Sustainable procurement in the NHS: barriers and enablers to staff behavioural change

Background/Aims There is a strong ethical impetus and a growing policy requirement for healthcare institutions to reduce their environmental impact. Procurement is area with significant opportunities to reduce the negative impacts of healthcare services on human and planetary health. This study explored experiences of barriers and enablers to sustainable procurement practices among NHS staff, looking at how the COM-B (capability, opportunity, motivation-behaviour) model could be applied to develop sustainable procurement systems. Methods A qualitative study was conducted, using semi-structured, in-depth interviews to collect data. Participants (n=11) were NHS staff working in roles that were connected to procurement and/or sustainability, including a variety of roles, bands and levels of experience. Participants were asked about their experiences of barriers and enablers to sustainable procurement practices. Data were recorded, transcribed and analysed using thematic analysis, with themes mapped on to the components of the COM-B model. Results Although barriers and enablers were identified for each component of the COM-B model, the opportunity component was the most prominent. Organisational culture was seen as a major barrier, with a strong influence on staff behaviour, while buy in from senior leadership was felt to be an essential enabler. Cross-cutting issues such as the COVID-19 pandemic and legislation were also mentioned, as were physical barriers such as costs and time constraints. Conclusions There are a wide range of barriers and enablers to achieving sustainable procurement in NHS hospitals. The application of the COM-B model in this study suggested that a more holistic approach is required, seeking to address the key barriers related to the opportunity component, with a particular focus on organisational culture. Implications for practice Existing interventions towards environmental sustainability in the NHS must be complemented by holistic strategies aiming to create a social environment that supports behavioural change. Such interventions should focus on empowering staff across all grades, promoting a culture of innovation, streamlining internal processes, enhancing pro-sustainability communications and adopting sustainability as a core cultural value.