IDEAS home Printed from https://ideas.repec.org/a/gam/jsusta/v17y2025i11p5156-d1671547.html
   My bibliography  Save this article

Integrated Quality and Environmental Management in Healthcare: Impacts, Implementation, and Future Directions Toward Sustainability

Author

Listed:
  • Dana-Gabriela Simion Ludușanu

    (Department of Environmental Engineering and Management, “Cristofor Simionescu” Faculty of Chemical Engineering and Environmental Protection, “Gheorghe Asachi” Technical University of Iasi, 700050 Iasi, Romania
    Institute of Cardiovascular Diseases, 50 Carol I Blvd., 700503 Iasi, Romania)

  • Daniela-Ionela Fertu

    (Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galati, 35 Al.I. Cuza Street, 800010 Galati, Romania)

  • Grigore Tinică

    (Institute of Cardiovascular Diseases, 50 Carol I Blvd., 700503 Iasi, Romania
    Department of Surgery I, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitații Street, 700115 Iași, Romania
    Academy of Romanian Scientists, 3 Ilfov Street, 050044 Bucharest, Romania)

  • Maria Gavrilescu

    (Department of Environmental Engineering and Management, “Cristofor Simionescu” Faculty of Chemical Engineering and Environmental Protection, “Gheorghe Asachi” Technical University of Iasi, 700050 Iasi, Romania
    Academy of Romanian Scientists, 3 Ilfov Street, 050044 Bucharest, Romania
    Academy of Technical Sciences of Romania, 26 Dacia Blvd., 010413 Bucharest, Romania)

Abstract

Healthcare institutions are under increasing pressure to deliver high-quality, patient-centered care while reducing their environmental footprint. Integrating quality and environmental management systems (ISO 9001 and ISO 14001) into a unified integrated management system (IMS) offers a potential pathway to meet these dual imperatives. This study investigates the effects of IMS implementation in three European hospitals through a comparative qualitative analysis of institutional reports, audit documentation, and performance indicators. The methodology combines a literature-informed conceptual framework with a multi-case analysis guided by four domains: environmental impact, care quality, process efficiency, and stakeholder engagement. The data were collected from institutional documentation over a six-year period (three years before and after IMS implementation), covering key indicators such as energy and water consumption, medical waste recycling, audit compliance, and patient satisfaction. The findings show that IMS adoption was associated with a 20–28% improvement in resource efficiency, increased recycling rates, and consistent gains in compliance and satisfaction metrics. These results were supported by strategic leadership, cross-functional training, and digital monitoring tools. The study concludes that IMS enhances institutional performance and sustainability while aligning healthcare operations with broader governance and policy goals. Further research is recommended to explore the long-term impacts and generalize the findings across healthcare systems.

