Emergent climate protection strategies in German hospitals: A cluster analysis

PLOS One | https://doi.org/10.1371/journal.pone.0312661 May 16, 2025 9 / 18 same allowing their employees to contribute ideas for climate actions. The second cluster comprises hospitals discovering climate protection and is labeled “Participative Explorers”. A notable feature of this cluster is the dual focus on employees´ ideas and administrative leadership´s pioneering role. The third cluster is labeled “Invested Practitioners”. This cluster not only encourages employee contributions and administrative leadership´s pioneering role but also stands out for allocat- ing additional human resources to facilitate the execution of climate-related actions. The best climate protection strategy characterizes Cluster 4, labeled as “Well-equipped Experts”. This cluster shares the focus on employee involvement, the allocation of human resources, and the pioneering role of administrative leadership with the previous cluster but is distin- guished by additional key factors. These include regular communication about carbon footprint performance indicators, regular climate protection meetings, established sustainability requirements for suppliers in accordance with the Act on Corporate Due Diligence Obligations in Supply Chains, and comprehensive strategic climate protection planning. The research has revealed significant differences in various aspects of climate action implementation. These aspects include the implementation of climate actions, the hospital areas and departments where these actions were implemented,

the allocation of responsibilities, the establishment of sustainability committees, and the responsibility among the employ- ees (see Tables 1–2). Cluster 1: Aspiring Novices. Comprising 32.20% of the sample, hospitals in Cluster 1 possess between 50 and 799 beds and are in public ownership. In particular, they are single hospitals that provide primary and standard care, while no university hospital is represented. This group displays a minor engagement with climate protection, exhibiting minimal strategic planning and implementation of climate actions (mv = 3.74), primarily implemented in the area of energy (mv = 4.30). Implementing climate actions occurs in hospital engineering (mv = 4.07), while medical departments are marginally affected. Hospital administrative leaders reported unclear responsibilities regarding climate protection (mv = 2.85). 1.52% of the hospitals in Cluster 1 have established a sustainability committee, and no hospital in this cluster possesses a cost center for implementing climate actions. Administrative leaders also reported collecting key performance indicators for climate protection in energy consumption (mv = 4.36) and water consumption (mv = 4.24). About 56% of hospitals have taken initiatives and projects for climate protection. While technical employees initiated initiatives and projects (mv = 5.22), hospital administrative leaders estimated limited climate protection efforts by medical employees. The hospital administrative leaders expect that technical employees (mv = 5.94) and hospital administrative leadership

(mv = 5.87) will assume greater responsibility for climate protection in the future, while no additional engagement is anticipated from medical employees. Cluster 2: Participative Explorers. Hospitals in Cluster 2 (26.34%) possess a medium number of beds and are mainly privately owned. In particular, they are part of a hospital group and provide primary and standard care. This group shows a moderate commitment to climate protection with moderate strategic planning efforts. Although the implementation of climate actions (mv = 4.63) is higher than in Cluster 1, it is in the lower range compared to the other clusters. The implementation of climate actions (mv = 4.63) focuses on energy (mv = 4.99) and food (mv = 4.79). Hospital administrative leaders reported implementing climate actions in hospital engineering (mv = 5.13) and food supply (mv = 4.61), while, similar to Cluster 1, the medical departments are slightly affected. Responsibilities for climate protection are significantly higher than in Cluster 1 but remain at a medium level in group comparison (mv = 4.11). In this cluster, 25.93% of hospitals have established a sustainability committee, and 3.70% possess a cost center for implementing climate actions. Key performance indicators for climate protection are collected in more areas than in Cluster 1, but least in the consumption quantity of transportation (mv = 3.58) as well as in consumption through procurement (mv = 3.74) and chemical disposal and anesthesia suction (mv = 3.78). About 87% of the hospital administrative leaders in Cluster 2 reported taking initiatives

and projects for climate protection. Technical (mv = 5.12) and, in some cases, administrative employees (mv = 4.66) lead initiatives for climate protection, while medical employees show little initiative. The hospital administrative leaders indicate that, in the future, all professional groups within the hospitals are expected to assume more responsibility for climate protection, with the primary responsibility remaining with the hospital administrative leadership (mv = 6.11).