Framing the Shades of Sustainability in Health Care: Pitfalls and Perspectives from Western EU Countries

Including environmental and social sustainability in the planning process of healthcare services: A case study of cancer screening programs in an inner area in Italy

Healthcare systems plan their activities to achieve efficiency and effectiveness, without addressing environmental and social sustainability. This paper describes a new approach adopted in Italy to plan and deliver health prevention services in an inner area of the Tuscany region (in Italy) to guarantee proximity of care and environmental and social sustainability. The project examines the design and delivery of cancer screening programmes using a mobile screening unit to maximise social benefits while minimising environmental waste. A cost analysis was developed to estimate the difference in CO2 equivalent emissions, travel costs, and productivity losses, comparing the current screening programmes against the introduction of a comprehensive full-service mobile screening unit. The results indicate that the new service model reduces direct non-medical costs incurred by the population and improves environmental sustainability. This alternative can reduce, annually, over 95,000 euros in terms of travel costs and productivity losses, as well as 35 tons of CO2-equivalent travel emissions for a population of 59,000 inhabitants in a mountainous area with around 6000 people involved in the screening programme. The study supports the need to adopt a new planning methodology that considers environmental, social, and financial sustainability jointly in the provision of public health services in rural areas.

Promoting advanced medical services in the framework of 3PM-a proof-of-concept by the "Centro" Region of Portugal

Multidisciplinary team from three universities based in the "Centro" Region of Portugal developed diverse approaches as parts of a project dedicated to enhancing and expanding Predictive, Preventive, and Personalized Medicine (3PM) in the Region. In a sense, outcomes acted as a proof-of-concept, in that they demonstrated the feasibility, but also the relevance of the approaches. The accomplishments comprise defining a new regional strategy for implementing 3PM within the Region, training of human resources in genomic sequencing, and generating good practices handbooks dedicated to diagnostic testing via next-generation sequencing, to legal and ethical concerns, and to knowledge transfer and entrepreneurship, aimed at increasing literacy on 3PM approaches. Further approaches also included support for entrepreneurship development and start-ups, and diverse and relevant initiatives aimed at increasing literacy relevant to 3PM. Efforts to enhance literacy encompassed citizens across the board, from patients and high school students to health professionals and health students. This focus on empowerment through literacy involved a variety of initiatives, including the creation of an illustrated book on genomics and the production of two theater plays centered on genetics. Additionally, authors stressed that genomic tools are relevant, but they are not the only resources 3PM is based on. Thus, they defend that other initiatives intended to enable citizens to take 3PM should include multi-omics and, having in mind the socio-economic burden of chronic diseases, suboptimal health status approaches in the 3PM framework should also be considered, in order to anticipate medical intervention in the subclinical phase.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-024-00353-9.

Back and Forth on Sustainable Development: A Focus on Healthcare Organisations

The sustainability of healthcare systems represents a relevant target of the 2030 Sustainable Development Goals Agenda. Nevertheless, academic research has neglected to study healthcare systems when focusing on the transition toward sustainable healthcare. This study addresses this gap by investigating the implementation of the sustainable development (SD) principle in the Italian healthcare system, in light of international and national institutional discourses on SD. A questionnaire-based survey has been directed to the General Directors (GDs) of government-funded healthcare orgsanisations to investigate their perceptions about the SD principle applied to healthcare, their strategic planning for SD, their implemented projects for sustainability and the intellectual capital factors that influence the latter’s implementation. The study was conducted in two waves: a first survey was administered in 2016, with a second one in 2021. We used content analysis to identify the potential differences emerging over time in GDs’ perceptions in light of the changes in the institutional discourse; we then assessed the differences over time in the perceived contribution of intellectual capital factors to the implementation of sustainability actions. Results show a substantial decrease in strategic planning for sustainability, as well as in the volume of sustainability projects implemented, as organisations were found to be less involved in implementing SD strategies and projects in 2021 than in 2016. Policies at the country level have mainly focused on balancing cost containment with quality targets, leaving the environmental dimension of sustainability and its connection with healthcare with limited guidelines. Regarding intellectual capital factors, organisational culture and technologies are increasingly perceived as enablers of SD; nevertheless, further studies are needed to deepen their effective contribution to sustainable healthcare.

