Emergent climate protection strategies in German hospitals: A cluster analysis

PLOS One | https://doi.org/10.1371/journal.pone.0312661 May 16, 2025 2 / 18 ongoing contribution to climate protection [8]. Fundamental climate actions such as strategies for energy efficiency, waste recycling, and low-carbon procurement can be mentioned as steps towards improving the climate, as numerous exam- ples show [9–12]. Furthermore, studies highlight the promotion of interdisciplinary collaboration between healthcare professionals and industry experts as a crucial strategy for climate protection [13,14]. Implementing climate actions will continue to be necessary as climate protection becomes increasingly important in public health and health policy debates [15]. The increased focus is also driven by global declarations such as the Paris Agree- ment, as the first universal and legally binding global climate agreement enacted in 2016 [16], or the European Green Deal enacted in 2021 [17]. In addition to political agreements, non-profit organizations are supporting the transformation of the healthcare sector towards greater sustainability. Internationally, the non-profit organization Health Care Without Harm initiated the Global Green and Healthy Hospitals (GGHH) network in 2011. This network, recognized by the World Health Organization, provides a comprehensive framework consisting of ten intercon- nected objectives for hospitals to promote greater sustainability and environmental health, including: 1. Leadership as a superordinate goal, essential at all levels to promote green and healthy hospitals. 2. Substitution of harmful chemicals with safer alternatives.

3. Reduction, treatment, and safe disposal of medical and non-medical waste. 4. Promotion of energy efficiency and clean, renewable energy generation, 5. Reduction of water consumption and provision of potable water, 6. Improvement of transport strategies for patients and employees, 7. Reduction of food waste and promotion of healthy, locally and sustainably pro- duced food, 8. Reduction of pharmaceutical pollution and prescription of safer pharmaceuticals, 9. Green buildings to develop greener and healthier hospital design and construction, 10. Purchase of sustainable products and materials [18,19]. The GGHH framework was selected as its categories provide a differentiated and applicable approach to climate protection research in hospitals [19]. It addresses unique challenges in healthcare, such as medical waste [20]. Furthermore, research based on the GGHH categories enables meaningful comparisons between hospitals regarding their specific climate protection initiatives [20,21]. With a view to these objectives of the framework, current research often addresses energy [22,23], waste [24,25], and transportation [26,27], while areas such as chemicals, water, food, phar- maceuticals, buildings, and purchasing are less investigated in comparison [28,29]. The role of hospital leadership in climate protection has long been overlooked in author (lara.schmidt@uni-wh.de) or to a rep- resentative of our Department of Management and Entrepreneurship, Witten/Herdecke University, Germany (mig@uni-wh.de). Funding: The APC is paid for under the ATLAS

project ‘Innovation and digital transformation in healthcare’ funded by the State of North Rhine- Westphalia, Germany (grant number: ITG-1-1). Competing interests: The authors have declared that no competing interests exist.