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... Till today, the quality of services offered in the healthcare sector has remained one of the most crucial issues because human beings wish to avail safe and reliable services (Otani et al., 2011;Sherman et al., 2020). The extensive review on earlier published literature also confirms that the quality of healthcare services still being offered to the people is not as desired (Mohammad Mosadeghrad, 2013;Mandal, 2020). ...
... The IT revolution plays an important role in the growth of the healthcare sector (Khamis et al., 2019;Sherman et al., 2020). The IT-enabled systems help in the data management of the patients and also ensure the security of the data stored. ...
... Empowerment enables employees to make decisions and come up with remedial actions quickly, hence saving the crucial time of treatment from being wasted by consulting from the senior professionals (Sherehiy et al., 2007;Sweis et al. 2013). Speedy responses can have a significant impact on the treatment of critical cases hence saving many lives (Sherman et al., 2020;Ertz and Patrick, 2020). Trained workers with high expertise lead to a higher innovation rate and at the same time boost the confidence of the workers (Presseau et al., 2017;Zarei et al., 2019). ...
Article
Abstract Purpose – It would not be an exaggeration to say that healthcare is the most crucial one in today's perspective. The health care sector, in general, is engaged in working on various dimensions simultaneously like the safety, care, quality, and cost of services, etc. Still, the desired outcomes from this sector are far away, and it becomes pertinent to address all such issues associated with healthcare on a priority basis for sustaining the outcomes in a long-term perspective. The present study aims to explore the healthcare sector and list out the directly associated enablers contributing to increasing the viability of the healthcare sector. Besides, the interrelationship among the enlisted enablers needs to be studied, which further helps in setting-out the priority to deal with individual enablers based on their impedance in the contribution towards viability increment. Design/methodology/approach – The authors have done an extensive review to list out the enablers of the health care sector to perform efficiently and effectively. Further, the attempt has been made on the enablers to rank them by using the modified Total Interpretative Structure Modelling (m-TISM) approach. The validation of the study reveals the importance of enablers based on their position in the hierarchical structure. Further, the MICMAC analysis on the identified enabler is performed to categorize the identified enablers in the different clusters based on their driving power and dependence. Findings – The research tries to envisage the importance of the healthcare sector and its contribution towards national development. The outcomes of the m-TISM model in the present study reveal the noteworthy contribution of the organizational structure in managing the healthcare facilities and represented it as the perspective of future growth. The well-designed organizational structure in the healthcare industry helps in establishing better employee-employer cooperation, workforce coordination, and inter-department cooperation. Research limitations/implications – Every research work has limitations. Likewise, the present research work also has limitations, i.e. input taken for developing the models are from very few experts that may not reflect the opinion of the whole sector. Practical implications- The healthcare sector is the growing sector in the present-day scenario, and it is essential to keep the quality of treatment in check along with the quantity. The present study has laid down the practical foundations for improvement in the healthcare sector viability. Besides, the study emphasized on accountability of the healthcare sector officials to go with the enablers having the strong driving power for effective utilization of all the resources. This would further help them in customer (patients) satisfaction. Originality/value – Despite an increase in demand for good quality healthcare facilities worldwide, the growth of this sector is bounded by the economic, demographic, cultural, and environmental concerns, etc. The present study proposed a unique framework that provides a better understanding of the enablers. It would further help in playing a key role in increasing the viability of the healthcare sector. The hierarchy developed with the help of m-TISM and MICMAC analysis will help the viewers to recognize the important enablers based on their contribution to the viability improvement of the healthcare sector.
... Embedding sustainability within hospital policies facilitates the delivery of the social and environmental benefits that improve healthcare safety, quality and patient and staff satisfaction in a cost-efficient manner, in accordance with the 'triple bottom line' [32,33,54,73]. ...
... Policies need to be actionable. Reducing energy consumption in theatres, for example, might involve policies that guide personnel to turn down heating, ventilation and air conditioning system exchange rates in unoccupied operating theatres, which can be achieved without impeding infection control [33,54]. • Contracts with manufacturers should be tendered only after careful consideration of their products' sustainability credentials. ...
... Decarbonisation of supply chains is crucial for achieving sustainable healthcare and circular economies (i.e. keeping materials in use and making more efficient use of natural resources) [8,13,14,16,49,54,[74][75][76]. ...
Article
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The Earth’s mean surface temperature is already approximately 1.1°C higher than pre‐industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three‐stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high‐, middle‐ and low‐income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists’ education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re‐evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.
... We propose three principles that should guide an informatics-centric approach for how information technology can and should be used to reduce healthcare's carbon emissions and electronic waste and promote sustainability. These principles are based on expert opinions of the authors gained from previous health IT 10 and environmental sustainability work 11 First, IT and healthcare-related equipment and software should be optimized to directly reduce their energy and material consumption. 12 For example, smart automation that allows powering down or turning off equipment or devices that are not expected to be in service can reduce electricity use, as can procuring more energy-efficient equipment. ...
... 15 Third, health IT and especially EHRs should influence resources used in delivery of clinical care, for example by identifying and facilitating more efficient clinical and administrative processes, and by informing environmentally preferable procurement and clinical decision-making. 11 All three principlesuse of more efficient IT/equipment, use of IT/equipment to monitor and control energy consumption/waste related to buildings and support services, and use of IT/equipment to influence care delivery and clinical decision-making, should be considered in any informatics-centric approach to promoting decarbonization and environmental sustainability. ...
... In addition to making changes in the procurement, use, and configuration of the hardware and software itself to address climate change, health IT can also enable clinicians and healthcare administrators to make climate-informed changes in their procurement and work processes. 11 A primary goal of Clinical Climate Informatics is to support more climate-friendly clinical decision-making. Substantial overuse of testing, medications, and supplies is ubiquitous in healthcare. ...
Article
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Addressing environmental pollution and climate change is one of the biggest sociotechnical challenges of our time. While information technology has led to improvements in healthcare, it has also contributed to increased energy usage, destructive natural resource extraction, piles of e-waste, and increased greenhouse gases. We introduce a framework “Information technology-enabled Clinical cLimate InforMAtics acTions for the Environment” (i-CLIMATE) to illustrate how clinical informatics can help reduce healthcare’s environmental pollution and climate-related impacts using 5 actionable components: (1) create a circular economy for health IT, (2) reduce energy consumption through smarter use of health IT, (3) support more environmentally friendly decision-making by clinicians and health administrators, (4) mobilize healthcare workforce environmental stewardship through informatics, and (5) Inform policies and regulations for change. We define Clinical Climate Informatics as a field that applies data, information, and knowledge management principles to operationalize components of the i-CLIMATE Framework.
... Several studies show that growing environmental management and responsibility in healthcare can drive better performance outcomes (e.g. Pinzone, 2016;Romero and Carnero, 2017;Sherman et al., 2020). Also, the literature shows that social responsibility is central for sustainable healthcare. ...
... The study also emphasizes the importance of sustainable human resource management (SHRM) and green human resource management (GHRM) practices as the emerging trend (Macke and Genari, 2019;Mousa and Othman, 2020). Thus, health-care firms should promote social and environmental responsibility in their organizational systems and practices (Mehralian et al., 2016;Sherman et al., 2020;Traina et al., 2019). To achieve organizational excellence and effectiveness, executives and managers should plan their leadership and management agenda to include these sustainability practices in their strategies (Hussain et al., 2018;Vainieri et al., 2019). ...
... ,Pinzone (2016),Romero and Carnero (2017),Sherman et al. (2020) Previous literature studied impacts of health-care activities and operations on the environment. Environmental management and responsibility in healthcare are found to drive better performance outcomes. ...
Purpose This empirical study aims to identify the essential strategic leadership and management factors underlying sustainability in healthcare. It also examines which factors drive sustainability performance outcomes (SPO) in health-care organizations, an analysis lacking to date. It provides a strategic leadership and management perspective toward sustainable healthcare, responding to the United Nations Sustainable Development Goals. Design/methodology/approach The investigation adopted Sustainable Leadership as its research framework. Using a cross-sectional survey, 543 employees working in health-care and pharmaceutical companies in Thailand voluntarily provided responses. Factor analyses and structural equation modeling were employed. Findings The results revealed an emergent research model and identified 20 unidimensional strategic leadership and management factors toward sustainability in healthcare. The findings indicate significant positive effects on SPO in health-care organizations. Significant factors include human resource management/development, ethics, quality, environment and social responsibility, and stakeholder considerations. Research limitations/implications The study was conducted in one country. Future studies should examine these relationships in diverse contexts. In practice, health-care firms should foster significant strategic leadership and management practices to improve performance outcomes for sustainability in healthcare. Originality/value This paper is the first empirical, multidisciplinary study with a focus on strategic leadership, health-care management and organizational sustainability. It identifies a proxy for measuring the effects of essential strategic leadership and managerial factors for sustainability in pharmaceutical health-care companies. It advances our currently limited knowledge and provides managerial implications for improving performance outcomes toward sustainable healthcare.
... Embedding sustainability within hospital policies facilitates the delivery of the social and environmental benefits that improve healthcare safety, quality and patient and staff satisfaction in a cost-efficient manner, in accordance with the 'triple bottom line' [32,33,54,73]. ...
... Policies need to be actionable. Reducing energy consumption in theatres, for example, might involve policies that guide personnel to turn down heating, ventilation and air conditioning system exchange rates in unoccupied operating theatres, which can be achieved without impeding infection control [33,54]. • Contracts with manufacturers should be tendered only after careful consideration of their products' sustainability credentials. ...
... Decarbonisation of supply chains is crucial for achieving sustainable healthcare and circular economies (i.e. keeping materials in use and making more efficient use of natural resources) [8,13,14,16,49,54,[74][75][76]. ...
Article
Full-text available
The Earth's mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.
... In the complex world we live in, the healthcare sector is not only generating a significant footprint, but also suffering from its consequences: more common and new conditions that need to be treated, a higher number of patients and, as made evident during the COVID-19 pandemic, the potential supply disruptions of resources required to guarantee uninterrupted activities (Miller et al., 2020). Unfortunately, the sector has done little to address this major challenge and further work is required to identify opportunities for improvement towards healthcare sustainability (Sherman et al., 2020). ...
... The healthcare sector relies on diverse products and services such as facilities, disposable products, complex machines, transportation, among others that have been only superficially explored from a sustainability lens. Efforts exist to understand and act upon sustainability aspects associated with the healthcare sector, however the level of awareness around this topic is considered low (Sherman et al., 2020). Further endeavors are required to identify knowledge gaps and to arrive to a common baseline to assess healthcare sustainability. ...
... Awareness on the environmental impacts from the healthcare sector have been increasing in the past years, but is still considered low (Sherman et al., 2020). International healthcare organisations have pointed the role of the sector in indirectly increasing the number of conditions related to sustainability issues (WHO, 2017;World Bank, 2017;Watts et al., 2017). ...
