Attitudes toward Sustainability among Surgeons at Ten Academic Hospitals in the United States: Are we Ready, Willing, and Incentivized to Change?

Abstract

Objective: Given the outsized contribution of surgical care to the carbon footprint of the health sector, we aim to understand attitudes towards sustainability among academic surgeons in the United States (U.S.).

Summary background data: The healthcare sector accounts for 8.5% of United States (U.S.) greenhouse gas emissions-of which one third come from surgical care. Though prior studies suggested that surgeons are aware of operating room waste and interested in improving sustainability, they were not nationally representative and did not ask about specific changes surgeons were willing to make or what incentives would promote such changes. In this study, we aim to ascertain a more granular understanding of surgeons' views on sustainability in a representative sample of U.S. academic surgeons.

Methods: We surveyed surgeons at ten academic surgery programs representing all U.S. geographic regions. The survey contained questions on general attitudes towards sustainability, willingness to make sustainable changes, and the degree to which certain incentives would motivate change. Surgeons rated questions on Likert scales, and we calculated the proportion of respondents who indicated strongly positive responses.

Results: Overall, 247 out of 523 surgeons (47%) responded to the survey. Similar majorities of respondents felt that the problem of operating room waste was critical (n=155, 63%) and were motivated to improve the sustainability of their practices (n=160, 65%). Five respondents (2%) felt their institution put effort into sustainability education. Most respondents (n=243, 98%) were willing to make at least one of the sustainable practice changes in our survey, with the greatest number willing to reduce items on their preference cards following periodic review (n=227, 92%). Respondents were more motivated by personal cash incentives than non-cash or departmental incentives. Using factor analysis, we derived five factors from survey responses: (1) general attitudes, (2) education, (3) willingness, (4) responsiveness to personal cash incentives, and (5) responsiveness to other incentives.

Conclusions: Surgeons understand that operating room waste is a problem and most say they are willing to make individual changes to improve operating room sustainability. However, a majority would be motivated to improve sustainability by personal cash incentives which are rarely implemented. Additional work will be needed to operationalize surgeons' positive views on sustainability into practice changes that meaningfully impact climate change.

Keywords: carbon footprint; decarbonization; operating room waste; sustainability; sustainability incentives.