Sustainability in Quality Improvement (SusQI): challenges and strategies for translating undergraduate learning into clinical practice

Abstract Background 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. 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. Methods We 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. Results Students 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. Conclusions We 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.

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Sustainability in Quality Improvement (SusQI): Challenges and Strategies for Translating Undergraduate Learning Into Clinical Practice

10.21203/rs.3.rs-154613/v1 ◽

2021 ◽

Author(s):

Oliver Marsden ◽

Philippa Clery ◽

Stuart d'Arch Smith ◽

Kathleen Leedham-Green

Keyword(s):

Quality Improvement ◽

Clinical Practice ◽

Clinical Care ◽

Change Theory ◽

Project Work ◽

Healthcare Sector ◽

Net Zero ◽

Clinical Workplace ◽

Zero Carbon ◽

The Uk

Abstract Background 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. Bristol Medical School piloted successful Sustainability in Quality Improvement (SusQI) teaching, but identified challenges translating classroom learning into clinical practice. This paper aims to identify and address those challenges. Methods We 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 framework. We then combined our findings with behaviour change theory to generate educational recommendations. Results Students 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. Conclusions We 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.

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Net zero carbon: Energy performance targets for offices

Building Services Engineering Research and Technology ◽

10.1177/0143624421991470 ◽

2021 ◽

Vol 42 (3) ◽

pp. 349-369

Author(s):

Robert Cohen ◽

Karl Desai ◽

Jennifer Elias ◽

Richard Twinn

Keyword(s):

Energy Efficiency ◽

Minimum Energy ◽

Energy Performance ◽

Consultation Process ◽

Net Zero ◽

Extensive Consultation ◽

Operational Energy ◽

Legislative Framework ◽

Zero Carbon ◽

The Uk

The UKGBC Net Zero Carbon Buildings Framework was published in April 2019 following an industry task group and extensive consultation process. The framework acts as guidance for achieving net zero carbon for operational energy and construction emissions, with a whole life carbon approach to be developed in the future. In consultation with industry, further detail and stricter requirements are being developed over time. In October 2019, proposals were set out for industry consultation on minimum energy efficiency targets for new and existing commercial office buildings seeking to achieve net zero carbon status for operational energy today, based on the performance levels that all buildings will be required to achieve by 2050. This was complemented by modelling work undertaken by the LETI network looking into net zero carbon requirements for new buildings. In January 2020 UKGBC published its guidance on the levels of energy performance that offices should target to achieve net zero and a trajectory for getting there by 2035. This paper describes the methodology behind and industry perspectives on UKGBC’s proposals which aim to predict the reduction in building energy intensity required if the UK’s economy is to be fully-powered by zero carbon energy in 2050. Practical application: Many developers and investors seeking to procure new commercial offices or undertake major refurbishments of existing offices are engaging with the ‘net zero carbon’ agenda, now intrinsic to the legislative framework for economic activity in the UK. A UKGBC initiative effectively filled a vacuum by defining a set of requirements including energy efficiency thresholds for commercial offices in the UK to be considered ‘net zero carbon’. This paper provides all stakeholders with a detailed justification for the level of these thresholds and what might be done to achieve them. A worked example details one possible solution for a new office.

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A qualitative assessment of the impact of smart homes and environmentally beneficial technologies on the UK 2050 net-zero carbon emission target

Smart and Sustainable Built Environment ◽

10.1108/sasbe-07-2021-0112 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Ghasson Shabha ◽

Francesca Barber ◽

Paul Laycock

Keyword(s):

