Introduction: The provision of health and social care for a country’s population is a concern for modern society. The economic, social and environmental sustainability of health and social care services are less often considered factors. These are large public services that consume large quantities of raw materials and produce hundreds of thousands of tonnes of waste per year. Improving the management of health and social care waste would contribute towards improving the sustainability of these services. The instigation of a reduce, re-use and recycle philosophy could help by reducing the carbon foot print of these services. For example, recycling is a cheaper disposal method than the incineration of clinical waste. The issue facing health and social care services managers is how to design and institute a sustainable waste management system that works. This study aimed to investigate how the health and social care organisations, the employees and the waste management system influenced the disposal and management of waste.

A mixed methods multi-strategy concurrent triangulation study, that included five sub-studies, was carried at four health and social care sites in the South West of England. The five sub-studies were; 1) A quantitative observation of waste disposal behaviour, 2) A qualitative observation of waste disposal behaviour, 3) A waste audit of the clinical and domestic waste streams, 4) A semi-structured interview study with the member of the management responsible for waste management, and 5) A pilot decision making questionnaire assessing the role of conscious and habitual decision making in waste disposal behaviour. The findings of all five studies were triangulated, then reconciled with the existing literature and used to construct a framework for the improvement of health and social care waste management.

The health and social care waste management behaviour improvement framework (HWMBIF) depicts the factors influencing individual waste management tasks/behaviours. The HWMBIF builds from the behaviour through the decision making processes to the factors impacting on waste management knowledge and memory. These factors include: visual cues, social influences, situational time pressures, a triadic interaction between environmental experiences, environmental attitudes and the salience of environmental issues in the task. Six points in the framework were identified as potential targets for interventions and plausible interventions suggested for them. Methods for measuring each facet of the model and a direct primary measure of waste disposal behaviour were proposed.

The HWMBIF has the potential to aid in the design, re-design and maintenance of health and social care waste management systems. The cost of designing or re-designing systems in this way would be countered by the potential for both financial and carbon savings. If non-clinical waste which is currently disposed of in the clinical waste is transferred to the municipal and recycling waste streams, financial savings can be made that can be reinvested into patient care. Environmental savings could be achieved with the introduction of recycling lowering carbon emissions and the need for raw material extraction. This framework is currently theoretical but has been built from rigorous and detailed empirical evidence. Future research will seek to test and refine the framework in a variety of health and social care settings.