Australian healthcare workers’ perspectives, practices, and perceived barriers to a more environmentally sustainable health system: a cross-sectional survey

Healthcare is a significant contributor to greenhouse gas emissions and solid waste. This study evaluated Australian healthcare workers’ knowledge, current behaviours and perceived barriers related to improving healthcare sustainability. From November 2023 to January 2024, we conducted an online cross-sectional survey of employees at 12 healthcare organisations in Victoria, Australia. All employees of participating institutions at the time of the survey were considered eligible; students were excluded. The survey link was distributed to all employees via email, and participation was based on self-selection. Our survey included questions from the validated Climate Change Attitudes Survey and Climate and Health Tool, focusing on the domains of awareness, concern and behaviours at home and at work. We also developed original, non-validated questions to explore self-reported barriers to reducing healthcare-associated greenhouse gas emissions and waste, and perceived responsibility for action. Statistical analyses included logistic and linear regression models with cluster-robust standard errors, paired t-tests, Wilcoxon and McNemar tests to compare responses across groups. We received 2,040 complete and eligible responses. Most respondents were women (1,559, 76%), working in metropolitan locations (1,787, 88%) and employed in the public sector (1,937, 95%). Overall, concern regarding climate change (mean score: 3.29; 5-point Likert scale from 0 to 4) was slightly higher than awareness (mean score: 3.09). Respondents reported taking fewer sustainability actions at work compared to their personal lives (mean score 2.09 versus 2.48, p < 0.001). Our original, exploratory questions demonstrated that the three most common barriers to reducing healthcare-associated waste and greenhouse gas emissions were identical: lack of knowledge (39% and 53%, respectively), busyness (26% and 20%) and perceived lack of support from superiors (26% and 19%). While respondents demonstrated high levels of climate awareness and concern, they faced numerous barriers to pursuing greater sustainability actions at work. The three most frequently reported barriers were a lack of knowledge, a lack of time, and a lack of support. Consistent with previous studies, employees struggled to transfer environmental sustainability practices from their personal lives to the workplace. Our findings offer practical insights into how employee perspectives can shape future strategies to enhance healthcare environmental sustainability.