Measuring environmental performance in hospitals: A practical approach

In hospitals, measuring environmental performance may lead to the reduction of environmental impact of their operations and improve the quality of processes and outcomes. Healthcare services employ a significant amount of hazardous and non-hazardous materials and produce polluting outputs. New frameworks are necessary to define relevant and meaningful indicators for monitoring and assessing environmental performance if healthcare systems and operations are to be improved. The literature review highlights concerns on the lack of strategic focus of performance indicators, relevance and robustness of metrics and difficulties for the deployment of measures within different hierarchical levels. Field studies conducted with 10 hospitals in the Southern region of Brazil underlined the scarcity of consistent frameworks applied in practice to measure, monitor, improve and report environmental performance. Considering this context, the study seeks to propose an alternative framework drawn from the review of literature, current legislation and feedback from field research. The proposed framework is operationalized through a 'process approach' and evaluated in terms of feasibility, usability and utility. Six case studies were conducted to test the applicability of the proposed approach. The framework was evaluated as 'Good' and 'Very Good'. Some of the advantages of the approach according to participants are: a) the framework and process make a significant contribution to practice, since they represent meaningful guidance for the formalization of strategies, goal setting and environmental assessment and monitoring; b) the approach is associated with a number of 'softer' outcomes related to the enhancement of communication and awareness of environmental issues, focus on environmental performance and continuous improvement initiatives; c) the framework facilitates the adjustment of hospitals to current legislation and quality requirements. Furthermore, the study contributes to a wider theoretical discussion on strategically focused public policy concerning the improvement of healthcare environmental performance. The framework and process also provide a systematic approach for hospitals performance monitoring and reporting.