RECOVERY OF A GREEN HOSPITAL SYSTEMS BASED ON ISO 14001: 2015 STANDARDS

Mkalaf, Khelood A.; Alshaheen, Nedaa; Al-Hadeethi, Rami Hikmat; Al-Bazi, Ammar

doi:10.1590/0101-7438.2023.043.00265411

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ARTICLES • Pesqui. Oper. 43 • 2023 • https://doi.org/10.1590/0101-7438.2023.043.00265411 copy

RECOVERY OF A GREEN HOSPITAL SYSTEMS BASED ON ISO 14001: 2015 STANDARDS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study targets six North Asia and African hospitals that provide clinical treatment, diagnostic, and consultation services. The study revealed a lack in the selected hospitals’ infrastructure to support implementation successfully Environmental Management Systems (EMS). A factor analysis was performed based on five factors; EMS efficiency, the hospital’s culture, support from top management, legislation, and time and budget controls. Out of 23 sub-factors tested, it has been found that 7 of them can control the differentiation of the factors. The results highlight human errors in chemical and medical materials that lead to environmental pollution. It was followed by a sub-factor that indicated that controls of hospital activities and correction of its performance depend on the feedback received from the environmental information system. The study’s main conclusion is that recovering green hospital systems depends on successfully carrying out the ISO 14001: 2015 standard.

Keywords:
environmental management system; green hospitals; ISO 14001: 2015 standards; continuous improvement; social responsibility; hazardous waste

Authors, Years	Years	Developed by	A series of development in the EMS
Lytle, 2007; Kroll, 2001	1962	Rachel Carson	He was the first to bring the world’s attention to the environment after the publication of her book Silent Spring in 1962, based on the atomic explosions that caused massive damage to the environment in 1955
Handl, 2012	1968	UNGA	United Nations General Assembly had proposed a conference about the environmental issues
Barrow, 2006	1970	Increased pollution	Begin attention to EM issues due to the effect on the environment by the industries and increase human beings’ activities
McAdam, 2017; Rhyner, 2017	1972	EC Stockholm, Sweden,	At the Environment Conference in Stockholm, Sweden determined the optimum utilization of the available material and social resources without harming the environment
Chu & Karr, 2017; Schuler et al., 2017	1987	Independent Commission on the Environment	It introduced the concept of sustainable development and defined the Organization’s operating environment and its impact on the surrounding environment.
Çalış & Büyükakıncı, 2019; Heras-Saizarbitoria et al., 2018	1992	British Standards Organization	British Standards Organization (BS 7750) was derived from quality specification 5750
Wilson & Campbell, 2020	1994	International Standard Organization	the Environmental Management Specification was issued by International ISO
Delmas, 2002	Sept. 1996	International Standard Organization	ISO issued the first edition of the ISO 14000 Series, a set of guidelines for developing systems and practices in six environmental sectors.
Delmas, 2002	Sept. 1996	ISO: EMS series contains six sections	ISO 14001 and 14004 (EMS), ISO 14010 to 14012 (Environmental Auditing), ISO 14020 to 14025 (Environmental Labeling), ISO 14031 (Environmental Performance Evaluation), ISO 14040 to 14043 (Life Cycle Assessment), and ISO 14060 (Environmental Aspects in Product Standards).

H	Healthcare services/Month	Patients	H	Healthcare services/Month	Patients
Public hospital	Clinical consultations	9175	Cardiac surgery	Cardiac surgical process	339
	Emergency department	2035		Cardiac consultations	2147
	Outpatient clinic	435		Surgical consultations	1051
	Hemodialysis	3462		Children’s consultations	1267
	Radiological tests	5,323		Cardiac catheterization	336
	Ultrasound tests,	627		ECG	1765
	Computerized Tomography	80		X-rays	1611
	MRI tests	516		Sonar	225
Maternity	Natural birth	334		Different diagnoses services	1461
	Surgical birth	298	Orthopaedic surgery	Clinical consultations	932
	Intensive care	300		Emergency department	377
	Resuscitation rooms for a new baby	180		Surgical operations	221
	Laboratory tests	1632		Intensive care	347
Child hospital	Clinical consultations	1213		physiotherapy clinic	197
	Emergency department	1931		ECG	345
	MRI	182		X-rays	2085
	Helical Press	145		Sonar	672
	Radiology Test	1535		MRI	378
	Sonar test	1061	General surgery	Various surgeries	2654
	ECG	14	General surgery	Laboratory tests	4672

Sub-Factors	Measuring Sub-Factors for the Environmental Information System (EIS)	Saturation ratio	Optimal solution
F1₁	Controls are based on feedback from the EIS.	0.856	Acceptable
F1₂	The hospitals face obstacles in implementing the EMS.	0.744	Acceptable
F1₃	It offers accurate information in the time that contributes to making the right environmental decision.	0.723	Acceptable
F1₄	It has effective coordination with environmental protection organizations.	0.574	Acceptable
F1₅	It offers information about environmental protection organizations.	0.757	Acceptable

Sub-Factors	Measuring sub-factors for supporting the top management’s commitment to applying the EMS	Saturation ratio	Optimal solution
F21	Knowledge and skill	0.814	Acceptable
F22	Support its application	0.724	Acceptable
F23	Provide resources	0.636	Acceptable