Thesis
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The activities required to provide healthcare services bring challenges to environmental sustainability. The sector relies on diverse products, services and facilities, including disposable products, complex equipment and transportation. This domain has not been well explored from a sustainability lens and the level of awareness around healthcare sustainability is low. Life-cycle based methods have the potential to characterize systems related to the healthcare sector and many others; however, these methods are mostly – if not exclusively – related to an inside-out pathway to assess impacts. From an outside-in perspective, there is potential for raw material criticality to assess resource availability in the healthcare sector, especially after the proposal to integrate it into the Life Cycle Sustainability Assessment (LCSA) framework.A pending task around this proposed methodological pathway is to explore the applicability and readiness of supply risk methods, specifically the geopolitical supply risk (GeoPolRisk) method has been proposed to assess resource related impacts. This research provides and integrates methods to assess environmental sustainability from a life cycle perspective with focus on enhancing criticality indicators as an outside-in impact pathway associated with the Area of Protection “Natural Resources” in Life Cycle Assessment (LCA); moreover, their applicability is validated with multiple case studies, being one of those a part of the healthcare sector.The thesis is divided in 9 chapters along two branches: “Healthcare Sustainability” and “Raw Material Criticality in Life Cycle Assessment”. The first chapter provides an introduction to the manuscript and presents the research question and objectives of the thesis; it is followed by the state of the art in chapter 2. Chapter 3 presents the development of a novel framework to help address sustainability challenges in the healthcare sector through life cycle thinking. Chapter 4 and Chapter 5 propose and test methodological enhancements to the geopolitical supply risk method required to better address resource related impacts in life cycle assessment. Chapter 6 presents an integrated assessment taking into account the enhanced method and its relation to more traditionally used environmental impact categories in LCA. In chapter 7, the GeoPolRisk method is used to better understand the relevance of assessing outside-in impacts associated to an element used in the healthcare sector. Chapter 8 integrates the methodological enhancements previously presented to study inside-out and outside-in impacts for a case study associated with medical imaging. Finally, accomplishments and future opportunities for development on the field are discussed as part of the last chapter of the manuscript.Along the branch of “Healthcare Sustainability” this work contributes to the development of an integrated framework to support research in this domain and the first application to a case study in the healthcare sector of an integrated life cycle assessment incorporating environmental indicators and the GeoPolRisk method. Along the branch of “Raw Material Criticality in LCA”, the PhD develops new approaches and proposes methodological enhancements to advance the assessment of resource use in LCA.
... ngle-use items, anesthetic gases and medication (Asfaw et al., 2021a). Therefore, in recent years much attention has been drawn to the issue of polymer-based waste generated by the hospitals and hospital-related facilities (Alharbi et al., 2021;Asfaw et al., 2021a;Campion et al., 2015;Chirani et al., 2021;Joseph et al., 2021;Petre & Malherbe, 2020;J. D. Sherman et al., 2020;Thiel et al., 2017). To make matters worse, the outbreak of COVID-19 pandemic has contributed to the problem deepening (Parashar & Hait, 2021a;Patrício Silva et al., 2021;Vanapalli et al., 2021). During this time, the growing expenditure of single-use polymer-based packaging materials, coupled with the increasing demand for medical produ ...
... Unfortunately, disposal means most often long-lasting and dead-end landfilling (Asfaw et al., 2021a;J. D. Sherman et al., 2020). Therefore, some advanced studies dedicated to the replacement of commonly used environmentally harmful plastics with sustainable materials that take advantage of natural substances are being carried out. Consequently, various trials of a partial (de Avila Delucis et al., 2019;Hejna et al., 2021;Kuciel et al., 2014;Olejnik & Masek, 2020 ...
Article
The aim of this research was to investigate for the first time the possible application range of sustainable cellulose-filled polymer-based materials dedicated for common use in healthcare sector. These products are exposed to contact with solutions of different acidity, microorganisms and are being constantly UV sterilized. Therefore, the impact of plant filler on the microbial growth, UV-aging and pH-resistance of cellulose-filled ethylene-norbornene copolymer (EN) was investigated, as the polymer matrix employed is widely used in healthcare applications. Moreover, two different coupling agents, vinyltrimethoxysilane (VTMS) and N-(2-aminoethyl)-3-aminopropyltrimethoxysilane (AEAPTMS), were used to promote the adhesion between the polymer matrix and cellulose (hydrophobization of fibres evidenced with increased water contact angle from 15 to 130°). Additionally, UV-aging revealed that the silane-originated functional groups might have possibly acted as free radical scavengers, hence, prolonging composites' shelf-life. Furthermore, incorporation of investigated amount of cellulose did not result in the decreased pH-resistance or improved growth of Escherichia coli.
... Environmental pollution is causing health problems and even death, in 2015 pollution caused nine million premature deaths which is 16 % from all deaths globally [1]. Healthcare facilities help patients to solve health problems from pollution but at the same time the healthcare sector is one of the major emitters of environmental pollutants [1]. ...
... Environmental pollution is causing health problems and even death, in 2015 pollution caused nine million premature deaths which is 16 % from all deaths globally [1]. Healthcare facilities help patients to solve health problems from pollution but at the same time the healthcare sector is one of the major emitters of environmental pollutants [1]. The population is aging and in 2050 people over the age of 60 will double from 901 million to almost 2.1 billion and the healthcare sector needs to deal with new healthcare needs and be more effective at it [2]. ...
Article
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Among other sectors prioritized in delivering the circular economy targets, such a major sector as health care should also be highlighted. According to World Bank data, current health expenditure is still rising, reaching globally 10.02 % in 2016 compared to 8.56 % in 2000. To ensure protection of public health, the management of health care waste should be based on the waste management hierarchy. Besides the preventive measures (waste minimization, green procurement, sustainable planning, environmental management systems), treatment methods should also be viewed in the context of the waste management hierarchy. To analyse the possibility to apply circular economy principles into health care waste management, evaluation of resource recovery alternatives as well as its multi-dimensional assessment was done. In the article quantitative and qualitative assessment was conducted through multicriteria decision analysis with a goal to do a quantitative and qualitative assessment of healthcare waste and resource potential assessment.
... 3,4 Healthcare HVAC systems could be safely manipulated to reduce energy use and environmental impact. 5 The American Society for Health Care Engineering (ASHE) hospital HVAC recommendations for ORs (unchanged during our survey) include (1) minimum efficiency reporting value (MERV) filter ratings of ≥14, (2) positive pressure ORs, and (3) minimum of 20 air changes per hour (4 outdoor air changes per hour minimum). 6 In a 2019 review of ASHE HVAC recommendations, outdoor air changes per hour and minimum total OR air changes per hour were rated as needing 'further investigation' due to little supporting clinical evidence, and other hospital area parameters had little or poor-quality evidence. ...
... Reductions in air changes in acute care has the potential for large energy, financial, and carbon savings. 5,8 Our survey's respondents indicated that climate change, pollution, and the healthcare industry's impact thereon were considered important. Despite absence of evidence of benefit, the extent to which HVAC energy resources should be used to prevent infections varied. ...
Article
In this cross-sectional survey, we assessed knowledge, attitudes and behaviors regarding operating room air-change rates, climate change, and coronavirus disease 2019 (COVID-19) pandemic implications. Climate change and healthcare pollution were considered problematic. Respondents checked air exchange rates for COVID-19 and ∼25% increased them. Respondents had difficulty completing questions concerning hospital heating, ventilation and air conditioning (HVAC) systems.
... Waste production and management: Concern about whether a health technology satisfies the waste management principles of refuse/reduce/reuse/repurpose/recycle could be another trigger. This could include technologies that are known to have a high environmental impact-such as frequently used disposable devices like inhalers, insulin injectors [22], disposable surgical custom packs [23,24], and medications packaged in larger quantities than needed by a single patient (which results in wasted product) [4]. It could also include technologies that may mitigate the environmental impact of health technologies (e.g., reusable or re-processible devices) [22]. ...
... Therefore, knowledge that a technology produces a high level of GHGs could trigger an assessment of environmental considerations. Examples include inhaled anesthetics, robotic surgery [23,24], and pharmaceuticals [2]. Technologies that could reduce GHGs could also trigger an environmental review-for example, virtual health technologies that may reduce the need for people to travel to medical facilities [25] and IV anesthetics as an alternative to inhaled anesthetics [23]. ...
Article
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There is growing awareness of the impact health technologies can have on the environment and the negative consequences of these environmental impacts on human health. However, health system decision-makers may lack the expertise, data, or resources to incorporate environmental considerations when making decisions about the adoption and use of health technologies. In this article, we describe how health technology assessment (HTA) is evolving to address climate change by providing health system decision-makers with the information they can use to reduce the impact of health care systems on the environment. Our objective is to consider approaches for including the environment domain when conducting an HTA—in particular, the use of the deliberative process—and for determining when the domain should be included. We explore the challenges of gathering the relevant data necessary to assess the environmental impact of a health technology, and we describe a “triage” approach for determining when an in-depth environmental impact assessment is warranted. We also summarize related initiatives from HTA agencies around the world.
... Experts promote sustainability through collaboration, communication, and sharing knowledge [159]. CSR implementation, such as environmental pollutant control [160] in supply management, is in demand [161] and aids in sustainability maintenance. ...
Article
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Corporate Social Responsibility (CSR) has been an articulated practice for over 7 decades. Still, most corporations lack an integrated framework to develop a strategic, balanced, and effective approach to achieving excellence in CSR. Considering the world’s critical situation during the COVID-19 pandemic, such a framework is even more crucial now. We suggest subsuming CRS categories under Sustainable Development Goals (SDGs) be used and that they subsume CSR categories since SDGs are a comprehensive agenda designed for the whole planet. This study presents a new CSR drivers model and a novel comprehensive CSR model. Then, it highlights the advantages of integrating CSR and SDGs in a new framework. The proposed framework benefits from both CSR and SDGs, addresses current and future needs, and offers a better roadmap with more measurable outcomes.
... One of them is "Goal 3: Good Health and Well-Being" which tries to ensure healthy lives and promote well-being for all at all ages. On the other hand, Sherman et al. (2020) state in their paper that conventional healthcare services are major emitters of environmental pollutants which adversely affect our health. That is also related to "Goal 13: Climate Action" which tries to take urgent action to combat climate change and its impacts. ...
Chapter
The cost of climate change risk should be analyzed not only from an economic perspective but also based on policies formulated, using climate science forecasts, the allocation of rights, and crucial or behavioral assumptions. The discount rate (pure rate of time preference, growth in per capita consumption, and relative risk-aversion), an indicator of the severity of climate change and desirable climate policy-level, is vital in estimating the social cost of carbon. Moreover, changes in temperature, precipitation, increase in sea level, and the sensitivity to emissions affect the vulnerability of the sectors within climate models. This study identifies social discount rate and cost of carbon within key factors of climate change adaptation and focuses on the range of uncertainty since the uncertainty is often skewed, and the damage function is often nonlinear.
... In many cases, these curricular changes have been driven by medical trainees themselves who see the importance of learning this material [55]. There have also been efforts to start incorporating environmental sustainability into the quality-improvement programs that are already commonly built into many hospital systems and in which many medical trainees are actively involved [56]. Through these changes, the system-wide interventions to make medicine greener will hopefully be supported by a more widespread medical culture that sees the significance of supporting efforts to address the impacts of climate change on their patients and on the doctor-patient relationship. ...