The Burden of Caring for Dependent Older People and the Resultant Risk of Depression in Family Primary Caregivers in Italy

Long-Term Care (LTC) for older people in need of care is a critical issue affecting the quality of life of family caregivers (as well as older people), encompassing both negative and positive caregiving experiences. Providing support to family caregivers is essential because they play a crucial role in sharing the societal burden of LTC for the growing frail older population. By presenting the results of a survey carried out in 2019–2020 in Central Italy, this study aims to describe the characteristics and estimate by a multivariate logistic model the correlates of depressive symptoms in 369 primary caregivers of dependent older people. Caregivers are mostly women who provide a high amount of care in terms of weekly hours as a result of insufficient assistance from public or private care services. More than half of the sample show depressive symptoms, indicating a fairly serious situation. Perceived burden is a strong predictor of depression. The findings offer suggestions and policy implications. The fragmentation of the care context should be addressed by allocating sufficient funding to expand the supply of public in-kind services and integrate cash-for-care schemes, thus alleviating the burden and mitigating the negative consequences of care on physical and mental health.

Does Financial Technology Improve Health in Asian Economies?

The progress of the health sector in a sustainable manner is crucial for the development of human capital, a significant and vital driver of economic growth. Hence, we aim to investigate the impact of FinTech on health outcomes in Asian economies over the period 2007–2019. The empirical estimation of the study is based on the 2SLS and GMM techniques. The outcomes confirmed the negative impact of ATMs and Debit cards on the infant mortality rate in both 2SLS and GMM models. Whereas, ATMs and Debit cards positively impact the life expectancy of people living in Asian economies irrespective of the estimation technique. Similarly, the association between the Internet and infant mortality rate is negative; whereas, this association is positive in the context of the Internet and life expectancy both with 2SLS and GMM. From these findings, we can confirm that the amalgamation of technology and the financial sector helps to improve health outcomes in Asian economies. Therefore, the integration of FinTech into the health sector should be part and parcel of every health policy in emerging Asian economies.

Exploring, Diversifying and Debating Sustainable Health (Care) Approaches

Today’s sustainability challenges have major implications for human health and health care. At the same time, the way health care is organized and conducted has major sustainability implications. Sustainable health and sustainable health care approaches in research, which engage with health and sustainability as intertwined phenomena, feature increasingly prominently in various literatures, i.e. (i) literature based on the premise of ‘(un)healthy environments result in (un)healthy people’ (e.g., planetary health); (ii) literature on the implications of ecological change for the sustainability of healthcare systems; and (iii) literature on healthcare systems’ sustainability in view of a range of socio-economic factors. However, an integrative elaboration of the manifold relationships between health and sustainability challenges in these literatures is currently lacking. This review paper therefore maps how these three literatures represent intertwinements between health and sustainability challenges, as well as their suggestions to address these challenges. In addition, we explore which themes and questions are pertinent, meaning they have remained largely unaddressed. By performing a qualitative mapping review, we find that calls for structural attention to inequality, to in-and exclusion, and to stakeholder needs and perspectives cut across these three literatures. Furthermore, we identify three cross-cutting key questions that require future research attention. First, how do divergent ideas on what is and divergent ideas on how can that be known give rise to different health- and sustainability visions and pathways? Second, what do abstract problem statements and solutions presented in agenda-setting work look like in practice in specific and diverse empirical contexts across the globe? And third, how are diverse health and sustainability dynamics historically and spatially interconnected? Moreover, we observe that some voices have so far remained largely silent in scientific debates on health and sustainability intertwinements, namely non-expert voices such as patients and citizens, voices from a variety of social scientific and humanities disciplines, voices from relevant domains beyond (environmental) health, and voices from the global South (from non-experts, social scientific and humanities researchers and domains beyond health). We conclude that a focus on inclusive and equitable engagement with intertwined health- and sustainability challenges is imperative. This requires moving away from developing universal knowledge to address generic problems, to foregrounding plurality in terms of problem statements, knowledge, solutions, and the values embedded therein.

A Sustainability Management Model for Local Government: An Explanatory Study

Although the scientific debate in the field of business economics is rich in contributions to the subject of sustainability, they mainly focus on a specific aspect represented by sustainability reporting. Consistent with this bibliographic evidence, the aim of this study was to investigate a sustainability management model in local authorities, which, by examining the dimensions of sustainability, goes beyond the focus of reporting highlighted in the literature to consider the entire sustainability cycle (from planning to measurement). To this end, the methodology of the single case study with multiple units of analysis is used, examining the case of an Italian local authority that has experimented with the sustainability management model described in this paper. The analysis of the case leads to some concluding remarks on the strengths and weaknesses of the model, contributing to the scientific debate on sustainability management and providing useful indications for public managers and political decision-makers.

