthetists. He is a member of the Patient, Carer and Public Involvement and Engagement Group (PCPIE). The Group provides support to research projects in anaesthesia.
- Ms Jennifer Dorey
Jennifer is a former hospital pharmacist, including 20 years as chief pharmacist in a large teaching hospital and pharmaceutical advisor to a strategic health authority. She is a lay member of the Royal College of Anaesthetists and on the board of the Centre for Peri-operative Care and the National Institute for Academic Anaesthesia.
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Ms Rebecca Knagg
Rebecca is the chair of the Maternity Voices Partnership for Morecambe Bay, a forum of women and their families, maternity staff and commissioners, Her role brings together maternity service users and providers to develop maternity care. Rebecca also sits on the Lancashire and South Cumbria maternity alliance board. Rebecca has previously worked for Health Watch Cumbria as an engagement officer.
- Mr John Hitchman
John is a retired Chartered Architect who has served as a member of the Diagnostic Advisory Committee of the National Institute for Health and Care Excellence (NICE) and the Lay Committee of the Royal College of Anaesthetists. Currently he is a lay member of the UK National Screening Committee’s Adult Reference Group and National Institute for Academic Anaesthesia’s Patient, Carer & Public Involvement & Engagement Group.
Clinical representatives
- Dr Cathy Lawson
Cathy is a specialty trainee in anaesthesia and intensive care medicine in the Northern School of Anaesthesia and ICM. She previously sat on the Association of Anaesthetists Environment and Sustainability committee and was the first national fellow in Environmentally Sustainable Anaesthesia. She continues work pertaining to sustainable anaesthesia and healthcare in the North East and Cumbria.
- Mr David Riding
David Riding is a Specialty Trainee in Vascular Surgery in North West England. He has taken time out of training to work in Uganda and to complete a PhD in venous disease, and recently completed his tenure as Trainee Member of Council at The Royal College of Surgeons of Edinburgh. He now chairs the College’s working group on sustainable surgery.
- Dr Fiona Brennan
Fiona is a Consultant Anaesthetist in Cardiff with an interest in planetary health and sustainable healthcare. She co-founded the Welsh Environmental Anaesthesia Network (WEAN) and is a co-educational supervisor to the Welsh Clinical Leadership Fellow in Sustainable Healthcare.
- Dr Louise Bates
Louise is an Anaesthetist who also works at the Centre for Perioperative Care (CPOC) – a cross-speciality centre dedicated to the promotion and development of peri-operative care. CPOC supports the advancement of sustainable peri-operative care which aligns with of their aims of simplifying, streamlining and improving pathways for the benefit of patients and the healthcare system.
- Mr Michael Donnellon
Mike is Chair of the College of Operating Department Practitioners Education and Standards Committee and co-ordinates the Clinical and University Educator (CUE) Forums. He has academic experience as a Senior Lecturer in Operating Department Practice at the University of Central Lancashire and clinical experience at Blackpool Victoria Hospital.
- Miss Victoria Pegna
Victoria is a senior colorectal and trauma registrar in the Kent, Surrey and Sussex (KSS) Deanery. She is a council member of the Royal College of Surgeons of England (RCSEng) and jointly set up the Sustainability in Surgery committee at RCSEng, of which she is Vice Chair. She plays an active role in addressing the environmental impact of surgery with webinars, lectures, projects and also on a personal level
- Dr Mike Kinsella
Mike is a Consultant Anaesthetist at University Hospitals Bristol & Weston, and Chair of the Environment and Sustainability Committee of the Association of Anaesthetists.
- Ms Jennifer Strong
Jennifer is Senior Sustainability Officer within the Energy and Sustainability team at Manchester Foundation Trust. The team lead on the delivery of the Trust Sustainable Development Management Plan. She has over 10 years’ experience in the sustainability sector predominantly working in the field of sustainability engagement and behaviour channels.
- Mr Dan Morris
Dan is an Ophthalmologist in Cardiff with a subspeciality interest in oculoplastic, lacrimal and orbital surgery. He is widely published, with areas including the carbon footprint of cataract surgery, and was a founding member of the sustainability group of the Royal College of Opthalmologists.
- Mr Tim Sheppard
Tim is a Consultant Obstetrician and Gynaecologist currently working in University Hospital Wales, Cardiff, with special interests in early pregnancy, acute gynaecology, abortion care and advanced labour ward practice. He has served in Army Reserve for 22 years ongoing.
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Miss Yasmina Hamadoui
Yasmina is a Clinical Pharmacist based in Ysbyty Gwynedd Hospital, North Wales and currently leads the pharmacy pre-operative assessment service. Yasmina also holds a committee role as Communications Officer for the hospital’s Green Group which aims to promote and improve environmental sustainability within healthcare.
- Mrs Tracey Radcliffe
Tracey qualified as a Registered Nurse in 1990 and has over 20 years’ experience of peri-operative practice, initially as an anaesthetic/recovery nurse and then in Practice Development. She currently works as Governance Lead Nurse in Glan Clwyd Hospital in North Wales. Tracey is the President of the British Anaesthetic and Recovery Nurses Association (BARNA) and previously Chair of the Royal College of Nursing Perioperative Forum.
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Ms Rebecca Diedo
Rebecca is a Senior Lecturer at the University of Brighton and has an interest in inter-professional education and patient safety. Prior to joining the University in 2017, Rebecca had worked in theatres as both an anaesthetic and scrub nurse. Rebecca joined the Royal College of Nursing Perioperative Forum in January 2020 and was elected Chair of the Forum the following year.
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