A Qualitative Approach to Assess Social Impacts in Healthcare Services – Combining Social and Environmental LCA for Insights on Renal Healthcare Services in Colombia

Sustainability is an evolving concept in healthcare, especially in the treatment of chronic diseases. Traditionally healthcare has been measured by just a few, primarily scientific and economic dimensions, namely safety,... [ view full abstract ]

Sustainability is an evolving concept in healthcare, especially in the treatment of chronic diseases. Traditionally healthcare has been measured by just a few, primarily scientific and economic dimensions, namely safety, efficacy, and pharmacoeconomics, though there are many more considerations and dimensions involved in the delivery of care and impact to patients, caregivers, healthcare providers and payers/governments. Quality of life, wellbeing, disease prevention, home treatment, disease self-management, and access to treatment are some of the emerging indicators used to assess the socio-economic aspects of healthcare services. Many tools and frameworks, including Social Life Cycle Assessment (S- LCA), aim to help companies evaluate their social and economic performance in addition to their environmental performance. In 2009, UNEP/SETAC developed S-LCA guidelines on how to assess social impacts of products (or services) across the life cycle to complement the Environmental Life Cycle Assessment (E-LCA) approach. While E-LCA is a well-established tool, S-LCA is an emerging area of research and not commonly used by manufacturers. Even with recent increasing publications by S-LCA practitioners, there is still no standardized methodology for selecting stakeholders, impact categories, subcategories, and indicators as well as assessing the impacts. In addition, many case studies focus on products and less on services. A key stakeholder group, the users of products (“consumers”), has also not been considered in most of the studies and, to our knowledge, there are no case studies on healthcare services, which require a unique set of impact categories, subcategories, and indicators.

This study assesses the social implications of renal healthcare services in Colombia using UNEP/SETAC S-LCA guidelines and a qualitative approach. The study includes two types of therapies for patients with end-stage kidney disease, in-clinic hemodialysis and peritoneal dialysis performed at home. Impact categories, subcategories, and indicators were identified and assessed using focus groups and in-depth interviews with the stakeholders: patients, as “consumers,” and caregivers, as a new stakeholder category. The information extends the set of stakeholders studied to include local community and society using previously conducted studies (including an E-LCA of both therapies), secondary data from literature, publicly available data (national and international), and information from the company providing the therapies in Colombia, Baxter International Inc.

The results offer (1) insights from stakeholders to decision makers, such as healthcare service providers and product manufacturers, on social risks and benefits of renal therapies, such as convenience of treatment and end of product life, (2) a better understanding of the environmental and social tradeoffs between the different aspects of the therapy services, and (3) supportive evidence for informed decision-making and value creation to a broader set of stakeholders. This study supports healthcare product manufacturers and providers in communicating the social value created and identifying opportunities for innovation across renal therapy options as they seek to provide patients the best possible life. It also demonstrates how healthcare and other industries may apply S-LCA to products and services and further sustainable development with a case study and robust methodology that addresses the needs of patients.