Keywords

1 Introduction

The SDG framework has reshaped development strategies, government priorities, business and citizen duties, and measures for monitoring development progress globally. Even though the term “sustainability” was first introduced through the topic of environmental degradation, sustainability in the context of SDG evolves around the three components of environment conservation, social responsibility, and economic progress (Fiksel et al. 2012).

Thus, more attention was drawn to the concept of sustainability within different sectors, and since public health is impacted by the state of our environment and social responsibility, sustainable practice in healthcare became a priority to governments and decision-makers (Mehra & Sharma 2021)The difficulty remains in determining how to best design and deliver sustainable healthcare to attain optimal health outcomes, such as improving health status in the future and creating a viable healthcare delivery system.

The application of sustainability approaches and understanding their dimensions are critical for an integrated system to address sustainability concerns in healthcare in light of existing standards and society’s needs. When carefully chosen and executed, sustainability measurements can assist managers and policymakers in developing strategies, establishing improvement targets, tracking progress, and benchmarking against other systems (Mehra & Sharma 2021).

Therefore, to gain more understanding of the emerging scope of sustainability practices in healthcare and ways to develop sustainable healthcare, this paper will explore the following research questions:

  1. 1.

    What are sustainable healthcare’s dimensions?

  2. 2.

    What are various practices for sustainable healthcare?

  3. 3.

    What are the strategies to implement sustainability effectively?

The present section gives a brief, outlining the idea of the paper. The second section presents the literature review with an overview of the keywords and their correlation. The third presents the methodology of the paper mentioning the sources of the literature, the search criteria, and the total number of papers reviewed. The fourth section outlays the findings and discussions of this paper. The fifth section summarizes the paper’s conclusions and recommendations for future research.

2 Literature Review

2.1 Dimensions of Sustainable Healthcare Practice

All national, regional, and international societies must prioritize healthcare and ensure its long-term viability. Sustainable healthcare refers to a complicated system that is long-term economically, socially, and environmentally sustainable for all people, with no adverse effects on any component of the healthcare system (Momete 2016). While Jameton & McGuire (2002) elaborate that sustainability in healthcare is maintaining a balance between patient requirements, financial considerations, and environmental costs.

Understanding sustainability-based activities is crucial for maximizing the advantages of sustainability practices inside a corporate or healthcare facility. Marimuthu & Paulose (2016) verified that sustainability practices in hospitals can be divided into four categories environment, customer, employee, and community oriented as a way to achieve sustainability goals to continuously improve quality and financial performance. Another approach explained by Mehra & Sharma (2021) came with a conceptual framework that incorporates three categories of environmental, social, and economic indicators and sub-measures derived from these practices.

Thus, for countries and nations to develop sustainable healthcare it is necessary to consider local and global challenges that impact it from the perspective of social, demographic, economic, and environmental variables. Then based upon that set conceptual frameworks that serve the country obtaining sustainable healthcare.

2.2 Sustainable Healthcare Practice in UAE

Yeboah (2016) investigated the healthcare system in relation to the social, economic, and environmental factors that make up the UAE society. Then worked to create a conceptual framework that would be used to suggest strategies and further used by healthcare professionals to improve healthcare toward sustainability and support governments for policymaking.

According to Yeboah (2016) developing sustainable health care within the UAE is affected by several different but linked variables that could have an impact. These include effective resource management, good planning and management, community factors, statistical evidence, and stakeholder partnership.

According to the framework, a variety of human, financial, and associated resources collaborate to accomplish sustainable healthcare in the UAE. Generally speaking, no nation offers appropriate funding for healthcare, and this is due to the scarce funding sources and competition for the country’s assets. Effective administration of health finances, creative funding strategies, and investments should all be part of the funding concept. This calls for skilled, qualified, and professional health personnel according to Yeboah (2016).

