Sustainability is momentous for the appropriate functioning of health care systems. In fact, health and sustainability are two strictly related values, which could not be separately sought. While studies discussing the contextualization of this issue with respect to the distinguishing attributes of health care systems are rapidly blooming, there is still little agreement about what is ultimately meant by sustainability in the health care arena. On the one hand, attention is primarily focused on the proper use of available financial resources; on the other hand, people engagement and empowerment are gradually arising as a crucial step to enhance the viability of the health care system. This paper tries to identify, from a conceptual point of view inspired by the European integrative movement, the different shades of sustainability in health care and proposes a recipe to strengthen the long-term viability of health care organizations. The balanced mix of financial, economic, political, and social sustainability is compelling to increase the ability of health care organizations to create meaningful value for the population served. However, the focus on a single dimension of sustainability is thought to engender several side effects, which compromise the capability of health care organizations to guarantee health gains at the individual and collective levels. From this standpoint, further conceptual and practical developments are envisioned, paving the way for a full-fledged understanding of sustainability in the health care environment.

Retinitis Pigmentosa (RP) is a hereditary genetic disease causing bilateral retinal degeneration. RP is a leading cause of blindness resulting in incurable visual impairment and drastic reduction in the Quality of life of the patients. Second Sight Medical Products Inc. developed Argus II, a retinal prosthesis system for treating RP. Argus II is the world’s first ever-commercial implant intended to restore some vision in the blind patients. The objective of this study was to assess the cost-effectiveness of the Argus® II Retinal Prosthesis System (Argus II) in Retinitis Pigmentosa (RP) patients. A multi -state transition Markov model was developed to determine the cost-effectiveness of Argus II versus usual care in RP from the perspective of healthcare payer. A hypothetical cohort of 1000 RP patients aged 46 years followed up over a (lifetime) 25-year time horizon. Health outcomes were expressed as quality adjusted life years (QALYs) and direct healthcare costs expressed in 2012 €. Results are reported as incremental cost per ratios (ICERs) with outcomes and costs discounted at an annual rate of 3.5%. The ICER for Argus II was €14,603/QALY. Taking into account the uncertainty in model inputs the ICER was €14,482/QALY in the probabilistic analysis. In the scenarios of an assumption of no reduction on cost across model visual acuity states or a model time horizon as short as 10 years the ICER increased to €31,890/QALY and €49,769/QALY respectively. This economic evaluation shows that Argus II is a cost-effective intervention compared to usual care of the RP patients. The lifetime analysis ICER for Argus II falls below the published societal willingness to pay of EuroZone countries.

Business management and, more generally, decision makers, are increasingly aware of the importance of corporate social responsibility and ethical choices within the strategic business vision. The number of tools (e.g., board of directors, organization actions), levers (e.g., cultural, social example of direct boss) and rules (e.g., protocols, certifications, law decrees) available, however, makes it difficult for management to identify the set of best practices to be adopted within its own organization. Further, the task is even more difficult when management is called upon to choose these tools for life-long learning programs intended for company staff as well as for new hires. The Italian Association for Managerial Training has promoted a survey that pays particular attention to the «ethical choices» and «behaviors» to be adopted in the organization’s management and their training programs. The results of the survey have been modelled through «Carroll’s conceptual framework» that, as known, is made of two parts: the most cited CSR pyramid and the least mentioned, but equally important, descriptive types of management. In this work, it has been employed a two steps multivariate analysis, employing an Exploratory Factor Analysis (EFA) and a Structural Equation Modelling (SEM). EFA has been used to identify Carroll’s descriptive types (or profiles), while SEMs were employed to verify the plausibility of the causal models that represent, in turn, thought experiments simulating «ethical dilemmas» useful for the company’s management during its decision making. The models identified, readable in the form of simple «heuristics», are interpreted in the light of Carroll’s «descriptive types» of management (i.e., moral, immoral and amoral). Thereby, any organization, even of a small size, interested in adopting «sustainable policies», can make use of the identified models to establish which guidelines can be adopted by the management during her/his decision making, and, according to Carroll, «to isolate the ethical or moral component of CSR and relate it to perspectives that reflect the three major ethical approaches to management», with the overall objective of managing with «stakeholders in an ethical or moral fashion».

Although the scientific debate in the field of business economics is rich in contributions to the subject of sustainability, they mainly focus on a specific aspect represented by sustainability reporting. Consistent with this bibliographic evidence, the aim of this study was to investigate a sustainability management model in local authorities, which, by examining the dimensions of sustainability, goes beyond the focus of reporting highlighted in the literature to consider the entire sustainability cycle (from planning to measurement). To this end, the methodology of the single case study with multiple units of analysis is used, examining the case of an Italian local authority that has experimented with the sustainability management model described in this paper. The analysis of the case leads to some concluding remarks on the strengths and weaknesses of the model, contributing to the scientific debate on sustainability management and providing useful indications for public managers and political decision-makers.