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Special Issue "Sustainability for Healthcare"

A special issue of Sustainability (ISSN 2071-1050).

Deadline for manuscript submissions: closed (31 December 2018)

Special Issue Editors

Guest Editor
Prof. Sergio Barile

Department of Management, Sapienza University of Rome, Rome, Italy
Website | E-Mail
Interests: systems thinking; viable systems approach (VSA); complexity, decision making; knowledge management; healthcare management
Guest Editor
Prof. Marialuisa Saviano

Department of Pharmacy and Pharmanomics Interdepartmental Research Center, University of Salerno, Salerno, Italy
Website | E-Mail
Interests: viable systems approach (VSA); healthcare management; pharmaceutical management; sustainability science; service & retail marketing; cultural heritage management; knowledge management
Guest Editor
Dr. Francesco Caputo

Department of Pharmacy and Pharmanomics Interdepartmental Research Center, University of Salerno, Italy
E-Mail
Interests: knowledge management; healthcare management; pharmaceutical management; viable systems approach (VSA)

Special Issue Information

Dear Colleagues,

Sustainability, as a research topic, is generally investigated to advance studies about environmental, cultural, economic, and social sustainability. More specifically, in the context of managerial and organizational studies, sustainability is largely investigated in terms of what organizations can contribute to the global challenges of sustainability.

By reversing the perspective (and in order to self-reinforce the engagement of organizations to sustainability), this Special Issue aims to investigate what “sustainability”, as a science, can contribute to people and organizations in the context of healthcare.

Healthcare is a worldwide concern. Indeed, it is the third of the 17 Sustainable Development Goals (SDGs)—“Ensure healthy lives and promote well-being for all at all ages”; it is also strongly related to most of the other SGDs.

Envisioning a transformational change in the management of healthcare, inspired by and to sustainability, this Special Issue welcomes manuscripts that advance studies in the fields of environmental, social, and economic sciences that can contribute the knowledge necessary to effectively manage healthcare and healthcare organizations in the light of a sustainability paradigm.

Adopting multi-, inter-, and trans-disciplinary perspectives and a systems approach, expected submissions cover the following topics:

  1. Sustainability science for healthcare management
  2. Sustainability values in healthcare management
  3. Systems management for sustainability in healthcare organizations
  4. Sustainability knowledge management in healthcare organizations
  5. The role of healthcare organizations in sustainable development
  6. Education for healthcare sustainability
  7. Engagement to sustainability in healthcare organizations
  8. New technologies for healthcare sustainability
  9. Measures of sustainability for healthcare organizations
  10. Healthcare and SDGs

This Special Issue is promoted by the Pharmanomics Interdepartmental Research Center, University of Salerno, Italy (http://www.pharmanomics.unisa.it/), the IASS, Italian Association for Sustainability Science, (http://www.scienzasostenibilita.org/) and the ASVSA, Association for Research on Viable Systems, (www.asvsa.org), Italy.

Prof. Sergio Barile
Prof. Marialuisa Saviano
Dr. Francesco Caputo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Sustainability is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • sustainability
  • sustainability science
  • sustainable development
  • healthcare
  • healthcare management
  • systems management
  • education for sustainability
  • new technology for sustainability
  • sustainability measures
  • sustainable development goals

Published Papers (19 papers)

