Model for Sustainability in Healthcare Organizations

Sustainable development may be defined as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs” (World Commission on Environment and Development, 1987). Decision-making in an environmental framework incorporates different technical, socioeconomic, environmental and political questions, which conflict with one another; it is also necessary to add the existence of different stakeholder views (Huang, Keisler, & Linkov, 2011). These conditions are ideal for the application of MultiCriteria Decision Analysis (MCDA) techniques, since they provide acceptable compromise solutions (Munda, Nijkamp, & Rietveld, 1994); in fact, the literature indicates that the application of MCDA techniques produces a significant improvement in the decision-making process which could guarantee public acceptance of a specific solution (Huang, Keisler, & Linkov, 2011). This has allowed the literature which applies MCDA in the environmental field to grow considerably over the last two decades. There are many contributions which apply MCDA in order to analyse different environmental questions in a variety of industries, for example, the textile industry (Aragones-Beltran et al., 2009), renewable energy (Higgs et al., 2008), the electronic industry (Hsu & Hu, 2008), waste treatment (Lahdelma, Salminen, & Hokkanen, 2002), the extraction industry (Lamelas et al., 2008), power generation (Liang et al., 2006), manufacturing (Tseng, Lin, & Chiu, 2009), chemical industry (Pilavachi, Chatzipanagi, & Spyropoulou, 2009), public transport (Tzeng & Lin, 2005). Herva and Roca (2013) review the application of MCDA techniques to corporate environmental evaluation However, contributions regarding the hospital environment are almost non-existent, despite the fact that hospital facilities also generate waste and environmentally harmful pollutants. Healthcare organizations should promote environmental awareness, keeping a balance with economic and clinical needs, such as to guarantee sustainable development. This implies minimizing the environmental impact, as well as improving the health of hospital workers and users and those who live nearby (Comunidad de Madrid, 2005). A body committed to looking after the health of the public must be aware of the need to include within its strategy objectives which lead to sustainable development. A large number of health organizations are therefore working towards certificates in environmental standard ISO 14001 or the EMAS regulation. As a part of this process, health centres produce annual sustainability records, which have necessitated the definition of environmental indicators to facilitate data comparison and the long term development of the environmental behaviour of the hospital. However, not all the environmental areas or the indicators recorded have the same impact on the environment; some may have serious repercussions while other only involve slight costs. It is also possible that several indicators are related and so the same environmental area is assessed more than once. It is here that methodologies for the development of an assessment system, such as auditing, a system of key performance indicators or a balanced scorecard, may fail; this latter technique also has further limitations (Grigoroudis, Orfanoudaki, María del Carmen Carnero Moya University of Castilla-La Mancha, Spain