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.

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.

Objective: The aim of this study was to define the economic and organizational impacts related to a broader utilization of bictegravir/emtricitabine/alafenamide (BIC/FTC/TAF) in Italian clinical practice. Methods: A budget impact analysis—representing the evolution of the Italian National Healthcare Service (NHS) healthcare expenditure over 3 years—was developed, considering the overall Italian population treated for human immunodeficiency virus (HIV). Model input variables were treatment history, therapeutic regimen, development of adverse events, achievement of an undetectable viral load and total direct healthcare costs. Besides the BIA, an organizational impact assessment was conducted to determine the impact on the use of healthcare resources, assessing the release of organizational hospital assets, focusing on the management of drug-related adverse events. Data were collected from scientific evidence, Italian national and regional legislations and healthcare professionals’ reports. To verify the robustness of the economic and organizational impact assessment, sensitivity analyses were performed. Results: Results demonstrate economic savings of about 26 million euros in total health spending, assuming a higher penetration rate for BIC/FTC/TAF. This change in the current case mix would lead to a reduction in the specific costs related to adverse event management (0.9 million euros; − 2.09%) and in the medical management of patients (38 million euros; − 7.79%), with a positive impact on the achievement of virological control. From an organizational perspective, a wider use of BIC/FTC/TAF generates a reduction in the utilization of healthcare resources due to a decrease in adverse events and complications. The model estimated a 19.64% reduction in HIV-related inpatient days, which freed up healthcare professional time. Conclusions: Capable of improving both economic and organizational sustainability for the entire HIV care continuum, BIC/FTC/TAF is an efficient therapeutic strategy for people with HIV.

Background: Early or preclinical stages of AD continuum may benefit from lifestyle interventions and cognitive rehabilitation strategies that can delay or prevent progression to dementia. In this context, digital health technologies offer a disruptive potential to expand access to cognitive rehabilitation and meet the increasing demand for early interventions. This study protocol outlines a randomized controlled trial (RCT) designed to evaluate the efficacy and efficiency of a personalized, multidomain digital cognitive rehabilitation approach compared to conventional paper-and-pencil therapy. A secondary objective is to investigate the structural and functional neuroplasticity mechanisms associated with both interventions, using advanced magnetic resonance imaging techniques. Methods: The study presents a single-blinded (assessors) 1:1 parallel-arm RCT design involving 102 patients with Subjective Cognitive Decline, o Mild Cognitive Impairment or early-stage dementia. For the experimental intervention group (EG) the digital therapeutic RICORDO-DTx will be employed, while the control group (CG) will perform an unstructured pencil-paper stimulation program. Both interventions will last 5 weeks with 3 session/week. Outcome measures will evaluate efficacy as changes in: behavioural and cognitive abilities, patients’ engagement, and structural and functional neuroplasticity mechanisms by means of Magnetic Resonance Imaging. Additional evaluation will include efficiency measures related to usability, acceptability, safety, sustainability and user experience. Patients will be evaluated at baseline (T0), after treatment (T1) and at follow up six months post baseline (T2). Data analyses will involve repeated measures ANOVA models on primary and secondary outcome measures to compare efficacy of intervention between EG and CG. Finally, efficiency measures will be reported with descriptive statistics. Conclusions: The expected results lay on the ability of RICORDO DTx, to adapt task difficulty automatically based on patients’ performance and perceived difficulty. This adaptive approach is anticipated to yield superior treatment outcomes relative to traditional pencil-and-paper exercises. Trial registration: ClinicalTrials.gov NCT07064226.

Background/Objectives: European healthcare systems are increasingly adopting automation technologies to improve efficiency. This study evaluates the economic viability of
hospital automation and medication management digitalization. Methods: An economic
evaluation was based on a standardized hospital model comprising 561 beds, representative of an average acute care hospital across EU27 + UK. For each technology, several cost
items were estimated using country-specific parameters such as labor costs, medication
error rates, healthcare expenditure, and money discount rate. The financial metrics (Return
On Investment—ROI, Net Present Value—NPV, Payback Time—PBT) were first calculated
at the hospital level. These results were then extrapolated to the national level by scaling
the per-hospital estimates according to the total number of hospital beds reported in each
country. Finally, national results were aggregated to derive the overall European impact.
Results: The analysis estimated a total European investment of EUR 3.55 billion, with an
average PBT of 4.46 years and annual savings of 1,96 billion. ROI averaged 167%, and
the total NPV was 8.21 billion. A major saving driver was the reduction in Medication
Administration Errors that has an impact of 37.2% on the total savings. Payback times
ranged from 3 years in high-GDP countries, to 7 years in lower-GDP nations. Conclusions:
These findings demonstrate how providing structured data on hospital automation benefits
could support decision-making processes, highlighting the organizational and economic
feasibility of the investment across different European national contexts.

The issue of facility location is of significant importance in numerous systems, where the efficient utilisation of resources is of great importance. Gravity models, which are inspired by Newtonian physics, are commonly employed to address these problems and have a long tradition of being used in healthcare. The objective of this paper is to enhance the comprehension of patients' decision-making processes in emergency healthcare by introducing an extension to existing gravity models, which includes two novel factors influencing emergency department choice: hospital sizes and patients' severity. The newly formulated gravity rule, which integrates these factors, demonstrated an extremely high accuracy against real-world data in terms of overall hospital location and flows between cities and hospitals, respectively 98.77% and 98.02%.