Suggested Citation

  • Dana-Gabriela Simion Ludușanu & Daniela-Ionela Fertu & Grigore Tinică & Maria Gavrilescu, 2025. "Integrated Quality and Environmental Management in Healthcare: Impacts, Implementation, and Future Directions Toward Sustainability," Sustainability, MDPI, vol. 17(11), pages 1-46, June.
    • Handle: RePEc:gam:jsusta:v:17:y:2025:i:11:p:5156-:d:1671547
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/2071-1050/17/11/5156/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/2071-1050/17/11/5156/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Sang M. Lee & DonHee Lee, 2022. "Developing Green Healthcare Activities in the Total Quality Management Framework," IJERPH, MDPI, vol. 19(11), pages 1-20, May.
    2. Alfonso Marino & Paolo Pariso & Michele Picariello, 2024. "Organizational and Energy Efficiency Analysis of Italian Hospitals and Identification of Improving AI Solutions," International Journal of Energy Economics and Policy, Econjournals, vol. 14(6), pages 628-640, November.
    3. van Schie, Vera, 2024. "Governance related factors influencing the implementation of sustainability in hospitals: A systematic literature review," Health Policy, Elsevier, vol. 146(C).
    4. Alfonso González González & Justo García-Sanz-Calcedo & David Rodríguez Salgado, 2018. "Evaluation of Energy Consumption in German Hospitals: Benchmarking in the Public Sector," Energies, MDPI, vol. 11(9), pages 1-14, August.
    5. Anna Pohle & Knut Blind & Dmitry Neustroev, 2018. "The Impact of International Management Standards on Academic Research," Sustainability, MDPI, vol. 10(12), pages 1-19, December.
    6. Shahbaz, Muhammad & Gao, Changyuan & Zhai, LiLi & Shahzad, Fakhar & Khan, Imran, 2021. "Environmental air pollution management system: Predicting user adoption behavior of big data analytics," Technology in Society, Elsevier, vol. 64(C).
    7. Lepore, Dominique & Dolui, Koustabh & Tomashchuk, Oleksandr & Shim, Heereen & Puri, Chetanya & Li, Yuan & Chen, Nuoya & Spigarelli, Francesca, 2023. "Interdisciplinary research unlocking innovative solutions in healthcare," Technovation, Elsevier, vol. 120(C).
    8. Aldona Frączkiewicz-Wronka & Tomasz Ingram & Karolina Szymaniec-Mlicka & Piotr Tworek, 2021. "Risk Management and Financial Stability in the Polish Public Hospitals: The Moderating Effect of the Stakeholders’ Engagement in the Decision-Making," Risks, MDPI, vol. 9(5), pages 1-23, May.
    9. Matthew J Eckelman & Jodi D Sherman & Andrea J MacNeill, 2018. "Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis," PLOS Medicine, Public Library of Science, vol. 15(7), pages 1-16, July.
    10. Domenico Bevere & Nicola Faccilongo, 2024. "Shaping the Future of Healthcare: Integrating Ecology and Digital Innovation," Sustainability, MDPI, vol. 16(9), pages 1-20, May.
    11. Maria Psillaki & Nikolaos Apostolopoulos & Ilias Makris & Panagiotis Liargovas & Sotiris Apostolopoulos & Panos Dimitrakopoulos & George Sklias, 2023. "Hospitals’ Energy Efficiency in the Perspective of Saving Resources and Providing Quality Services through Technological Options: A Systematic Literature Review," Energies, MDPI, vol. 16(2), pages 1-21, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Aurel Mihail Titu & Alina Bianca Pop, 2025. "Integrated Quality Management for Automotive Services—Addressing Gaps with European and Japanese Principles," Sustainability, MDPI, vol. 17(20), pages 1-36, October.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Chro Hama Radha, 2023. "Retrofitting for Improving Indoor Air Quality and Energy Efficiency in the Hospital Building," Sustainability, MDPI, vol. 15(4), pages 1-20, February.
    2. Mohammad Daradkeh, 2023. "Exploring the Curvilinear Relationship between Academic-Industry Collaboration Environment and Innovation Performance: A Multilevel Perspective," Sustainability, MDPI, vol. 15(10), pages 1-20, May.
    3. Catherine Lalman & Hirushie Karunathilake & Rajeev Ruparathna, 2023. "To Dispose or to Reuse? Analyzing the Life Cycle Impacts and Costs of Disposal, Sterilization, and Reuse of Electrophysiological Catheters," Sustainability, MDPI, vol. 15(6), pages 1-23, March.
    4. Jessica F. Davies & Forbes McGain & Jillian J. Francis, 2023. "Consensus on Prioritisation of Actions for Reducing the Environmental Impact of a Large Tertiary Hospital: Application of the Nominal Group Technique," IJERPH, MDPI, vol. 20(5), pages 1-15, February.
