Healthcare sustainability and the role of intellectual capital Evidence from an Italian Regional Health Service

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.