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Open AccessArticle Empowering Patients to Co-Create a Sustainable Healthcare Value
Sustainability 2019, 11(5), 1315; https://doi.org/10.3390/su11051315
Received: 31 December 2018 / Revised: 21 February 2019 / Accepted: 23 February 2019 / Published: 2 March 2019
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Abstract
Extensive literature suggests that a solution to the current problems of healthcare sustainability is the active involvement of patients in health management through the empowerment of their abilities. Latest marketing frameworks suggest that patients are important resources for co-creating health value together with [...] Read more.
Extensive literature suggests that a solution to the current problems of healthcare sustainability is the active involvement of patients in health management through the empowerment of their abilities. Latest marketing frameworks suggest that patients are important resources for co-creating health value together with operators. This research aims to analyze the effects of patient empowerment on patients’ value co-creation behaviors. An empirical survey was conducted on 250 patients with chronic diseases in Italy. The results, analyzed using the structural equation modeling, showed that their empowerment enhanced value co-creation behaviors. Patients apply their health competencies and resources in their co-creation of health service with operators. It is, therefore, important to empower patients in their transformation from passive to active stakeholders, working with providers for the most optimal health outcomes. This research provides practitioners with suggestions for patient involvement which utilizes their knowledge, capabilities and responsibility to improving healthcare services. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle From Rare to Neglected Diseases: A Sustainable and Inclusive Healthcare Perspective for Reframing the Orphan Drugs Issue
Sustainability 2019, 11(5), 1289; https://doi.org/10.3390/su11051289
Received: 29 December 2018 / Revised: 17 February 2019 / Accepted: 26 February 2019 / Published: 1 March 2019
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Abstract
This work is about how healthcare issues can be reframed from a sustainable and inclusive development perspective. Focusing on the case of orphan drugs and rare diseases, first, a country-based review of the main regulatory approaches to orphan drugs is conducted; then, the [...] Read more.
This work is about how healthcare issues can be reframed from a sustainable and inclusive development perspective. Focusing on the case of orphan drugs and rare diseases, first, a country-based review of the main regulatory approaches to orphan drugs is conducted; then, the main contributions of the literature are reviewed to identify dominant views and the way the problem is more commonly framed. The main findings reveal that the dominant regulatory approaches and theoretical interpretations of the problem are mainly based on economic considerations. However, this does not seem to have led to very satisfactory results. Reflecting upon what the sustainability perspective can highlight with reference to healthcare, substantial connections between the orphan drugs issue and that of neglected diseases are highlighted. These connections suggest reframing the orphan drugs issue as a social equality and inclusiveness problem, hence the need to adopt a sustainable and inclusive development perspective. As a key sustainable development goal (SGD) to be shared by all nations, healthcare should always be approached by putting the principles of sustainable and inclusive development at the core of policy makers’ regulatory choices. Accordingly, we think that the orphan drugs issue, like that of neglected diseases, could be better faced by adopting a social equality and inclusiveness perspective. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Healthcare and SDGs Governance in Light of the Sustainability Helix Model: Evidence from the African Continent
Sustainability 2019, 11(4), 1203; https://doi.org/10.3390/su11041203
Received: 31 December 2018 / Revised: 30 January 2019 / Accepted: 20 February 2019 / Published: 25 February 2019
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Abstract
This work is based on a view of healthcare as a fundamental Sustainable Development Goal (SDG) to share globally to be effective at local level. On this basis, the paper analyzes the health programs in less-favored areas with the aim of understanding why [...] Read more.
This work is based on a view of healthcare as a fundamental Sustainable Development Goal (SDG) to share globally to be effective at local level. On this basis, the paper analyzes the health programs in less-favored areas with the aim of understanding why the United Nations SDGs are so difficult to reach in some countries. A brief review of the main literature and research on the health governance systems in three countries of the African continent have been conducted to this aim. The results are interpreted through the sustainability helix model (SHM). Key roles and conditions of effectiveness of the health sustainable development governance approach in the investigated countries are discussed. The main findings reveal that the analyzed governance systems lack implementation plans. By discussing the observed problem in the light of the sustainability helix model, fundamental elements of a health sustainable development helix model have been identified in less favored countries where key actors and roles are identified. The study highlights, in particular, the relevance of ‘interface’ roles played by non-governmental actors (NGA) and international actors (IA) in the health governance system of less-favored countries. These actors and roles allow connections between the global and the local levels of action favoring interaction among actors institutionally devoted to governing development. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Engagement in Healthcare Systems: Adopting Digital Tools for a Sustainable Approach
