ASSESSING MULTIDIMENSIONAL SUSTAINABILITY OF REGIONAL HOSPITALS TOWARD GREEN HOSPITAL TRANSFORMATION: A MULTI-DIMENSIONAL SCALING APPROACH
DOI:
https://doi.org/10.18623/rvd.v23.6310Palabras clave:
Green Hospital, Sustainability, Multi-Dimensional Scaling, Leverage Factors, District HospitalResumen
This study aimed to evaluate the overall sustainability status of Kaur Regional Public Hospital and identify leverage factors across sustainability dimensions. The study was conducted from February to July 2026. Data were collected through field observation, questionnaires involving 74 respondents, interviews, and document review. Multi-Dimensional Scaling was applied across five dimensions: ecology, resource efficiency, social and organizational behavior, sustainable economy and procurement, and institutional and management. The results showed that the multidimensional sustainability status was moderately sustainable, with an index of 51.47. The highest index was found in institutional and management at 60.19, followed by ecology at 56.12 and resource efficiency at 55.09. Sustainable economy and procurement scored 44.84, while social and organizational behavior scored 41.13, indicating less sustainable status. Leverage factors included indoor air monitoring, smoke-free policy, non-medical wastewater recycling, renewable energy use, eco-friendly behavior socialization, employee environmental awareness, low-emission operational vehicles, single-use plastic reduction, and human resource capacity development. Strengthening organizational behavior, sustainable procurement, environmental monitoring, and cross-unit governance is needed to support an integrated green hospital transition process.
Citas
Ahmad, J., Al Mamun, A., Masukujjaman, M., Mohamed Makhbul, Z. K., & Mohd Ali, K. A. (2023). Modeling the workplace pro-environmental behavior through green human resource management and organizational culture: Evidence from an emerging economy. Heliyon, 9(9), e19134. https://doi.org/10.1016/j.heliyon.2023.e19134
Aryani, Y., Purwana, R., Herdiansyah, H., & Suryabrata, J. A. (2025). Advancing indoor environmental quality (IEQ) in Indonesian hospital wards: an integrated importance performance analysis (IPA) and objective approach. Energy and Built Environment. https://doi.org/10.1016/j.enbenv.2025.07.004
Badanta, B., Porcar Sierra, A., Fernández, S. T., Rodríguez Muñoz, F. J., Pérez-Jiménez, J. M., Gonzalez-Cano-Caballero, M., Ruiz-Adame, M., & de-Diego-Cordero, R. (2025). Advancing Environmental Sustainability in Healthcare: Review on Perspectives from Health Institutions. Environments, 12(1), 9. https://doi.org/10.3390/environments12010009
Bauer, P., Greiling, D., Grüb-Martin, B., & Kienast, L. (2025). Sustainability management control in healthcare organizations - current state and future directions. BMC Health Services Research, 26(1), 125. https://doi.org/10.1186/s12913-025-13845-9
Berniak-Woźny, J., & Rataj, M. (2023). Towards Green and Sustainable Healthcare: A Literature Review and Research Agenda for Green Leadership in the Healthcare Sector. International Journal of Environmental Research and Public Health, 20(2), 908. https://doi.org/10.3390/ijerph20020908
Cappelli, G., Rapi, I., Dugheri, S., Fanfani, N., Traversini, V., Baldassarre, A., Korelidou, A., Mersel, M.-A., Baravelli, F., Louka, M., Mucci, N., & Kourtella, L. (2025). Managing and monitoring indoor air quality and surface decontamination in healthcare environments. Archives of Industrial Hygiene and Toxicology, 76(4), 222–241. https://doi.org/10.2478/aiht-2025-76-4013
Cheng, Q., Fattah, R. A., Susilo, D., Satrya, A., Haemmerli, M., Kosen, S., Novitasari, D., Puteri, G. C., Adawiyah, E., Hayen, A., Mills, A., Tangcharoensathien, V., Jan, S., Thabrany, H., Asante, A., & Wiseman, V. (2025). Determinants of healthcare utilization under the Indonesian national health insurance system – a cross-sectional study. BMC Health Services Research, 25(1), 48. https://doi.org/10.1186/s12913-024-11951-8
