Emergent climate protection strategies in German hospitals: A cluster analysis

PLOS One | https://doi.org/10.1371/journal.pone.0312661 May 16, 2025 11 / 18 climate actions (mv = 6.37) across all areas except chemicals (mv = 3.3), focusing on energy (mv = 5.87), food (mv = 5.4), and buildings (mv = 5.35). Climate actions are actively implemented in all hospital areas and departments. Hospital administrative leaders reported clear responsibilities regarding the implementation of climate actions (mv = 6.43). About 56.90% of hospitals established a sustainability committee, and 39.66% reported a cost center for implementing climate actions. They also reported collecting key performance indicators for climate protection in all areas except food supply (mv = 3.83). All hospitals have taken initiatives and projects for climate protection. In cluster comparison, employees’ contribution to initiatives and projects in Cluster 4 is at the highest level, except for medical employees (mv = 3.8). Hospital administrative leaders indicate that all professional groups are expected to take on greater responsibility for climate protection in the future, with the primary responsibility remaining with the administrative leadership (mv = 6.2) and technical employees (mv = 6.11). The hospital structure data for each cluster is provided in Table 4. Discussion Climate protection is an integral aspect of corporate strategies, and garners increased attention among companies. This trend, well documented in recent literature [75–77], aligns with objectives of enhancing operational efficiency, foster-

ing competitive advantage, and contributing to climate protection efforts [11,78]. The healthcare sector, in particular, is advancing towards embracing ecological sustainability principles. Academic research on climate protection in hospitals has primarily concentrated on energy efficiency and waste management practices [22]. Little is known about hospitals´ administrative leadership strategies for climate protection [28]. Recent studies emphasize the importance of integrating climate protection into hospital leadership, highlighting the transformation of organizational culture and active employee engagement as key success factors [30,79]. This study aimed to scrutinize the strategic position of German hospitals towards climate protection and assess hospitals´ contribution to climate protection from the administrative leadership´s perspective. The research focuses on the organization and communication characteristics of German hospitals and explores different stages in strategy development for climate protection while underscoring the engagement of hospital employees in climate protection initiatives. Hospitals were grouped into four distinct clusters, and stages of strategic development toward climate protection were identified. Hospitals were categorized into Cluster 1–4, while Cluster 1 indicates minimal engagement, whereas Cluster 4 signifies the most proactive attitude. Each cluster with unique characteristics highlights the relevance of administrative

leadership´s organization and communication in hospitals climate protection efforts. The results indicate that a minority of hospitals (28.29%) attained the highest level of commitment (Cluster 4), while a smaller fraction (13.17%) was classified into Cluster 3. However, a significant majority (58.54%) fell into the medium and low engagement categories (Cluster 2 and 1), underscoring a need for more proactive administrative leadership in addressing climate protection. These findings underscore the need for hospital administrative leadership to promote a more proactive approach to climate protection [80] and confirm previous research indicating that German hospitals are yet to fully embrace active roles in climate protec- tion [81,82]. Characteristics of hospitals While the analysis showed no differences based on hospital ownership, other structural characteristics proved statistically significant. Specifically, single hospitals demonstrated less commitment to climate protection efforts. In contrast, hospitals affiliated in groups exhibited a markedly higher commitment to climate protection initiatives, including notable efforts to engage employees in these processes. A comparative analysis across four homogenous clusters further highlights this trend, revealing that larger hospitals within groups are better positioned to implement sustainability actions effectively than smaller and single hospitals. This advantage might be attributed to larger institutions´ superior resources and organiza-

tional framework facilitating more comprehensive and impactful climate protection initiatives [83]. Regulations, such as the