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.

In the light of current institutional pressures concerning sustainable development, Circular Economy principles emerge as an opportunity to mitigate environmental impacts, ensuring also economic and societal outcomes. The study investigates the adoption of circular principles within the New Product Development processes of the healthcare manufacturing sector, exploring how companies incorporate circular practices when developing healthcare technologies and identifying the required core competencies and resources. Adopting the theoretical lenses of New Product Development and Resource-Based View, the significance of integrating circular practices throughout the technological development process is highlighted, considering the innovation process and the capabilities required to overcome sector-specific barriers. A multiple case study approach is adopted, and research findings provide a detailed framework prioritizing competencies and resources. Moreover, the study identifies the regulatory context as a contextual input, permeating the innovation process and revealing the necessity to adhere to regulatory standards. Contributing to the knowledge at the intersection between circular economy, innovation and healthcare management, the study shows how the adoption of circular thinking shapes the dynamics of conceiving new healthcare technologies, providing also a practical framework aimed at helping managers to allocate capabilities, designing targeted interventions and guiding both strategic and operational choices in sustainable healthcare technology development.

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.

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.

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.