Indices de eficiencia ambiental en el sector público hospitalario

This doctoral research addresses the escalating importance of sustainability within the healthcare sector through the proposition and application of environmental performance indicators. Employing the methodology of Life Cycle Assessment (LCA), this study evaluates the environmental impacts associated with various operational activities inherent to hospital function – ranging from material procurement and waste management to logistical transport protocols. The investigation identifies transportation of patients, personnel, and supplies, alongside intensive material consumption and resultant waste generation, as areas exhibiting the most significant environmental impact. Findings indicate that strategic hospital location planning, implementation of sustainable procurement policies (prioritizing materials with a demonstrably reduced environmental footprint), and efficient waste management systems are critical determinants in enhancing sector-wide environmental performance. A substantial component of this thesis focuses on analyzing the disruptive influence of the COVID-19 pandemic on previously established environmental efficiency metrics. Through comparative analysis of a district hospital’s performance before and during the pandemic (2019-2020), evidence suggests that while the public health crisis spurred innovation in areas such as telemedicine, it simultaneously induced a substantial increase in Personal Protective Equipment (PPE) consumption and significantly altered transportation patterns. This reinforces the necessity for a transition towards a value-based healthcare model prioritizing efficiency gains, preventative care, and reduced onsite visits through leveraging digital technologies. Furthermore, this research explores the environmental benefits of decentralized healthcare delivery by comparing three distinct scenarios: conventional hospital-centric care with alternatives predicated on domiciliary care or local health center models. Results indicate that these latter options have the potential to significantly mitigate the environmental impact associated with medical transportation. The utilization of electric vehicles for home-based care offers additional advantages regarding emission reduction and ozone depletion, however, also presents challenges pertaining to battery production and recycling – processes which contribute to increased human toxicity and aquatic ecotoxicity. This underscores the imperative of conducting a comprehensive life cycle assessment when evaluating seemingly “green” solutions. In conclusion, this research provides valuable tools for evidence-based decision-making within healthcare administration, fostering a more sustainable and efficient approach that considers environmental, economic, and social dimensions without compromising patient care quality. The thesis also delineates key areas requiring further investigation, including the impact of emerging COVID-19 variants and the exploration of strategies for long-term, holistic, and sustainable management practices.