Abstract
BackgroundThe healthcare sector is a major contributor to climate change and there are international calls to mitigate environmental degradation through more sustainable forms of clinical care. The UK healthcare sector has committed to net zero carbon by 2040 and sustainable healthcare is a nationally mandated outcome for all UK graduating doctors who must demonstrate their ability to address social, economic, and environmental challenges. Bristol Medical School piloted successful Sustainability in Quality Improvement (SusQI) workshop, but identified challenges translating classroom learning into clinical practice. This paper aims to identify and address those challenges.MethodsWe conducted five focus groups that identified and iteratively explored barriers and facilitators to practice among medical students, comparing a range of experiences to generate a conceptual model. We then combined our findings with behaviour change theory to generate educational recommendations.ResultsStudents that applied their learning to the clinical workplace were internally motivated and self-determined but needed time and opportunity to complete projects. Other students were cautious of disrupting established hierarchies and practices or frustrated by institutional inertia. These barriers impacted on their confidence in suggesting or achieving change. A minority saw sustainable healthcare as beyond their professional role.ConclusionsWe present a series of theoretically informed recommendations. These include wider curricular engagement with concepts of sustainable clinical practice; supportive workplace enablement strategies such as workplace champions and co-creation of improvement goals; and time and headspace for students to engage through structured opportunities for credit-bearing project work.
Highlights
The healthcare sector is a major contributor to climate change and there are international calls to mitigate environmental degradation through more sustainable forms of clinical care
National Health Service (NHS) England has committed to carbon neutrality by 2040 [4] and the UK’s General Medical Council (GMC) has mandated that by 2020 all graduating doctors “must be able to apply the principles, methods and knowledge of sustainable healthcare to medical practice” and “be able to apply the principles and methods of quality improvement to improve practice” [5]
We found no comments explained by goal-orientation, perhaps because their Sustainability in Quality Improvement (SusQI) projects were not summatively assessed
Summary
The healthcare sector is a major contributor to climate change and there are international calls to mitigate environmental degradation through more sustainable forms of clinical care. The UK healthcare sector has committed to net zero carbon by 2040 and sustainable healthcare is a nationally mandated outcome for all UK graduating doctors who must demonstrate their ability to address social, economic, and environmental challenges. Climate change and environmental degradation have been recognised as both a threat to human health and a catalyst for new and improved practices [1, 2] One such practice is the introduction of sustainable healthcare into undergraduate medical curricula. The Sustainable Development Unit of the UK’s National Health Service (NHS) defines sustainable healthcare as “working across the health system and partners to deliver healthcare that delivers on the triple bottom line, i.e., simultaneous financial, social and environmental return on investment. Quality improvement (QI) and sustainable healthcare have become part of the core curriculum at all UK medical schools, and all UK practising doctors are expected to demonstrate engagement with QI as part of postgraduate training and professional revalidation
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