Dewi, F. G., Yuliansyah, Soeprihatini, R. A., Said, J., Muttaqin, A., & Propheto, A. (2025). The Future of Green Hospitals: Sustainable Business Models and Adoption Prospects in Indonesia and Malaysia. International Journal of Sustainable Development and Planning, 20(8), 3587–3599. https://doi.org/10.18280/ijsdp.200838
Dolcini, M., Ferrè, F., Brambilla, A., & Capolongo, S. (2025). Integrating environmental sustainability into hospitals performance management systems: a scoping review. BMC Health Services Research, 25(1), 764. https://doi.org/10.1186/s12913-025-12928-x
Fangqi, D., Butt, R. S., Muneer, S., Naseem, W., Bhatti, S. M., & Naveed, R. T. (2025). Sustainability in action: How green hospitals foster ecological behavior through social and normative pathways. Discover Sustainability, 6(1), 587. https://doi.org/10.1007/s43621-025-00845-2
Harvey, J., van Alphen, D., Azan, S. J., Camacho, R., Buter, C., Ugarte, C., Reballos, L., Camacho-Vasconez, A., Izquierdo-Condoy, J. S., Vasconez-Gonzalez, J., & Ortiz-Prado, E. (2025). Smart greening initiatives for healthcare facilities: A caribbean case study on environmental sustainability and disaster resilience. The Journal of Climate Change and Health, 26, 100525. https://doi.org/10.1016/j.joclim.2025.100525
Hsiao, B. (2026). Governance capacity and environmental sustainability in hospital systems: A BOCR-based multi-criteria assessment from a developing-country context. Environment, Development and Sustainability. https://doi.org/10.1007/s10668-026-07654-1
Ibrahim, M., Ghofar, A., Purwanti, L., & Iqbal, S. (2025). Sustainability Practices in Hospitals: A Systematic Literature Review and Research Agenda. Sage Open, 15(3). https://doi.org/10.1177/21582440251357033
Shah, D. R. S. I., Anuar, N. F., Panizan, N. A. Z., Ibrahim, R., Ramli, R., Perai, N. A. A., & Aghamohammadi, N. (2026). Toward sustainable healthcare: Circular economy models in hospital operations and waste management. Critical Reviews in Environmental Science and Technology, 56(10), 530–550. https://doi.org/10.1080/10643389.2026.2641479
Jallouli, S., Chouchene, K., Ben Hmida, M., & Ksibi, M. (2022). Application of Sequential Combination of Electro-Coagulation/Electro-Oxidation and Adsorption for the Treatment of Hemodialysis Wastewater for Possible Reuse. Sustainability, 14(15), 9597. https://doi.org/10.3390/su14159597
Lee, S. M., & Lee, D. (2022). Developing Green Healthcare Activities in the Total Quality Management Framework. International Journal of Environmental Research and Public Health, 19(11), 6504. https://doi.org/10.3390/ijerph19116504
Li, Y., Zhang, H., Shen, X., Sun, B., & Qu, K. (2024). Evaluating building performance and patient well-being in healthcare facilities: A literature review of environmental quality and design strategies. Journal of Building Engineering, 98, 111031. https://doi.org/10.1016/j.jobe.2024.111031
Loureiro, A., Ferreira, A., & Barros, N. (2025). Systematic review of the literature on indoor air quality in healthcare units and its effects on health. BMC Public Health, 25(1), 2398. https://doi.org/10.1186/s12889-025-23445-1
MacNeill, A. J., McGain, F., & Sherman, J. D. (2021). Planetary health care: a framework for sustainable health systems. The Lancet Planetary Health, 5(2), e66–e68. https://doi.org/10.1016/S2542-5196(21)00005-X
Maden, Ş., & Kerse, G. (2026). Redesigning healthcare facilities for sustainability: green hospital transformations and new infrastructure planning. BMC Health Services Research, 26(1), 380. https://doi.org/10.1186/s12913-026-14160-7
Nematollahi, H., Tuysserkani, M., & Nematollahi, A. (2025). Medical waste management in the modern healthcare era: A comprehensive review of technologies, environmental impact, and sustainable practices. Results in Engineering, 28, 107210. https://doi.org/10.1016/j.rineng.2025.107210
Nowlan, J., & Miller, F. A. (2025). Estimating greenhouse gas emissions from the health sector in Canada: Mind the gap. Healthcare Management Forum, 38(4), 339–345. https://doi.org/10.1177/08404704251316859