    5. Ahmet Bircan Atmaca & Gülay Zorer Gedik & Andreas Wagner, 2021. "Determination of Optimum Envelope of Religious Buildings in Terms of Thermal Comfort and Energy Consumption: Mosque Cases," Energies, MDPI, vol. 14(20), pages 1-17, October.
    6. Vanesa Jiménez-Lacarra & Eduardo Martínez-Cámara & Juan Carlos Sáenz-Diez Muro & Emilio Jiménez-Macías & Julio Blanco-Fernández, 2024. "Environmental Benefits of Reducing Patient Mobility and Hospitalization," Sustainability, MDPI, vol. 16(24), pages 1-15, December.
    7. Yi Feng & Diyun Peng & Yafei Li & Shuai Liu, 2024. "Can regional integration reduce carbon intensity? Evidence from city cluster in China," Environment, Development and Sustainability: A Multidisciplinary Approach to the Theory and Practice of Sustainable Development, Springer, vol. 26(2), pages 5249-5274, February.
    8. Emanuel George Mesteru, 2025. "Sustainability in the Management of the Private Medical Sector in Romania: A European, USA and Japan Comparison," Sustainability, MDPI, vol. 17(12), pages 1-27, June.
    9. Or, Zeynep & Seppänen, Anna-Veera, 2024. "The role of the health sector in tackling climate change: A narrative review," Health Policy, Elsevier, vol. 143(C).
    10. Klemeš, Jiří Jaromír & Fan, Yee Van & Jiang, Peng, 2020. "The energy and environmental footprints of COVID-19 fighting measures – PPE, disinfection, supply chains," Energy, Elsevier, vol. 211(C).
    11. Solomon Dargie Chekole & Walter Timo de Vries & Pamela Durán-Díaz & Gebeyehu Belay Shibeshi, 2020. "Performance Evaluation of the Urban Cadastral System in Addis Ababa, Ethiopia," Land, MDPI, vol. 9(12), pages 1-14, December.
    12. Robert H. Sarikas & Elizabeth Tipton & Andy Fodor & Arsen M. Djatej, 2023. "Sustainability Methodologies and Sustainability-linked Senior Management Compensation Policies: An Analysis of Relationships for Global Companies in the Healthcare and Educational Services Sectors," Environmental Management and Sustainable Development, Macrothink Institute, vol. 12(1), pages 82-109, December.
    13. Soo Jung Oh & Shufeng (Simon) Xiao & Byung Il Park & Taewoo Roh, 2025. "Coping or threat? Unraveling the mechanisms enabling user acceptance of blockchain technologies," Information Technology and Management, Springer, vol. 26(2), pages 219-233, June.
    14. Benedetto, Vera & Ferrè, Francesca & Nuti, Sabina, 2024. "Including environmental and social sustainability in the planning process of healthcare services: A case study of cancer screening programs in an inner area in Italy," Health Policy, Elsevier, vol. 144(C).
    15. Yuan, Yun-Peng & Tan, Garry Wei-Han & Ooi, Keng-Boon, 2025. "What shapes mobile fintech consumers' post-adoption experience? A multi-analytical PLS-ANN-fsQCA perspective," Technological Forecasting and Social Change, Elsevier, vol. 217(C).
    16. Ibrahim Alkish & Kolawole Iyiola & Ahmad Bassam Alzubi & Hasan Yousef Aljuhmani, 2025. "Does Digitization Lead to Sustainable Economic Behavior? Investigating the Roles of Employee Well-Being and Learning Orientation," Sustainability, MDPI, vol. 17(10), pages 1-29, May.
    17. Masoumeh Vali & Khodakaram Salimifard & Amir H. Gandomi & Thierry J. Chaussalet, 2022. "Care process optimization in a cardiovascular hospital: an integration of simulation–optimization and data mining," Annals of Operations Research, Springer, vol. 318(1), pages 685-712, November.
    18. Maria Chanioti & Georgios Nikolelis & Ioanna Mitsika & Maria Antoniadou, 2025. "The Role of Dentists in Promoting Environmental Awareness and Climate Consciousness for Sustainability," Circular Economy and Sustainability, Springer, vol. 5(4), pages 3645-3669, August.
    19. Cristina Ventura & Ferdinando Chiacchio & Diego D’Urso & Giuseppe Marco Tina & Gabino Jiménez Castillo & Ludovica Maria Oliveri, 2025. "An AHP-Based Multicriteria Framework for Evaluating Renewable Energy Service Proposals in Public Healthcare Infrastructure: A Case Study of an Italian Hospital," Energies, MDPI, vol. 18(17), pages 1-34, September.
    20. Florence Degavre & Suzanne Kieffer & David Bol & Rémi Dekimpe & Charlotte Desterbecq & Thibault Pirson & Georgiana Sandu & Sandy Tubeuf, 2022. "Searching for Sustainability in Health Systems: Toward a Multidisciplinary Evaluation of Mobile Health Innovations," Sustainability, MDPI, vol. 14(9), pages 1-17, April.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jsusta:v:17:y:2025:i:11:p:5156-:d:1671547. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.