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<p>Achieving sustainability in healthcare facilities requires an integrated approach that combines environmental, social, and governance (ESG) dimensions with the principles of the circular economy. This study aims to identify and structure the key drivers of sustainable and circular hospitals using a hybrid methodology: Delphi technique, Interpretive Structural Modeling (ISM), and MICMAC analysis. Twelve sustainability factors were identified from literature and refined through expert consultation involving eight professionals from hospitals, academia, and public health institutions. The study incorporates circular economy principles—such as reducing resource consumption, promoting reuse and recycling, and minimizing environmental impact—into healthcare settings. These are reflected in foundational drivers like energy efficiency (F1), water conservation (F2), and integrated waste management (F3), which align with circular practices in infrastructure and operations. Through ISM, a five-level hierarchical model was developed to map the interrelationships among the factors, while MICMAC analysis classified them based on their driving and dependence power. The hierarchy places energy management (F1) at Level 5; water and waste management (F2, F3) at Level 4; green procurement and green building design (F4, F5) at Level 3; sustainable transportation (F6) at Level 2; and safety, comfort, quality of care, staff well-being, governance and leadership, and sustainability transparency (F7–F12) at Level 1. In terms of MICMAC classification, the variables are grouped into drivers (F1–F5), linkage (F6), dependent (F7–F12), with no autonomous factors identified. Results show that environmental factors rooted in circular economy practices are the primary enablers of hospital sustainability. Meanwhile, social and governance outcomes—such as patient safety, service quality, and transparency—are positioned as dependent variables. This structured framework provides valuable insights for hospital administrators and policymakers seeking to adopt circular and sustainable approaches. It supports strategic planning for green infrastructure, efficient resource use, and improved health service delivery. The methodological integration also offers a replicable decision-support model for embedding circularity in public health systems. Future studies are encouraged to expand the scope through broader stakeholder engagement and policy scenario analysis.</p>

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A Multi-Method Framework for Prioritizing Circular Economy Drivers in Sustainable Hospitals

  • 期刊论文

  • 发表日期：

    2026年3月3日

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  • Asep Marfu,
  • Agung Purwanto,
  • Dwi Atmanto,
  • Henita Rahmayanti,
  • Arita Marini,
  • Desy Safitri,
  • Vera Julia,
  • Leola Dewiyani,
  • Rezeqi Hardam Saputro,
  • Nindhita Priscillia Muharrani,
  • Septantri Shinta Wulandari,
  • Anna Sofia Atichasari

摘要

Achieving sustainability in healthcare facilities requires an integrated approach that combines environmental, social, and governance (ESG) dimensions with the principles of the circular economy. This study aims to identify and structure the key drivers of sustainable and circular hospitals using a hybrid methodology: Delphi technique, Interpretive Structural Modeling (ISM), and MICMAC analysis. Twelve sustainability factors were identified from literature and refined through expert consultation involving eight professionals from hospitals, academia, and public health institutions. The study incorporates circular economy principles—such as reducing resource consumption, promoting reuse and recycling, and minimizing environmental impact—into healthcare settings. These are reflected in foundational drivers like energy efficiency (F1), water conservation (F2), and integrated waste management (F3), which align with circular practices in infrastructure and operations. Through ISM, a five-level hierarchical model was developed to map the interrelationships among the factors, while MICMAC analysis classified them based on their driving and dependence power. The hierarchy places energy management (F1) at Level 5; water and waste management (F2, F3) at Level 4; green procurement and green building design (F4, F5) at Level 3; sustainable transportation (F6) at Level 2; and safety, comfort, quality of care, staff well-being, governance and leadership, and sustainability transparency (F7–F12) at Level 1. In terms of MICMAC classification, the variables are grouped into drivers (F1–F5), linkage (F6), dependent (F7–F12), with no autonomous factors identified. Results show that environmental factors rooted in circular economy practices are the primary enablers of hospital sustainability. Meanwhile, social and governance outcomes—such as patient safety, service quality, and transparency—are positioned as dependent variables. This structured framework provides valuable insights for hospital administrators and policymakers seeking to adopt circular and sustainable approaches. It supports strategic planning for green infrastructure, efficient resource use, and improved health service delivery. The methodological integration also offers a replicable decision-support model for embedding circularity in public health systems. Future studies are encouraged to expand the scope through broader stakeholder engagement and policy scenario analysis.