Healthcare is an essential part of our lives, promoting and preserving the health of individuals and society. The industry has been evolving at a high pace over the last few decades, driven by technology and growing care demands. This progress is currently having an opposite effect on the overarching objective of serving healthy living due to the increasing environmental footprint and social toll of the industry. Today, healthcare accounts for nearly 4.4% of global CO2 net emissions worldwide, while in the Netherlands, the sector accounts for about 7% of the national footprint. In particular, Radiology represents a clinical area of great concern, being a major contributor to the healthcare carbon footprint due to its high energy consumption and hazardous waste generation. Furthermore, Radiology professionals face heavy workloads due to rising demands for imaging exams, driven by patient expectations on the one hand, and the convenience of leading doctors, as well as existing differences in protocols across hospitals, on the other hand. These complex Environmental, Social, and Governance (ESG) challenges must be approached in an integrated way, to effectively enable the embedding of sustainable practices at the core of healthcare, accelerating in this way the transition towards a circular economy across the industry. This research aims to provide broad and deep insights into the Radiology ecosystem in the Netherlands, ESG definition guidance, and an end-to-end ESG strategic design toolkit that aims to simplify, measure, and integrate ESG efforts across healthcare. An integrated department-, hospital-, national-, and global approach is being proposed to streamline efforts towards 2030 ESG goals and beyond.

A systemic design approach is proposed for this study, combining mixed methodologies of qualitative, quantitative, and co-creation efforts with cross-disciplinary experts from six university hospitals, as well as the national Radiology association in the Netherlands. The steps towards framing, prioritizing, and embedding ESG into the Radiology workflow are consistently captured as research findings, concluding contextual insights on the ESG impact across the different levels of the system. These are represented as an ESG pyramid in this study. Identifying key ESG healthcare challenges and influential entities in the system offers a foundation for strategic dialogues on ESG goals definition. Additionally, an ESG healthcare ecosystem map has been developed to further understand the dynamics among key system stakeholders, on three main dimensions: financial, clinical compliance, and ESG. The perspective of embedding ESG in Radiology, within the Netherlands, is taken as a representative industry case study. Consolidation of clinical workflow data, operational insights, and current ESG context resulted in a cross-hospital view of Radiology ESG hotspots, dependencies, and opportunities. Interventions on ESG hotspots are then addressed and positioned, at corresponding decision power levels, within the larger system. Furthermore, a solution for integrated ESG value-impact measurement and continuous monitoring is proposed. Such a simplified and transparent way of working has the potential to increase awareness, drive collaboration, significantly reduce ESG spending and identify new circular value opportunities.

The outcomes of this research indicate that embedding ESG hotspots into the Radiology workflow should be approached in a holistic and systemic way. The ESG strategic design toolkit can facilitate relevant dialogues on the value and impact of ESG interventions across levels in the healthcare ecosystem, enabling hospitals and departments to effectively define ESG goals and programs. This simplifies complexity and provides consistency across the broader system hierarchy.