Yeboah (2005) explicates an innovative funding and planning approach that suggests the UAE adopt a place-based model instead of the population-based model as a comprehensive approach. As it considers the local demographic, socioeconomic, and environmental factors and accessible resources of each Emirate. Furthermore, Yeboah (2016) includes several community factors in the framework. They comprise of the population including size, composition, distribution, and dynamics within 7 Emirates as well as sociocultural, economic, and political aspects. As these factors vary between 7 Emirates, this request to skillfully handle and analyze their different needs and availability of the resources to provide long-term quality healthcare accordingly.

The identification of important stakeholders and the creation of partnerships are the focus of another component of the framework for sustainable health care. This is consistent with place-based health planning principles. Patient and patient advocacy groups, public and private service providers, and professional associations for the healthcare industry are some of the key stakeholders. Consultation and collaboration are key aspects of partnership to achieve sustainable healthcare, according to Richetta (2013). And this should be guided by effective and efficient management between the federal and Emirate level to achieve a collaborative decision-making process. Management and leadership skills are one of the main variables in the sustainable healthcare framework (Yeboah 2016).

The framework further suggests using epi-statistical data in the planning and provision of sustainable healthcare for each Emirate. This will allow to attain affordable healthcare for all populations and evolve new strategies to attain sustainable health care incorporating evidence from needs assessment, including future predictions, data on patterns of disease and injury, funding, and demographic dynamics (Yeboah 2007).

On the other hand, AlJaberi, Hussain & Drake (2020) examined the factors that measure sustainability in healthcare in the UAE and prioritize them. Data was gathered from five major hospitals in the capital of UAE, Abu Dhabi. The factors include corporate social responsibility (CSR), lean management, patient satisfaction, staff satisfaction, continuous improvement, brand, and accreditation. Further, the main resources of the healthcare sector are those who carry out the industry’s goals and objectives. Many different elements go into employee work satisfaction.

The Analytical Hierarchy Process (AHP) approach is used to rank items according to their level of relevance in order to analyze the results. This aids in the development and stimulation of multi-criteria decision-making ( AlJaberi, Hussain & Drake 2020).

According to the study’s findings, respondents ranked patient satisfaction as the most significant attribute, giving it a priority weight of 25%. Employee satisfaction came in second, with a competitive priority of 20%. Brands and accreditation were deemed to be the two least significant attributes, whereas continuous improvement, lean management, and CSR were ranked third, fourth, and fifth, respectively. This concludes the importance of social aspect factors to influence healthcare sustainability. This suggests that decision-makers in the healthcare industry must work to guarantee that best practices are applied in favor of patients and staff through appropriate policies, rules, initiatives, and strategies.

2.3 Sustainable Healthcare in European Union

The healthcare systems in the European Union are designed to aim that everyone has access to high-quality healthcare without placing a heavy financial burden on them or driving them into poverty (Popescu et al. 2018). However, the difficulties that European health systems face are numerous, but in the current socioeconomic environment are; firstly the aging of Europe’s population, which increases the risk of developing chronic conditions and increasing the demand for health care. Secondly the uneven distribution of health professionals, which hinders some areas of care and adversely affects certain geographic areas; also, the access to healthcare is not spread equally in the EU causing differences in health outcomes at the social level; lastly the costs of innovative technologies and medications are rising, placing stress on the public finance systems (Pavoni and Piselli 2016).

Momete (2016) states that the current difficulties associated with population aging, financial responsibilities, and the management of chronic diseases, EU28 needs to pursue a new set of objectives when creating sustainable healthcare. Momete (2016) further developed a conceptual framework considering the inputs and outputs into and out of the healthcare system, in which sustainable healthcare includes four components and eight fundamental variables that promote individual well-being in terms of health. Due to the use of quantitative data in the European Comparative Analysis, the data for all the criteria is available and comparable for all EU28 member countries.

