Lights and shadows of sustainability in healthcare: a literature review

Sustainability is becoming a crucial research area, not only considering industrial contexts, but also managing healthcare, environmental, and social issues, adopting a holistic, multidimensional, and multi-stakeholders’ approach. In a world where economic growth has been the primary objective in all the industries, the need to integrate environmental and social sustainability into business strategies first and then into daily activities is strongly emerging. Sustainability could be declined in three main pillars: economic, social, and environmental, traditionally in all the industrial and organizational settings, but this could generate peculiar instances also in the healthcare field. Being sustainable is becoming an urgent priority for the development of worldwide population. This unmet need should be addressed in any settings of the healthcare context, considering macro (i.e., healthcare system), meso (i.e., hospital) and micro (i.e., process) levels. Healthcare services are necessary for sustaining and improving human well-being, but the environmental impacts and the carbon footprint generated by these services, contributing to environment-related threats, are high. Assuming the One Health approach (Atlas, 2013) and referring to the health, environmental and social dimensions as closely interconnected, the importance of investigating the link between technology and sustainability emerges. To achieve this goal, a systematic literature review was conducted, including 86 articles that were divided into three different clusters considering papers devoted to technological aspects, models, assessment frameworks’ development, and telemedicine. An analysis of the research areas interested was performed considering a double perspective, assessing environmental and social issues. From the literature evidence, a strong relevance of technologies as the principal driver to guide the sustainable transition and an impulse to define quantitative indicators and assessment tools, emerged, also considering the necessity to support the decision-making process and the stakeholders’ knowledge, to guarantee a green and sustainable development of healthcare systems. The results included in the review demonstrate a significant diffusion of performance measurement models and systems, especially in relation to the environmental aspects, also considering innovative processes and technologies. The analysis of the social aspects is still limited, particularly in relation to the corporate social responsibility topic. Therefore, this contribution would highlight the need to define multidimensional assessment models, integrating the different pillars of sustainability, also into the technological governance process.