Sustainable Healthcare Research Articles

Enhancing Hematopoietic Stem Cell Transplantation Success: The Crucial Role of Architectural Design in Transplant Units and Hematology Departments

Aim: This paper aims to explore the critical role of architectural design in Hematopoietic Stem Cell Transplantation (HSCT) procedures, focusing on how various aspects of design influence patient outcomes, staff efficiency, infection control, and overall safety. The study seeks to understand how the physical environment impacts both the immediate and long-term recovery of patients undergoing HSCT and to advocate for design principles that enhance patient and caregiver experiences. Discussion: Hematopoietic Stem Cell Transplantation (HSCT) has emerged as a vital therapeutic modality for a diverse spectrum of hematological disorders and malignancies. As medical and technological advancements continue to evolve, the significance of the physical environment in which HSCT procedures are conducted becomes increasingly evident. This paper delves into how architectural design affects patient well-being, staff efficiency, and infection control, emphasizing the importance of creating environments that support psychological well-being. It examines the impact of design on infection prevention, safety during emergencies, and the overall efficiency of healthcare delivery. The discussion also highlights the role of sustainability and green design principles in minimizing the environmental footprint while promoting patient recovery. Conclusions: The paper concludes that architectural design plays a transformative role in enhancing patient experiences and healthcare outcomes in HSCT settings. It underscores the need for a patient-centric approach to design that integrates wellness-focused elements and advanced technology. The study advocates for a collaborative effort among healthcare institutions, architects, designers, and policymakers to create supportive, efficient, and sustainable healthcare environments. By prioritizing these design considerations, healthcare environments can significantly improve the HSCT journey and contribute to the broader realm of healthcare excellence.

Insured Health System: A Potential Solution for a Sustainable Healthcare Future

Insured Health System: A Potential Solution for a Sustainable Healthcare Future

A mountain of waste created daily: a thematic analysis of environmental sustainability experiences of postgraduate intensive care nursing students

BackgroundThe healthcare sector has a negative ecological impact, and intensive care is one of the most resource-consuming areas. Nurses have a duty to contribute to climate change reduction, design climate-resilient healthcare systems, and support individuals and communities in adapting to the effects of the planetary health crisis. It is essential to incorporate environmental sustainability into nursing education so that nurses can advocate for conscientious and ethically sustainable healthcare that benefits both patients and the planet. This study aimed to explore postgraduate intensive care nursing student experiences of environmental sustainability in clinical practice at intensive care units.MethodsData were collected using a qualitative questionnaire, and the data were analysed using inductive thematic analysis. The participants were 24 registered nurses studying postgraduate, specialist intensive care nursing courses at four universities in the south and west regions of Sweden.ResultsThe results describe critical care students’ environmental sustainability experiences in one overarching theme with five subthemes. Intensive care is a challenging context in terms of sustainability, where saving lives is the number one priority. There were good and bad sustainability habits among the staff, and awareness was key to improving. Clinical supplies come in unsustainable packages, and the participants wished for better alternatives and they wanted more knowledge and education on sustainable practices. The findings also emphasized the importance of a holistic perspective throughout each patient’s pathway.ConclusionsSustainability in intensive care units is somewhat unrecognised today, although intensive care nurses want that to change. The context where saving lives is prioritized makes implementing ecologically responsible practices a challenge. However, environmental sustainability in intensive care is feasible, with education needed for nurses to take on the responsibility of making improvements. Hospital management prioritizing sustainability is also important to support clinicians in implementing sustainable practices in intensive care units.

Estimated Carbon Savings from Changing Surgical Trends in Primary Elective Total Hip Arthroplasty in England: A Retrospective Observational Study.