... This is, in particular, true when it comes to the healthcare sector [3], where massive information describing one's state of health is being produced every single day. The proper optimization of clinical information workflow, exchange, and retention may contribute to sustainable development in terms of equalization of universal access to medical services, lowering the overall costs of both medical services being provided and the IT infrastructure needed to host clinical information systems, even reducing the footprint on the environment [4]. ...
Article
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In this article, the authors, using information-systems modeling techniques, and considering current national legal regulations, present the cloud-enabled architecture of a clinical data repository. The patient’s medical record is an important carrier of information necessary for accurate diagnosis and selection of the correct treatment process. Therefore, it is not surprising that since the beginning of the development of computer technologies, databases have been built to enable the management of a patient’s medical records. These systems were most-often deployed locally at individual healthcare units, which carried certain limitations both in terms of the security and availability of the stored information, and the possibility of exchanging it with other clinics. However, recent developments in the standardization of medical information exchange in Poland, together with the revolution in cloud computing, have opened up completely new perspectives for clinical-data-repository implementations helping to make them far more sustainable. Although, the practical aspects of implementing clinical-documentation repositories are studied both in forums of European countries and also around the world; so far, no similar research was conducted with respect to Poland. This study tries to fill that gap by proposing a flexible multi-variant cloud-enabled architecture of the system providing the services of a clinical-data repository. The goal of the work was to propose such a system architecture that allows having a system that is either cloud-agnostic, that uses specifically selected cloud services, or that is even deployable locally. Thanks to the use of cloud computing services, the implemented system is characterized by high availability, scalability, and the possibility of exchanging data between medical institutions, which enables the improvement in the quality of medical processes for the whole Polish population.
... Environmental engineering tools and methods to quantify carbon and other environmental emissions are well established, and life cycle assessment is the gold standard in healthcare sustainability research. 27 Although the emissions and public health damages from low value care are not yet known, it stands to reason that reducing unnecessary care would reduce emissions and costs, provided that the emissions intensity of required care is simultaneously reduced. ...
... Sustainable healthcare education develops students' knowledge, skills and attitudes about the interdependence of climate, ecosystems and health, as well as the healthcare sector's environmental impact and provides practical solutions to support ecosystems and human health (19-21). Primarily, education needs to empower learners to embrace their professional duty of resource stewardship and environmentally preferable practice (22). ...
Article
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Background The cultural-cognitive, normative and regulative pillars of institutions influence the ability of hospitals to change how they function at an organizational and operational level. As more hospitals and their foodservices instigate changes to address their environmental footprint and impact on food systems, they move through the “sustainability phase model” from no response through to high level action and leadership. The aim of this study was to describe and compare the pillars of institutions between hospitals in different stages of achieving environmentally sustainable foodservices (business-as-usual vs. exemplar hospitals). Methods For this qualitative inquiry study, interviews were conducted with 33 hospital staff from 3 business-as-usual hospitals in Melbourne, Australia and 21 hospital staff from 14 exemplar hospitals across 9 countries. Participants were asked questions about their perspectives on environmental sustainability in foodservices and the barriers, enablers and drivers they experienced. Each data set was analyzed thematically and then compared. Findings There was a clear and distinct difference in responses and behaviors within each pillar between the exemplar and business-as-usual hospitals. The cultural-cognitive pillar identified a similarity in personal belief in the importance of addressing environmental impacts of foodservices, but difference in how staff saw and acted on their responsibility to drive change. The normative pillar uncovered a supportive culture that encouraged change in exemplar hospitals whilst business-as-usual hospital staff felt disheartened by the difficult processes and lack of support. The regulative pillar reflected business-as-usual hospital staff feeling restricted by government policy vs. exemplar hospital participants who were motivated to internalize government policy in different ways and work with other hospitals to advocate for better policy. Interpretation These findings highlight strategies related to each of the three pillars of institutions that can be used to drive effective, sustainable long term change within hospitals. This includes staff education and training, revisiting hospital culture and values around environmental sustainability, embedding sustainable foodservices in internal policies, and a comprehensive government policy approach to sustainable healthcare.
... One of them is "Goal 3: Good Health and Well-Being" which tries to ensure healthy lives and promote well-being for all at all ages. On the other hand, Sherman et al. (2020) state in their paper that conventional healthcare services are major emitters of environmental pollutants which adversely affect our health. That is also related to "Goal 13: Climate Action" which tries to take urgent action to combat climate change and its impacts. ...
Chapter
In this paper, we aim to examine the effect of health information orientation on attitudes toward using digital health services and explore the mediating role of e-health literacy in this relationship. We also tested the impact of attitudes toward using digital health services on digital health service use intention. We collected data through an online survey method. A total of 520 respondents participated, and data were analyzed using structural equation modeling. The results showed that people who are health information oriented and capable of finding and utilizing e-health information have positive attitudes and intention toward using digital health service. Variables in the model explain 60% of the variance in digital health service use intention. This study confirmed the partial mediating role of e-health literacy on the relationship between health information orientation and attitudes toward using digital health services. Future research is needed to explore whether these relationships are confirmed in a specific health context. Furthermore, comparing the digital health service usage attitudes and intentions of people who have and do not have chronic illnesses can also be insightful. Cross-cultural comparisons may also add to the knowledge related to the adoption of digital health services. We conducted this study during the early phase of COVID-19 pandemic in Turkey and explored the digital health service use intention partly within the Theory of Reasoned Action framework. We have also tried to contribute to Sustainable Development Goals with our research results.
... In addition to these health impacts, the urgency for healthcare professionals to address environmental issues, directly and indirectly, is further exacerbated by the fact that healthcare systems and services contribute to climate change and environmental degradation. Healthcare-related carbon emissions, waste production, plastic pollution, toxic waste, and other undesirable outputs are also threatening good health, or even contributing to poor health in a Sisyphean process of improving the health of people [18][19][20]. Nevertheless, neither contribution to the problem nor contribution relative to the size of the country, healthcare system, or service are necessary to recognize the ethical imperative and professional stringency for the medical and health professions to understand and act on biodiversity loss, climate change and environmental degradation. ...
Article
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Climate change, biodiversity loss and large-scale environmental degradation are widely recognized as the biggest health threats of the 21st century, with the African continent already amongst the most severely affected and vulnerable to their further progression. The healthcare sys-tem's contribution to climate change and environmental degradation requires healthcare professionals to address environmental issues urgently. However, the foundation for context-relevant interventions across research, practice, and education is not readily available. Therefore, we conducted a convergent mixed-methods study to investigate South African healthcare professionals' knowledge, attitudes, practices, and barriers to environmental sustainability. Healthcare professionals participated in a cross-sectional questionnaire (n = 100) and in-depth semi-structured focus group discussions (n = 18). Data were analyzed using descriptive statistics and thematic analysis, respectively, and integrated to provide holistic findings. Our results confirm overwhelmingly positive attitudes and a high degree of interest in education, implementation, and taking on more corresponding responsibility, but a lack of substantial knowledge of the subject matter, and only tentative implementation of practices. Identified barriers include a lack of knowledge, resources, and policies. Further research, education, and policy development on overcoming these barriers is required. This will facilitate harnessing the extant enthusiasm and advance environmental sustainability in South Africa's healthcare practice.
... The increase in poor sanitation and hygiene, waste, pesticides, water and air pollutants pose environmental risks in Africa but with limited research attention to their impact on human health (Joubert et al., 2020) EH issues are complex and require adequate and efficient systembased approaches and strategies that enable effective and efficient interventions in the long term (Rosenthal et al., 2020). Every country strives for EH management by emphasizing that all stakeholders are fully involved in protecting and preserving the environment (Sherman et al., 2020). ...
Article
The study aimed to critically assess secondary school students' perceptions of the nature and magnitude of environmental health problems in Mtwara town, Tanzania. A structured questionnaire was used to collect data, while descriptive statistics such as frequencies, percentages, mean, or standard deviation were applied to describe the basic characteristics of the data. Principal components analysis was used to examine the dominant modes of variation of functional data in environmental health concerns of Mtwara town. The students perceived the following seven environmental health issues that are urgent in Mtwara town: water supply and management, natural disasters, sanitation and hygiene, solid waste, air quality, climate change, and population concern. To ensure that generations live in a healthy and safe environment, one must consider creating environmentally conscious individuals.
... Recent literature has emphasized how healthcare sustainability strategies must employ a multi-perspective approach based on the structure, management, and prevention of care issues [42,43]. Other authors highlighted how studies on practices and/or case studies contribute significantly to sustainable health system strategies [44,45]. ...
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... This approach is favoured due to the limitations of existing process-based databases for health-care products such as the absence of data on the environmental costs of pharmaceuticals in lifecycle inventory databases. 41 The Eyefficiency app and some included studies implement this hybrid approach 22,34,36,38 and other studies only make use of an economic approach. 26,32 The other 14 studies included were observational and quantified the environmental impacts of interventions or clinical pathways, in some cases comparing options such as the environmental impacts of different retinal angio graphy modalities. ...
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Pharmaceuticals represent a significant contributor to the environmental impact of healthcare. Biopharmaceuticals are a rapidly growing category in that industry. They provide considerable health benefits, but the environmental impact to produce them is still largely unclear. In this paper, we examined the cost–benefit of monoclonal antibody (mAb) production in terms of operating cost and environmental impact through an extended life cycle assessment including 15 environmental categories, disability-adjusted life years, and Eco-index. Based on a detailed kinetic model, we assessed the impacts of four production scenarios at a commercial scale of batch and continuous production using single-use and multi-use equipment. We further performed a sensitivity analysis on the cost–benefit analysis results to determine elements with the highest impact on process improvement. The results showed that there is a trade-off between the operating cost and human health among the four process scenarios. Continuous modes (i.e., perfusion cultivation) have the least human health damage but with the highest operating costs, while the combination of fed-batch and multi-use equipment yields the lowest operating cost with the highest human health damage. To improve the cost–benefit of mAb cultivation, the sensitivity analysis showed the high effectiveness of potential improvements to cell’s growth characteristics such as the specific production rate.
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A changing climate will have demonstrable effects on health and healthcare systems, with specific and disproportionate effects on communities in Africa. Emergency care systems and providers have an opportunity to be at the forefront of efforts to combat the worst health effects from climate change. The 2020 African Conference on Emergency Medicine, under the auspices of the African Federation for Emergency Medicine, convened its first ever workshop on the topic of climate change and human health. Structured as a full day virtual course, the didactic sections were available for both live and asynchronous learning with more than 100 participants enrolled in the course. The workshop introduced the topic of the health effects of climate as they relate to emergency care in Africa and provided a forum to discuss ideas regarding the way forward. Lectures and focused discussions addressed three broad themes related to: health impacts, health care delivery, and advocacy. To our knowledge, this is the first workshop for health professionals to cover topics specific to emergency care, climate change, and health in Africa. The results of this workshop will help to guide future efforts aimed at advancing emergency care approaches in Africa with regard to medical education, research, and policy. African relevance •Climate-related extreme weather events are adversely affecting health and health care delivery in African countries. •African organisations, cities, and nations have taken positive steps to adapt and build climate resilience. •There are opportunities for emergency care professionals and scholars to continue to expand, and lead, climate and health education, research, and policy initiatives on the continent.
