Emergent climate protection strategies in German hospitals: A cluster analysis

PLOS One | https://doi.org/10.1371/journal.pone.0312661 May 16, 2025 4 / 18 stakeholder needs with organizational goals [55,56] and as a strategic variable to achieve long-term and sustainable busi- ness success by strengthening stakeholder cooperation and trust [49,51,57]. In the context of hospital administrative leadership´s implementation of climate protection strategies, employees play a crucial and active role in achieving sustainability outcomes. Employees are at the forefront of the organization, contributing innovative ideas, providing solutions to problems, and implementing climate actions [58]. Their involve- ment in shaping initiatives contributes to broader ecological sustainability performance, enhancing the acceptance of changes within the corporate culture [59]. Therefore, access to information, support, and communication through the administrative leadership is essential for employees to propose initiatives and participate in climate protection [60]. The participatory process of addressing their interests and engagement is essential for strategic alignment in climate protection [61]. In this context, hospital administrative leaders need to find ways to meet their employees´ various interests and needs [49,57] and simultaneously align these interests through organization and communication [51]. In their pioneering role, administrative leaders can motivate employees to contribute to climate protection [62,63]. To understand which strategies German hospitals adopt to contribute to climate protection, the administrative leader-

ship is examined regarding their organization and communication and, in this context, the role of employees in implement- ing climate actions. Methodology A quantitative research methodology was employed to collect numerical data from hospital administrative leaders. Sample and data collection A cross-sectional survey design was utilized for this research. Surveys were conducted across public, private non-profit, and private for-profit hospitals in Germany. Day-care hospitals and psychosomatic clinics were excluded. The study´s sample comprised hospital administrative leaders from 1.169 hospitals. These hospital administrative leaders hold the highest organizational position within the hospital. Data was collected between December 12, 2022, and March 19, 2023. Administrative leaders were identified through the hospital´s website and quality reports. Survey invitations and a brief introduction of the study were disseminated via email and LinkedIn. In instances where contact information was unavail- able, the hospital´s email address for general inquiries was used, with a request to forward the survey to the hospital administrative leader. After six weeks, a reminder was sent to encourage participation in the survey. Ethical statement This study was approved by the Witten/Herdecke University Ethics Committee (S-295/2024). All participants were informed about the study design and its purpose, contact information were provided to ask any questions related to study.

Participants were fully informed about their rights and withdrawal mechanism and gave written consent. The collected data were kept anonymous and cannot be traced back. Questionnaire design The survey´s design was crafted, drawing upon an extensive literature review that delved into hospitals’ contributions to climate protection [28,64]. Before the start of the survey, participants were informed about its duration, data anonymity, and compliance with data protection regulations, which they acknowledged by checking a box. This served as written con- sent, ensuring that participants were aware of the purpose of the study, how the data would be handled, and their rights before proceeding. The questionnaire was presented in German and comprised six sections to identify emerging strate- gies and, in this context, to examine the role of organization and communication: