Emergent climate protection strategies in German hospitals: A cluster analysis

PLOS One | https://doi.org/10.1371/journal.pone.0312661 May 16, 2025 10 / 18 Cluster 3: Invested Practitioners. Hospitals in Cluster 3 (13.17%) possess a medium number of beds and are primarily non-profit in their ownership. In particular, they are part of a hospital alliance and have the highest proportion of specialized care clinics in cluster comparison. They demonstrate a higher commitment to climate protection with a moderate strategic focus. Hospitals in Cluster 3 implement climate actions in almost all areas (mv = 5.68), with a particular focus on energy (mv = 5.87) and the area of pharmaceuticals only being moderately developed (mv = 4.06). In a cluster comparison, hospitals in Cluster 3 implement an above-average number of climate actions in chemicals (mv = 4.41). Unlike previous clusters, hospital administrative leaders reported implementing more climate actions in medical departments, except for the intensive care unit (mv = 3.95). Clearly defined responsibilities for implementing climate actions characterize Cluster 3 (mv = 5.66). In this cluster, 33.33% of hospitals have established a sustainability committee, and 14.81% possess a cost center for implementing climate actions. Key performance indicators for climate protection are collected in all areas except for the consumption of transportation (mv = 3.84) and consumption through procurement (mv = 3.79). In a cluster comparison, the most critical performance indicators for food disposal are collected

in Cluster 3 (mv = 4.88). About 96.30% of the hospital administrative leaders reported taking initiatives and projects for climate protection. Although technical employees (mv = 5.29) and administrative employees (mv = 4.83), in particular, are driving forward climate protection initiatives, medical employees also make a moderate contribution to climate protection (mv = 4.2). The contribution of the physicians was the highest in cluster comparison (mv = 3.92). The hospital administrative leaders expect that all professional groups will assume more responsibility in the future, with employees in functional service being assigned the most responsibility in cluster comparison (mv = 4.93). Cluster 4: Well-equipped Experts. Cluster 4 (28.29%) comprises large hospitals with the highest proportion of university hospitals. These hospitals are single hospitals, part of a hospital group, and in public ownership. They are most actively engaged in climate protection and possess a comprehensive strategic planning. They report extensive Table 4. Hospital structure of the four clusters. Category Cluster 1 (n = 66) Cluster 2 (n = 54) Cluster 3 (n = 27) Cluster 4 (n = 58) Hospital beds Less than 50 1.52% 5.56% 3.70% 0.00% 50–49 25.76% 16.67% 14.81% 10.34% 150–299 18.18% 20.37% 14.81% 24.14% 300–499 21.21% 29.63% 33.33% 24.14% 500–799 24.24% 14.81% 18.52% 17.24% More than 800 9.09% 12.96% 14.81% 24.14% Level of care Specialist care 22.73% 18.52% 25.93% 8.62% Primary and standard care 39.39% 44.44% 29.63% 37.93%

Intermediate care 25.76% 27.78% 25.93% 29.31% Maximum care 12.12% 7.41% 7.41% 6.90% University clinic 0.00% 1.85% 11.11% 17.24% Hospital ownership Public 45.45% 29.63% 29.63% 43.10% Private non-profit 30.30% 24.07% 51.85% 36.21% Private for-profit 24.24% 46.30% 18.52% 20.69% Hospital structure Single hospital 56.06% 27.78% 25.93% 39.66% Hospital alliance 22.73% 22.22% 48.15% 18.97% Hospital group 21.21% 50.00% 25.93% 41.38% https://doi.org/10.1371/journal.pone.0312661.t004