Challenges of Achieving Green Hospital Criteria: A Mixed Method Research in Iran

Document Type : Original Research

Authors

1 Department of Health Management and Economics, Faculty of Health, Tehran University of Medical Sciences, Tehran, Iran

2 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract

Background and Aim: Green Hospital is a concept that protects the environment from destructive human actions. It has emerged to achieve the goals of sustainable development, following the world wars, the industrial revolution, and the increment of environmental destruction. Further, Hospitals have moved towards the implementation of green hospital criteria according to their social responsibilities. This study aimed to investigate the challenges of achieving green hospital indicators.
Methods: The present study was conducted as a Mixed Method (quantitative and qualitative) in a military, educational, and selected reference hospital in Tehran in 2016. The first phase was quantitative which was performed based on collected information through translated checklists and initial hospital statistics. In the second phase, qualitative information was obtained by using semi-structured interviews with 10 hospital employees working in the fields related to the green hospital, Finally. the data were analyzed with EXCEL and ATLAS.ti software (Version 7) by utilizing central criteria (quantitative) and conventional content analysis (qualitative).
Results: Based on quantitative findings of the checklist, the rate of compliance with the Green Hospital criteria was 56.8 percent. In the qualitative phase, the main challenges of the hospital were divided into two main categories (Internal and External factors) and 7 sub-categories, including the challenges of human resources, organizational and managerial, technical, financial, laws and foreign issues, cultural, and factors related to the organization's clients.
Conclusion: Based on the identified challenges, hospitals should work with external collaboration on educating and cultivating the clients and staff, amending government laws, modifying management thinking against environmental issues, and prioritizing these issues to pave the way for achieving green hospital criteria.