Sustainability 2019, 11(1), 220; https://doi.org/10.3390/su11010220
Received: 31 October 2018 / Revised: 15 December 2018 / Accepted: 24 December 2018 / Published: 4 January 2019
Cited by 1 | PDF Full-text (699 KB) | HTML Full-text | XML Full-text
Abstract
The rapid development of new technologies has created interesting and unexpected possibilities in e-health, and digital platforms have become widespread, connecting users, experts, and practitioners of the health world. This triggered our investigation into the relationship between the engagement platforms used by 293 [...] Read more.
The rapid development of new technologies has created interesting and unexpected possibilities in e-health, and digital platforms have become widespread, connecting users, experts, and practitioners of the health world. This triggered our investigation into the relationship between the engagement platforms used by 293 doctors with various specializations, their satisfaction, and the dimensions of social sustainability in the healthcare sector. The research focused on professional interaction and its sphere of action in engagement platforms, defined as virtual contact points for exchanging information, thus increasing the co-creation of value between physicians and patients. In order to verify our hypothesis, a health digital platform called paginemediche.it was used, and the two dimensions of engagement and sustainability were considered, examining their causal relationship and evaluating their effects on physician loyalty in terms of the re-use of the digital platform by doctors. Our results, using a multiple linear regression analysis, showed that the social sustainability of the digital health platform was directly influenced by online engagement, generating a positive effect on physician loyalty. In particular, the human dimension of social sustainability proved to be decisive for the re-use of the platform. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Pursuing Sustainability for Healthcare through Digital Platforms
Sustainability 2019, 11(1), 165; https://doi.org/10.3390/su11010165
Received: 28 November 2018 / Revised: 18 December 2018 / Accepted: 21 December 2018 / Published: 29 December 2018
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Abstract
Sustainability, as well as the sustainable use of resources and related issues, has inspired a long-lasting and lively debate among scholars of different disciplines. Due to under-investigation of several of the sustainability-related challenges, this paper aims to better understand the system dynamics that, [...] Read more.
Sustainability, as well as the sustainable use of resources and related issues, has inspired a long-lasting and lively debate among scholars of different disciplines. Due to under-investigation of several of the sustainability-related challenges, this paper aims to better understand the system dynamics that, supported by some digital enablers (e.g., digital technologies and platforms), boost the sustainability of complex service systems such as healthcare. To this end, the theoretical meta-model of interaction types, which inspired the prototype digital platform dedicated to the online delivery of health-related services, is presented. Moreover, some healthcare usage scenarios, based on the prototype’s functions, are analysed and discussed. This allows understanding of how important the role of technologies and, in particular, digital platforms, are in empowering actors and in making them willing to interact, and share their own resources in continually new ways. This paves the way for ongoing value co-creation, which is essential for healthcare system sustainability. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle From Health Technology Assessment to Health Technology Sustainability
Sustainability 2018, 10(12), 4748; https://doi.org/10.3390/su10124748
Received: 30 October 2018 / Revised: 3 December 2018 / Accepted: 11 December 2018 / Published: 12 December 2018
Cited by 1 | PDF Full-text (2491 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
This paper aims to propose a methodological lens to the assessment of technological innovations in healthcare based on the principles of social, economic, and political sustainability. Starting from the consideration of a lack of a unified interpretative framework of health technology assessment, using [...] Read more.
This paper aims to propose a methodological lens to the assessment of technological innovations in healthcare based on the principles of social, economic, and political sustainability. Starting from the consideration of a lack of a unified interpretative framework of health technology assessment, using a content analysis of the relevant literature on the topic, we identified both the scientific perspectives adopted by the scholars and the most widely discussed topics. Consequently, the less explored scientific areas were framed, and, therefore, those more susceptible to further investigation came to light. The result is an overall picture which highlights the absence of unified and generally accepted approaches to evaluation, together with the lack of awareness on the fact that the multiplicity of methods adopted is essentially connected to the multiplicity of innovations, for each of which a method (or a set of methods) of preferable evaluation can be prefigured. Based on these observations, we propose a general reference framework for evaluation, based on the Viable Systems Approach (vSa), and a schematic outline of the connections between the complexity of innovations and the evaluation methodologies. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Socio-Cultural Sustainability of Private Healthcare Providers in an Indian Slum Setting: A Bottom-of-the-Pyramid Perspective
