Understanding Sustainability in Operating Theaters: An Ethnographic Study to Determine Drivers of Unsustainable Behaviors

This study identified widespread unsustainable culture and practices in operating theaters that compromise patient safety, and financial and environmental sustainability. It provides a nuanced understanding of contextual factors and their drivers, such as the strong impact of habit, knowledge, and the striving for efficiency, highlighting the need for both bottom-up engagement and top-down prioritization. The study provides a foundation for designing targeted interventions that integrate education, leadership engagement, and environmental restructuring to embed sustainability into routine surgical practice while ensuring patient safety and operational efficiency.