Leading through the ‘new normality’ of health care

Health care institutions are witnessing a ‘new normality’, which profoundly reshapes the strategic and management challenges faced by health professionals in their attempt to achieve excellence in the design and delivery of care. This ‘new normality’ triggers a transformation of conventional managing models and leadership styles, which have proved to be unfit with the changed attributes of the external and internal contexts of health care organizations. The ‘new normal’ leadership style relies on the ability of leaders to make sense out of the new challenges that are faced by health care organizations and on their capability to act managerially, sticking to an empowering approach which enables followers. However, the transformation of conventional leadership style is impossible if a rethinking of training activities and learning experiences delivered to health professionals is missing. The article provides an overview of the issues that health leaders and managers encounter in the ‘new normality’ of health care, identifying several unanswered questions which should be addressed to thrive in the changed landscape of health services’ delivery.

Boosting Sustainability in Healthcare Sector through Fintech: Analyzing the Moderating Role of Financial and ICT Development

Healthcare organizations are setting new targets of sustainable practices to improve their financial performance without depleting social and natural capital. Maintaining a sustainable, resilient, and durable healthcare system facilitate economies to achieve sustainable competitiveness. Thus, it is important to address and fill the knowledge gap by identifying factors that improve a firm's sustainability. Drawing on technological knowledge spillover theory, this study investigates the effect of FinTech development on the sustainable performance of healthcare firms using panel data comprised of 11 Asia-Pacific countries. By applying the 2-step GMM technique, we find a robust estimate that digital financial technologies improve the sustainable performance of the firms. Contrary to the substitution effect, our results further indicate that financial institutions are collaborating with FinTechs to facilitate financing at the individual and firm-level. We also find that financial and ICT development positively moderates the relationship between FinTech development and sustainable performance.

Binary Programming Model for Rostering Ambulance Crew-Relevance for the Management and Business

The nature of health care services is very complex and specific, thus delays and organizational imperfections can cause serious and irreversible consequences, especially when dealing with emergency medical services. Therefore, constant improvements in various aspects of managing and organizing provision of emergency medical services are vital and unavoidable. The main goal of this paper is the development and application of a binary programming model to support decision making process, especially addressing scheduling workforce in organizations with stochastic demand. The necessary staffing levels and human resources allocation in health care organizations are often defined ad hoc, without empirical analysis and synchronization with the demand for emergency medical services. Thus, irrational allocation of resources can result in various negative impacts on the financial result, quality of medical services and satisfaction of both patients and employees. We start from the desired staffing levels determined in advance and try to find the optimal scheduling plan that satisfies all significant professional and regulatory constraints. In this paper a binary programming model has been developed and implemented in order to minimize costs, presented as the sum of required number of ambulance crews. The results were implemented for staff rostering process in the Ambulance Service Station in Subotica, Serbia. Compared to earlier scheduling done ad hoc at the station, the solution of the formulated model provides a better and equable engagement of crews. The developed model can be easily modified and applied to other organizations with the same, stochastic, nature of the demand.

Sustainability of Youth Careers in Romania—Study on the Correlation of Students’ Personal Interests with the Selected University Field of Study

Sustainable use of resources is an act of social responsibility, in which all the factors that benefit or exploit that resource are involved. Education, with its most important goal—finding a place in the labor market in the form of a career—is a process that involves multiple financial, human and institutional resources. The present study analyzes to what extent the careers that young people in Romania build correlate with their personal interests. Using the Holland Test, the interests of a group of engineering students were identified. It was observed that there are three typologies of people: those who have chosen their field of study according to their interests, those who are interested in interdisciplinary fields of which engineering is a part and the third category, who have no interest in the field of engineering. The percentages of the three categories are approximately equal, which should determine the change of educational policies in Romania, in the sense of promoting and practicing career guidance for the early discovery of young people’s interests and the sustainable convergence of all resources towards them.

Financial Sustainability of Local Governments in the Eyes of Finnish Local Politicians

Local government aims for financial sustainability in ensuring the wellbeing of citizens at the expense of their tax incomes. As members of local councils, local politicians are the highest decision-makers who are responsible for setting the aims and evaluating the outcome of municipal operations. Hence, local politicians’ notions on financial sustainability play an important role in sustainable decision-making. Although financial sustainability is seen important, previous research is limited in providing studies on the multidimensional nature of financial sustainability. Prior research has focused on the measurement of financial sustainability, often in the contexts of financial difficulties. This paper aims to answer this research gap by studying local politicians’ interpretations on financial sustainability and contributing to a deeper understanding of the phenomenon. This qualitative study employs interview data collected from 24 Finnish local politicians from five municipalities. Based on the content analysis of the interview data, financial sustainability is, in the eyes of local politicians, a political issue with multiple factors in and out of the reach of decision-makers. These notions could be utilized in future research in developing methods for measuring and managing financial sustainability in local governments.