To explain the framework, the input consists of two components of “Supply access” and “Providers of health”. The supply access further consists of two factors medical doctors and out-of-pocket expenditure. The number of health graduates was regarded as a sign of the qualified medical supply that was accessible considering social and demographic needs. While “out-of-pocket expenditure” element was taken into account since a patient’s access to the healthcare system may be hindered by their inability to pay out-of-pocket, as healthcare systems with minimal out-of-pocket payment requirements may offer better protection to the poor population (Xu et al. 2005). The providers-to-health component consists of two factors of “available hospital beds” as socioeconomic improvement in the EU is typically measured by the number of hospital beds available as a measure of healthcare accessibility. International organizations also utilize it as a health service indicator to represent the hospital capacity available to the population of a certain nation. And the second factor of “health expenditure” as a percentage of GDP, since McKee et al. (2004) stressed that decreased healthcare spending is associated with the key issues in the 13 member states that joined the EU after 2004.

On the other hand, the output of EU healthcare in the framework has “personal health” and “disease control” as two major components. Personal health further considers two aspects of “life expectancy” and “fertility rate”. An essential result of the medical systems, life expectancy at birth was chosen as the measure of all-cause mortality and includes preventable deaths, it also includes quantity and quality of life. Additionally, the fertility rate was chosen as a component because it considers three different aspects: lifestyle choices, national policies supporting rising birth rates in developed countries, and health issues and how they are handled by the healthcare system. For the disease control component, two factors were studied first is “incidence of tuberculosis” as its prevalence is used as a marker for the healthcare system’s potential to eradicate serious illnesses that could be prevented and treated. The second is “infant mortality rate” as it illustrates how to assist the emergence of new life, thus the likelihood of a newborn survive is one key result of the sustainability of the healthcare system (Eurostat 2011).

Momete (2016) employed a composite index for sustainable health (ISH) as a tool for analysis while looking at the results of this study. Findings indicate that the EU28 region’s healthcare system declined, with the EU average showing a decline of roughly 7% during the previous 20 years. The alarming fact is that in 2013 there were six more unsustainable nations than there were in 1995. This calls for efficient decision-making and collaboration of academics and stakeholders to work for the ultimate goal of population welfare.

3 Methodology

This study conducted a systematic mapping process, the main research steps in the methodology are as follows: identifying, reading, and comprehending significant publications; and systematic analysis of the discovered articles. This section breaks down the methodological approach of the paper into the following categories:

  1. (1)

    Identifying the research questions

  2. (2)

    Identify the scope and conduct the search

  3. (3)

    Screening for the relevant paper

  4. (4)

    Keywording the using abstract and inclusion and exclusion search criteria

  5. (5)

    Data extraction and mapping process

The following keywords were used to search the papers: “sustainable practice,” “sustainability,” “healthcare,” and “sustainable model,” in the search engine’s title, abstract, and keywords sections. Only those papers that have been indexed by the university database for high credibility and are written in English match the given query are retrieved and examined; all other papers are rejected. The databases initially produced a combined 30 records as a result of this. A list of publications for further analysis was produced after manually applying inclusion-exclusion criteria based only on abstracts and keywords and removing the duplicate articles. The study flow diagram for the research papers under examination is shown in (Fig. 1).

Fig. 1.
figure 1

Systematic mapping process (Sharma, Yadav & Chopra 2020)

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4 Discussion

This paper aims to examine the existing studies linked to sustainable practice in healthcare. The mapping study’s findings would assist us in identifying and outlining potential research areas and best practices for understanding sustainable practice variables and developing frameworks and strategies (Sharma, Yadav & Chopra 2020) (Fig. 2).