The National Health Service (NHS) in England has set a target to be net zero for carbon emissions by 2045. The aim of this study was to investigate how changes in key aspects of clinical practice over the last 8 years have contributed towards reducing the per-patient carbon footprint of elective total hip arthroplasty (THA). This was a retrospective analysis of administrative data. Data were extracted from the Hospital Episode Statistics database for all adult (≥ 17 years), primary, elective THA procedures conducted in England from 1 April, 2014 to 31 March, 2022. The estimated carbon footprint for key elements of the surgical pathway were calculated based on data from Greener NHS and the Sustainable Healthcare Coalition. Data were available for 537,441 THA procedures conducted during the study period. The per-patient carbon footprint associated with the primary THA (index) procedure fell by around 25% from 2014/15 to 2021/22. Length of stay was by far the largest contributor to this decline, falling from 169.1 kgCO2e to 117.6 kgCO2e per patient from 2014/15 to 2021/22. Absolute declines in the carbon footprint associated with emergency readmissions, revisions and outpatient attendances were more modest. If all patients in all years had the 2021/22 average carbon footprint, then carbon equivalent to powering 19,976 UK homes for 1year would have been saved. Improving per-patient efficiency of surgery is likely to contribute towards meeting the NHS's net-zero target whilst also helping to improve patient outcomes, reduce costs and cut waiting lists.

Sustainable Health Care: How Traditional, Complementary, and Integrative Medicine Could Lead the Shift Towards Eco-Friendly Practices.

Sustainable Health Care: How Traditional, Complementary, and Integrative Medicine Could Lead the Shift Towards Eco-Friendly Practices.

Exploring Sustainability and Efficiency Improvements in Healthcare: A Qualitative Study

The integration of Green Lean Six Sigma (GLSS) within healthcare systems presents an opportunity to improve operational efficiency, environmental sustainability, and the quality of patient care. This study examines healthcare professionals’ initial perceptions of GLSS adoption in their work environments, especially in the context of Industry 4.0, the COVID-19 pandemic, and economic constraints. Through semi-structured interviews with healthcare workers and academics, the study reveals a cautious yet optimistic outlook. Participants recognize the potential for significant efficiency gains and waste reduction but also voice concerns about resource limitations and the need for comprehensive training. These preliminary findings provide important insights into the opportunities and challenges associated with implementing GLSS in healthcare, laying a foundation for future research and practical applications aimed at enhancing hospital operations through sustainable practices.

Advancing Sustainable Healthcare Technology Management: Developing a Comprehensive Risk Assessment Framework with a Fuzzy Analytical Hierarchy Process, Integrating External and Internal Factors in the Gulf Region

Advancing Sustainable Healthcare Technology Management: Developing a Comprehensive Risk Assessment Framework with a Fuzzy Analytical Hierarchy Process, Integrating External and Internal Factors in the Gulf Region

Healthcare can't stop evolving: innovation as the catalyst for unleashing the managerial potential of value-based healthcare by stimulating intangible assets and enhancing organizational resilience.

With increasing healthcare service utilization and the introduction of costly therapies, healthcare organizations are pressured to deliver cost-effective services within constrained budgets. Rising costs and the need for efficient healthcare delivery are major concerns for governments, insurers, and health plans. It aims to understand the impact of these intangible assets on creating value and organizational resilience in healthcare, informing better practices and strategies for VBHC implementation. An applied research approach using the Work Breakdown Structure (WBS) methodology was adopted. The research was divided into seven interconnected Work Packages (WPs), each designed to investigate different aspects of the integration between VBHC and intangible assets, with a focus on enhancing organizational resilience through innovative health processes. Key methodologies included literature reviews and qualitative analyses, employing Open Innovation and Design Thinking. The study revealed a dynamic interplay between VBHC, organizational resilience, and intangible assets. It showed that managerial effectiveness is influenced by direct patient outcomes and elements like intellectual capital and organizational reputation. Data integration from various Work Packages provided new insights into how intangible assets underpin VBHC strategies, proposing novel management approaches. Findings highlight the essential role of intangible assets in enhancing service delivery and fostering sustainable healthcare practices. The study highlights a significant oversight in the integration of intangible assets within healthcare organizations, despite their crucial role in optimizing VBHC. It supports literature emphasizing the importance of intellectual capital and organizational culture in enhancing healthcare management efficiency and resilience. A paradigm shift in VBHC to include these assets is needed for building a more adaptable and sustainable healthcare system. This integration can lead to better clinical outcomes, patient satisfaction, and overall healthcare efficiency, aligning more closely with VBHC goals. Recognizing and effectively managing intangible assets are paramount for the successful implementation of VBHC and enhanced organizational resilience. Strategic integration of these assets into healthcare management practices can significantly improve patient outcomes and create a more sustainable, patient-centered, and resilient healthcare system. Future studies should develop methodologies for robust measurement and integration of these assets to fully realize the potential of VBHC.

