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EnergyCare: Analysis and Development of Sustainable Organisational Methodologies and Solutions in Healthcare Systems / Savio, A.. - (2026 Jun 26).

EnergyCare: Analysis and Development of Sustainable Organisational Methodologies and Solutions in Healthcare Systems

SAVIO, ANNA
2026-06-26
26-giu-2026
The healthcare system occupies a structurally paradoxical position within the contemporary sustainable transition: it is simultaneously exposed to the consequences of environmental degradation and significantly contributes to the processes it is institutionally called to contain. Climate change and the ecological crisis do not represent external threats to healthcare, but structural determinants of population health, reshaping the demand for care through heat-related mortality, the geographical redistribution of vector-borne pathogens, food insecurity, and the psychosocial consequences of climate-induced forced displacement. At the same time, the healthcare system generates a significant share of global greenhouse gas emissions through the energy consumption of facilities, pharmaceutical and medical device supply chains, anaesthetic gases, waste production, and the logistics of care delivery. This feedback loop, in which greater environmental damage produces a greater demand for care, which in turn generates further impacts, constitutes the structural motivation of this doctoral thesis. Despite the growing international awareness of this paradox, most hospital management systems lack the necessary infrastructure to translate environmental concern into concrete operational action. The most significant barrier to healthcare decarbonisation is not the unavailability of low climate impact technologies; many viable alternatives already exist and are economically feasible. The real obstacle lies in the distributed invisibility of environmental impact within complex socio-technical organisations that neither measure it systematically nor translate the results into feedback loops capable of guiding clinical and managerial behaviour. This dissertation directly addresses that gap. Environmental sustainability in healthcare is not primarily a technological issue, nor exclusively a regulatory issue: it is a problem of distributed organisational knowledge, and its solution requires the construction of measurement, modelling, and decision support systems designed to operate within the socio-technical complexity of hospitals, not despite it. The research programme is structured into four sequentially interconnected methodologies. Each phase produces outputs that serve as inputs for the next, following a cumulative logic. This logic progresses from a critical understanding of the existing literature to the proposal of conceptual and operational tools, and from their empirical validation to the construction of a decision-support model parameterised with real-world data. Eight scientific contributions are presented along this methodological progression, all focused on two clinical domains that the international literature consistently identifies as the main environmental hotspots within hospitals: the operating theatres and the diagnostic imaging departments. The choice of these two areas is not arbitrary: both concentrate the highest densities of energy consumption, single-use material flows, gases with a high global warming potential, and resource-intensive processes, making them the most strategically relevant sites. All empirical studies were conducted in real Italian hospital settings, primarily in the Lombardy region, contributing primary evidence to a national context that remains systematically underrepresented in the international literature on healthcare sustainability. The body of evidence produced by the research converges towards a reformulation of the problem: hospital sustainability is not a property of the institution, but the aggregated result of thousands of daily decisions distributed among departments, roles, shifts, and hierarchical levels, none of which are individually perceived as an environmental decision. This distributed nature of impact production has a direct and often overlooked consequence for governance: the interventions most capable of generating lasting reductions are not those aimed at the largest aggregate emission sources, but those that make the impact visible and actionable at the organisational level where the decisions that generate it are made. The evidence consistently shows that organisational and operational levers perform better than technological ones when evaluated at the level of the patient or the individual procedure, and that the reliability of the environmental data on which purchasing decisions are based cannot be taken for granted in the absence of independent validation. The resulting structural diagnosis is unequivocal: the most significant barrier to health sustainability is not the unavailability of solutions, as alternatives with a lower climate impact exist in most of the examined domains, but the absence of a measurement and feedback infrastructure that would make those solutions visible, comparable, and actionable within the governance structures of real health systems.
EnergyCare: Analysis and Development of Sustainable Organisational Methodologies and Solutions in Healthcare Systems / Savio, A.. - (2026 Jun 26).
8.1 Tesi di dottorato
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11379/651125
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