Decarbonizing surgical care: a qualitative systematic review guided by the Congruence Model

The healthcare sector must navigate the challenge of caring for individuals affected by climate change while being a significant emitter of carbon emissions. This study focuses on direct sources of carbon emissions from hospital surgical care, a major contributor to the sector's overall carbon footprint. The goal is to identify the main sources of direct carbon emissions in surgical care and to analyze these sources according to the Congruence Model. We employ the Congruence Model for a systemic analysis of emission sources within the organizational context. The change-oriented model examines (in)congruences across the domains of People, Work, Culture, and Structure, aiding in the understanding of organizational change.

A qualitative systematic literature review was conducted following PRISMA guidelines, covering three extensive databases: PubMed, Business Source Premier, and EBSCOhost. The review provides a broad perspective on the topic under study. The qualitative analysis is guided by the Congruence Model, which serves as a conceptual lens to analyze and interpret the findings.

The study offers a comprehensive overview of research focused on emissions related to surgery. Hotspots of carbon emissions in surgical care, such as anesthetic gases, sterilization procedures, and habitual behaviors, are linked with the Work and People elements of the Congruence Model. Additionally, sustainability measures are predominantly associated with the Structural element of the Congruence Model, including policies for recycling and waste segregation. The research reflects on the (in)congruencies between different factors of the Congruence Model and actions related to reducing carbon emissions.

The Congruence Model provides a useful conceptual lens to categorize the sources of carbon emissions in terms of People, Work, Structure and Culture. In addition, the Congruence Model allows us to explore the (in)congruencies between these functional elements. Ultimately, our research identifies opportunities to improve carbon emissions related to the surgical care process.