Sustainability 2018, 10(12), 4702; https://doi.org/10.3390/su10124702
Received: 22 October 2018 / Revised: 4 December 2018 / Accepted: 4 December 2018 / Published: 10 December 2018
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Abstract
Delivery of affordable healthcare services to communities is a necessary precondition to poverty alleviation. Co-creation approaches to the development of business models in the healthcare industry proved particularly suitable for improving the health-seeking behavior of BOP patients. However, scant research was conducted to [...] Read more.
Delivery of affordable healthcare services to communities is a necessary precondition to poverty alleviation. Co-creation approaches to the development of business models in the healthcare industry proved particularly suitable for improving the health-seeking behavior of BOP patients. However, scant research was conducted to understand BOP consumers’ decision-making process leading to specific healthcare choices in slum settings, and the relative balance of socio-cultural and socio-economic factors underpinning patients’ preferences. This article adopts a mixed-method approach to investigate the determinants of BOP patients’ choice between private and public hospitals. Quantitative analysis of a database, composed of 436 patients from five hospitals in Ahmedabad, India, indicates that BOP patients visit a public hospital significantly more than top-of-the-pyramid (TOP) patients. However, no significant difference emerges between BOP and TOP patients for inpatient or outpatient treatments. Qualitative findings based on 21 interviews with BOP consumers from selected slum areas led to the development of a grounded theory model, which highlights the role of aspirational demand of BOP patients toward private healthcare providers. Overall, healthcare provider choice emerges as the outcome of a collective socio-cultural decision-making process, which often assigns preference for private healthcare services because of the higher perceived quality of private providers, while downplaying affordability concerns. Implications for healthcare providers, social entrepreneurs, and policy-makers are discussed. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Designing a Data Visualization Dashboard for Managing the Sustainability Communication of Healthcare Organizations on Facebook
Sustainability 2018, 10(12), 4447; https://doi.org/10.3390/su10124447
Received: 29 October 2018 / Revised: 23 November 2018 / Accepted: 24 November 2018 / Published: 27 November 2018
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Abstract
Healthcare organizations are being increasingly requested to publicize their sustainability efforts on digital environments and social media, in part because previously passive patients are now becoming active customers. This paper investigates how leading healthcare organizations are using Facebook to communicate their sustainability, in [...] Read more.
Healthcare organizations are being increasingly requested to publicize their sustainability efforts on digital environments and social media, in part because previously passive patients are now becoming active customers. This paper investigates how leading healthcare organizations are using Facebook to communicate their sustainability, in terms of their focus on different components of the 3Ps (people, profit, planet) and interactive communication strategies used on social media. A content analysis was made of the Facebook posts (n = 6145) of healthcare organizations in the Forbes Global 2000 (2017 annual ranking) from 2015 to mid-2018. Our findings show that the social component of sustainability prevails over environmental and economic issues, although it does not seem to generate increased consumer engagement (in terms of users’ likes, comments, reactions, etc.). A data visualization dashboard was developed to help managers in benchmarking competitors and assessing how they can increase response rates and public engagement on social media, thus encouraging the active participation of users. The study also provides useful insights for communication managers in identifying how to use deliberative tools to develop consumer relationships on social media and aligning companies and consumers regarding shared sustainability themes. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Framing the Shades of Sustainability in Health Care: Pitfalls and Perspectives from Western EU Countries
Sustainability 2018, 10(12), 4439; https://doi.org/10.3390/su10124439
Received: 31 October 2018 / Revised: 23 November 2018 / Accepted: 25 November 2018 / Published: 27 November 2018
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Abstract
Sustainability is momentous for the appropriate functioning of health care systems. In fact, health and sustainability are two strictly related values, which could not be separately sought. While studies discussing the contextualization of this issue with respect to the distinguishing attributes of health [...] Read more.
