1. Health Systems Sustainability Health Systems Sustainability Bernardo Ramirez MD, MBA University of Central Florida College of Health and Public Affairs Department of Health Management and Informatics

2. 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

3. Sustainable 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 industrysustainable development

4. Areas and Dimensions Sustainability of Processes Sustainability of OrganizationsOrganizations The dimensions of sustainability are grouped in five areas:sustainability – The environment The environment – Socio-Cultural Socio-Cultural – Institutional Capacity Development Institutional Capacity Development – The Financial Dimension The Financial Dimension – The Political Dimension The Political Dimension

5. The Environmental Dimension The Environmental Dimension Pollution of the Environment Waste ManagementManagement – Solid Residues (biological and infectious) Solid Residues – Radioactive Residues – Chemical and Gases Security measures for staff, patients and all users Security measures for staff, patients and all users

6. Socio-Cultural Dimension Social conditions and local cultural peculiaritieslocal cultural peculiarities Demographic and Epidemiological Characteristics of the Service Area Community Participation Shared Trust and Social AccountabilitySocial Accountability Integrated Networks of Services that include providers, users and community Integrated Networks

7. Guidelines to establish a framework of shared responsibility Clear roles and responsibilities Clear and achievable Performance expectations Balanced capacities and expectations among the participants (Partners) Accurate and timely reports Reasonable adjustments and reviews

8. Institutional Capacity Development Institutional Capacity Development Governance Involvement and Leadership Governance Involvement and Leadership Management Capacity Facilities and Technology The Human Capital Institutional Values and Ethics Performance, quality and safety Knowledge Management

9. Financial Dimension Financial Dimension Internal Financial Capacity (An efficient accounting system and cost control) Internal Financial Capacity A Financial Plan for sustainability (Long and middle term) A Financial Plan for sustainability – A Business Plan – Financial Reserves – Resource Generation and investment – To be and stay competitive

10. Political Dimension Balance of the internal and external political forces Leadership and negotiating capacity of the senior executives Communication skills

11. Additional 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/302/18/1970http://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 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 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.htmlhttp://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.pdfhttp://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 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.cfmhttp://www.financeproject.org/special/engage/workbook.cfm