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The objective of the article is to analyse selected indicators of sustainable development in the field of “public health”, especially those related to health and health-related inequalities. The article focuses on the analysis of indicators in the field of “public health” presented by Eurostat. These indicators were presented in terms of averages and medians. Moreover, the paper indicates the amount of funds allocated for prevention in health care. In addition, the cluster method was used to identify EU countries similar to each other in terms of the leading indicator of sustainable development (SD). The study was conducted using annual data for 2010–2019 for Poland as compared to other EU countries. The study used data from the Eurostat and OECD databases. In almost all of the analysed countries, in relation to the demographic and health situation, there is a close link between the financial situation, health and inequalities in health-related fields. Patients’ sense of safety has decreased in Poland, which is the result of the growing consumption of health services and emerging problems with the availability of health care services as well as environmental pollution. Among others, the percentage of people with health problems and low income has increased. Although the percentage of unmet needs resulting from income inequalities has decreased over the past year in the analysed groups of countries, it is still high in Poland. The low level of expenditure on prevention makes these difficulties even more severe. In summary, capturing changes in indicators describing public health in the context of its impact on sustainable development plays a key role in balancing out inequalities in the EU countries and in managing a common policy.
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Background: Both human health and the health systems we depend on are increasingly threatened by a range of environmental crises, including climate change. Paradoxically, health care provision is a significant driver of environmental pollution, with surgical and anesthetic services among the most resource-intensive components of the health system. Objectives: This analysis aimed to summarize the state of life cycle assessment (LCA) practice as applied to surgical and anesthetic care via review of extant literature assessing environmental impacts of related services, procedures, equipment, and pharmaceuticals. Methods: A state-of-the-science review was undertaken following a registered protocol and a standardized, LCA-specific reporting framework. Three bibliographic databases (Scopus®, PubMed, and Embase®) and the gray literature were searched. Inclusion criteria were applied, eligible entries critically appraised, and key methodological data and results extracted. Results: From 1,316 identified records, 44 studies were eligible for inclusion. The annual climate impact of operating surgical suites ranged between 3,200,000 and 5,200,000 kg CO2e. The climate impact of individual surgical procedures varied considerably, with estimates ranging from 6 to 1,007 kg CO2e. Anesthetic gases; single-use equipment; and heating, ventilation, and air conditioning system operation were the main emissions hot spots identified among operating room- and procedure-specific analyses. Single-use equipment used in surgical settings was generally more harmful than equivalent reusable items across a range of environmental parameters. Life cycle inventories have been assembled and associated climate impacts calculated for three anesthetic gases (2-85 kg CO2e/MAC-h) and 20 injectable anesthetic drugs (0.01-3.0 kg CO2e/gAPI). Discussion: Despite the recent proliferation of surgical and anesthesiology-related LCAs, extant studies address a miniscule fraction of the numerous services, procedures, and products available today. Methodological heterogeneity, external validity, and a lack of background life cycle inventory data related to many essential surgical and anesthetic inputs are key limitations of the current evidence base. This review provides an indication of the spectrum of environmental impacts associated with surgical and anesthetic care at various scales. https://doi.org/10.1289/EHP8666.
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Einleitung: Die Auswirkungen des Klimawandels auf die Gesundheit und die Notwendigkeit, die Treibhausgasemissionen des Gesundheitswesens zu reduzieren, werden zunehmend thematisiert. Über die Haltung ambulant tätiger Ärztinnen und Ärzte zum Klimaschutz in Praxen ist bisher wenig bekannt. Methodik: Zwischen Oktober 2020 und Februar 2021 wurden ambulant tätige Ärztinnen und Ärzte zu einer deutschlandweiten Online-Umfrage eingeladen. 1683 Teilnehmende beantworteten 39 Fragen zu den Bereichen Energie, Mobilität, Gebrauchsmaterialien, Finanzen und Patient*innenberatung. Dabei wurden Daten zu Ist-Zustand, Bereitschaft, Hürden und Wünschen hinsichtlich Klimaschutz in Praxen erhoben. Ergebnisse: 83% der Teilnehmenden sahen den Klimawandel als dringendes Problem, das sofortiges Handeln erfordere. Eine Mehrheit berichtete von klimawandelbedingten Folgen für die Gesundheit ihrer Patient*innen. Für Klimaschutz in ihren Praxen fühlten sich die meisten zuständig. Die Teilnehmenden zeigten große Bereitschaft zur Umsetzung klimafreundlicher Maßnahmen. Als Hindernisse wurden fehlende Information und Unterstützung durch Berufsverbände sowie finanzielle Mehrausgaben genannt. Der Großteil forderte die Entwicklung von klimafreundlichen Strategien durch Politik und Institutionen. Schlussfolgerung: Angesichts nationaler Klimaziele und Bereitschaft ambulant tätiger Ärztinnen und Ärzte zu Klimaschutz in Praxen ist berufspolitische Unterstützung z.B. durch Handlungsempfehlungen und finanzielle Förderungen zur klimafreundlichen Transformation des Gesundheitswesens im Einklang mit Planetary Health nötig. Für die Entwicklung effektiver Maßnahmen zur Einsparung von Treibhausgasemissionen in Arztpraxen sollten begleitende Studien zusätzliche Evidenz schaffen.
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Because of its energy intensive requirements and multi-disciplinary interdependencies, perioperative care, including surgery, anesthesia, and pathology, is one of the greatest contributors to the direct greenhouse gas emissions of healthcare systems. By reducing this contribution, the paradox of harming human health through the delivery of healthcare services can be addressed. Energy use and waste generation are the main underlying factors contributing to these downstream health harms of providing surgical care. On-site energy is consumed primarily by heating ventilation and air conditioning systems, lighting, and equipment. A variety of different types of waste are also generated on-site, including regulated medical waste, healthcare plastic and packaging waste, single-use devices, anesthetic gases, medication, chemicals, and water. In this review, we discuss practical ways to reduce direct energy use and decrease and avoid waste generation during the surgical experience. Following these environmental best practices supports triple bottom line performance, which delivers significant financial, environmental, and social benefits.
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Die Gemeinwohlökonomie beschreibt – ganz im Einklang mit vielen staatlichen Verfassungen – das Wohl von Mensch und Umwelt als oberstes Ziel des Wirtschaftens. In ähnlicher Weise stehen Ärztinnen und Ärzte durch den Grundsatz „primum non nocere – erstens nicht schaden“ aus dem hippokratischen Eid in der Verantwortung, zu handeln, wenn die Gesundheit von Menschen und der Welt, in der sie leben, auf dem Spiel steht. Einer der Bereiche, auf den die Gemeinwohlökonomie fokussiert, ist der der ökologischen Nachhaltigkeit.
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Background Education is a social tipping intervention necessary for stabilising the earth's climate by 2050. Integrating sustainable healthcare into healthcare professions curricula is a key action to raise awareness. Objectives This study aimed to: i) investigate nursing students' attitudes towards and awareness of climate change and sustainability issues and its inclusion in nurse education, ii) explore differences across a range of countries, and iii) compare attitudes in 2019 with those of a similar sample in 2014. Design A cross-sectional multicentre study. Data were collected through the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire. Settings Seven different universities and schools of nursing in five countries (UK, Spain, Germany, Sweden, and Australia). Participants A convenience sample of first-year undergraduate nursing students. Methods The SANS_2 questionnaire was self-administered by nursing students at the seven participating universities at the start of their undergraduate degree, between September 2019 and February 2020. Results Participants from all seven universities (N = 846) consistently showed awareness and held positive attitudes towards the inclusion of climate change and sustainability issues in the nursing curriculum (M = 5.472; SD: 1.05; min-max 1–6). The relevance of climate change and sustainability to nursing were the highest scored items. Esslingen-Tübingen students scored the highest in the ‘inclusion of climate change and sustainability in the nursing curricula’. Students at all universities applied the principles of sustainability to a significant extent at home. Nursing students' attitudes towards climate change and sustainability showed significantly higher values in 2019 (Universities of Plymouth, Brighton, Esslingen-Tübingen, Jaen, Murcia, Dalarna, and Queensland) than in 2014 (universities of Plymouth, Jaen, Esslingen, and Switzerland). Conclusions Nursing students have increasingly positive attitudes towards the inclusion of sustainability and climate change in their nursing curriculum. They also recognise the importance of education regarding sustainability and the impact of climate change on health, supporting formal preparation for environmental literacy. It is time to act on this positive trend in nursing students' attitudes by integrating these competencies into nursing curricula.
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Healthcare creates a significantly sizeable environmental footprint, worsening the climate crisis, polluting air, soil and water, damaging biodiversity and causing ecological damage. Planetary health and public health are interlinked and healthcare professionals in all roles, including orthopaedics and trauma, have a role to play in improving the environmental sustainability of their healthcare practice. The principles of sustainable clinical practice emphasize prevention and patient self-care as vital for addressing environmental issues in healthcare in order to reduce waste and avoid using resources unnecessarily. Lowering the ecological footprint can also be achieved through more efficient, lean working practices and low-carbon alternatives where they are available. This article explores these sustainability principles in healthcare, along with the role of systems thinking, behaviour change and quality improvement as central concepts for improving environmental sustainability, while also seeking financial, social and clinical co-benefits within orthopaedics and trauma services.
Article
The objective of the present study was to identify the environmental sustainability indicators in the hospitals of Bihar, India and assess the performance of hospitals on these indicators. We adapted the sustainability index from Smercenik and Anderson (2011) and evaluated the environmental performance of hospitals on six dimensions: Sustainable Management, Managing Hospital Pollution, Environmental Communication, Resource Conservation, Energy Conservation, and Patient Room Sustainability. The sample consisted of 234 medical practitioners and administrative staffs employed in 76 private and government hospitals located in Bihar. The data were analyzed using SPSS 24. Descriptive statistics and bar graphs were used to examine the degree of implementation of environmental sustainability practices. The results revealed a below average level of implementation of sustainability practices in the sampled hospitals. The highest level of implementation was found for ‘resource conservation’ followed by ‘managing hospital pollution’, ‘patient room sustainability’, and ‘energy conservation’. The least implemented practices were ‘sustainable management’ followed by ‘environmental communication’ and ‘water recycling’. This study by investigating the status and nature of implementation of eco-friendly practices in a resource constrained state of India contributes to the scant knowledge base on the state of environmental sustainability from developing cities of the world. It provides important insights on current trends in the healthcare industry and paints a picture of environmental sustainability in hospitals.