A systematic review of arab community perceptions and awareness of family medicine.

Family medicine, often known as general practice, is the foundation of sustainable and universal healthcare worldwide. As a new specialty in the Eastern Mediterranean Region (EMR), it must recruit doctors and gain public acceptability, which has traditionally favored specialists. This research examined studies on Arab populations' attitudes toward family medicine and the specialty to discover barriers to creating and embracing this vital specialty. This review was based on the PRISMA guidelines and encompassed peer-reviewed articles from reputable sources such as PsychNet, Web of Science, PubMed, Embase, Scopus, and grey literature. A comprehensive search was conducted across databases for peer-reviewed studies that explored Arabs' awareness, perceptions, and attitudes toward family medicine and physicians. After a rigorous selection process, nineteen studies were deemed suitable for analysis. These studies encompassed diverse participants, including medical students, physicians, patients, and the general public. The overall perception of family medicine was positive, but it was noted that few had direct exposure to family physicians during their medical education or in the clinical setting. Our review suggests five significant efforts: 1) an education campaign for the general public about the role of Family Medicine; 2) increasing training capacity for family physicians; 3) early exposure to family physicians during medical school; 4) developing a process for continually improving the education and quality of family physician, 5) Further research on the challenges to FM practice in Arab countries are required to understand the situation better and work toward its improvement.

Evaluation of Operating Room Staff Awareness of Environmental Sustainability and Medical Waste Management.

This study aims to identify the obstacles to recycling and environmental sustainability habits in a university hospital's operating room (OR) environment in Turkey and lay the groundwork for potential solutions. A questionnaire was used to measure current views among the 140 OR staff members aged 20-54 years. The survey assessed awareness and behaviors of recycling at home and in the OR, as well as awareness of environmentally safe anaesthesia practices. Half of the participants believed that ORs significantly affected their carbon footprint, and most agreed that these environmental effects could be reduced. The primary barriers to recycling were inadequate knowledge, negative staff attitudes and insufficient services. Notably, 76% of participants paid attention to segregating OR waste, yet many lacked formal education about the environmental impact of their practices. Approximately 89% agreed that the environmental effects of ORs could be further reduced, with education being a critical need. The healthcare sector's contribution to carbon emissions and waste production is significant, especially in ORs. The lack of education regarding ecological implications is concerning. Implementing standardized training programs and enhancing recycling services can substantially reduce the environmental impact of ORs, highlighting the need for a more sustainable healthcare system.

Prescribing a Green Future: A Review of Antimicrobial Waste in Pediatric Hospitals and Practices to Promote Healthcare Sustainability.

Pediatric hospitals are uniquely positioned to be impacted by antimicrobial waste. To explore this issue, we reviewed the current literature to identify the reasons, costs, and potential solutions to waste. Identified reasons for waste included weight-based dosing, medication order changes due to changing patient status, loss or expiration of doses, and medication errors. The cost of waste included financial costs, promotion of antimicrobial resistance, and generation of greenhouse gases. Proposed interventions to reduce waste included an early switch from intravenous to oral administration, required stop dates, standardized dosing times, and optimization of the pharmacy batching process. However, additional studies are needed to assess the potential correlation between these proposed interventions and waste reduction. Antimicrobial stewardship programs have been identified as a group that can play a crucial role in partnering to implement these interventions to potentially reduce antimicrobial waste and promote better healthcare sustainability.