Climate Change ◽

Carbon Emissions ◽

Smart Home ◽

Smart Homes ◽

Content Type ◽

Net Zero ◽

Zero Carbon ◽

The Uk ◽

Home Technology ◽

Smart Home Technology

PurposeThere are 29 million homes in the UK, accounting for 14% of the UK's energy consumption. This is given that UK has one of the highest water and energy demands in Europe which needs to be addressed according to the Committee on Climate Change (CCC). Smart homes technology holds a current perception that it is principally used by “tech-savvy” users with larger budgets. However, smart home technology can be used to control water, heat and energy in the entire house. This paper investigates how smart home technology could be effectively utilised to aid the UK government in meeting climate change targets and to mitigate the environmental impact of a home in use towards reducing carbon emissions.Design/methodology/approachBoth primary and secondary data were sought to gain insight into the research problem. An epistemological approach to this research is to use interpretivism to analyse data gathered via a semi-structured survey. Two groups of participants were approached: (1) professionals who are deemed knowledgeable about smart home development and implementation and (2) users of smart home technology. A variety of open-ended questions were formulated, allowing participants to elaborate by exploring issues and providing detailed qualitative responses based on their experience in this area which were interpreted quantitatively for clearer analysis.FindingsWith fossil fuel reserves depleting, there is an urgency for renewable, low carbon energy sources to reduce the 5 tonnes annual carbon emissions from a UK household. This requires a multi-faceted and a multimethod approach, relying on the involvement of both the general public and the government in order to be effective. By advancing energy grids to make them more efficient and reliable, concomitant necessitates a drastic change in the way of life and philosophy of homeowners when contemplating a reduction of carbon emissions. If both parties are able to do so, the UK is more likely to reach its 2050 net-zero carbon goal. The presence of a smart meter within the household is equally pivotal. It has a positive effect of reducing the amount of carbon emissions and hence more need to be installed.Research limitations/implicationsFurther research is needed using a larger study sample to achieve more accurate and acceptable generalisations about any future course of action. Further investigation on the specifics of smart technology within the UK household is also needed to reduce the energy consumption in order to meet net-zero carbon 2050 targets due to failures of legislation.Practical implicationsFor smart homes manufacturers and suppliers, more emphasis should be placed to enhance compatibility and interoperability of appliances and devices using different platform and creating more user's friendly manuals supported by step-by-step visual to support homeowners in the light of the wealth of knowledge base generated over the past few years. For homeowners, more emphasis should be placed on creating online knowledge management platform easily accessible which provide virtual support and technical advice to home owners to deal with any operational and technical issues or IT glitches. Developing technical design online platform for built environment professionals on incorporating smart sensors and environmentally beneficial technology during early design and construction stages towards achieving low to zero carbon homes.Originality/valueThis paper bridges a significant gap in the body of knowledge in term of its scope, theoretical validity and practical applicability, highlighting the impact of using smart home technology on the environment. It provides an insight into how the UK government could utilise smart home technology in order to reduce its carbon emission by identifying the potential link between using smart home technology and environmental sustainability in tackling and mitigating climate change. The findings can be applied to other building types and has the potential to employ aspects of smart home technology in order to manage energy and water usage including but not limited to healthcare, commercial and industrial buildings.

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High-dose and combination antipsychotic prescribing in acute adult wards in the UK: The challenges posed by p.r.n. prescribing

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.042895 ◽

2008 ◽

Vol 192 (6) ◽

pp. 435-439 ◽

Cited By ~ 94

Author(s):

Carol Paton ◽

Thomas R. E. Barnes ◽

Mary-Rose Cavanagh ◽

David Taylor ◽

Paul Lelliott

Keyword(s):

Quality Improvement ◽

Clinical Practice ◽

Clinical Guidelines ◽

Standard Dose ◽

High Dose ◽

Quality Improvement Programme ◽

Prescribing Practice ◽

Improvement Programme ◽

Antipsychotic Prescribing ◽

The Uk

BackgroundClinical guidelines recommend the routine use of a single antipsychotic drug in a standard dose, but prescriptions for high-dose and combined antipsychotics are common in clinical practice.AimsTo evaluate the effectiveness of a quality improvement programme in reducing the prevalence of high-dose and combined antipsychotic prescribing in acute adult in-patient wards in the UK.MethodBaseline audit was followed by feedback of benchmarked data and delivery of a range of bespoke change interventions, and then by a further audit 1 year later.ResultsThirty-two services participated, submitting data for 3942 patients at baseline and 3271 patients at the 1-year audit. There was little change in the prevalence of high-dose (baseline 36%; re-audit 34%) or combined antipsychotic prescribing (baseline 43%; re-audit 39%). As required (‘p.r.n.’) prescriptions were the principal cause of both high-dose and combined antipsychotic prescribing on both occasions.ConclusionsThe quality improvement programme did not have a demonstrable impact on prescribing practice in the majority of services. Future efforts to align practice with clinical guidelines need to specifically target the culture and practice of p.r.n. prescribing.