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Purpose Environmental sustainability is a growing concern to healthcare providers, given the health impacts of climate change and air pollution, and the sizable footprint of healthcare delivery itself. Though many studies have focused on environmental footprints of operating rooms, few have quantified emissions from inpatient stays. This study quantifies solid waste and greenhouse gas emissions (GHGs) per bed-day in a regular inpatient (low intensity) and intensive care unit (high intensity). Methods This study uses hybrid environmental life cycle assessment (LCA) to quantify average emissions associated with resource use in an acute inpatient unit with 49 beds and 14,427 hospitalization days and an intensive care unit (ICU) with 12 beds and 2536 hospitalization days. The units are located in a single tertiary, private hospital in Brooklyn, NY, USA. Results and discussion An acute care unit generates 5.5 kg of solid waste and 45 kg CO2-e per hospitalization day. The ICU generates 7.1 kg of solid waste and 138 kg CO2-e per bed day. Most emissions originate from purchase of consumable goods, building energy consumption, purchase of capital equipment, food services, and staff travel. Conclusions The ICU generates more solid waste and GHGs per bed day than the acute care unit. With resource use and emission data, sustainability strategies can be effectively targeted and tested. Medical device and supply manufacturers should also aim to minimize direct solid waste generation.
Article
The United States health care industry is the second largest in the world, expending an estimated 479 million metric tons (MMT) of carbon dioxide per year, nearly 8 percent of the country's total emissions. The importance of carbon reduction in health care is slowly being accepted. However, efforts to “green” health care are incomplete since they generally focus on buildings and structures. Yet hospital care and clinical service sectors contribute the most carbon dioxide within the U.S. health care industry, with structures/equipment and pharmaceuticals ranking as the third and fourth highest emitters in the industry. Given the magnitude of health care carbon emissions—and the paucity of attention to the carbon of hospital care and clinical services—this essay identifies overuse of health care as a health threat with serious ethical implications, offers a data‐driven action plan for carbon reduction in health care, and provides practical suggestions for more sustainable health care delivery in the United States.
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The medical device manufacturing industry is important to the Irish economy, but it is an industry that produces a lot of waste. Therefore, the introduction of a closed-loop supply chain could be very beneficial. This empirical study was conducted to identify what barriers prevent the successful implementation of a closed-loop supply chain to the industry. Industry experts’ pairwise comparisons of the barriers were used as inputs for the Bayesian Best–Worst Method to rank the barriers based on their relative importance to remove. This method contains an error with how weight is distributed to barriers in categories of different sizes and a novel adjusted global weight approach is presented. Product design was found to be the most important barrier to remove, and customer perception was found to be least important barrier to remove. Managerial actions and government policy recommendations are made to address the most severe barriers.
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The life cycle assessment method was applied for the evaluation of the impacts related to the recycling process of carbon-fiber/thermoset composite through solvolysis and the reuse of the recovered carbon fibers in the production of new composite laminates. The avoided impacts were calculated for the case of replacing virgin carbon fibers and virgin glass fibers with recycled carbon fibers in the production of laminates for skis. Avoided impacts on the main impact categories were accounted by the CML mid-point impact assessment method. Damage on human health, resources and ecosystems were calculated with the Recipe end-point method. Reduced damages were found when replacing virgin fibers (both carbon and glass) with recycled carbon fibers. In our study we assumed that the recycled carbon fibers were ready to use and no other treatment was required. The life cycle assessment (LCA) was used to assist the eco-design of a new possible ski structure.
Article
The healthcare sector accounts for nearly 5% of global greenhouse gas emissions (GHG) and is a significant contributor to complex waste. Reducing the environmental impact of technology-heavy medical fields such as cardiac electrophysiology (EP) is a priority. The aim of this survey was to investigate the practice and expectations in European centres on EP catheters environmental sustainability. A 24-item online questionnaire on EP catheters sustainability was disseminated by the EHRA Scientific Initiatives Committee in collaboration with the Lyric Institute. A total of 278 physicians from 42 centres were polled; 62% were motivated to reduce the environmental impact of EP procedures. It was reported that 50% of mapping catheters and 53% of ablation catheters are usually discarded to medical waste, and only 20% and 14% of mapping and ablation catheters re-used. Yet, re-use of catheters was the most commonly cited potential sustainability solution (60% and 57% of physicians for mapping and ablation catheters, respectively). The majority of 69% currently discarded packaging. Reduced (42%) and reusable (39%) packaging also featured prominently as potential sustainable solutions. Lack of engagement from host institutions was the most commonly cited barrier to sustainable practices (59%). Complexity of the process and challenges to behavioral change were other commonly cited barriers (48% and 47%, respectively). The most commonly cited solutions towards more sustainable practices were regulatory changes (31%), education (19%), and product after-use recommendations (19%). In conclusion, EP physicians demonstrate high motivation towards sustainable practices. However, significant engagement and behavioural change, at local institution, regulatory and industry level is required before sustainable practices can be embedded into routine care.
Article
Motivated by the increasing demand for integrated, value-based healthcare, this study proposes a valid measurement scale for sustainability in the healthcare sector. The model focuses on implementation strategies to foster social, environmental and broader economic value-based sustainability in healthcare. This unique holistic approach aligns with the UN SDGs agenda, focusing on environmental considerations and societal health and wellbeing through a multidimensional mix of leading economic, social and environmental performance indicators. Exploratory factor analysis revealed seven dimensions of the measurement scale for sustainability measured by 39 items. Confirmatory factor analysis has been used to confirm the factor structure of the study and the results indicate that the proposed measurement is valid. This measurement scale serves as the basis of a comprehensive benchmark, developed to assess sustainability-related performance in the healthcare industry. The study also explains the theoretical and practical implications of the findings, followed by the limitations and agenda for future research.
Article
Climate change has been increasingly recognized in the healthcare sector over recent years, with global implications in infrastructure, economics, and public health. As a result, a growing field of study examines the role of healthcare in contributing to environmental sustainability. These analyses commonly focus on the environmental impact of the operating room, due to extensive energy and resource utilization in surgery. While much of this literature has arisen from other surgical specialties, several environmental sustainability studies have begun appearing in the field of orthopaedic surgery, consisting mostly of waste audits and, less frequently, more comprehensive environmental life cycle assessments. The present study aims to review this limited evidence. The results suggest that methods to reduce the environmental impact of the operating room include proper selection of anesthetic techniques that have a smaller carbon footprint, minimization of single use instruments, use of minimalist custom-design surgical packs, proper separation of waste, and continuation or implementation of recycling protocols. Future directions of research include higher-level studies, such as comprehensive life cycle assessments, to identify more opportunities to decrease the environmental impact of orthopaedic surgery.
Article
Objectives To identify key attributes of healthcare quality relevant to patients and kin and to compare them to Lachman’s multidimensional quality model. Methods Four focus groups with patients and kin were conducted using a semi-structured interview guide and a purposive sampling method. Classical content analysis and constant comparison method were used to focus data analysis on individual and group level. Results Communication with patients, kin and professionals emerged as a new dimension from interview transcripts. Other identified key attributes largely corresponded with Lachman’s multidimensional quality model. They were mainly classified in dimensions: ‘Partnership and Co-Production’, ‘Dignity and Respect’ and ‘Effectiveness’. Technical quality dimensions were linked to organisational aspects of care in terms of staffing levels and time. The dimension ‘Eco-friendly’ was not addressed by patients or kin. Conclusions The results enhance the comprehension of healthcare quality and contribute to its academic understanding by validating Lachman’s multidimensional quality model from patients’ and kin’s perspective. The model robustness is increased by including communication as a quality dimension surrounding technical domains and core values. Practice Implications The key attributes can serve as a holistic framework for healthcare organisations to design their quality management system. An instrument can be developed to measure key attributes. Data availability Due to the sensitive nature of the questions asked in this study, participants were assured raw data would remain confidential and would not be shared.
Article
Climate change, human health, and healthcare systems are inextricably linked. As the climate warms due to greenhouse gas (GHG) emissions, extreme weather events, such as floods, fires, and heatwaves, will drive up demand for healthcare. Delivering healthcare also contributes to climate change, accounting for ∼5% of the global carbon emissions. To rein in healthcare’s carbon footprint, clinicians and health policy makers must be able to measure the GHG contributions of healthcare systems and clinical practices. Herein, we scope potential informatics solutions to monitor the carbon footprint of healthcare systems and to support climate-change decision-making for clinicians, and healthcare policy makers. We discuss the importance of methods and tools that can link environmental, economic, and healthcare data, and outline challenges to the sustainability of monitoring efforts. A greater understanding of these connections will only be possible through further development and usage of models and tools that integrate diverse data sources.
Article
Hospitals are using an important number of textiles for employees, patients and visitors. These textiles are mainly disposable, but reusable options are becoming increasingly interesting. A Life Cycle Assessment (LCA) of reusable scrub suits in France was conducted to assess their potential environmental impacts compared to disposable scrub suits using ten environmental indicators. The functional unit is “to provide an operating room employee with scrub suits daily during 4 years' service”. Primary data were collected from a reusable suit producer, its suppliers and clients. A reusable scrub suit system has a lower environmental impact for the majority of indicators. Reusable’ impact on climate change decreases by 31% compared to disposable scrub suit system. When considering the use of 1.8 disposable scrub suit instead of one per day of work, the impact on climate change of reusable solution is 62% lower compared to disposable scrub suits. However, the impact on water depletion remains much higher for the reusable scrub suit scenario, especially due to the impact of cotton production. Overall, the reusable scrub suit seems an attractive solution for the healthcare sector leading to a reduction of the environmental footprint compared to a standard disposable option.
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Objective To assess the environmental and economic impacts of reusable and disposable blood pressure cuffs. Setting Out-patient clinic and ambulatory procedure rooms, and five-day in-patient regular ward and intensive care unit (ICU) health care encounters. Methods Environmental modeling using life cycle assessment was employed to estimate greenhouse gas (GHG) emissions and other environmental impacts, from cuff manufacturing, packaging, transportation, use, cleaning, and landfill or incineration waste management. Cuff, cleaning, and packaging materials were identified and weighed directly. Both per-encounter and per-day low-level disinfection scenarios were performed. Life cycle costs were determined with hospital data, including procurement, labor (time-motion observations), and waste disposal. Results For all use and cleaning scenarios, the reusable cuff was environmentally preferable in terms of GHG emissions and other impact categories, in some cases by a factor of 40. Disposable cuff emissions are dominated by materials manufacturing, while reusable cuff emissions are dominated by production of disinfection wipes. Reusable cuffs are far cheaper than disposables in the out-patient settings. Disposable cuffs are slightly lower cost in the in-patient setting where reusable BP cuffs are shared among patients and therefore require frequent cleaning. However, reusable cuffs are also more economical in the in-patient settings when patients have dedicated personal equipment (i.e., stays with them during their entire health care encounter) whether cleaned daily or at the end of their stay. Conclusion Life cycle assessment and costing highlight environmental and financial trade-offs between manufacturing and cleaning when comparing reusable and disposable BP cuffs.
