Health Systems SustainabilityHealth Systems Sustainability

Bernardo Ramirez MD, MBA

University of Central Florida

College of Health and Public Affairs

Department of Health Management and Informatics

Sustainability:Sustainability:

The capacity of health services to function with efficiency, including the financial, environment and social interaction that guaranties an effective service now and in the future, with a minimum of external intervention and without limiting the capacity of future generations to fulfill their needs.

Adapted from Gallopin Gilberto. A systems approach to sustainability and sustainable development. Sustainable Development and Human settlements Division. ECLAC/Government of the Netherlands. Project “Sustainable Assessment in Latin America and the Caribbean” Santiago de Chile, March 2003

Sustainable DevelopmentSustainable Development

Sustainability and sustainable development are concepts and principles that impact all human activities and permeate throughout all the fields of knowledge. Founded in basic principles of environmental and social development have essential implications for organizations and countries alike. In health care quality sustainability principles and practices can be applied to every aspect of this complex and multidisciplinary industry

Areas and DimensionsAreas and DimensionsSustainability of ProcessesSustainability of OrganizationsThe dimensions of sustainability are

grouped in five areas:– The environment – Socio-Cultural– Institutional Capacity Development– The Financial Dimension – The Political Dimension

The Environmental Dimension

Pollution of the EnvironmentWaste Management

– Solid Residues (biological and infectious) – Radioactive Residues– Chemical and Gases

Security measures for staff, patients and all users

Socio-Cultural Dimension Socio-Cultural Dimension

Social conditions and local cultural peculiarities

Demographic and Epidemiological Characteristics of the Service Area

Community ParticipationShared Trust and Social AccountabilityIntegrated Networks of Services that

include providers, users and community

Guidelines to establish a framework Guidelines to establish a framework of shared responsibilityof shared responsibility

Clear roles and responsibilitiesClear and achievable Performance

expectations Balanced capacities and expectations

among the participants (Partners) Accurate and timely reports Reasonable adjustments and reviews

Institutional Capacity Development

Governance Involvement and Leadership

Management CapacityFacilities and TechnologyThe Human CapitalInstitutional Values and EthicsPerformance, quality and safetyKnowledge Management

Financial Dimension

Internal Financial Capacity (An efficient accounting system and cost control)

A Financial Plan for sustainability (Long and middle term)– A Business Plan– Financial Reserves – Resource Generation and investment– To be and stay competitive

Political DimensionPolitical Dimension

Balance of the internal and external political forces

Leadership and negotiating capacity of the senior executives

Communication skills

Additional ReferencesAdditional References Chung, J. (2009) Estimate of the Carbon Footprint of the US Health Care Sector. Journal of the

American Medical Association. Vol 302, No.18 pp1970-72 http://jama.ama-assn.org/cgi/content/full/302/18/1970

Gallopin G. (2003). A systems approach to sustainability and sustainable development. Environment and Development. Sustainable Development and Human Settlements Division. ECLAC/Government of the Netherlands. Project “Sustainable Assessment in Latin America and the Caribbean” Santiago de Chile. Retrieved on May 15, 2010 from: http://www.eclac.org/publicaciones/xml/8/12288/lcl1864i.pdf

Middleberg M. (2004) Assessing Management Capacity Among Non-Governmental Organizations. Management and Organizational Sustainability Tool (MOST). Management Sciences for Health. Bethesda MD. Retrieved on May 15, 2010 from: http://erc.msh.org/toolkit/toolkitfiles/file/ngo2.pdf

Sustainable Development Appraisal Tool. Health Impact Assessment. Tools, guides and overview. (n.d.) Yorkshire/Humberside Regional Working Group. World Health Organization. Retrieved on May 15, 2010 from: http://www.who.int/hia/tools/toolkit/whohia102/en/index.html

Sustainable Development Indicators to monitor the implementation of the EU Sustainable Development Strategy. (2005). Commission of the European Community. Brussels, BE. Retrieved on May 15, 2010 from: http://ec.europa.eu/sustainable/docs/sec2005_0161_en.pdf

Sustainable Development Indicators in Your Pocket. (2009). Securing the Future: Delivering UK Sustainable Development Strategy. Department for Environment, Food and Rural Affairs, London, UK. Retrieved on May 15, 2010 from: http://www.defra.gov.uk/sustainable/government/progress/documents/SDIYP2009_a9.pdf

The Sustainability Planning Workbook. (2010) The Finance Project. Washington D.C. Retrieved on May 15, 2010 from: http://www.financeproject.org/special/engage/workbook.cfm