The choice of functional unit in organisational LCAs of hospitals and other healthcare organisations

Main Presenter:    Mattis Keil 


This contribution aims to assess possible reference flows and functional units which can be used by healthcare organizations to communicate their environmental impact through life-cycle assessment. As the healthcare sector increasingly prioritizes sustainability, understanding the choice of the functional unit or reference flow is crucial. It can impact comparisons within an organization over time or between different organizations. This contribution aims to provide recommendations for effective communication of environmental performance by hospitals or other healthcare organisations.

Reference flows and functional units were identified by a systematic literature search for life-cycle assessments and carbon footprint studies in the healthcare sector. Additionally, guidelines on life-cycle assessment of organizations were included in the final analysis and discussion. The identified reference flows or functional units were analysed using seven criteria, including the differentiation between input and output flows, treatment complexities, quantity of provided services, quality of provided services, longevity of services, matching with system boundaries, and data availability.

Seven reference flows were identified: (i) organization’s area, (ii) number of beds, (iii) workforce, (iv) expenditure, (v) patient load, (vi) revenue, and (vii) the diagnosis-related groups case mix. Each flow has its own advantages and disadvantages; the best reference flow for an assessment depends on the specific goals and objectives and should be meaningful to stakeholders. However, none of the reference flows measure the actual function of healthcare organizations, i.e., the impact on the health of the patients. However, data on this flow, such as quality-adjusted life years, are not available in a meaningful quantity.

In conclusion, this contribution highlights the importance of functional unit selection in the communication of environmental impacts of healthcare organizations through life-cycle assessment. The present analysis identified seven reference flows, each with its own advantages and disadvantages. These findings are of importance for decision makers to contextualize given data and to choose the most suitable reference flow for their own assessment. Future research might evaluate the quantitative impact of the reference flow decision.

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