Sustainability is momentous for the appropriate functioning of health care systems. In fact, health and sustainability are two strictly related values, which could not be separately sought. While studies discussing the contextualization of this issue with respect to the distinguishing attributes of health care systems are rapidly blooming, there is still little agreement about what is ultimately meant by sustainability in the health care arena. On the one hand, attention is primarily focused on the proper use of available financial resources; on the other hand, people engagement and empowerment are gradually arising as a crucial step to enhance the viability of the health care system. This paper tries to identify, from a conceptual point of view inspired by the European integrative movement, the different shades of sustainability in health care and proposes a recipe to strengthen the long-term viability of health care organizations. The balanced mix of financial, economic, political, and social sustainability is compelling to increase the ability of health care organizations to create meaningful value for the population served. However, the focus on a single dimension of sustainability is thought to engender several side effects, which compromise the capability of health care organizations to guarantee health gains at the individual and collective levels. From this standpoint, further conceptual and practical developments are envisioned, paving the way for a full-fledged understanding of sustainability in the health care environment. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Knowledge Management in Healthcare Sustainability: A Smart Healthy Diet Assistant in Traditional Chinese Medicine Culture
Sustainability 2018, 10(11), 4197; https://doi.org/10.3390/su10114197
Received: 28 September 2018 / Revised: 7 November 2018 / Accepted: 9 November 2018 / Published: 14 November 2018
Cited by 1 | PDF Full-text (2606 KB) | HTML Full-text | XML Full-text
Abstract
In the past 40 years, with the changes to dietary structure and the dramatic increase in the consumption of meat products in developing countries, especially in China, encouraging populations to maintain their previous healthy eating patterns will have health, environmental, and economic co-benefits. [...] Read more.
In the past 40 years, with the changes to dietary structure and the dramatic increase in the consumption of meat products in developing countries, especially in China, encouraging populations to maintain their previous healthy eating patterns will have health, environmental, and economic co-benefits. Healthy diet education plays an important role in the promotion of people’s healthy behavior. However, in the modern age, the data regarding healthy diets available on the internet is increasing rapidly and is distributed on multiple sources. It is time-consuming for users to learn about healthy diets on the internet: they need to search data on multiple platforms, choose and integrate information, and then understand what they have learned. To help people retrieve and learn healthy diet knowledge more efficiently and comprehensively, this paper designs a knowledge graph to integrate healthy diet information on the internet and provides a semantic retrieval system. In the knowledge graph, five main concepts are defined, including food material, dish, nutritional element, symptom, and crowd, as well as the relationships among them. In addition, Chinese dietary culture elements and traditional Chinese medicine (TCM) theory are also contained in the knowledge graph. The preliminary results show that by using the system, users learn healthy diet knowledge more quickly and comprehensively and they are more inclined to have balanced diets. This work could be regarded as a retrieval and education tool, which can assist healthcare and national sustainable development. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Managing Healthcare Service Ecosystems: Abstracting a Sustainability-Based View from Hospitalization at Home (HaH) Practices
Sustainability 2018, 10(11), 3951; https://doi.org/10.3390/su10113951
Received: 11 October 2018 / Revised: 26 October 2018 / Accepted: 27 October 2018 / Published: 30 October 2018
Cited by 2 | PDF Full-text (1088 KB) | HTML Full-text | XML Full-text
Abstract
Sustainability seems to be a hot topic today upon which a paradigmatic transformation is going on; this affects many fields and sectors by revealing the significant implications for actors’ participation, such as in healthcare. Today, healthcare calls for renewing and increasing its own [...] Read more.
Sustainability seems to be a hot topic today upon which a paradigmatic transformation is going on; this affects many fields and sectors by revealing the significant implications for actors’ participation, such as in healthcare. Today, healthcare calls for renewing and increasing its own main processes of hospitalization, as inspired by the current new light of sustainability; hospitalization at home (HaH) practices allow for new forms of hospitalizations, which are much more adherent to the real needs of patients and caregivers. Studies in service dominant logic (S-D logic) on service ecosystems help us in understanding which are the dynamics that are shaping actual conditions in healthcare. With the aim of contributing to the challenging debate about the role of “sustainability for healthcare”, this manuscript proposes a conceptual framework for investigating healthcare domains through the interpretative lens provided by the service ecosystems view. Previous managerial contributions are analyzed in an attempt to emphasize the contact points between studies about service ecosystem and sustainability so as to outline the possible roadmaps for sustainability in the healthcare domain. The three dimensions of HaH—efficiency of healthcare service, effectiveness in resource usage, and patients’ satisfaction—have been identified as possible levers on which promoting healthcare processes inspired by sustainability principles and their relations with the three pillars of sustainability science—the economy, society, and environment—have been analyzed. The reflections herein are finally discussed for proposing possible future directions for research interested in promoting a sustainability-based healthcare management. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Higher Sustainability and Lower Opportunistic Behaviour in Healthcare: A New Framework for Performing Hospital-Based Health Technology Assessment
Sustainability 2018, 10(10), 3550; https://doi.org/10.3390/su10103550