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Background: The health sector plays an important part in adapting to climate change; however, the sector is also responsible for significant greenhouse gas (GHG) emissions. In high-income countries, the carbon footprints of health-care systems have been estimated to be 3-10% of the total national GHG emissions, but no in-depth investigation has been done for China. This study aims to examine the carbon footprint of the Chinese health-care system and identify emission hotspots. Methods: Environmentally extended input-output analysis and structural path analysis were used to assess the lifecycle GHG emissions of the Chinese health-care system. A satellite account of GHG emissions was constructed for 46 economic sectors in China using energy data from the National Bureau of Statistics based on the numbers reported by a large number of enterprises. Data on health expenditure for medical institutions, pharmaceuticals, construction, administration, and research were obtained from multiple Chinese official statistics yearbooks and the national input-output table. Findings: In 2012, China spent CNY 2539 billion on health care, leading to emissions of 315 (68% CI 267-363) megatonnes CO2 equivalent. Health care accounted for 2·7% (68% CI 2·3-3·1) of China's total GHG emissions. The major contributors of GHG emissions in the health-care system were public hospitals (148 megatonnes [47%]), non-hospital purchased pharmaceuticals (56 megatonnes [18%]), and construction (46 megatonnes [15%]). In medical institutions, energy use for buildings and transport accounted for only 16% of the total carbon footprint, whereas 84% was embodied in the purchased goods and services. Interpretation: China has a much smaller health-care carbon footprint per capita than developed countries, such as the USA and Australia. However, its carbon emissions per unit of health expenditure are relatively high because of the expenditure structure and the carbon intensity of the country's entire economy. The results suggest the need for a nationwide carbon-efficient target for health care and use of low-carbon alternatives in making supply chain choices to achieve reductions in the carbon footprint. Funding: Natural Science Foundation of China.
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Introduction: In Great Britain, roughly half of people with at least one long-standing illness (LSI) live in low-income households. Lower-income households are at risk of fuel poverty and living in a colder house, which can worsen certain health conditions, causing related morbidity and mortality. This pilot study aimed to assess whether raising occupants' awareness of indoor temperatures in the home could initiate improved health and well-being among such vulnerable residents. Methods: Thermometers were placed inside a manufactured bamboo brooch to be worn or placed within homes during the winter of 2016/17. These devices were supplied to households (n = 34) already assisted by Community Energy Plus, which is a private social enterprise in Cornwall, United Kingdom (UK), using initiatives aimed at maintaining "healthy homes". Questionnaires were supplied to households before devices were supplied, and then again at the end of a three-month period, with further questions asked when devices were collected. Temperatures were recorded automatically every half-hour and used to draw inference from questionnaire responses, particularly around health and well-being. Results: Questionnaires were completed by 22 households. Throughout the winter, those declaring the poorest health when supplied with devices maintained homes at a higher average temperature. There were also indications that those with raised awareness of interior temperatures sought fewer casual medicines. Conclusion: Simple telemetry could play a role in the management of chronic health conditions in winter, helping healthcare systems become more sustainable. The need for higher indoor temperatures among people with an LSI highlights the need to consider this approach alongside more sustainable household energy-efficiency improvements. A larger study is needed to explore this further and quantify the cost benefit of this approach.
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Pollution is a leading cause of morbidity and mortality, and was associated with an estimated 9 million premature deaths globally in 2015 or 16% of all deaths.¹ Most environmentally mediated deaths are linked to air pollution,¹ with many health experts believing climate change is the leading public health issue of the 21st century. Major disruptions to food production, water supplies, and coastal livability are predicted unless significant action is taken to reduce greenhouse gas (GHG) emissions.² Ironically, modern health care is a major contributor to pollution that adversely affects human health.³⁻⁶ It is estimated that the health sectors of the United States,³ Australia,⁴ England,⁵ and Canada⁶ emit a combined 748 million metric tons of carbon dioxide equivalents annually. If the health sectors of these countries were an independent nation, they would rank seventh in the world for GHG emissions.
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Climate change confronts the health care sector with a dual challenge. Accumulating climate impacts are putting an increased burden on the service provision of already stressed health care systems in many regions of the world. At the same time, the Paris agreement requires rapid emission reductions in all sectors of the global economy to stay well below the 2 C target. This study shows that in OECD countries, China, and India, health care on average accounts for 5% of the national CO2 footprint making the sector comparable in importance to the food sector. Some countries have seen reduced CO2 emissions related to health care despite growing expenditures since 2000, mirroring their economy wide emission trends. The average per capita health carbon footprint across the country sample in 2014 was 0.6 tCO2, varying between 1.51 tCO2/cap in the US and 0.06 tCO2/cap in India. A statistical analysis shows that the carbon intensity of the domestic energy system, the energy intensity of the domestic economy, and health care expenditure together explain half of the variance in per capita health carbon footprints. Our results indicate that important leverage points exist inside and outside the health sector. We discuss our findings in the context of the existing literature on the potentials and challenges of reducing GHG emissions in the health and energy sector.
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Introduction: Healthcare facilities are complex infrastructures where different features from technological, social, clinical and architectural field interact. In modern healthcare systems there is a growing attention to the need of quality in terms of process and outcome, while the structural (physical) aspects are not often considered. Since the Nineties the theory of the Evidence Based Design (EBD) states that there is significant relationship between built environment and health related outcome. Objective: Aim of this paper is to investigate, in the recent scientific literature, which are the most important occupants' and organizational outcomes influenced by EBD hospital built environment qualities. Methodology: A Literature Review based on Scopus and PubMed databases has been run in order to understand the existing situation in terms of hospital quality evaluation from the physical and architectural point of view and to highlight the current trends. The results of the different reviews, empirical studies and post Occupancy Evaluations have been analyzed according to Ulrich's EBD conceptual framework. Results: 35 peer reviewed papers from the last 2 years were included. The methodologies adopted are very different and data are mainly collected through structured interviews or observations and elaborated with qualitative (33%), quantitative (26%) or mixed (41%) methodologies. The topic is mostly investigated in USA, Australia, Canada, UK and in the Scandinavian region; few contributions come also from Italy. Built environment variables that affect user's or organizational outcomes are mainly the Visual Environment (29%), the Audio Environment (20%) and the Patient Room Design (20%). Discussion and conclusion: The most recurrent outcomes found to be affected by the built environmental qualities are staff job satisfaction (n=11), patients' stress reduction (n=9), patients' satisfaction (n=6) and patients' fall reduction (n=6). Organizational outcomes are mentioned only two times. Although EBD is an old theory, the topic is both contemporary and relevant. Due to the diversity of the contributions and the limitations of the research, a deep comparison is challenging. Further investigation is necessary to deepen each of the variables identified.
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Comparative life-cycle assessment (LCA) of pharmaceutical drugs would enable clinicians to choose alternatives with lower environmental impact from options offering equivalent efficacies and comparable costs. However, life-cycle inventory (LCI) data of individual pharmaceutical drugs is limited to only a few compounds. In this study, we use chemical engineering methods for process scale-up and process design to utilize lab-scale synthesis data, available in patents and other public literature, to generate cradle-to-gate LCI data of 20 commonly used injectable drugs in anesthesia care to calculate their greenhouse gas impact. During the process of building the life-cycle trees of these drugs, missing life-cycle inventories for more than 130 other chemical compounds and pharmaceutical intermediates were accounted for using process-based methods and stoichiometric calculations. The cradle-to-gate GHG emissions of the 20 anesthetic drugs range from 11 kg CO2 eq. for succinylcholine to 3,000 kg CO2 eq. for dexmedetomidine. GHG emissions are positively correlated with the number of synthesis steps in the manufacturing of the drug. The LCI methods and data generated in this work greatly expand the available environmental data on APIs and can serve as a guide for LCA practitioners in future analysis of other pharmaceutical drugs. Most importantly, these LCA results can be used by clinical practitioners and administrators building toward sustainability in the health care sector.
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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. https://www.mdpi.com/2071-1050/11/1/220
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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.
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Anesthetic agents are known greenhouse gases with hundreds to thousands of times the global warming impact compared with carbon dioxide. We sought to mitigate the negative environmental and financial impacts of our practice in the perioperative setting through multidisciplinary staff engagement and provider education on flow rate reduction and volatile agent choice. These efforts led to a 64% per case reduction in carbon dioxide equivalent emissions (163 kg in Fiscal Year 2012, compared with 58 kg in Fiscal Year 2015), as well as a cost savings estimate of $25,000 per month.
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Importance Sustainability practices by large corporations are increasingly important to reduce the environmental and social impacts of the business enterprise. The health care industry represents 18% of the US economy, employs more people than any other economic sector, and is responsible for 10% of US carbon emissions. The engagement of large health care delivery organizations in reporting sustainability efforts has not been previously assessed. Objective To evaluate sustainability reporting by large US health care delivery organizations compared with reporting trends in all other economic sectors. Design, Setting, and Participants Cohort study of 49 large health care organizations (HCOs) by inclusion on one of the following lists in 2015 or 2016: Fortune 500, S&P (Standard & Poor) 500, Forbes 100 Largest Charities, Becker’s Hospital Review of largest HCOs, and 24/7 Wall St’s largest state employers. Each HCO was analyzed for sustainability reporting by reviewing the main corporate website, Google search, and search of publicly available databases. The percentage of sustainability reporting by HCOs on each list was compared with the percentage of sustainability reporting by all corporations on each list as obtained from public reports and publicly available databases. Data analysis was conducted in January 2018. Main Outcomes and Measures The percentages of large health care corporations and other corporations publicly reporting sustainability information. Results Forty-nine large for-profit and nonprofit US HCOs were analyzed (10 appeared on >1 list but were analyzed only once) appearing on the Fortune 500 (8 [16%]), S&P 500 (3 [6%]), Forbes 100 Largest Charities (8 [16%]), largest state employers (14 [29%]), largest for-profit HCOs (11 [22%]), and largest nonprofit HCOs (17 [35%]) by facilities owned for sustainability reporting. Among them, 4 of 8 (50%) on the Fortune 500, 1 of 3 (33%) on the S&P 500, and 6 of all 49 health care corporations (12%) published a sustainability report compared with 389 of 500 (78%) on the Fortune 500 and 410 of 500 (82%) on the S&P 500 reporting by all economic sectors. Conclusions and Relevance The health care delivery sector lags behind other US economic sectors in sustainability reporting. Publicly reporting sustainability activities would provide HCOs with an incentive to quantify and reduce their environmental impacts, lower costs, and protect human health.
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Background Human health is dependent upon environmental health. Air pollution is a leading cause of morbidity and mortality globally, and climate change has been identified as the single greatest public health threat of the 21st century. As a large, resource-intensive sector of the Canadian economy, healthcare itself contributes to pollutant emissions, both directly from facility and vehicle emissions and indirectly through the purchase of emissions-intensive goods and services. Together these are termed life cycle emissions. Here, we estimate the extent of healthcare-associated life cycle emissions as well as the public health damages they cause. Methods and findings We use a linked economic-environmental-epidemiological modeling framework to quantify pollutant emissions and their implications for public health, based on Canadian national healthcare expenditures over the period 2009–2015. Expenditures gathered by the Canadian Institute for Health Information (CIHI) are matched to sectors in a national environmentally extended input-output (EEIO) model to estimate emissions of greenhouse gases (GHGs) and >300 other pollutants. Damages to human health are then calculated using the IMPACT2002+ life cycle impact assessment model, considering uncertainty in the damage factors used. On a life cycle basis, Canada’s healthcare system was responsible for 33 million tonnes of carbon dioxide equivalents (CO2e), or 4.6% of the national total, as well as >200,000 tonnes of other pollutants. We link these emissions to a median estimate of 23,000 disability-adjusted life years (DALYs) lost annually from direct exposures to hazardous pollutants and from environmental changes caused by pollution, with an uncertainty range of 4,500–610,000 DALYs lost annually. A limitation of this national-level study is the use of aggregated data and multiple modeling steps to link healthcare expenditures to emissions to health damages. While informative on a national level, the applicability of these findings to guide decision-making at individual institutions is limited. Uncertainties related to national economic and environmental accounts, model representativeness, and classification of healthcare expenditures are discussed. Conclusions Our results for GHG emissions corroborate similar estimates for the United Kingdom, Australia, and the United States, with emissions from hospitals and pharmaceuticals being the most significant expenditure categories. Non-GHG emissions are responsible for the majority of health damages, predominantly related to particulate matter (PM). This work can guide efforts by Canadian healthcare professionals toward more sustainable practices.