Sub-Factors	Measuring sub-factors for organization knowledge and culture about EMS	Saturation ratio	Optimal solution
F3₁	More table Hospital staff has specialization qualifications in the EMS.	0.583	Acceptable
F3₂	There are ongoing training programs in the EMS.	0.585	Acceptable
F3₃	The hospital has the plan to develop employees’ knowledge about EMS.	0.766	Acceptable
F3₄	The hospital is interested in carrying out internal operations and activities more than solving environmental problems.	0.697	Acceptable
F3₅	The hospital managers believe rivers and oceans are the best way to solve environmental pollution.	0.696	Acceptable
F3₆	Hospital waste leads to pollution and environmental damage	-0.863	Unacceptable
F3₇	The local population is causing substantial environmental pollution	-0.869	Unacceptable
F3₈	The hospital staff was exposed to health risks due to the hospital’s activities and operations.	-0.892	Unacceptable
F3₉	Human errors in the use of chemical and medical materials lead to environmental pollution	0.944	Acceptable

Sub-Factors	Measuring sub-factors for controls and legislation rules that support applying the EMS	Saturation ratio	Optimal solution
F4₁	All hospital activities are operating to protect the environment.	0.808	Factor loading
F4₂	It is committed work to protect environmental legislation.	0.764	Factor loading
F4₃	Compulsory legislation & instructions are available to protect the environment.	0.608	Factor loading
F4₄	Its usage of legislation and legal support the oversight role towards environmental protection.	0.474	Unacceptable

Sub-Factors	Measuring sub-factors for the time and budget factor	Saturation ratio	Optimal solution
F5₁	Appling EMS needs a long time.	0.599	Acceptable
F5₂	Appling EMS has required an expensive budget.	0.768	Acceptable

Main factors	Sub-Factors	EISF1	MCF2	OKCEF3	CLF4	BTF5
EISF1	F1 ₁	0.856
	F1 ₂	0.744
	F1 ₃	0.723
	F1 ₄	0.574
	F1 ₅	0.757
MCF2	F2 ₁		0.814
	F2 ₂		0.724
	F2 ₃		0.636
OKCEF3	F3 ₁			0.583
	F3 ₂			0.585
	F3 ₃			0.766
	F3 ₄			0.697
	F3 ₅			0.696
	F3 ₆			-0.863
	F3 ₇			-0.869
	F3 ₈			-0.892
	F3 ₉			0.944
CLF4	F4 ₁				0.808
	F4 ₂				0.764
	F4 ₃				0.608
	F4 ₄				0.474
BTF5	F5 ₁					0.599
BTF5	F5 ₂					0.768

Sub-Factors	Over loading	Level	Matrix components of the Current EMS
F3₉	0.944	1	Human errors in the use of chemical and medical materials lead to environmental pollution
F1₁	0.856	2	Controls of hospital activities and correction of its performance depend on the feedback received from the EIS
F2₁	0814	3	The hospital’s senior management has Knowledge and skill
F4₁	0.808	4	All hospital activities are operating to protect the environment.
F5₂	0.768	5	Appling EMS has required an expensive budget
F3₃	0.766	6	The hospital has the plan to develop employees’ knowledge about EMS.
F4₃	0.764	7	Compulsory legislation & instructions are available to protect the environment.
F1₅	0.757	8	It offers information about environmental protection organizations.
F1₂	0.744	9	The hospitals face obstacles in implementing the EMS.
F2₂	0.724	10	The hospital’s senior management supports the application of the EMS
F1₃	0.723	11	It offers accurate information in the time that contributes to making the right environmental decision.
F3₄	0.697	12	The hospital is interested in carrying out internal operations and activities more than solving environmental problems.
F3₅	0.696	13	The hospital managers believe rivers and oceans are the best way to solve environmental pollution.
F2₃	0.636	14	The hospital’s senior management provides resources that required to apply for EMS
F4₂	0.608	15	It is committed to protecting environmental legislation.
F5₁	0.599	16	Appling EMS needs a long time.
F3₂	0.585	17	There are ongoing training programs in the EMS.
F3₁	0.583	18	More table Hospital staff has specialization qualifications in the EMS.
F1₄	0.574	19	It has effective coordination with environmental protection organizations.
F4₄	0.474	20	Its usage of legislation and legal support the oversight role towards environmental protection.
F3₆	-0.863	21	Hospital waste leads to pollution and environmental damage
F3₇	-0.869	22	The local population is causing substantial environmental pollution
F3₈	-0.892	23	The hospital staff was exposed to health risks due to the hospital’s activities and operations.

Saturation values for the set of squares			Factor (roots)
Cumulative contrast ratio	Percentage of variance	Totally	Factor (roots)
16.044	16.044	3.690	1
29.237	13.199	3.035	2
42.382	13.145	3.023	3
55.030	12.648	2.909	4
66.518	11.488	2.642	5
75.233	8.715	2.004	6
82.991	7.758	1.784	7

No.	Main Factors	Sub-Factors	Factor Loading	Cronbach’s α	Composite Reliability	Average Variance Extracted
1	The efficiency of the environmental information system	F1₁	0.856	0.725	0.823	0.516
		F1₂	0.744
		F1₃	0.723
		F1₄	0.574
		F1₅	0.757
2	Supporting top management’s commitment to applied EMS	F2₁	0.814	0.737	0.791	0.561
		F2₂	0.724
		F2₃	0.636
3	Hospital Culture and knowledge about EMS	F3₁	0.583	0.756	0.834	0.507
		F3₂	0.585
		F3₃	0.766
		F3₄	0.697
		F3₅	0.696
		F3₆	-0.863
		F3₇	-0.869
		F3₈	-0.892
		F3₉	0.944
4	Controls, legislation, and laws used to apply EMS	F4₁	0.808	0.852	0.890	0.621
		F4₂	0.764
		F4₃	0.608
		F4₄	0.474
5	Time and budget need to apply to EMS	F5₁	0.599	0.714	0.805	0.455
5	Time and budget need to apply to EMS	F5₂	0.768	0.714	0.805	0.455

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