Keywords


1. Green Service Selection Instructions, (2008). [In Persian]. Available from: https://igm.doe.ir/portal/file/?1065488/%D8%AF%D8%B3%D8%AA%D9%88%D8%B1%D8%A7%D9%84%D8%B9%D9%85%D9%84.pdf. [accessed 12 October 2021] 2. Khan FI, Raveender V, Husain T. Effective environmental management through life cycle assessment. Journal of Loss Prevention in the Process Industries. 2002;15(6):455-66. https://doi.org/10.1016/S0950-4230(02)00051-7 3. Petak WJ. Environmental planning and management: The need for an integrative perspective. Environmental Management. 1980;4(4):287-95. https://doi.org/10.1007/BF01869422 4. Iran's general environment policy (2015). [In Persian]. Available from: https://farsi.khamenei.ir/news-content?id=31422. [accessed 12 October 2021] 5. Vision of the Islamic Republic of Iran in 1404, (2003). [In Persian]. Available from: https://rc.majlis.ir/fa/law/show/132295. [accessed 12 October 2021] 6. Constitution of the Islamic Republic of Iran, (1979). [In Persian]. Available from: https://rc.majlis.ir/fa/content/iran_constitution. [accessed 12 October 2021] 7. Firoozi M. The right to the environment. Tehran: Publications SID; 2005. [In Persian] 8. Reller A, Bristol-Myers Squibb C, Wissenschaftszentrum U. Greener hospitals : improving environmental performance. Augsburg: Wiss.-Zentrum Umwelt, Univ.; 2000. Available from: https://www.bms.com/assets/bms/us/en-us/pdf/greener-hospitals.pdf. [accessed 12 October 2021] 9. World Health Organization. Healthy hospitals, healthy planet, healthy people: Addressing climate change in healthcare settings. Geneva: WHO. 2008. Available from: https://cdn.who.int/media/docs/default-source/climate-change/healthy-hospitals-healthy-planet-healthy-peopled30658c8-3801-4dae-84cc-37b964fdd0bd.pdf?sfvrsn=8b337cee_1&download=true. [accessed 12 October 2021] 10. Sahamir SR, Zakaria R. Green Assessment Criteria for Public Hospital Building Development in Malaysia. Procedia Environmental Sciences. 2014;20:106-15. https://doi.org/10.1016/j.proenv.2014.03.015 11. Ali Taleshi M, Nejadkoorki F, Azim Zadeh H, Ghaneian M T, Namayandeh S M. Toward Green Hospital Standards in Yazd Educational Hospitals in 2013. sjimu. 2014; 22 (5) :114-127. http://sjimu.medilam.ac.ir/article-1-1516-en.html 12. Ferenc J. Going greener. Hospitals continue to make sustainability a priority. Health Facil Manage. 2010 Dec;23(12):24-8. PMID: 21265426. 13. Tan LP. Implementing ISO 14001: is it beneficial for firms in newly industrialized Malaysia? Journal of Cleaner production. 2005;13(4):397-404. https://doi.org/10.1016/j.jclepro.2003.12.002 14. Shaabani Y, VafaeeNajar A, Hooshmand E. Investigation and Comparison of Available Models for Green Hospitals. Journal of Healthcare Management. 2016;7(1):15-25. 15. Teymourzadeh E, Yaghoubi R, Ghanizadeh G, Zaboli R. Green Hospital; an Overview of the Most Important Indicators. hrjbaq. 2022;7(2):106-24. http://dx.doi.org/10.52547/hrjbaq.7.2.106 16. Murray GF. “Though Medicine Can Be Learned, It Cannot Be Taught”—The First 100 Years: Flexnerian Competency 2010. The Annals of thoracic surgery. 2010;90(1):1-10. https://doi.org/10.1016/j.athoracsur.2010.03.060 17. Karimi S, Nasr A. Methods for analyzing interview data. Pazhuhesh. 2013;4(1). [In Persian] 18. Cheng L, Sun N, Li Y, Zhang Z, Wang L, Zhou J, Liang M, Cui X, Gao G, Yuan Q. International comparative analyses of incidents reporting systems for healthcare risk management. J Evid Based Med. 2011 Feb;4(1):32-47. https://doi.org/10.1111/j.1756-5391.2011.01119.x 19. Azar FE, Farzianpour F, Foroushani AR, Badpa M, Azmal M. Evaluation of Green Hospital Dimensions in Teaching and Private Hospitals Covered by Tehran University of Medical Sciences. Journal of Service Science and Management. 2015;Vol.08No.02:8. http://dx.doi.org/10.4236/jssm.2015.82029 20. Teymourzadeh E, Ghanizadeh G, Zaboli R, Yaghoubi R. Survey on Key Indicators of the "Green Hospital" in a Selected Military Hospital. Journal of Military Medicine. 2020;22(4):401-9. http://dx.doi.org/10.30491/JMM.22.4.10 21. Mostafa GM, Shazly MM, Sherief WI. Development of a waste management protocol based on assessment of knowledge and practice of healthcare personnel in surgical departments. Waste management. 2009;29(1):430-9. https://doi.org/10.1016/j.wasman.2007.12.009 22. Abdulla F, Qdais HA, Rabi A. Site investigation on medical waste management practices in northern Jordan. Waste management. 2008;28(2):450-8. https://doi.org/10.1016/j.wasman.2007.02.035 23. Askarian M, Vakili M, Kabir G. Hospital waste management status in university hospitals of the Fars province, Iran. International Journal of Environmental Health Research. 2004;14(4):295-305. https://doi.org/10.1080/09603120410001725630 24. Bastani P, Vatankhah S, Salehi M. Performance Ratio Analysis: A National Study on Iranian Hospitals Affiliated to Ministry of Health and Medical Education. Iranian Journal of Public Health. 2013;42(8):876-82. 25. McKee M, Healy J. The role of the hospital in a changing environment. Bulletin of the World Health Organization. 2000;78(6):803-10. PMID: 10916917; PMCID: PMC2560784. 26. Ravangard R, Hatam N, Teimourizad A, Jafari A. Factors affecting the technical efficiency of health systems: A case study of Economic Cooperation Organization (ECO) countries (2004–10). International Journal of Health Policy and Management. 2014;3(2):63-9. https://doi.org/10.15171/ijhpm.2014.60 27. Shepard d, S., Dominic h, Yvonne E. Analysis of hospital costs: a manual for managers. Geneva: World Health Organization, 2000. 28. Zahedi S, Rahmati L. Environment Management System effectiveness in Tehran's Hospitals Based on ISO 14000. J Publ Admin. 2009;1:49-60. 29. AbbasZadeh A, Borhani F, SeyedGheibi FS, Shokouhi M. Organizational commitment and its dimensions in nurses working in hospitals affiliated to Shiraz University of Medical Sciences. Journal of Medical Ethics. 2013;7(23):33-46. [In Persian]. https://doi.org/10.22037/mej.v7i23.4542 30. Soliman SM, Ahmed AI. Overview of biomedical waste management in selected Governorates in Egypt: A pilot study. Waste management. 2007;27(12):1920-3. https://doi.org/10.1016/j.wasman.2006.08.009 31. Boyle C. Solid waste management in New Zealand. Waste Management. 2000;20(7):517-26. https://doi.org/10.1016/S0956-053X(00)00023-4 32. Shinee E, Gombojav E, Nishimura A, Hamajima N, Ito K. Healthcare waste management in the capital city of Mongolia. Waste management. 2008;28(2):435-41. https://doi.org/10.1016/j.wasman.2006.12.022 33. Read AD. Making waste work: making UK national solid waste strategy work at the local scale. Resources, conservation and recycling. 1999;26(3):259-85. https://doi.org/10.1016/S0921-3449(99)00015-4b