Background The health care sector is among the most carbon-intensive sectors, contributing to societal problems like climate change. Previous research demonstrated that especially the use of personal protective equipment (e.g., aprons) in critical care contributes to this problem. To reduce personal protective equipment waste, new sustainable policies are needed. Aims Policies are only effective if people comply. Our aim is to examine whether compliance with sustainable policies in critical care can be increased through behavioural influencing. Specifically, we examined the effectiveness of two sets of nudges (i.e., a Prime + Visual prompt nudge and a Social norm nudge) on decreasing apron usage in an intensive care unit (ICU). Study Design We conducted a field experiment with a pre- and post-intervention measurement. Upon the introduction of the new sustainable policy, apron usage data were collected for 9 days before (132 observations) and 9 days after (114 observations) the nudge interventions were implemented. Results Neither the Prime + Visual prompt nudge, nor the Social norm nudge decreased apron usage. Conclusions While previous studies have found that primes, visual nudges and social norm nudges can increase sustainable behaviour, we did not find evidence for this in our ICU field experiment. Future research is needed to determine whether this null finding reflects reality, or whether it was due to methodological decisions and limitations of the presented experiment. Relevance to Clinical Practice The presented study highlights the importance of studying behavioural interventions that were previously proven successful in the lab and in other field contexts, in the complex setting of critical care. Results previously found in other contexts may not generalize directly to a critical care context. The unique characteristics of the critical care context also pose methodological challenges that may have affected the outcomes of this experiment.@en

The merits of electronic procurement (EP) tools have been widely acknowledged. Achieving these benefits remains a challenge, as companies are experiencing difficulties with human adoption during the implementation of such tools. In this article we focus on the intra-organizational spread of EP adoption from one actor to another. Based on exploratory interviews with experts and representatives of large Dutch purchasing organizations, we have identified nine categories of influences on actor-to-actor dissemination: perceived advantage, communication, demonstration, enforcement, training, involvement, risk reduction, reward, and disposition. This study is beneficial to companies engaging in the implementation of EP tools as it provides a portfolio of interventions that can be used to stimulate the spread of adoption. This article addresses a new area in EP research and opens up possibilities for future research in EP implementation.@en