The economic burden of prostate cancer in Iran: a cross-sectional cost-of-illness study

ObjectiveThis study aims to assess the economic burden of prostate cancer in Iran by analyzing direct medical costs, direct non-medical costs, and indirect costs. We conducted a cross-sectional cost-of-illness study in Khorramabad, located in western Iran, during 2023, using a prevalence-based, bottom-up approach. Data were collected from 285 prostate cancer patients using questionnaires, interviews, and patient records.ResultsOur study estimated the economic burden of prostate cancer at $744,990. Direct medical costs accounted for 63.50% of this, totaling $153,330, with therapy being the largest component. Direct non-medical costs were $62,130, and indirect costs from productivity losses were $209,760. The calculated overall cost per patient was $2,614.88. Extrapolating from the 2021 Global Burden of Disease data, which reported approximately 83,000 prostate cancer patients in Iran, the national economic burden is estimated at $217,034,040. This substantial burden highlights the need for improved insurance coverage and early detection. The findings suggest that policymakers and healthcare providers in Iran should develop standardized cost analysis methods and enhance financial protection to alleviate economic strain and improve healthcare outcomes and sustainability.

Advancing sustainable healthcare: a concept analysis of eco-conscious nursing practices

BackgroundAs the healthcare sector grapples with its environmental footprint, the concept of Eco-conscious Nursing emerges as a pivotal framework for integrating sustainability into nursing practice. This study aims to clarify and operationalize Eco-conscious Nursing, examining its attributes, antecedents, consequences, and providing operational definitions to guide future research and practice.MethodsUtilizing a systematic literature review across PubMed, Google Scholar, and CINAHL Ultimate, this study identifies and analyzes existing theories, frameworks, and practices related to eco-conscious nursing. Through conceptual analysis, key attributes, antecedents, and consequences of Eco-conscious Nursing are delineated, leading to the formulation of comprehensive operational definitions.ResultsThe study reveals Eco-conscious Nursing as a multifaceted concept characterized by environmental stewardship, sustainable healthcare practices, and a commitment to reducing the ecological impact of nursing care. Operational definitions highlight the role of education, awareness, and institutional support as antecedents, with improved environmental health and sustainable healthcare outcomes as key consequences.ConclusionEco-conscious Nursing represents a crucial ethos for the nursing profession, emphasizing the necessity of sustainable practices within healthcare. The operational definitions provided serve as a foundation for embedding eco-conscious principles into nursing, addressing the urgent need for sustainability in healthcare settings. Future research should focus on the empirical application of these definitions and explore the economic and cross-cultural dimensions of eco-conscious nursing.

Comparative life cycle assessment of hospital waste management scenarios in Isfahan, Iran: Evaluating environmental impacts and strategies for improved healthcare sustainability

This study presents a life cycle assessment (LCA) of hospital waste management scenarios in Isfahan, Iran. Daily hospital waste generation totals 20 tons, with 44 % infectious and 56 % non-infectious waste. The non-infectious stream comprises 40 % food waste. Pyrolysis, chemical disinfection, composting, and material recovery were evaluated across ten environmental impact categories using TRACI 2014 methodology. Composting and material recovery reduce smog-forming emissions by 126.79 kg O3 eq/ton and 129.02 kg O3 eq/ton, respectively, and fossil fuel depletion by 255.04 MJ surplus/ton and 471.97 MJ surplus/ton compared to incineration. Chemical disinfection of infectious waste shows lower global warming potential (859.89 kg CO2 eq/ton) than pyrolysis (1483.15 kg CO2 eq/ton). The third scenario, prioritizing composting and material recovery, minimizes ecotoxicity with lowest emissions of cadmium (0.33 g/ton) and nickel (16.23 g/ton) to air, and arsenic (0.003 g/ton) and chromium (0.28 g/ton) to water. This study addresses a rarely assessed system in LCA literature, offering valuable insights for improving waste management in similar contexts worldwide. Recommendations include developing regulatory frameworks, investing in infrastructure, promoting collaboration, implementing training programs, and adopting circular economy principles. The research contributes to building life cycle thinking capability within the Iranian healthcare sector through stakeholder engagement, workshops, and public dissemination of findings.