Received: 22 August 2018 / Revised: 26 September 2018 / Accepted: 30 September 2018 / Published: 3 October 2018
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Abstract
Innovative health technology deployment represents the primary challenge within the sustainability of public health systems. On one hand, new technologies may potentially improve access to care and the quality of services. On the other hand, their rapid evolution and broad implications on existing [...] Read more.
Innovative health technology deployment represents the primary challenge within the sustainability of public health systems. On one hand, new technologies may potentially improve access to care and the quality of services. On the other hand, their rapid evolution and broad implications on existing procedures increase the risk to adopt technologies that are not value for money. As a consequence, Health Technology Assessment (HTA) is a critical process at each level of the National Health System. Focusing on the organisational level, this paper explores the current practices of Hospital-Based HTA (HB-HTA) in terms of management, control and behaviours of various actors involved. Among several tasks, decision-makers are appointed at managing the conflict of interest around health technology development, that could pave the way for corruption or other misleading behaviours. Accordingly, the purpose of the study is proposing a new strategic framework, named Health Technology Balanced Assessment (HTBA), to foster hospital-based health technology management aimed to align strategy and actions. The conceptual model is developed on three perspectives (clinical, economic and organisational) to make the actors involved in the assessment (clinicians, health professionals, hospital managers and patients) aware of the impact of new technology on the value chain. Besides supporting the decision-making process, such a tool represents support for the internal control system as a whole. By promoting structured evaluation, it increases transparency and accountability of public health organisations. Moreover, in the long run, the framework proposed will be useful to reach selected United Nations Sustainable Development Goals (UN SDGs) to enhance the quality of healthcare in the future. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Monitoring Viability and Sustainability in Healthcare Organizations
Sustainability 2018, 10(10), 3548; https://doi.org/10.3390/su10103548
Received: 23 August 2018 / Revised: 27 September 2018 / Accepted: 29 September 2018 / Published: 3 October 2018
Cited by 5 | PDF Full-text (2771 KB) | HTML Full-text | XML Full-text
Abstract
The paper aims to advocate the incorporating of the sustainability perspective into the management control system of healthcare organizations. The study is based on two main premises: (1) the evolution of business models towards a wide perspective of the sustainability approach; (2) the [...] Read more.
The paper aims to advocate the incorporating of the sustainability perspective into the management control system of healthcare organizations. The study is based on two main premises: (1) the evolution of business models towards a wide perspective of the sustainability approach; (2) the evolution of control systems in healthcare organizations towards a control-based approach to monitor the effectiveness and efficiency of the service targeted primarily to cut costs and expenses. Our methodology is developed at theoretical and conceptual level starting from: (1) a literature review on the issue, highlighting main trends and gaps and (2) the adoption of the Viable Systems Approach (VSA) as a conceptual framework oriented to integrate a wide variety of stakeholder perspectives and interests into the business model. Our findings lead us to introduce the Systems Viability Monitoring Model for Sustainability as a potential reference framework to build healthcare management control systems in which the notion of ‘systems viability,’ as defined by VSA, becomes a bridging concept by means of which the sustainability perspective can be incorporated into the management control system of healthcare organizations. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Investigating Health Systems in the European Union: Outcomes and Fiscal Sustainability
Sustainability 2018, 10(9), 3186; https://doi.org/10.3390/su10093186
Received: 8 August 2018 / Revised: 3 September 2018 / Accepted: 3 September 2018 / Published: 6 September 2018
Cited by 1 | PDF Full-text (1264 KB) | HTML Full-text | XML Full-text
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Healthcare systems aim to provide access to good quality care, while ensuring equity and solidarity. The fiscal sustainability of healthcare systems has become a matter of concern in recent European Union (EU) debates, considering the ever increasing need for adequate healthcare determined by [...] Read more.
Healthcare systems aim to provide access to good quality care, while ensuring equity and solidarity. The fiscal sustainability of healthcare systems has become a matter of concern in recent European Union (EU) debates, considering the ever increasing need for adequate healthcare determined by factors such as aging population, investments in technology and infrastructure, medical products and wages. Our paper seeks to measure the health system performances of the EU countries by building up a composite index, which will then be used as a tool in investigating the relationship between health performance and the fiscal sustainability of health systems. A principal components analysis (PCA) was applied to build the composite index through the use of the most relevant health indicators provided by Eurostat and the Sustainable Development Knowledge Platform. The composite index offers a comprehensive performance assessment and provides a clear ranking of the EU countries based on their health system performances. Further investigation of the link between health performance and fiscal sustainability revealed that higher ranks are associated with higher shares of health expenditures in gross domestic product (GDP), a large share of employment in the health sector, and higher duration of working life. These patterns are followed by efficient health systems, encountering reduced sustainability risks. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessFeature PaperArticle The Prevention of Corruption as an Unavoidable Way to Ensure Healthcare System Sustainability