Nurfikri, A., Purwana, R., Soesilo, T. E. B., & Kesa, D. D. (2026). Sustainability Assessment and Sustainable Management Scenarios as a Green Hospital Model in West Java, Indonesia: A Multi-Aspect Method. Sustainability, 18(7), 3211. https://doi.org/10.3390/su18073211
Olawade, D. B., Popoola, T. T., Egbon, E., & David-Olawade, A. C. (2025). Sustainable healthcare practices: Pathways to a carbon-neutral future for the medical industry. Sustainable Futures, 9, 100783. https://doi.org/10.1016/j.sftr.2025.100783
Or, Z., & Seppänen, A.-V. (2024). The role of the health sector in tackling climate change: A narrative review. Health Policy, 143, 105053. https://doi.org/10.1016/j.healthpol.2024.105053
Pitcher, T. J., & Preikshot, D. (2001). Rapfish: A Rapid Appraisal Technique to Evaluate the Sustainability Status of Fisheries. Fisheries Research, 49(3), 255–270. https://doi.org/10.1016/S0165-7836(00)00205-8
Pörtner, L. M., Schlenger, L., Gabrysch, S., & Lambrecht, N. J. (2025). Dietary quality and environmental footprint of health-care foodservice: a quantitative analysis using dietary indices and lifecycle assessment data. The Lancet Planetary Health, 9(7), 101274. https://doi.org/10.1016/j.lanplh.2025.05.004
Psillaki, M., Apostolopoulos, N., Makris, I., Liargovas, P., Apostolopoulos, S., Dimitrakopoulos, P., & Sklias, G. (2023). Hospitals’ Energy Efficiency in the Perspective of Saving Resources and Providing Quality Services through Technological Options: A Systematic Literature Review. Energies, 16(2), 755. https://doi.org/10.3390/en16020755
Read, J., & Meath, C. (2025). A Conceptual Framework for Sustainable Evidence-Based Design for Aligning Therapeutic and Sustainability Outcomes in Healthcare Facilities: A Systematic Literature Review. HERD: Health Environments Research & Design Journal, 18(1), 86–107. https://doi.org/10.1177/19375867241302793
Rojas-Rueda, D. (2025). Green hospitals: maximizing health and climate benefits globally. Science of The Total Environment, 982, 179692. https://doi.org/10.1016/j.scitotenv.2025.179692
Saleem, F., Sundarasen, S., & Malik, M. I. (2025). Green Leadership and Environmental Performance in Hospitals: A Multi-Mediator Study. Sustainability, 17(12), 5376. https://doi.org/10.3390/su17125376
Schwab, R., Schiestl, L. J., & Hasenburg, A. (2025). Greening the future of healthcare: implementation of sustainability strategies in German hospitals and beyond—a review. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1559132
Silva, B. V. F., Holm-Nielsen, J. B., Sadrizadeh, S., Teles, M. P. R., Kiani-Moghaddam, M., & Arabkoohsar, A. (2024). Sustainable, green, or smart? Pathways for energy-efficient healthcare buildings. Sustainable Cities and Society, 100, 105013. https://doi.org/10.1016/j.scs.2023.105013
Vallée, A. (2024). Green hospitals face to climate change: Between sobriety and resilience. Heliyon, 10(2), e24769. https://doi.org/10.1016/j.heliyon.2024.e24769
Wang, Y., Arshad, M. Z., & Arshad, D. (2025). Proactive eco-initiatives in healthcare: Exploring the role of motivation, organizational culture, and leadership. Acta Psychologica, 255, 104921. https://doi.org/10.1016/j.actpsy.2025.104921
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
I (we) submit this article which is original and unpublished, of my (our) own authorship, to the evaluation of the Veredas do Direito Journal, and agree that the related copyrights will become exclusive property of the Journal, being prohibited any partial or total copy in any other part or other printed or online communication vehicle dissociated from the Veredas do Direito Journal, without the necessary and prior authorization that should be requested in writing to Editor in Chief. I (we) also declare that there is no conflict of interest between the articles theme, the author (s) and enterprises, institutions or individuals.
I (we) recognize that the Veredas do Direito Journal is licensed under a CREATIVE COMMONS LICENSE.
Licença Creative Commons Attribution 3.0