A Green Laboratory Approach to Medical Sample Transportation: Assessing the Carbon Dioxide (CO2) Footprint of Medical Sample Transportation by Drone, Combustion Car, and Electric Car

In response to escalating climate change concerns, this study evaluates the ecological impact and efficiency of medical sample transportation using drones, combustion cars, and electric cars across various terrains and weather conditions in Liechtenstein and Switzerland. Through a comparative analysis, we found that combustion cars emit the highest average CO2 at 159.5 g per kilometer (g/km), while electric cars significantly reduce emissions to an average of 3.43 g/km, representing just 2.15% of the emissions from combustion vehicles. Drones emerged as the most environmentally sustainable option, with an average CO2 emission of 0.09 g/km, which is only 0.07% of combustion car emissions and 2.6% of electric car emissions. Drones also demonstrated superior transport efficiency, covering routes that were, on average, 17% shorter in flat terrain and 24% shorter in mountainous regions compared to cars. Additionally, drones achieved substantial time savings, ranging from 13% to 80% faster delivery times depending on the terrain and traffic conditions. These findings highlight the potential of drone technology to revolutionize healthcare logistics by significantly reducing carbon footprints, optimizing transport routes, and improving delivery efficiency. Integrating drones into healthcare transportation networks offers a promising pathway toward a more sustainable and resilient healthcare system.

Accelerating the pace of value-based transformation for more resilient and sustainable healthcare

Value-based healthcare (VBHC; delivering the best possible health outcomes for patients in a cost-efficient manner) has been a strategic priority among healthcare stakeholders for years. Pioneering providers embrace VBHC principles (such as organising care delivery around medical conditions, monitoring health outcomes and costs per patient group along the clinical pathway, and using those metrics to drive organisational improvements). Still, widespread adoption has been slow due to multiple factors, one of which is the sheer complexity of such a transformation. However, because of the urgent need for infection control during the COVID-19 pandemic, providers made unprecedented strides towards VBHC and achieved VBHC goals that were unattainable before. This article considers the barriers to adopting VBHC and shares best practices from an extensive knowledge base to advise providers on capitalising on the pandemic's momentum to implement value improvement quickly and efficiently.

Designing a new sustainable healthcare network considering the COVID-19 pandemic: Artificial intelligence-based solutions

The COVID-19 pandemic, which is still spreading its new mutations all around the world, is considered a healthcare challenge around the world. The best approach to forestall this pandemic is to avoid exposure to the virus. Therefore, medical protective equipment is essential for fighting this pandemic. This underlines the chief role of having a sustainable supply chain network (SCN) for producing and distributing personal protective equipment to avoid shortage and augmenting costs. The reality, however, is that the COVID-19 pandemic leads to many developments in countries and this study is another step for these purposes. This research developsa multi-period, multi-objective, multi-echelon, and multi-product medical protective equipment sustainable SCN considering the production, distribution, allocation, and inventory with “risk pooling” strategy effect with the aim of filling the existing gaps in health SCN research during the COVID-19 pandemic. By applying the risk pooling strategy, lower inventory levels or higher service levels can be achieved without increasing inventory costs. This model explores the possibility of lateral transshipments between distribution centers, as a way to increase the reliability of SCN performance. We model a new production, inventory, distribution, location, and allocation problem and consider four objectives for our suggested model (i) minimizing total SCN costs, (ii) minimizing environmental effects, (iii) minimizing social impacts, and (iv) maximizing the reliability of demand delivery. The proposedmodel simultaneously examines all three dimensions of sustainability (economic, environmental, and social) as well as the reliability of demand delivery. Considering all of these decisions and assumptions brings the studied problem closer to reality. We employ various algorithms for solving our developed model with different sizes: the improved version of the augmented ε-constraint (AUGMECON2) algorithm for small and medium-sized problems and two meta-heuristic algorithms, i.e., Multi-Objective Whale Optimization Algorithm (MOWOA) and Multi-Objective Variable Neighborhood Search (MOVNS) algorithm, for large-sized ones. The Taguchi approach is used to tune the parameters of meta-heuristic algorithms, and a comparison is performed using four evaluation metrics: Mean Ideal Distance (MID), Number of Pareto Solutions (NPS), Maximum Spread (MS), and Spread of Non-Dominance Solution (SNS). Proposed solving methods for the studied problem and making comparisons between them are another innovation of this study. A couple of numerical examples are provided to illustrate the applicability of the presented solution methods. Finally, sensitivity analysis for problem parameters is performed to validate our suggested model. Our study reveals the superiority of the MOWOA over the other algorithms.