Sustainability 2018, 10(9), 3071; https://doi.org/10.3390/su10093071
Received: 7 August 2018 / Revised: 24 August 2018 / Accepted: 27 August 2018 / Published: 29 August 2018
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Abstract
Corruption has found very fertile ground in the health sector. Many studies demonstrate the negative relationship between sustainability and corruption. However, relatively little is known at this time about how to prevent corruption in healthcare organizations (HCOs), and thus to recover the important [...] Read more.
Corruption has found very fertile ground in the health sector. Many studies demonstrate the negative relationship between sustainability and corruption. However, relatively little is known at this time about how to prevent corruption in healthcare organizations (HCOs), and thus to recover the important sustainability of the entire healthcare system. After noticing this gap in the literature, the authors’ aim in undertaking this study was twofold: first, to analyze the current state of knowledge about how Italian HCOs adopt corruption prevention plans in compliance with the National Plan issued by the National Anti-Corruption Authority; second, to identify some clusters of HCOs which represent different adoption patterns of corruption prevention interventions and to classify these HCOs. For these purposes, the authors studied 68 HCOs along 13 dimensions that characterized the corruption prevention plans. The empirical results showed that the HCOs were not fully compliant with the anti-corruption legislation. At the same time, the authors identified three clusters of HCOs with different patterns of anti-corruption prevention interventions. The clusters that adopted some specific interventions seemed to be more sustainable than others. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
Open AccessArticle Information Technology in Healthcare: HHC-MOTES, a Novel Set of Metrics to Analyse IT Sustainability in Different Areas
Sustainability 2018, 10(8), 2721; https://doi.org/10.3390/su10082721
Received: 28 June 2018 / Revised: 30 July 2018 / Accepted: 30 July 2018 / Published: 2 August 2018
Cited by 1 | PDF Full-text (742 KB) | HTML Full-text | XML Full-text
Abstract
Sustainability, as a science, is the guideline of the present work. It aims to analyse, by means of a literature review, various areas of healthcare in which information technology (IT) has been- or could be-used, leading to several sources of sustainability, for example, [...] Read more.
Sustainability, as a science, is the guideline of the present work. It aims to analyse, by means of a literature review, various areas of healthcare in which information technology (IT) has been- or could be-used, leading to several sources of sustainability, for example, cost savings, better teamwork, higher quality and efficiency of medical care. After a brief introduction analysing the strategic contexts in which innovation in general, and IT in particular, can be a source of general improvements in efficiency, cost savings and service quality, the research focuses on the healthcare system by discussing the different nature of private and public organizations in terms of adopting innovations and changes and discussing the issue of consumer health costs and consumer choices. The following part focuses on the qualitative benefits of IT in healthcare and discusses the importance of metrics for measuring performance, costs and efficiency in this area. The work then qualitatively introduces a new set of Key Performance Indicators (KPI), partly based on literature from different topics and existing and validated sets of metrics, analysing, under the point of view of sustainability, the implementation of IT in healthcare, namely in management, organization, technology, environment and social fields (HHC-MOTES framework). The model, inspired by and to sustainability, can be used as a decision support at the strategic management level as well as for the analysis and investigation of the effects of IT systems in the healthcare sector from various perspectives. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Using Traditional Chinese Medicine Ideas as a Mechanism to Engage People in Health Awareness
Sustainability 2018, 10(8), 2702; https://doi.org/10.3390/su10082702
Received: 4 July 2018 / Revised: 24 July 2018 / Accepted: 30 July 2018 / Published: 1 August 2018
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Abstract
Improving health awareness is essential to health and healthcare sustainability. How to arouse attention to the health of people and encourage them to attend to healthcare progress so that we can reduce the costs of promoting healthcare by achieving more with less effort [...] Read more.
