Sustainable healthcare: how to assess and improve healthcare structures' sustainability

Searching for Sustainability in Health Systems: Toward a Multidisciplinary Evaluation of Mobile Health Innovations

Mobile health (mHealth) innovations are considered by governments as game changers toward more sustainable health systems. The existing literature focuses on the clinical aspects of mHealth but lacks an integrated framework on its sustainability. The foundational idea for this paper is to include disciplinary complementarities into a multi-dimensional vision to evaluate the non-clinical aspects of mHealth innovations. We performed a targeted literature review to find how the sustainability of mHealth innovations was appraised in each discipline. We found that each discipline considers a different outcome of interest and adopts different time horizons and perspectives for the evaluation. This article reflects on how the sustainability of mHealth innovation can be assessed at both the level of the device itself as well as the level of the health system. We identify some of the challenges ahead of researchers working on mobile health innovations in contributing to shaping a more sustainable health system.

Sustainability in Healthcare: Perspectives and Reflections Regarding Laboratory Medicine

Healthcare structures serve to protect and improve public health; however, they can have negative effects on human well-being and the environment. Thus, sustainability is an important target in a rapidly changing healthcare environment. We analyzed the state of the art in research on healthcare and sustainability by exploring literature on different healthcare systems and their relations with the environment. Our review presents conceptual and practical developments regarding sustainability, as well as an overview of their evolution in the healthcare sector over time. We also discuss how sustainability could be applied to reduce the environmental impact of clinical laboratories by ensuring that resources are used efficiently and responsibly. Finally, we describe how laboratory medicine can contribute to a sustainable healthcare system through integration of innovation and emerging technologies while providing high-quality services to patients and caregivers.

An Exponentially Distributed Stochastic Model for Sustainability Measurement of a Healthcare System

As the global environment is getting more competitive, sustainability is increasingly becoming an important assessment tool. An exponential distribution stochastic model is developed for the purpose of assessing and measuring the sustainability of healthcare system. The aim of this study is to provide a sustainability measuring model that is driven by the actual distribution status of the sustainability indicators. In this paper, the notions of the “Triple Bottom Line” (TBL) are followed in deriving the sustainability challenge and capacity indicators for the environmental, social, and economic indicators. Since basic challenges and capacities depend on the modes of the organization, the study proposes an exponentially distributed stochastic model for measuring sustainability. A numerical illustration of Iranian healthcare is presented to demonstrate the efficiency of the proposed model. In the results obtained, sustainability index for environmental, economic, and social are 54.40%, 48.80%, and 66.80% respectively. It indicates the healthcare achieved some sustainability through the social aspect; therefore, improving the environmental and economic aspect of the TBL is necessary. The proposed model can be used as a panoramic tool for effective measurement of the sustainability level of any healthcare system.

Indoor Air Quality in Inpatient Environments: A Systematic Review on Factors that Influence Chemical Pollution in Inpatient Wards

Introduction

Indoor air quality is one the main issues in which governments are focusing. In healing spaces, several research studies are reporting a growing number of data analysis and research works in order to guarantee and prevent health of users and workers. Currently the main investigations are about biological and physical risks; otherwise chemical ones are less investigated. Several countries are carrying out indoor air quality monitoring in those professional workplaces in which chemicals are used but also in some typically indoor (generic) spaces for the building hygiene assessment. The indoor air is affected by several factors that currently are analyzed punctually, without a whole scenario of all the variable performances. The authors have done a systematic review on the current state of the art and knowledge related to chemical pollution in healing spaces and the emerging strategies, supported by scientific literature, for healthy inpatient rooms and their indoor air.

Methodology

The systematic review has been done through the analysis of papers from SCOPUS, DOAJ, and PubMed databases. The survey sample considered 483 scientific articles, between 1989 and 2017, and starting the systematic reading and analysis of the abstracts, only 187 scientific papers were selected, and only 96 were accessible.

Discussion

Since scientific literature reports very different outputs and results, the resulting work from the survey is divided into specific fields of interest related to construction and finishing materials, installations, components, ventilation systems, processes, etc. Starting from the systematic reading, the paper classifies the factors of indoor air in four macroareas: outdoor air and microclimatic factors (temperature, relative humidity, air velocity, air change, etc.); management activities (management and maintenance activities, ventilation systems, HVAC, cleaning and disinfectant activities, etc.); design factors (room dimensions, furniture, finishing materials, etc.); and human presence and medical activities (users' presence, their health status, and medical activities carried out in inpatient rooms).

Conclusion

The systematic review gives rise to a broad scenario on the existing knowledge regarding the indoor air pollution, design, and management strategies for healthy spaces and several emerging topics. Although the aim of the investigation is strictly related to chemical pollution, several considerations from the biological point of view have been listed. The systematic review, supported by the existing scientific literature, becomes a starting point for considering the importance of the topic and to stimulate the knowledge around this field of interest for improving studies, analysis, and simulations.

Healthy Design and Urban Planning Strategies, Actions, and Policy to Achieve Salutogenic Cities

Starting from a previous experience carried out by the working group "Building and Environmental Hygiene" of the Italian Society of Hygiene and Preventive Medicine (SItI), the aim of the present work is to define new strategic goals for achieving a "Healthy and Salutogenic City", which will be useful to designers, local governments and public bodies, policy makers, and all professionals working at local health agencies. Ten key points have been formulated: 1. climate change and management of adverse weather events; 2. land consumption, sprawl, and shrinking cities; 3. tactical urbanism and urban resilience; 4. urban comfort, safety, and security perception; 5. strengths and weaknesses of urban green areas and infrastructures; 6. urban solid waste management; 7. housing emergencies in relation to socio-economic and environmental changes; 8. energy aspects and environmental planning at an urban scale; 9. socio-assistance and welfare network at an urban scale: importance of a rational and widespread system; and 10. new forms of living, conscious of coparticipation models and aware of sharing quality objectives. Design strategies, actions, and policies, identified to improve public health and wellbeing, underline that the connection between morphological and functional features of urban context and public health is crucial for contemporary cities and modern societies.