Improving Health Professionals’ Involvement Whilst Sustaining Work–Life Balance: Evidence from an Empirical Analysis

Most sustainability studies applied to healthcare primarily focus on external viability. In particular, they look at the ability of healthcare institutions to establish an economic, environmental, social, and political consonance with their context. Conversely, limited attention has been paid to issues related to internal sustainability. The article discusses health professionals’ involvement as a human resource management practice which contributes to the viability of healthcare organizations. A sequential mediation analysis was designed to shed light on the effects of employees’ involvement on work–life balance, which is an essential ingredient of the recipe for internal sustainability. The study findings suggest that health professionals’ involvement may determine an intensification and an extensification of work efforts, which undermine their work–life balance. Nevertheless, the implications of employees’ involvement on work–life balance are positively and significantly mediated by supportive relationships at work and positive organizational climate. From this standpoint, health professionals’ involvement may act as an effective strategy to enhance the internal sustainability of health care organizations if matched with better relationships with supervisors and improved organizational climate. Whilst calling for further research to enlighten issues and challenges related to internal sustainability, the article stresses that health professionals’ involvement should be paired with an improvement of the organizational climate to contribute to an increased viability of health care institutions.

IC-Health Project: Development of MOOCs to Promote Digital Health Literacy: First Results and Future Challenges

Digital health literacy (DHL) is the ability to search, understand and evaluate information from digital media and apply that knowledge to solve health problems. However, currently many citizens have not developed these skills, and this compromises not only the self-management of their health, but the possibility that health services are socially sustainable. The objective of this article was to present the objectives, activities and results of the IC-Health project whose objective was to develop a series of massive open online courses (MOOCs) to improve the DHL skills of European citizens. An exploratory report on DHL’s current evidence was developed. Furthermore, a survey, focus groups and group interviews were conducted to determine DHL levels and the needs of population cohorts (children; adolescents; pregnant and lactating women; the elderly; and people affected by type 1 and type 2 diabetes). A participation strategy with end users was designed through a community of practice for the creation of MOOCs with the seven European countries that participated in the consortium. Thirty-five MOOCs were developed in eight different languages and a descriptive and exploratory assessment of MOOCs was conducted with new participants. This first evaluation indicated that MOOCs can be an effective educational resource for DHL and a facilitator of shared decision-making processes. The process of co-creation of MOOCs, the components, the challenges and the opportunities identified in this European project could be useful for other developers of MOOCs who want to co-create interventions with beneficiaries in similar settings. Further longer-term actions are still needed to improve citizens’ DHL.

Engaging citizens in collective co-production

Purpose

Citizen engagement and public service co-production have been identified as essential ingredients of the recipe for public services’ quality improvement. However, the process of citizens’ involvement has rarely been investigated in the scientific literature. The purpose of this paper is to shed light on this issue, examining the expectations and perspectives of people involved in an ongoing process of collective public service co-production implemented in Val Brembilla, a small-sized municipality located in North-Western Italy.

Design/methodology/approach

A mixed research strategy was designed. First, seven focus groups involving both citizens and entrepreneurs participating in public service co-production were established. Second, a semi-structured survey was administered to 463 co-producers (including both citizens and entrepreneurs), in order to elicit their perceptions and expectations.

Findings

An institutional trigger, namely, the decision of the municipality’s board to purchase the Kuwait Expo 2015 pavilion, initiated the process of public service co-production. Although citizens did not fully agree with the decision to buy the pavilion, due to its negative implications on the municipality’s finances, they were found to be willing to participate in public value co-creation. The opportunity to promote territorial identity through public value co-creation represented the main driver for citizens and entrepreneurs’ involvement.

Practical implications

Collective public service co-production is a sustainable and effective way to enhance the provision of public services. Several barriers are thought to prevent citizens’ engagement in collective public service co-production. First, people expect to be engaged from the initial steps of the process; second, the distinguishing role of territorial identity in influencing citizens’ behaviors and expectations should be recognized and properly addressed to avoid shortcomings in citizens’ engagement.

Originality/value

This paper investigates an ongoing collective public service co-production experience; moreover, it highlights the role of public service co-production in enhancing the public sector entities’ ability to recognize the evolving needs of the community.