Introduction: Given the availability of a growing number of HIV treatment options, it becomes essential to have a clear understanding of the related economic-organizational evidence, to operate informed and conscious choices. The study aims to define the economic and organizational impact related to a consolidated use of Bictegravir/Emtricitabine/Tenofovir Alafenamide (BIC/FTC/TAF), within the Italian National Healthcare Service (NHS), for the treatment of both naïve and experienced HIV individuals. Materials and methods: A budget impact analysis was developed assuming the NHS perspective and considering a 36-month time horizon. Scenario A, representative of the current situation of consumption of the different therapeutic alternatives (derived from the most update guidelines), was compared with Scenario B, assuming a greater adoption of BIC/FTC/TAF. An organizational impact analysis was conducted to define any advantages for hospitals, devoted to the management of any ART-related adverse events. Results: The BIA revealed an economic saving of 0.97% (26,040,271.36 €) given a higher penetration rate for BIC/FTC/TAF, for the treatment of HIV individuals assuming ART in Italy. From an organizational perspective, a greater BIC/FTC/TAF administration would generate a reduction in the overall hospital accesses devoted to the management of adverse events, generating an overall saving of 245,938 hours, considering the time spent by the healthcare professionals involved in the care and treatment of individuals with HIV. Conclusions: BIC/FTC/TAF represent an interesting possibility for the rapid initiation of ART, as well as for switches, being able to optimize the clinical pathway of a patient with HIV, from an economic and organizational perspective.

Introduction: The treatment of patients with cardiogenic shock (CS) has been focused historically on single interventions (medical treatments, percutaneous and surgical interventions and, more recently, various temporary mechanical circulatory supports). However, none of these interventions has significantly changed the short-term prognosis of CS. Moreover, considerable interest in interventions applied in the acute setting has not been matched with comprehensive assessment of patients’ long-term follow-up, not only for survival and rehospitalisation but also for quality of life and functional status, recovery from critical illness and its destructive sequelae, and a global evaluation of the overall sustainability of pathways of care. To fill this knowledge gap, the ENIGMA study will be conducted. Methods and analysis: This is a prospective and retrospective multicentre registry conducted under the scientific coordination of the IRCCS Fondazione Don Gnocchi and funded by the Italian Ministry of Health (PNRR-MCNT2-2023-12377767). Data referring to 2000 patients included in the Altshock registry, the largest multicentre CS registry in Italy, will be analysed. A standardised protocol of high-intensity cardiac rehabilitation has been defined and will be followed by the involved institutions after the inclusion of the first 1000 patients. Where feasible, this new pathway will be implemented in every institution. All the patients enrolled will be evaluated according to the Long-Term Conditions Questionnaire, the Kansas City Cardiomyopathy Questionnaire and a questionnaire on the patient experience at 6-month follow-up, to evaluate real-life comparative effects on patient outcomes and experiences. In conclusion, a health technology assessment (HTA) analysis, grounded in the EUnetHTA Core Model, will be conducted to define the potential multidimensional benefits and effects with regard to the overall economic, organisational and social sustainability of the innovative dedicated pathway. Various data sources will be used to conduct the HTA: (1) literature evidence, to define the evidence-based comparative indicators considering both surgical approaches; (2) real-world anonymised data from the hospitals included in the study, to enable costing of the rehabilitative pathways; and (3) healthcare professionals’ perceptions, defining the perceived added value of the innovative pathway versus the historical one, based on an evaluation scale ranging from −3 to +3. Ethics and dissemination: The study was approved by the ethical committee (EC) of Lombardy Region (CET 44/24), on 28 May 2024, and is under evaluation by the EC of three other centres. The study protocol will be evaluated for ethics by 10 more centres in January 2025. Study results will be published in peer-reviewed publications and disseminated through conference presentations. The Associazione Nazionale Scompensati Cardiaci (AISC; ‘National Association of Patients with Heart Failure’), the Progetto Vita initiative and the non-profit organisation ‘Heart Helps Heart’ have endorsed the project and will be involved in disseminating information about the project and its outcomes to the general public.

Objectives: To evaluate the efficacy, safety and efficiency performances related to the introduction of innovative traceability platforms and integrated blood collection systems, for the improvement of a total testing process, thus also assessing the economic and organizational sustainability of these innovative technologies. Methods: A mixed-method approach was utilized. A key-performance indicators dashboard was created based on a narrative literature review and expert consensus and was assessed through a real-life data collection from the University Hospital of Padova, Italy, comparing three scenarios over time (2013, 2016, 2019) with varying levels of technological integration. The economic and organizational sustainability was determined considering all the activities performed from the tube check-in to the validation of the results, with the integration of the management of the prevalent errors occurred during the process. Results: The introduction of integrated venous blood collection and full sample traceability systems resulted in significant improvements in laboratory performance. Errors in samples collected in inappropriate tubes decreased by 42 %, mislabelled samples by 47 %, and samples with irregularities by 100 %. Economic analysis revealed a cost saving of 12.7 % per tube, equating to a total saving of 447,263.80 € over a 12-month period. Organizational efficiency improved with a reduction of 13,061.95 h in time spent on sample management, allowing for increased laboratory capacity and throughput. Conclusions: Results revealed the strategic relevance of introducing integrated venous blood collection and full sample traceability systems, within the Laboratory setting, with a real-life demonstration of TLA economic and organizational sustainability, generating an overall improvement of the process efficiency.