Public-Private Partnerships in the Healthcare Sector and Sustainability: Managerial Insights from a Systematic Literature Review

This article aims to critically understand the current state of the art of Public-Private Partnerships (PPPs) in the health sector and to highlight implications useful for implementing sustainability-oriented PPPs. By employing text mining to analyze the sampled articles, we identify the main themes distinguishing healthcare PPPs and sustainability. We critically discuss the narrative underlying the results achieved in terms of emerging topics: governance, managerial tools, barriers, advantages/disadvantages, and big data. Finally, we propose a literature-driven framework on PPP management that identifies implications – systemic approach, technical managerial skills, governance balance, operational instruments – that can facilitate the development of sustainability-oriented PPPs in the healthcare sector.

Prevalence and future estimates of frailty and pre-frailty in a population-based sample of people 70 years and older in Norway: the HUNT study

BackgroundFrailty in older people is a rising global health concern; therefore, monitoring prevalence estimates and presenting projections of future frailty are important for healthcare planning.AimTo present current prevalence estimates of frailty and pre-frailty and future projections according to both dominant frailty models in a large population-based observational study including adults ≥ 70 years in Norway.MethodsIn this population-based observational study, we included 9956 participants from the HUNT4 70 + study, conducting assessments at field stations, homes, and nursing homes. Frailty was assessed using Fried criteria and a 35-item frailty index (HUNT4-FI). Inverse probability weighting and calibration using post-stratification weights and aggregated register data for Norway according to age, sex, and education ensured representativeness, and population projection models were used to estimate future prevalence.ResultsAccording to Fried criteria, the current prevalence rates of frailty and pre-frailty in people ≥ 70 years were 10.6% and 41.9%, respectively, and for HUNT4-FI 35.8% and 33.2%, respectively. Compared to previous European estimates we identified higher overall frailty prevalence, but lower prevalence in younger age groups. Projections suggest the number of Norwegian older adults living with frailty will close to double by 2040.ConclusionFrailty in older people in Norway is more prevalent than previous European estimates, emphasising the imperative for effective interventions aimed to delay and postpone frailty and ensure healthcare system sustainability in an ageing population. Future planning should consider the great heterogeneity in health and functioning within the 70 + population.

Risk management and insurance failures: the case of Ghana’s National Health Insurance Scheme

Since its inception, Ghana’s National Health Insurance Scheme (NHIS) has brought about notable improvements in healthcare access and health outcomes. However, challenges have arisen, threatening its intended function. This study aims to investigate the challenges encountered by NHIS participants and their risk management practices in response to insurance failures. Convenience and purposeful sampling techniques were employed to gather data from 45 Quality Insurance Company (QIC) employees residing in the Greater Accra area of Ghana who are NHIS members. A quantitative approach was utilized, and a questionnaire was administered to collect data. The study employed Cronbach’s alpha to assess the reliability and validity of the data. Additionally, Regression analysis, correlation, and descriptive statistics were utilized to achieve the study's objectives. The study revealed several challenges facing the NHIS, including a shortage of medical specialists, medications, and hospital beds, as well as high patient out-of-pocket expenses. Despite these challenges, the NHIS has not yet failed. However, the majority of NHIS cardholders (62.20%) would be adversely affected in the event of system failure, as they primarily rely on NHIS for risk management. Conversely, a minority of participants (37.80%) are less likely to experience the effects of failure due to alternative insurance plans and personal savings. Therefore, understanding these dynamics is crucial for policymakers and stakeholders to strengthen the NHIS and ensure sustainable healthcare access for all Ghanaians.