Understanding waste management behaviour in care settings in South West England: a mixed methods study

Abstract

Introduction - Health and social care sector activities in the United Kingdom have a considerable carbon footprint which impacts on the natural environment. Waste management is one area of focus for the reduction of this environmental impact. Previous research has studied the quantities and compositions of healthcare waste highlighting the potential for recycling. Limited research to date has investigated both health and social care waste management in a holistic study incorporating the behaviour, composition and systems. The current study aimed to investigate waste management behaviour, systems and compositions at four health and social care sites in the South West of England, then derive a framework of health and social care waste management behaviour incorporating points of intervention for the improvement of waste management practices. Methods - A mixed methods multi-strategy concurrent triangulation design was used to investigate the waste management at four health and social care sites in the South West of England. This consisted of a management interview sub-study investigating waste management policy, guidance and training. An observational sub-study was used to investigate health and social care employee waste management behaviour. An audit of the clinical and domestic waste streams provided an overview of the waste composition at each site. Finally a self-report questionnaire sub-study of decision making was conducted to investigate the conscious and habitual aspects of waste management decision making. The findings from these four sub-studies were then synthesised through a data triangulation process. Findings - The domestic waste bins were most commonly used to dispose of waste during the observational sub-study. The waste audit sub-study found the domestic waste stream contained the largest percentage of potentially recyclable waste. The observational sub-study also uncovered twenty unique primary themes influencing the employee waste management behaviour. These themes included aspects internal to the health and social employee such as confusion, and external themes such as equipment. The management interviews highlighted a lack of waste management training and a reliance on the local site waste management policies to guide and monitor employee waste management behaviour. Discussion - The health and social care waste management behaviour improvement framework (HWMBIF) is presented. The HWMBIF is a novel framework, derived from the triangulated data of the current study, for understanding and improving waste management behaviour at the participating sites. Several interventions based in the HWMBIF and on the study findings are presented. Future research will focus on testing and refining the HWMBIF, the suggested interventions and developing further interventions.