Sustainability in healthcare: A new model for the future

One chapter of the OASI Report 2024 studies how healthcare organizations can integrate environmental sustainability into their daily practices. For the first time in Italy, this raises some questions about the strategies and tools adopted by the most advanced of these organizations:

1. What policies and regulations are shaping the landscape of environmental sustainability in healthcare?
2. How do organizations interpret the concept of environmental sustainability, and what strategies are they adopting?
3. What tools and metrics are being used to measure progress?

The chapter also examines how the institutional context influences organizations' ability to implement sustainable practices, highlighting differences between systems with centralized national policies, like the UK, and Italy’s current approach, which gives organizations more autonomy in decision-making.

To explore how Italian healthcare organizations are beginning to incorporate sustainability strategies and practices, analysis centered on the connections between strategic planning, governance models, and performance management systems. The study included semi-structured interviews with top managers from six public and private Italian healthcare organizations, complemented by an in-depth document analysis of the Green Plans of 94 NHS trusts in England.

In Italy, the lack of national standards has resulted in a wide variety of approaches to sustainability. By contrast, England benefits from clear guidelines and regulatory mandates. Green Plans are strategic documents developed by NHS trusts to plan and implement concrete actions for environmental sustainability, aligning with national Net Zero carbon targets by 2040. These initiatives must be specific, measurable, achievable, relevant, and time-bound (SMART), ensuring effective monitoring and tangible results.

For Italian healthcare organizations, motivations for embracing sustainability are primarily economic, so energy efficiency is where most attention is focused. Related initiatives are straightforward to measure and provide a high return on effort. Waste management and disposal are also common areas of focus.

Private organizations have greater spending flexibility and must comply with the EU’s Corporate Sustainability Reporting Directive (CSRD). They tend to move faster and leverage their sustainability achievements as public communication tools.

The introduction of national guidelines would be a meaningful step forward for environmental sustainability in Italian healthcare, encouraging action even from organizations that have not yet prioritized these issues. Given the wide diversity among Italian healthcare providers in terms of size and structure, such guidelines should identify common system-wide goals and measurement methods, while allowing organizations to choose specific objectives to pursue.

In a regulatory framework that currently lacks clear environmental priorities, organizations must define their own, considering the specific needs of their local contexts. Once priorities are established, improvement efforts should focus on four key areas:

• Advanced metrics. Develop specific indicators to measure the impact of sustainability initiatives and integrate them into performance management systems.
• Integrated governance. Establish clear roles and responsibilities to make sustainability an integral part of strategic decision-making. In leading UK examples, sustainability managers are often supported by multidisciplinary teams.
• Training and organizational culture. Promote a culture of sustainability through training programs and staff engagement.
• Partnership agreements. Strategic collaborations with public or private actors can accelerate the implementation of innovative solutions, such as energy management systems and sustainable infrastructure.

Future research could explore scaling best practices at a systemic level and assess the long-term impact of national policies. With advancements in green technologies and evolving regulations, the healthcare sector has the opportunity to become a good example of sustainability and innovation.

Michela Bobini, Amelia Compagni, Andrea Rotolo,  “La sostenibilità ambientale in sanità: strategie, modelli di governance e strumenti di management a confronto tra Italia e Inghilterra,” in Rapporto OASI 2024, pp. 585-628.

Read other articles in the OASI Report 2024 series:

Ricci, Longo - Tell me the truth about the Italian NHS: Four steps toward sustainable universality.

Broccolo, Guerra, Longo, Zazzera - The digital revolution of general practitioners and their patients.