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African primary care research: Quality improvement cycles

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v6i1.598 ◽

2014 ◽

Vol 6 (1) ◽

Cited By ~ 3

Author(s):

Claire Van Deventer ◽

Bob Mash

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Clinical Practice ◽

Clinical Care ◽

Research Quality ◽

Project Proposal ◽

Research Project ◽

Primary Care Research ◽

Care Research

Improving the quality of clinical care and translating evidence into clinical practice is commonly a focus of primary care research. This article is part of a series on primary care research and outlines an approach to performing a quality improvement cycle as part of a research assignment at a Masters level. The article aims to help researchers design their quality improvement cycle and write their research project proposal.

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Coordinating UK trade and climate policy ambitions: A legislative and policy analysis

Environmental Law Review ◽

10.1177/1461452920960349 ◽

2020 ◽

Vol 22 (4) ◽

pp. 280-295

Author(s):

Emily Lydgate ◽

Chloe Anthony

Keyword(s):

Trade Policy ◽

Global Climate ◽

World Trade Organisation ◽

Trade Restrictions ◽

Climate Target ◽

Net Zero ◽

Zero Carbon ◽

Major Increase ◽

The Uk ◽

Liberal Trade

The UK Government has pledged to achieve net-zero carbon emissions by 2050 but also champion open multilateral trade and pursue new trade relationships with geographically distant partners. The dynamism of policymaking in both areas, as the UK leaves the EU, provides a useful case study for the larger question of how to reconcile liberal trade policy with a net-zero target. After setting out the relevance of trade policy to the climate target, we examine areas at their intersection: current and proposed UK green subsidies, regulatory trade barriers, potential carbon border adjustment, fossil fuel subsidies and free trade agreements. We apply two analytical tests: compliance with relevant World Trade Organisation obligations and coherence with the net-zero climate target. The analysis is hindered by uncertainty, primarily regarding the extent of future global climate ambition, but there are clear areas in which the UK could strengthen its approach to climate change mitigation without undermining its commitment to open trade. Barring a major increase in global ambition, achieving the net-zero target will, however, likely require new trade restrictions. The implication is that, rather than being situated at the margins, the climate target must comprise a central objective of trade strategy.

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05/01793 Leading by example. Wind developer builds first commercial net zero carbon dioxide emissions building in the UK

Fuel and Energy Abstracts ◽

10.1016/s0140-6701(05)81800-4 ◽

2005 ◽

Vol 46 (4) ◽

pp. 263

Keyword(s):

Carbon Dioxide ◽

Carbon Dioxide Emissions ◽

Net Zero ◽

Zero Carbon ◽

The Uk

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Identifying the Lack of Energy-Conscious Behaviour in Clinical and Non-Clinical Settings: An NHS Case Study

Electronics ◽

10.3390/electronics10202468 ◽

2021 ◽

Vol 10 (20) ◽

pp. 2468

Author(s):

Ahmad Taha ◽

Tim Hopthrow ◽

Ruiheng Wu ◽

Neil Adams ◽

Jessica Brown ◽

...

Keyword(s):

Energy Savings ◽

Electricity Consumption ◽

Working Hours ◽

Hospital Staff ◽

Negative Energy ◽

Clinical Settings ◽

Energy Usage ◽

Net Zero ◽

Zero Carbon ◽

The Uk

The race against climate change has been a great challenge for years, and the UK government has taken serious steps towards achieving the net-zero carbon target by 2050. Technology is leading the way and innovation is believed to be a key solution. Nevertheless, tackling the issue, by attempting to limit the waste in energy, due to negative energy usage behaviour, has proven to be a successful approach that is capable of complementing other technology-based initiatives. The first step towards this is to promote energy-conscious behaviour and pinpoint where savings can be made. Thereby, this paper contributes to the existing literature, by presenting a new methodology to identify potential energy waste and negative energy usage behaviour in an NHS hospital. The paper presents an analysis of electricity consumption vs occupancy during minimal consumption periods (i.e, bank holidays and weekends) and it presents a log of equipment left switched on outside of working hours, in order to highlight the level of energy-conscious behaviour. The results revealed that the proposed technique is not only able to identify negative energy usage behaviour amongst the hospital staff but helps identify areas where immediate energy savings can be made, with potential savings of more than 30,000 pounds, if action is taken.

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