Emergent climate protection strategies in German hospitals: A cluster analysis

PLOS One | https://doi.org/10.1371/journal.pone.0312661 May 16, 2025 1 / 18 OPEN ACCESS Citation: Schmidt L, Bohnet-Joschko S (2025) Emergent climate protection strategies in German hospitals: A cluster analysis. PLoS One 20(5): e0312661. https://doi.org/10.1371/ journal.pone.0312661 Editor: Manuel Herrador, University of Jaen: Universidad de Jaen, SPAIN Received: November 21, 2024 Accepted: April 10, 2025 Published: May 16, 2025 Copyright: © 2025 Schmidt, Bohnet-Joschko . This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data availability statement: The dataset analyzed in this study is not publicly available due to ethical constraints. This precaution is taken as there is a potential that participants can be identified based on their individual data. However, the dataset can be made available upon reasonable request to the corresponding RESEARCH ARTICLE Emergent climate protection strategies in German hospitals: A cluster analysis Lara Schmidt *, Sabine Bohnet-Joschko Department of Management and Entrepreneurship, Witten/Herdecke University, Witten, Germany * lara.schmidt@uni-wh.de Abstract Hospitals emit large amounts of greenhouse gas emissions during healthcare deliv- ery due to their extensive resource utilization and substantial waste generation. By implementing climate actions, hospitals can significantly contribute to climate pro-

tection in healthcare. This paper delves into the climate protection efforts of German hospitals, with a specific focus on the emergent strategies of hospital administrative leaders and the employee engagement within the framework of Stakeholder Theory. The investigation is based on primary data from an online survey of hospital admin- istrative leaders in German hospitals. Employing a hierarchical cluster analysis, the study identifies four distinct clusters of hospitals. These clusters vary significantly in their organization and communication strategies regarding climate protection and allocation of responsibilities, indicating that German hospitals prioritize climate protection to varying degrees. The findings suggest that employee engagement depends on how hospital administrative leaders organize and communicate the topic of climate protection in their institutions. The study underscores the importance of strategic leadership for climate protection in hospitals. Introduction Climate change represents one of the greatest challenges to humankind and signifi- cantly impacts both physical and mental health [1]. Examples include heat-related illnesses and deaths due to dehydration, heat stroke, and cardiovascular diseases [2]. Climate-related impacts are projected to increase in intensity throughout this century, threatening to disrupt the ability of healthcare systems to provide quality care [3]. Furthermore, healthcare delivery has also been shown to contribute to cli- mate change [4]. The modern healthcare sector accounts for approximately 4–5%

of global greenhouse gas (GHG) emissions [3,5]. Specifically, hospitals emit large amounts of GHG emissions through their medical care and associated administra- tive activities [6], utilizing numerous resources and producing various wastes [7]. By taking action to reduce GHG emissions, hospitals can make a significant and