Emanuela Foglia

Healthcare professionals’ well-being is increasingly recognized as a critical organizational priority, given the risks posed by rising workloads, staff shortages, and burnout to the sustainable delivery of high-quality care. However, limited evidence exists on how work environments and technology adoption influence the healthcare professionals’ well-being across hospital settings. This study explores healthcare professionals’ perceptions of psychological and physical safety, professional engagement, and mental well-being. It also assesses the role of technology in fostering a culture of safety and well-being. A cross-sectional qualitative anonymous online survey was distributed across 13 countries in Europe, Middle East and Africa, targeting professionals working in hospital pharmacy, diagnostic laboratory, and ward settings. The questionnaire, available in five languages, included validated items. Data were analyzed using descriptive and inferential statistics, with subgroup analyses by setting and region. Responses were collected between February and August 2024. A total of 449 healthcare professionals participated. The sample presented a positive perception of psychological safety (61%) and professional engagement (55%). However, 27% of responders frequently experienced work-related stress, with 40% feeling exhausted, 25% reporting mental distance, and 23% cognitive impairment. Perceived physical safety was generally high (70%), although ward staff reported higher exposure to stress and interpersonal aggression. Overall, 58% of responders expressed satisfaction with their professional quality of life. Technology was perceived to enhance efficiency, safety, and collaboration. However, its impact was dependent on the quality of implementation and level of organizational support. Results may inform strategic interventions and policies aimed at promoting a resilient and sustainable workforce.

Healthcare systems are challenged to balance high-quality care with growing demands for green transition. Within the Italian context, PNRR encourages targeted investments and reforms promoting sustainability, resilience, and innovation in healthcare, while hospitals encounter barriers such as regulatory constraints, cultural resistance, and limited resources. This paper investigates how Italian hospitals are integrating environmental sustainability practices in response to increasing institutional pressures on environmental issues and green objectives achievement. Adopting a qualitative multiple case study approach, the paper examines four healthcare organizations varying in size, location, and sustainability degree. Results identify three organizational profiles: pioneers, regulatory responders and fragmented adopters. Sustainable practices mainly involve energy efficiency, waste management, and green mobility, but their implementation is influenced by internal resources, cross-functional competencies, and external incentives. The preliminary results show that sustainability in healthcare requires more than technological solutions, demanding organizational adaptation, skill development, and institutional alignment supporting a systemic and long-term transformation.

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.
•The paper investigates environmental sustainability's evidence in healthcare.•A scoping review and Nominal Group Technique support the framework's definition.•The framework defines dimensions and sub-dimensions of analysis, actions, targets.•A holistic framework is defined with a practical contribution for the performance.•The framework could guide interventions, policies, and decision-making processes.

Il settore sanitario sta vivendo una profonda trasformazione spinta da cambiamenti normativi, organizzativi e tecnologici che impongono nuovi modelli di erogazione dei servizi, sempre più orientati alla prossimità, al territorio e alle cure domiciliari. In questo contesto, l’innovazione può esprimere tutto il suo valore solo se accompagnata da un ripensamento dei processi e delle strutture organizzative, supportato da strumenti di monitoraggio e gestione delle performance. I professionisti che operano oggi in sanità dispongono davvero degli strumenti necessari per affrontare queste sfide? Le competenze cliniche e tecniche, pur indispensabili, sono sufficienti per governare la complessità del sistema? Il volume risponde a queste domande, proponendo metodologie avanzate di management, dalla mappatura e gestione dei processi al lean management, dal business process reengineering al project management, integrate da esempi concreti e casi applicativi. Un percorso pratico di «pillole di management» pensato per professionisti con background diversi, orientato a migliorare efficienza, qualità e valore dei servizi sanitari.