Improving health awareness is essential to health and healthcare sustainability. How to arouse attention to the health of people and encourage them to attend to healthcare progress so that we can reduce the costs of promoting healthcare by achieving more with less effort remains to be explored. In this paper, we provide a simplified health management app, called iTongue, with a basis in traditional Chinese medicine. People use iTongue to take pictures of their tongues to have a general idea of their health. We realize automated tongue image diagnosis using machine learning techniques to establish the relationship between the tongue image features and the cold or hot ZHENG (traditional Chinese medicine syndrome) in traditional Chinese medicine by learning through examples and assisting people to engage in health management. The results show that health management interaction based on traditional Chinese medicine has a positive influence on improving people’s attention to their health, encouraging them to participate in health management activities and develop the habit of caring about their health over the long term. In the future, we could consider using this kind of traditional Chinese medicine idea as a means of publicity to engage people in healthcare and to assist healthcare sustainability development. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessArticle Multilevel Analysis of International Scientific Collaboration Network in the Influenza Virus Vaccine Field: 2006–2013
Sustainability 2018, 10(4), 1232; https://doi.org/10.3390/su10041232
Received: 2 March 2018 / Revised: 13 April 2018 / Accepted: 17 April 2018 / Published: 18 April 2018
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Abstract
Influenza virus vaccine plays an important role in preventing influenza and protecting people’s health. The international collaboration in influenza virus vaccine field is related to the sustainability of healthcare. To understand the elaborate characteristics of multiform international collaboration in the influenza virus vaccine [...] Read more.
Influenza virus vaccine plays an important role in preventing influenza and protecting people’s health. The international collaboration in influenza virus vaccine field is related to the sustainability of healthcare. To understand the elaborate characteristics of multiform international collaboration in the influenza virus vaccine field, this paper constructs a multilayered analytical framework (at the country, city and institution levels) of international scientific collaboration to examine the regional distribution, dynamic changes and common themes of collaboration. A total of 1878 international collaboration papers of the influenza virus vaccine field published from 2006 to 2013 were collected from the Web of Science database. Based on this dataset, the paper utilizes bibliometrics and social network analysis approaches to explore international publication trends and collaboration performance in the influenza virus vaccine field. Results show that: (1) the three kinds of collaboration networks (country, city and institution levels) all present dynamic structures, strong core-periphery characteristics, and their degree centrality distributions follows segmented Zifp-Pareto distribution; and (2) although it is known that there exist corresponding relationships among countries, cities and institutions in the geographical position, most of their associated categories, network locations and changing trends are all non-conformal. These findings suggest that multilayered analysis enables a more comprehensive understanding of international scientific collaboration in the influenza virus vaccine field. In general, detailed conclusions can help different levels of governments to draw policy implications for promoting further international collaboration research to enhance the ability on preventing the disease. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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Open AccessConcept Paper An Embedded Systems Perspective in Conceptualizing Canada’s Healthcare Sustainability
Sustainability 2019, 11(2), 531; https://doi.org/10.3390/su11020531
Received: 10 December 2018 / Revised: 13 January 2019 / Accepted: 17 January 2019 / Published: 20 January 2019
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Abstract
Healthcare sustainability has been dominated by a strong fiscal orientation. In an era of budget cuts and staff reductions, the financial challenges in Canadian healthcare are immediate and must be addressed. However, an independent focus on financial viability is too narrow a framing; [...] Read more.
Healthcare sustainability has been dominated by a strong fiscal orientation. In an era of budget cuts and staff reductions, the financial challenges in Canadian healthcare are immediate and must be addressed. However, an independent focus on financial viability is too narrow a framing; too limited to allow for the kind of creative, novel, and even radical thinking that is required to fundamentally alter the current course of healthcare in Canada and internationally. Prospects for solving the current financial challenges are likely to be greatly enhanced if we simultaneously account for the broad and interrelated dimensions of sustainability. What would a healthcare system look like if sustainability were adopted as the focal and principal goal? And what might a “deep” sustainability orientation imply for how we think about and manage healthcare systems? This analysis is informed by the notion that healthcare systems are fully contained within the societal system, which is itself fully contained within the broader ecological system. This model, which foregrounds nature as the most fundamental and important system, has both greater ecological validity and particular relevance to the healthcare context given the interdependence between the health of natural systems and the health of humans. Our understanding of nature in relation to health may be key to solving or at least reducing the economic burden of healthcare. A multidimensional systems orientation thus has the potential to unveil new modes of thinking that highlight intersectoral relations, communications, collaboration, and cross-boundary learning for improved health and wellbeing, healthcare performance, and sustainability. Full article
(This article belongs to the Special Issue Sustainability for Healthcare)
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