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The Lancet Countdown tracks progress on health and climate change and provides an independent assessment of the health effects of climate change, the implementation of the Paris Agreement, and the health implications of these actions. It follows on from the work of the 2015 Lancet Commission on Health and Climate Change, which concluded that anthropogenic climate change threatens to undermine the past 50 years of gains in public health, and conversely, that a comprehensive response to climate change could be “the greatest global health opportunity of the 21st century”. The Lancet Countdown is a collaboration between 24 academic institutions and intergovernmental organisations based in every continent and with representation from a wide range of disciplines. The collaboration includes climate scientists, ecologists, economists, engineers, experts in energy, food, and transport systems, geographers, mathematicians, social and political scientists, public health professionals, and doctors. It reports annual indicators across five sections: climate change impacts, exposures, and vulnerability; adaptation planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. The key messages from the 40 indicators in the Lancet Countdown’s 2017 report are summarised below.
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Purpose: There are no comparative assessments on the environmental impact of endourologic instruments. We evaluated and compared the environmental impact of single-use flexible ureteroscopes with reusable flexible ureteroscopes. Patients and methods: An analysis of the typical life cycle of the LithoVue™ (Boston Scientific) single-use digital flexible ureteroscope and Olympus Flexible Video Ureteroscope (URV-F) was performed. To measure the carbon footprint, data were obtained on manufacturing of single-use and reusable flexible ureteroscopes and from typical uses obtained with a reusable scope, including repairs, replacement instruments, and ultimate disposal of both ureteroscopes. The solid waste generated (kg) and energy consumed (kWh) during each case were quantified and converted into their equivalent mass of carbon dioxide (kg of CO2) released. Results: Flexible ureteroscopic raw materials composed of plastic (90%), steel (4%), electronics (4%), and rubber (2%). The manufacturing cost of a flexible ureteroscope was 11.49 kg of CO2per 1 kg of ureteroscope. The weight of the single-use LithoVue and URV-F flexible ureteroscope was 0.3 and 1 kg, respectively. The total carbon footprint of the lifecycle assessment of the LithoVue was 4.43 kg of CO2per endourologic case. The total carbon footprint of the lifecycle of the reusable ureteroscope was 4.47 kg of CO2per case. Conclusion: The environmental impacts of the reusable flexible ureteroscope and the single-use flexible ureteroscope are comparable. Urologists should be aware that the typical life cycle of urologic instruments is a concerning source of environmental emissions.
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The Commission on Investing in Health (CIH), an international group of 25 economists and global health experts, published its Global Health 2035 report in The Lancet in December 2013. The report laid out an ambitious investment framework for achieving a "grand convergence" in health-a universal reduction in deaths from infectious diseases and maternal and child health conditions-within a generation. This article captures ten key elements that the CIH found important to its process and successful outcomes. The elements are presented in chronological order, from inception to post-publication activities. The starting point is to identify the gap that a new commission could help to narrow. A critical early step is to choose a chair who can help to set the agenda, motivate the commissioners, frame the commission's analytic work, and run the commission meetings in an effective way. In selecting commissioners, important considerations are their technical expertise, ensuring diversity of people and viewpoints, and the connections that commissioners have with the intended policy audience. Financial and human resources need to be secured, typically from universities, foundations, and development agencies. It is important to set a clear end date, so that the commission's work program, the timing of its meetings and its interim deadlines can be established. In-person meetings are usually a more effective mechanism than conference calls for gaining commissioners' inputs, surfacing important debates, and 'reality testing' the commission's key findings and messages. To have policy impact, the commission report should ideally say something new and unexpected and should have simple messages. Generating new empirical data and including forward-looking recommendations can also help galvanize policy action. Finally, the lifespan of a commission can be extended if it lays the foundation for a research agenda that is then taken up after the commission report is published.
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Background: Traditional medical device procurement criteria include efficacy and safety, ease of use and handling, and procurement costs. However, little information is available about life cycle environmental impacts of the production, use, and disposal of medical devices, or about costs incurred after purchase. Reusable and disposable laryngoscopes are of current interest to anesthesiologists. Facing mounting pressure to quickly meet or exceed conflicting infection prevention guidelines and oversight body recommendations, many institutions may be electively switching to single-use disposable (SUD) rigid laryngoscopes or overcleaning reusables, potentially increasing both costs and waste generation. This study provides quantitative comparisons of environmental impacts and total cost of ownership among laryngoscope options, which can aid procurement decision making to benefit facilities and public health. Methods: We describe cradle-to-grave life cycle assessment (LCA) and life cycle costing (LCC) methods and apply these to reusable and SUD metal and plastic laryngoscope handles and tongue blade alternatives at Yale-New Haven Hospital (YNHH). The US Environmental Protection Agency's Tool for the Reduction and Assessment of Chemical and other environmental Impacts (TRACI) life cycle impact assessment method was used to model environmental impacts of greenhouse gases and other pollutant emissions. Results: The SUD plastic handle generates an estimated 16-18 times more life cycle carbon dioxide equivalents (CO2-eq) than traditional low-level disinfection of the reusable steel handle. The SUD plastic tongue blade generates an estimated 5-6 times more CO2-eq than the reusable steel blade treated with high-level disinfection. SUD metal components generated much higher emissions than all alternatives. Both the SUD handle and SUD blade increased life cycle costs compared to the various reusable cleaning scenarios at YNHH. When extrapolated over 1 year (60,000 intubations), estimated costs increased between $495,000 and $604,000 for SUD handles and between $180,000 and $265,000 for SUD blades, compared to reusables, depending on cleaning scenario and assuming 4000 (rated) uses. Considering device attrition, reusable handles would be more economical than SUDs if they last through 4-5 uses, and reusable blades 5-7 uses, before loss. Conclusions: LCA and LCC are feasible methods to ease interpretation of environmental impacts and facility costs when weighing device procurement options. While management practices vary between institutions, all standard methods of cleaning were evaluated and sensitivity analyses performed so that results are widely applicable. For YNHH, the reusable options presented a considerable cost advantage, in addition to offering a better option environmentally. Avoiding overcleaning reusable laryngoscope handles and blades is desirable from an environmental perspective. Costs may vary between facilities, and LCC methodology demonstrates the importance of time-motion labor analysis when comparing reusable and disposable device options.
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Background Carbon footprints stemming from health care have been found to be variable, from 3% of the total national CO2 equivalent (CO2e) emissions in England to 10% of the national CO2e emissions in the USA. We aimed to measure the carbon footprint of Australia's health-care system. Methods We did an observational economic input–output lifecycle assessment of Australia's health-care system. All expenditure data were obtained from the 15 sectors of the Australian Institute of Health and Welfare for the financial year 2014–15. The Australian Industrial Ecology Virtual Laboratory (IELab) data were used to obtain CO2e emissions per AUS$ spent on health care. Findings In 2014–15 Australia spent $161·6 billion on health care that led to CO2e emissions of about 35 772 (68% CI 25 398–46 146) kilotonnes. Australia's total CO2e emissions in 2014–15 were 494 930 kilotonnes, thus health care represented 35 772 (7%) of 494 930 kilotonnes total CO2e emissions in Australia. The five most important sectors within health care in decreasing order of total CO2e emissions were: public hospitals (12 295 [34%] of 35 772 kilotonnes CO2e), private hospitals (3635 kilotonnes [10%]), other medications (3347 kilotonnes [9%]), benefit-paid drugs (3257 kilotonnes [9%]), and capital expenditure for buildings (2776 kilotonnes [8%]). Interpretation The carbon footprint attributed to health care was 7% of Australia's total; with hospitals and pharmaceuticals the major contributors. We quantified Australian carbon footprint attributed to health care and identified health-care sectors that could be ameliorated. Our results suggest the need for carbon-efficient procedures, including greater public health measures, to lower the impact of health-care services on the environment. Funding None.
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Background Climate change is a major global public health priority. The delivery of health-care services generates considerable greenhouse gas emissions. Operating theatres are a resource-intensive subsector of health care, with high energy demands, consumable throughput, and waste volumes. The environmental impacts of these activities are generally accepted as necessary for the provision of quality care, but have not been examined in detail. In this study, we estimate the carbon footprint of operating theatres in hospitals in three health systems. Methods Surgical suites at three academic quaternary-care hospitals were studied over a 1-year period in Canada (Vancouver General Hospital, VGH), the USA (University of Minnesota Medical Center, UMMC), and the UK (John Radcliffe Hospital, JRH). Greenhouse gas emissions were estimated using primary activity data and applicable emissions factors, and reported according to the Greenhouse Gas Protocol. Findings Site greenhouse gas evaluations were done between Jan 1 and Dec 31, 2011. The surgical suites studied were found to have annual carbon footprints of 5 187 936 kg of CO2 equivalents (CO2e) at JRH, 4 181 864 kg of CO2e at UMMC, and 3 218 907 kg of CO2e at VGH. On a per unit area basis, JRH had the lowest carbon intensity at 1702 kg CO2e/m², compared with 1951 kg CO2e/m² at VGH and 2284 kg CO2e/m² at UMMC. Based on case volumes at all three sites, VGH had the lowest carbon intensity per operation at 146 kg CO2e per case compared with 173 kg CO2e per case at JRH and 232 kg CO2e per case at UMMC. Anaesthetic gases and energy consumption were the largest sources of greenhouse gas emissions. Preferential use of desflurane resulted in a ten-fold difference in anaesthetic gas emissions between hospitals. Theatres were found to be three to six times more energy-intense than the hospital as a whole, primarily due to heating, ventilation, and air conditioning requirements. Overall, the carbon footprint of surgery in the three countries studied is estimated to be 9·7 million tonnes of CO2e per year. Interpretation Operating theatres are an appreciable source of greenhouse gas emissions. Emissions reduction strategies including avoidance of desflurane and occupancy-based ventilation have the potential to lessen the climate impact of surgical services without compromising patient safety. Funding None.
