Healthcare sustainability and the role of intellectual capital. Evidence from an Italian Regional Health Service
| Published date | 10 July 2017 |
| DOI | https://doi.org/10.1108/JIC-12-2016-0128 |
| Pages | 544-563 |
| Date | 10 July 2017 |
| Author | Caterina Cavicchi |
| Subject Matter | Information & knowledge management,Knowledge management,HR & organizational behaviour,Organizational structure/dynamics,Accounting & Finance,Accounting/accountancy,Behavioural accounting |
Healthcare sustainability and the
role of intellectual capital
Evidence from an Italian Regional Health Service
Caterina Cavicchi
Dipartimento di Economia e Management, Universita degli Studi di Ferrara,
Ferrara, Italy
Abstract
Purpose –The purpose of this paper is to investigate the role of intellectual capital (IC) in promoting the
sustainable development (SD) program of the Emilia-Romagna Health Service. The contributions of the
following assets were investigated: leadership and competences, culture, performance measurement and
incentives systems, social capital and technologies.
Design/methodology/approach –The case study was conducted following a hierarchical approach:
perceptions of the regional directorate of public and social health, the general directors and healthcare
professionals of the regional health system (the setting) were analyzed through interviews, focus groups and
documentation in order to investigate: the emerging definition of SD within the setting; the role of IC, if any,
in the achievement of the regional SD goals.
Findings –SD culture did not expand at the operative level because of the lack of involvement of healthcare
professionals in a permanent dialogue for sustainability. Sustainability projects were not systematic which
restricted the development of staff awareness of sustainability issues. Social capital enabled environmental
projects and medical projects that increased patients’involvement in disease management. Technology could
help the shift toward sustainability, but it requires consideration of tangible and intangible costs for its
successful adoption. SD performance measurement and incentives were in their infancy and cost accounting
continues to dominate the healthcare sustainability debate.
Research limitations/implications –Despite the low number of healthcare professionals involved in the
focus groups, the paper represents one of the first attempts to frame their perceptions on SD implementation
in healthcare.
Practical implications –Regional institutions should consider new ways of enacting SD which should be
more inclusive of healthcare professionals. The establishment of a permanent interdisciplinary dialogue on
sustainability would develop human, social and structural capital for sustainability. Healthcare organizations
should monitor the environmental and social effects of their operations to enact their primary mission:
the promotion of health.
Originality/value –The paper contributes to theory development related to the role of IC for SD in the
public sector context and, in particular, in the healthcare sector where evidence is currently limited.
Keywords Sustainable development, Intellectual capital, Healthcare
Paper type Case study
1. Introduction
The literature on the connections among intellectual capital (IC) and sustainable
development (SD) mainly looked at the private sector. It includes: the strategic role of IC
(Mertins and Orth, 2012; Robinson et al., 2006; López-Gamero et al., 2011); the effects of IC on
sustainable performance (Chen, 2008; Yahya et al., 2014; Liu, 2010), reporting practices
(Pedrini, 2007; Oliveira et al., 2010; Dumay, 2016); and the relation between environmental
innovation, IC and corporate reputation (de Leaniz and del Bosque, 2013).
It is only recently that scholars have begun to discuss the potential of IC for the
achievement of sustainability in all kind of organizations including also public sector ones
(Allee, 2000) and, in particular, in the healthcare context where sustainability has
been discussed as a major challenge to address (United Nations General Assembly, 2015).
Indeed, public sector organizations (such as healthcare organizations (HCOs)) as social
services providers can play a relevant role in implementing and assessing tracks toward SD
(Ball and Bebbington, 2008). They also have relevant responsibilities to support the shift
Journal of Intellectual Capital
Vol. 18 No. 3, 2017
pp. 544-563
© Emerald PublishingLimited
1469-1930
DOI 10.1108/JIC-12-2016-0128
The current issue and full text archive of this journal is available on Emerald Insight at:
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544
JIC
18,3
of the whole society toward sustainability as their activity substantially impacts on the
public (see e.g. World Health Organization, 2009 for hospitals). Moreover, they can act as
change agents promoting sustainability initiatives that can benefit their stakeholders.
In HCOs, implementing SD requires to balance concepts of cost containment with quality of
services and with reduction of environmental impacts of healthcare facilities (Jameton and
McGuire, 2002). Focusing on examples of research about the role of IC for SD in the
Italian healthcare service the studies of Botturi et al. (2015) and Lavalle et al. (2015) can be
considering as pioneering, given the limitednumber of evidences about IC role for HCOs’SD.
Botturi et al. (2015) argued that sustainable healthcare systems can be achieved if urgent
action is taken to: strengthen the role of social capital for sustainability through cooperation
between citizens and professionals in the planning and assessment of healthcare services;
develop professionals’competences devoted to innovation for sustainability; change the
culture and structure of HCOs to overcome the main efficiency orientation of healthcare
services and embrace SD; and improve the exchange of health data with the use of
informationand communications technology (ICT)and social web to increase patients’ability
to manage their own diseases and support healthcare professionals during decision making.
Borgonovi and Compagni (2013) discussed the necessity to involve citizens and patients in
shaping a healthcaresystem’s capability to satisfytheir needs, strengthen the personalization
of care paths,and as a support for diversityand inclusivity principles.Pencheon (2013) argued
that healthcare systems face three challenges that need to be addressed to enable
sustainability: patients should be accompanied in the management of their diseases by
collaborativeapproaches includingthe key role of healthcare professionals;technology should
enable prevention by health data management and the provision of home care to patients;
environmental resource limits should stimulate awareness of value in healthcare expenditure
and lead to environmental and social co-benefits (e.g. if we prevent, we spend less on
treatments; if we increase the rate of physical exercise and do not use transport, then we
improve our health status and do not pollute). Naylor and Appleby (2013) argued that
sustainabilityrequires change to where, what and how healthcare is delivered; in detail, they
argued that hospitals can contribute tosustainability by: reducing the environmental impact
of their facilities and transport for staff and patients (where); focusing on prevention and
evidence-based care to minimize care necessities (what); changing the general models of care
furnishing(how), in particular promotingintegration between healthand social care, reducing
the inappropriate prescribing of drugs, and exploiting technological innovations that can
guarantee financial, environmentaland social sustainability. The processof change is often a
matter of leadership, especially whenHCOs’managers have to overcome the traditionalfocus
on costs and quality of service provision and to start including environmental concerns in
their way of thinking and doing things (Chiarini and Vagnoni, 2016). Then, leadership
challenge consistsin introducing SD goals in HCOs’planning activities, structure, mon itoring
and accountability systems (Pencheon,2015). Despite the huge potentialof IC described in the
literature that is inherent to the shift toward sustainable healthcare, research in this fieldhas
been overlooked. For this reason, the present paper aims at filling that gap by analyzing the
contribution of IC to a SD program in a Regional Health Service of Italy; the author selected
the Emilia-Romagna Regional Health Service that started its commitment to sustainability in
2007 when a new policy agenda was set. The paper analyzes the emerging interpretation of
SD within the regional healthcare system at the regional, organizational and operative level
and the role of IC in the design and implementation of sustainability initiatives within local
HCOs. The paperis structured as follows.Section 2 presents a review of theliterature in which
the author critically examined the potential of IC in the healthcare context, while Section 3
focuses on the role of IC for HCOs’SD. Section 4 summarizes the history of SD in the
Emilia-Romagna Regional Health Service. The methodology is described in Section 5.
The results are presented in Section 6 and conclusions are drawn in Section 7.
545
Healthcare
sustainability
and the role
of IC
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