Developing a sustainable National Health Service

A sustainable NHS

The Challenge

Some of the most interesting operations management, organisational innovation and supply chain research is within the context of health and care provision. The context is complex, diverse and improved services have a direct impact on the quality of lives for patients and staff. Research to improve process safety, quality, and to compress time have been key global challenges since the early 2000s to ensure the economic viability of services and sustainability of change interventions within the organisation. Many savings resulted from leaner ways of working, safety and quality innovations and greater agility with the care provider and with innovations across the supply chain management. More recently, the viability of environmental sustainability has joined the general process of health and care improvement. Interventions to conform with global best practices and to offer a healthier environment for the local community have increased and created a new agenda to improve working practices and to rethink how best to deliver health and care. These innovations go beyond reducing and recycling materials to embrace innovations and new approaches to clinical care delivery. The new improvement mindset is expansive and holistic. It is well suited to a post-pandemic world of austerity and conservation – making the most of what resources are available without depleting them and generating new possibilities to serve society. These challenges cannot incur a trade-off and each environmental solution introduced must also represent the enhancement of economic value and patient value too if true and meaningful impact is to result from practical research.

The Method

The projects that have been undertaken with organisations that form the Welsh NHS are broad ranging and have traditionally focused on process improvement but now have a broader focus on sustainability and innovation.  The research projects that have been undertaken include rethinking waste streams but challenging old mindsets. Each hospital has a significant range of opportunities to embrace environmental thinking and the circular economy for good outcomes. The recent projects have included the review of land estates to convert to farming so that greater fresh and low carbon footprint (from farm to the fork of the patient or for the local citizen). These farms can offer new forms of meaningful employment in the form of therapies for citizens/patients who would benefit from exercise regimes, social interaction and the benefits of being a team member and the mental health benefits of being productive. Other experiments include capturing and cleaning the steam and heat from hospital processes to use to support crop growing. Waste land is also being targeted for solar farming to offset energy bills and to assure a low cost sustainable NHS service. Other recycling opportunities have been exploited so that a societal benefit results from every research project – these have included the repurposing of beds from temporary Covid hospitals to local children to alleviate sleep poverty. Other projects include rethinking the role of the central pharmacy to reduce medicine wastes and packaging, recycling hospital consumable items to convert into new products of value to non-health supply chains and questioning the design of future hospitals and how efficiencies can be generated by better operating theatre designs and waste free flows. It is a research agenda that is boundless and of the highest importance.

Randomised control trials have dominated the ‘scientific way’ and clinical thinking for generations. But studies of organisations must be more contextual and participative. No two organisations, of the same size or function, ever behave in the same way. Local nuances exist when attempting to make changes to working practices and inform better practice through research. The most appropriate approach is abductive (drawing from working practices) to assure research impact. The preferred methodologies include those aimed at solving problems - case study analysis, participative action research and experiment cycles unite academics and professionals. These learning groups and communities of practice co-develop new theory and release pragmatic benefits for a variety of stakeholders including the NHS staff, the Welsh Government, key clinical professions and the patient, local community and local environment.  The research includes key stakeholders of all forms, a diverse range of backgrounds, and ages but each has an interest in improving processes and practices for future generations.


The wide portfolio of ongoing research is delivering significant impact for stakeholders and academics across a range of fields of study (operations management, environmental management, supply chain management, innovation management and change management). The immediate impact is in the form of resource efficiency for the organisation and in total cost of ownership reductions. New impact has also been generated by the development of new community impact companies that are capable of generating profits and revenues that make the service provided ‘free’. But, in the health and care context where governance is key, there are many other tangible and intangible benefits including improvements in staff and patient morale, patient and process safety, the delivery of care in terms of access, location and form, and also in operational costs (actual savings, reduced avoidable costs, less waste, less effort and such like). But the biggest outcome, is to create an economic and environmentally sustainable health and care service for the community by harnessing the talents of NHS staff with the support of robust research of high impact to professional practice, student education and the most contemporary of academic debate.