An organising framework for healthcare decarbonisation research: an exploratory classification study

ObjectivesTo develop an organising framework for healthcare decarbonisation research which goes beyond classification schemes based on Scope 1, 2 and 3 emissions or lists of loosely connected themes, and which is intended to support the coordination, funding and application of research into policy and practice. The organising framework should be focused on the NHS in England but enable application to healthcare systems more broadly. DesignAn exploratory manual (non-machine-led) classification study of over 160 research questions derived from a scoping review of 10 systematic reviews (118 screened), 13 stakeholder documents (35 key stakeholder websites searched), two research priority exercises, and four research funder sources (over 430 funding areas screened). The above and a further 21 sources were also used to identify areas without explicit research questions but of clear thematic relevance. SettingPrimarily high-income healthcare systems, with a focus on the NHS in England. ParticipantsNot applicable. Primary outcomeA multi-level thematic framework representing current and missing areas of research in healthcare decarbonisation. ResultsThe framework comprises six top-level themes, grouping 39 sub-themes at level two, and 86 sub-themes at level three. The top-level themes are: Natural resource use and sources of carbon; Healthcare contexts; Solutions; Stakeholders; Organisational levers for change; and Scientific measurement and theory (the "NHS-SOS framework"). ConclusionsThis framework offers a structured, empirically derived representation of the emerging field of healthcare decarbonisation research. It is intended as a living tool to support shared understanding, prioritisation and action, and to foster coherence in a currently fragmented research landscape. Article summaryO_ST_ABSStrengths and limitations of this studyC_ST_ABSO_LIThe study used a transparent and structured process to derive themes from over 160 research questions, sourced from a diverse set of systematic reviews, stakeholder documents, research priority exercises, and funding calls. C_LIO_LIThe inductive approach respected the complexity, breadth and multiple perspectives inherent to healthcare decarbonisation research. C_LIO_LIThe study drew on a wide range of sources selected for conceptual and perspectival breadth but was nonetheless small relative to the volume of publications in the field. C_LIO_LIMany of the research questions were not explicitly stated in the source documents and had to be derived through interpretive analysis. This introduced a potential for bias, which was mitigated through a clearly documented and transparent process outlining how interpretations were made. C_LI