Emergent climate protection strategies in German hospitals: A cluster analysis

PLOS One | https://doi.org/10.1371/journal.pone.0312661 May 16, 2025 14 / 18 limited. This study represents the first comprehensive analysis of German hospitals’ contribution to climate protection as reported by hospital administrative leaders. The findings reveal a heterogeneous landscape of climate protection strategies across German hospitals. Four distinct clusters of hospitals were identified, associated with various struc- tural characteristics and administrative leaders´ strategies regarding climate protection. While large hospitals contribute more extensively to climate protection and demonstrate a strategic planning, many smaller and medium-sized hospitals lack strategies and targeted climate actions. These disparities can be attributed to differences in personnel and financial resources, societal pressure to reduce GHG emissions, and the CSRD. Climate actions were focused on energy, with key performance indicators for energy consumption being recorded across all hospitals. Medical departments remain largely uninvolved in climate protection. In contrast, technical and administrative employees are the driving force behind the implementation of climate actions. Most hospitals still lack clear climate protection strategies. Communication appears insufficiently embedded within most hospital structures. Since effec- tive communication fosters employee initiative, it should be recognized as a key determinant of the long-term success and legitimacy of climate actions in hospitals. To enhance participation in climate protection initiatives, hospital administrative

leaders could implement targeted training programs and incentive systems for employees. This study emphasizes the pivotal role of hospital administrative leadership and employees’ engagement in advancing climate protection in hospitals. However, regulatory constraints, strategic shortcomings, and cultural specifics continue to limit hospitals´ contribution to planetary health. Focusing intra-organizational challenges that hamper the implementation of climate protection actions, future research might address behavioral and organizational barriers within the hospital. The role of healthcare professionals, especially physicians, might be pivotal, as they are directly involved in medical care. Their acceptance of and engagement in climate protection actions are crucial for implementing climate actions in hospitals. Therefore, a deeper understanding of their perceptions, attitudes, and contributions to climate protection might represent a significant research topic. Supporting information S1 Table. Sample description. (DOCX) Author contributions Conceptualization: Lara Schmidt, Sabine Bohnet-Joschko. Data curation: Lara Schmidt. Formal analysis: Lara Schmidt. Investigation: Lara Schmidt. Methodology: Lara Schmidt. Supervision: Sabine Bohnet-Joschko. Visualization: Lara Schmidt. Writing – original draft: Lara Schmidt. Writing – review & editing: Lara Schmidt, Sabine Bohnet-Joschko. References 1. World Health Organization. Climate Change. 2023 [cited 19 July 2024]. Available from: https://www.who.int/news-room/fact-sheets/detail/ climate-change-and-health

2. Haines A, Ebi K. The Imperative for Climate Action to Protect Health. N Engl J Med. 2019;380(3):263–73. https://doi.org/10.1056/NEJMra1807873 PMID: 30650330