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<p>Hospitals in developing countries face persistent environmental challenges, including hazardous waste generation, resource inefficiency, and pollution risks, under constrained institutional conditions. We develop and apply the Cleaner Hospital Governance Framework (CHGF), integrating DEMATEL, DANP, and VIKOR within a Benefits–Opportunities–Costs–Risks (BOCR) structure to examine how governance mechanisms shape hospital environmental performance. We collected expert assessments from 32 professionals across seven major Panama City hospitals (four public, three private). Results show Benefits and Opportunities, particularly safety culture (B3.3, weight = 0.07), service accessibility (B2.3, weight = 0.06), and regional healthcare coordination (O2.1, weight = 0.10), are primary upstream drivers of environmental performance; Costs and Risks act as downstream outcomes of governance deficiencies. Private hospitals consistently outperform public hospitals across VIKOR sensitivity scenarios (<i>v</i> = 0.1–0.9); ranking deviations remained within ± 0.032, indicating robustness. Public–private disparities in governance maturity correspond to differences in hazardous-waste control, operational efficiency, and pollution-risk exposure. The findings show that strengthening institutional governance capacity, rather than relying solely on technological interventions, is a critical pathway to improving healthcare environmental sustainability. The CHGF offers policymakers a practical decision-support tool to prioritize governance reforms aligned with SDG 3 (Good Health and Well-Being) and SDG 12 (Responsible Consumption and Production) in resource-constrained settings.</p>

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Governance capacity and environmental sustainability in hospital systems: A BOCR-based multi-criteria assessment from a developing-country context

  • 期刊论文

  • 发表日期：

    2026年4月23日

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  • Bo Hsiao

摘要

Hospitals in developing countries face persistent environmental challenges, including hazardous waste generation, resource inefficiency, and pollution risks, under constrained institutional conditions. We develop and apply the Cleaner Hospital Governance Framework (CHGF), integrating DEMATEL, DANP, and VIKOR within a Benefits–Opportunities–Costs–Risks (BOCR) structure to examine how governance mechanisms shape hospital environmental performance. We collected expert assessments from 32 professionals across seven major Panama City hospitals (four public, three private). Results show Benefits and Opportunities, particularly safety culture (B3.3, weight = 0.07), service accessibility (B2.3, weight = 0.06), and regional healthcare coordination (O2.1, weight = 0.10), are primary upstream drivers of environmental performance; Costs and Risks act as downstream outcomes of governance deficiencies. Private hospitals consistently outperform public hospitals across VIKOR sensitivity scenarios (v = 0.1–0.9); ranking deviations remained within ± 0.032, indicating robustness. Public–private disparities in governance maturity correspond to differences in hazardous-waste control, operational efficiency, and pollution-risk exposure. The findings show that strengthening institutional governance capacity, rather than relying solely on technological interventions, is a critical pathway to improving healthcare environmental sustainability. The CHGF offers policymakers a practical decision-support tool to prioritize governance reforms aligned with SDG 3 (Good Health and Well-Being) and SDG 12 (Responsible Consumption and Production) in resource-constrained settings.