Fig.  2.
figure 2

Systematic mapping process steps (Sharma, Yadav & Chopra 2020)

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The first step of the systematic mapping process starts with defining the research questions which were stated earlier followed by the second step through identifying the scope and conducting the study. To implement this step, we developed a search scope to be used to gather papers relevant to the topic and keywords to avoid research bias. This process starts with identifying keywords to be used for searches within databases. The words “sustainable practice,” “sustainability,” “healthcare,” and “healthcare sustainability,” are in the search engine’s title, abstract, and keywords sections. The process of extraction of articles was completed by manual research on Google Scholar (GS) through the monitoring of citations of further relevant articles in high-ranking quality journals. The selection of journals was made based on relevance to the topics investigated. The selected papers were from Springer Link, Elsevier, Emerald, and other global journals. Additionally, journals that are known to receive documents on global sustainable practice in healthcare were consulted, such as the Journal of environmental research and public health, BMJ global health journal, BMC Medical informatics and decision making, Greener journal of medical science, Journal of Business Research and Business Horizons. The official websites of the UAE government and the United Nations (UN) were searched for relevant recent data and records, and this resulted in 35 papers in total.

The third stage of mapping requires the screening of relevant papers. The initial selection was based on titles and keywords and eliminating studies that did not apply to the research question. Five papers were legitimately excluded since they were obviously outside the scope of this mapping project. However, in several instances, it was challenging to infer the paper’s relevance from the title alone. In these cases, we forwarded the article to the following step for additional reading. The excluded papers with keywords “socially sustainable”, “education for sustainable healthcare”, and “sustainable digital health”. Going further with the fourth step of keywording with reading the abstract in the first stage. The next step was to build on these terms to have a more advanced understanding. Through clustering the keywords and forming titles to retrieve more accurate results such as “sustainable dimensions in healthcare practice”, “sustainable model in EU” and “sustainable practice in UAE”. The “Snowball” technique was then used on a few chosen articles to discover any further articles that might have inspired the first keyword search. This led to excluding another 5 papers and including another 5, ending up with 35 papers for this paper data extraction which is the last step of the process. As the papers that made it through the first and second stages were included along with papers that addressed research questions and were relevant to the title and inclusion keywords. Findings from 30 papers extracted concluded that a comprehensive approach to managing influencing variables and challenges would facilitate improvement in developing sustainable practices in healthcare.

The findings demonstrate that a sustainable healthcare system must include environmental, social, and economic considerations along with the current challenges and needs in a comprehensive approach. Therefore, to add value, these variables must be considered while developing frameworks and strategies for the healthcare sector. When creating a conceptual framework for the UAE, it should consider the efficient funding for healthcare and patient and staff satisfaction should be primarily taken into consideration as a basis for enhancing strategy and future efforts. Furthermore, to summarize the findings the of EU study, it highlights the challenges that Europe is facing in the context of input and output factors that collaborate to make the EU28 high quality healthcare affordable and sustainable. The eight factors considered for analysis do provides an outline of the group of countries that are sustainable, on track and, not sustainable and therefore identify measures needed for each group to improve the healthcare through encouraging strong factors and improving weak factor.

5 Conclusion and Future Recommendations

To conclude, healthcare throughout the globe including UAE and EU is pulled by two main contradictory requirements, the need to sustain an increased demand and the need to lower the cost of healthcare services. The task is to balance healthcare costs with the importance of patient care by developing a cost-effective sustainable healthcare system for future years, which will be able to confront challenging issues. This can only be done through an integrated approach that balances social, environmental, and economic variables within proactive strategy.

For the UAE in specific, sustainability can be achieved through leadership, commitment, collection, and analysis of health data that will acquire current social needs. This could be done through collaborative effort of all stakeholders involved to support innovative improvements in healthcare systems in an integrated approach. It will further generate community initiatives and government programs to support country’s policymaking and strategies to cost effective healthcare development and economic growth. To improve funding and quality of healthcare, the UAE recently has used public private partnership (PPP) as an alternative model to fund and operate existing public healthcare services.

For EU 28 member countries, sustainable healthcare development requires supporting health system strong factors and working on the weak factors, this requests for improving funding and governed health policy. Thus, a common health policy that creates improvements rather than reforming will allow to improve patient quality care and lower cost. Creating a uniform European health strategy will address resource inequalities and promote equal access to affordable healthcare. This would help the EU countries score more similarly and enhance it further while taking socioeconomic challenges and resources into account.