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. 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).
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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).
    7. 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.
    8. 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.
    9. Domenico Bevere & Nicola Faccilongo, 2024. "Shaping the Future of Healthcare: Integrating Ecology and Digital Innovation," Sustainability, MDPI, vol. 16(9), pages 1-20, May.
    10. 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.
    11. van Schie, Vera, 2024. "Governance related factors influencing the implementation of sustainability in hospitals: A systematic literature review," Health Policy, Elsevier, vol. 146(C).
    Full references (including those not matched with items on IDEAS)

    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. Hensher, Martin & Canny, Ben & Zimitat, Craig & Campbell, Julie & Palmer, Andrew, 2020. "Health care, overconsumption and uneconomic growth: A conceptual framework," Social Science & Medicine, Elsevier, vol. 266(C).
    4. Alla Mostepaniuk & Turgay Akalin & Mohammad Reza Parish, 2023. "Practices Pursuing the Sustainability of A Healthcare Organization: A Systematic Review," Sustainability, MDPI, vol. 15(3), pages 1-21, January.
    5. Reem F. Alruwaili & Nourah Alsadaan & Abeer Nuwayfi Alruwaili & Afrah Ghazi Alrumayh, 2023. "Unveiling the Symbiosis of Environmental Sustainability and Infection Control in Health Care Settings: A Systematic Review," Sustainability, MDPI, vol. 15(22), pages 1-16, November.
    6. 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.
    7. 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.
    8. Changchun Zhu & Jianguo Du & Fakhar Shahzad & Muhammad Umair Wattoo, 2022. "Environment Sustainability Is a Corporate Social Responsibility: Measuring the Nexus between Sustainable Supply Chain Management, Big Data Analytics Capabilities, and Organizational Performance," Sustainability, MDPI, vol. 14(6), pages 1-20, March.
    9. 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.
    10. Sang M. Lee & DonHee Lee, 2022. "Effective Medical Waste Management for Sustainable Green Healthcare," IJERPH, MDPI, vol. 19(22), pages 1-17, November.
    11. David Duindam, 2022. "Transitioning to Sustainable Healthcare: Decarbonising Healthcare Clinics, a Literature Review," Challenges, MDPI, vol. 13(2), pages 1-20, December.
    12. 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.
    13. Knut Blind & Alex Fenton, 2022. "Standard-relevant publications: evidence, processes and influencing factors," Scientometrics, Springer;Akadémiai Kiadó, vol. 127(1), pages 577-602, January.
    14. 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.
    15. 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.
    16. François, Agnès & Roche, Robin & Grondin, Dominique & Winckel, Nastasya & Benne, Michel, 2024. "Investigating the use of hydrogen and battery electric vehicles for public transport: A technical, economical and environmental assessment," Applied Energy, Elsevier, vol. 375(C).
    17. Agnieszka Ociepa-Kubicka & Iwona Deska & Ewa Ociepa, 2021. "Organizations towards the Evaluation of Environmental Management Tools ISO 14001 and EMAS," Energies, MDPI, vol. 14(16), pages 1-19, August.
    18. 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).
    19. 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).
    20. 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.

    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.