Emergent climate protection strategies in German hospitals: A cluster analysis

PLOS One | https://doi.org/10.1371/journal.pone.0312661 May 16, 2025 6 / 18 MANOVA is a well-established statistical method used to explore the relationships between several categorical indepen- dent variables and two or more metric dependent variables [67]. A chi-square test was conducted to assess differences in hospital characteristics. This non-parametric method, chosen for its ability to compare proportions between two or more groups and to test the null hypothesis of independence [74], has practical implications for understanding the distribution of climate actions across the clusters. An additional MANOVA was conducted to describe the characteristics of each cluster and assess significant differences across multiple depen- dent variables (see Table 1, 1 – 4i and Table 2, 1a – 2g). Table 1. Cluster description: Implementation of climate actions. Centroids MANOVA Test Statistics Characteristics (mv) Cluster 1 (32.20%) Cluster 2 (26.34%) Cluster 3 (13.17%) Cluster 4 (28.29%) Total F-Value Sig. 1 Hospital has already implemented climate actions 3.74 4.63 5.68 6.37 4.95 32.81 <.001 2 Areas in which hospitals have already implemented climate actions a Energy 4.30 4.99 5.71 5.87 5.12 18.915 <.001 b Water 3.07 3.83 4.34 4.98 3.96 15.607 <.001 c Transportation 2.89 3.75 4.51 4.95 3.91 17.663 <.001 d Waste 3.26 4.27 4.68 5.05 4.24 16.479 <.001 e Chemicals 3.09 4.11 4.41 3.30 3.96 9.067 <.001 f Pharmaceuticals 3.26 3.97 4.06 4.57 3.92 6.207 <.001 g Purchasing 3.45 4.26 4.41 5.00 4.22 11.097 <.001

h Food 3.42 4.79 4.61 5.40 4.51 17.925 <.001 i Buildings 3.57 4.32 4.46 5.35 4.35 11.163 <.001 3 Hospital areas and departments in which climate actions are implemented a Intensive care unit 2.87 3.50 3.95 4.94 3.7 15.102 <.001 b Operating room 2.94 3.97 4.17 5.05 3.95 15.245 <.001 c Inpatient ward 3.08 3.90 4.54 5.18 4.06 24.438 <.001 d Functional area 3.11 3.93 4.29 5.03 4 18.345 <.001 e Food supply 3.10 4.61 4.39 5.33 4.31 20.676 <.001 f Hospital engineering 4.07 5.13 5.41 5.80 5.04 16.588 <.001 g Medical technology 3.09 4.28 4.18 5.10 4.11 19.477 <.001 h IT 2.93 4.16 4.27 5.13 4.05 21.244 <.001 i Hospital administration 3.28 4.37 4.71 5.08 4.29 16.773 <.001 4 Key performance indicators for climate protection a Energy consumption 4.36 5.27 5.78 6.55 5.38 16.273 <.001 b Water consumption 4.24 4.87 5.29 6.32 5.07 13.666 <.001 c Waste quantity 3.70 4.76 5.22 6.20 4.85 20.031 <.001 d Chemical disposal and anesthesia scavenging 2.90 3.78 4.28 5.22 3.93 14.169 <.001 e Pharmaceutical waste disposal 3.27 4.10 4.26 5.21 4.13 9.19 <.001 f Consumption quantity transportation 2.71 3.58 3.84 5.18 3.72 18.412 <.001 g Food disposal 3.13 4.33 4.88 3.83 4.42 26.504 <.001 h Building consumption 4.02 4.98 5.10 6.15 4.98 15.951 <.001 i Consumption through procurement and purchasing 3.03 3.74 3.79 5.37 3.88 19.351 <.001 https://doi.org/10.1371/journal.pone.0312661.t002