Seventy-two shades of environmental sustainability in healthcare: A holistic framework proposal

Sustainability is emerging as a critical research domain, transcending industrial applications to also address healthcare issues. This necessitates the adoption of an all-encompassing holistic, multidimensional, and multi-stakeholder approach. In an era where economic growth has predominantly driven all industries, integrating environmental sustainability into business strategies and, subsequently, into daily operations is increasingly emerging. Different levels (macro, considering the national healthcare system; meso, focusing on a single hospital or healthcare facility; and micro, concerning the single process) might be considered to address the unmet need to transform the healthcare sector towards a net-zero emissions approach, especially for the environmental impacts and carbon footprint generated by this industry.

A more comprehensive framework emerges as a priority for both scholars and practitioners, to manage and synthesize these aspects. To achieve this objective, a scoping literature review was conducted, including 72 articles, as the starting point for the development of a holistic framework, and then the Nominal Group Technique was applied to perform the validation phase, measuring the experts’ agreement on the framework proposed. The latter comprises three principal dimensions: i) infrastructure, ii) organisation, and iii) technology, emerging as the primary units of analysis for evaluating environmental sustainability within the healthcare sector. By assessing these three main outlined dimensions, decision-makers and healthcare professionals can gain a comprehensive understanding of sustainability performance. This will guide the evaluation process and provide a structured approach to assess current and future practices, set targets, implement actions, and monitor progress towards environmentally sustainable goals. This is also important in relation to international and national policies, such as the 2030 Agenda. The present research aims to investigate the available evidence on the topic and suggest a new framework. This proposed model aims to overcome the existing limitations, related to already proposed one-dimensional framework or models concerning only limited and not integrated aspects (building, supply chain or HR management). It also aims to provide guidance to healthcare professionals and policymakers in making informed decisions and prioritising interventions that comply with environmentally sustainable principles.