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PurposeWhile environmental LCA is relatively well developed, impact assessment methods for the “natural resources” AoP are weak. In particular, resource “criticality” is not addressed in conventional environmental impact assessment methods, though it could be captured within life cycle sustainability assessment. In that regard, the present article extends the previously developed geopolitical supply risk (GPSR) method by demonstrating the connection of criticality to a functional unit while incorporating measures of material substitutability to reflect the “vulnerability” dimension of criticality. Methods The GPSR method developed by Gemechu et al. (J Ind Ecol 20:154–165, 2015a) and subsequently extended by Helbig et al. (J Clean Prod 137:1170–1178, 2016a), and Cimprich et al. (J Clean Prod, 2017) is integrated into an LCIA characterization model. Further, semi-quantitative material substitutability indicator values based on a study by Graedel et al. (PNAS 112:6295–6300, 2015) are incorporated to represent the vulnerability dimension of criticality. The method is demonstrated with an update of a previously published case study of a European-manufactured electric vehicle by Gemechu et al. (Int J Life Cycle Assess 22:31–39, 2015b), along with a new case study of dental X-ray equipment. Due to novel aspects of the GPSR method, the latter case involves constructing an unusually comprehensive bill of materials by tracing unit processes to input commodities with identification codes for collecting commodity trade data. Results and discussionSupply risk “hotspots” are often associated with “minor” commodities such as neodymium in an electric vehicle and cesium iodide in a dental X-ray system. Though difficult to measure, material substitutability can mitigate supply risk. Environmental loads of a dental X-ray system are dominated by production of relatively small specialized functional components like capacitors and printed circuit boards, which are far more environmentally intensive per unit of mass than common structural and mechanical components. Thus, small components comprised of minor materials can “pack a punch” from a supply risk and environmental perspective. Conclusions The GPSR method presented in the present article brings resource criticality assessment to a product-level while addressing a gap in conventional LCIA methods regarding short-run, socioeconomic availability of natural resources. Further, the case studies illustrate the significance of material substitutability in supply risk assessment. Several complications and limitations of the GPSR method offer directions for future research. Nonetheless, the GPSR method complements environmental LCA to better inform design and management decisions on a product-level.
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Introduction National Health Service (NHS) England dental teams need to consider from a professional perspective how they can, along with their NHS colleagues, play their part in reducing their carbon emissions and improve the sustainability of the care they deliver. In order to help understand carbon emissions from dental services, Public Health England (PHE) commissioned a calculation and analysis of the carbon footprint of key dental procedures. Methods Secondary data analysis from Business Services Authority (BSA), Health and Social Care Information Centre (HSCIC) (now called NHS Digital, Information Services Division [ISD]), National Association of Specialist Dental Accountants (NASDA) and recent Scottish papers was undertaken using a process-based and environmental input-output analysis using industry established conversion factors. Results The carbon footprint of the NHS dental service is 675 kilotonnes carbon dioxide equivalents (CO2e). Examinations contributed the highest proportion to this footprint (27.1%) followed by scale and polish (13.4%) and amalgam/composite restorations (19.3%). From an emissions perspective, nearly 2/3 (64.5%) of emissions related to travel (staff and patient travel), 19% procurement (the products and services dental clinics buy) and 15.3% related to energy use. Discussion The results are estimates of carbon emissions based on a number of broad assumptions. More research, education and awareness is needed to help dentistry develop low carbon patient pathways.
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Objectives: To quantify the increased disease burden caused by US health care sector life cycle greenhouse gas (GHG) emissions of 614 million metric tons of carbon dioxide equivalents in 2013. Methods: We screened for health damage factors that linked GHG emissions to disease burdens. We selected 5 factors, based on appropriate temporal modeling scales, which reflect a range of possible GHG emissions scenarios. We applied these factors to health care sector emissions. Results: We projected that annual GHG emissions associated with health care in the United States would cause 123 000 to 381 000 disability-adjusted life-years in future health damages, with malnutrition being the largest damage category. Conclusions: Through their contribution to global climate change, GHG emissions will negatively affect public health because of an increased prevalence of extreme weather, flooding, vector-borne disease, and other effects. As the stewards of global health, it is important for health care professionals to recognize the magnitude of GHG emissions associated with health care itself, and the severity of associated health damages. (Am J Public Health. Published online ahead of print October 26, 2017: e1-e3. doi:10.2105/AJPH.2017.303846).
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Purpose: Inappropriate use of medicines causes increased morbidity, mortality, adverse drug reactions, therapeutic failures and drug resistance as well as wastes valuable resources. Evidence-based cost-effective treatment recommendations of essential medicines are a way of avoiding these. We assessed primary care prescribers' knowledge about and perceptions of an essential medicines formulary, as well as the reasons for adhering to the recommendations. Methods: We conducted a web based questionnaire survey targeting all physicians working in the primary healthcare of the Stockholm healthcare region (2.3 million inhabitants), regarding the knowledge of, attitudes to and usefulness of the essential medicines formulary of the Stockholm Drug and Therapeutics Committee, the so-called Wise List. Results: Of the 1862 physicians reached by our e-mail invitations, 526 (28%) participated in the survey. All but one respondent knew of the formulary, and 72% used it at least once a week when prescribing. The main reason for using the formulary was evidence-based prescribing; 97% trusted the guidelines, and almost all (98%) found the content easy to understand. At the same time, many prescribers thought that the annual changes of some recommendations were too frequent, and some felt that a national formulary would increase its trustworthiness. Conclusions: We found that the essential medicines formulary was widely used and trusted by the prescribers. The high uptake of the treatment recommendations could be due to the Stockholm Drug and Therapeutics Committee's transparent process for developing recommendations involving respected experts and clinicians using strict criteria for handling potential conflicts of interest, feedback to prescribers, continuous medical education and minor financial incentives.
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Background: Physicians will be called upon to care for patients who bear the burden of disease from the impact of climate change and ecologically irresponsible practices which harm ecosystems and contribute to climate change. However, physicians must recognize the connection between the climate, ecosystems, sustainability, and health and their responsibility and capacity in changing the status quo. Sustainable healthcare education (SHE), defined as education about the impact of climate change and ecosystem alterations on health and the impact of the healthcare industry on the aforementioned, is vital to prevention of adverse health outcomes due to the changing climate and environment. Objective: To systematically determine which and when a set of SHE objectives should be included in the medical education continuum. Design: Fifty-two SHE experts participated in a two-part modified-Delphi study. A survey was developed based on 21 SHE objectives. Respondents rated the importance of each objective and when each objective should be taught. Descriptive statistics and an item-level content validity index (CVI) were used to analyze data. Results: Fifteen of the objectives achieved a content validity index of 78% or greater. The remaining objectives had content validity indices between 58% and 77%. The preclinical years of medical school were rated as the optimal time for introducing 13 and the clinical years for introducing six of the objectives. Respondents noted the definition of environmental sustainability should be learned prior to medical school and identifying ways to improve the environmental sustainability of health systems in post-graduate training. Conclusions: This study proposes SHE objectives for the continuum of medical education. These objectives ensure the identity of the physician includes the requisite awareness and competence to care for patients who experience the impact of climate and environment on health and advocate for sustainability of the health systems in which they work. Abbreviations: CVI: Content validity index; SHE: Sustainable healthcare education.
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Background: Medical devices (MDs) in polyvinyl chloride (PVC) are not a well-known source of exposure to plasticizers, in particular during pregnancy. Because of its toxicity, the di-(2-ethylhexyl) phthalate (DEHP) has been replaced by other plasticizers such as di (isononyl)-cyclohexane-1,2-dicarboxilic acid (DINCH), tri-octyltrimellitate (TOTM) and di-(isononyl) phthalate (DiNP). Our study aimed to quantify the plasticizers (DEHP and alternative plasticizers) contained in PVC medical devices used for hospitalised pregnant women and to describe which these MDs had been used (type, number, duration of exposure). Methods: The plasticizers contained in the MDs used for daily care in the Obstetrics Department of a French University Hospital were extracted from PVC (after contact with a chloroform solution), identified and quantified by gas-chromatography-mass-spectrometry analysis. A total of 168 pregnant women hospitalised in the Obstetrics Department with at least one catheter were included in the observational study. The median number of MDs containing plasticizers used and the daily duration of exposure to the MDs were compared in three groups of pregnant women: "Pathology group" (women hospitalised for an obstetric disorder who did not give birth during this hospitalisation; n = 52), "Pathology and delivery group" (hospitalised for an obstetric disorder and who gave birth during this stay; n = 23) and "Delivery group" (admitted for planned or spontaneous delivery without obstetric disorder; n = 93). Results: DiNP, TOTM and DINCH were the predominant plasticizers contained in the MDs at an amount of 29 to 36 g per 100 g of PVC. Women in the "Pathology group" (preterm labour or other pathology) were exposed to a median number of two MDs containing TOTM and one MD containing DiNP, fewer than those in the "Pathology and delivery group" (p < 0.05). Women in the "Pathology group" had a median exposure of 3.4 h/day to MDs containing DiNP and 8.2 h/day to MDs containing TOTM, longer than those in the "Delivery group" (p < 0.01). Conclusions: Our study shows that the medical management of pregnant women in a hospital setting entails exposure to MDs containing alternative plasticizers (DiNP, TOTM and DINCH).
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Background While petroleum-based plastics are extensively used in health care, recent developments in biopolymer manufacturing have created new opportunities for increased integration of biopolymers into medical products, devices and services. This study compared the environmental impacts of single-use disposable devices with increased biopolymer content versus typically manufactured devices in hysterectomy. Methods A comparative life cycle assessment of single-use disposable medical products containing plastic(s) versus the same single-use medical devices with biopolymers substituted for plastic(s) at Magee-Women’s Hospital (Magee) in Pittsburgh, PA and the products used in four types of hysterectomies that contained plastics potentially suitable for biopolymer substitution. Magee is a 360-bed teaching hospital, which performs approximately 1400 hysterectomies annually. Results There are life cycle environmental impact tradeoffs when substituting biopolymers for petroplastics in procedures such as hysterectomies. The substitution of biopolymers for petroleum-based plastics increased smog-related impacts by approximately 900% for laparoscopic and robotic hysterectomies, and increased ozone depletion-related impacts by approximately 125% for laparoscopic and robotic hysterectomies. Conversely, biopolymers reduced life cycle human health impacts, acidification and cumulative energy demand for the four hysterectomy procedures. The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects. However, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts of products and devices made using biopolymers. Conclusions The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects; however, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts.
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Importance Reducing the carbon footprint of the healthcare sector can be achieved along with quality patient outcomes at lower environmental impact. Objective For the first time to categorize peer-reviewed articles that report quantitative improvement in greenhouse gas emissions related to medical devices and services, overview of trends, and identify some gaps for future research. Data sources Database searches resulted in 822 peer-reviewed articles (January 1, 2000 and December 31, 2016) on healthcare and environmental sustainability. Study selection A systematic review methodology identifies, critically evaluates, and integrates the findings. Articles reviewed 1) provided quantitative global warming potential (GWP) information, 2) were published in peer-reviewed journals, and 3) were related to one of the twelve hospital service categories. Results Patient care teams are substantially limited by a lack of data related to the environmental impact of their services. Of the one of three potential environmental scopes—travel-related energy, direct energy, and the procured goods and equipment embodied energy—only six articles covered all three scopes. Conclusions and relevance This research provides healthcare nurses, physicians, and administrators with the location of procedures, patient-based decisions, and other avenues to hospital sustainability improvements in twelve hospital service categories.