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

Dana-Gabriela Simion Ludușanu, Daniela-Ionela Fertu (), Grigore Tinică and Maria Gavrilescu ()
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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
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
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

Sustainability, 2025, vol. 17, issue 11, 1-46

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.

Keywords: environmental sustainability; healthcare quality; hospital management; Integrated Management Systems; ISO 9001; ISO 14001; patient satisfaction (search for similar items in EconPapers)
JEL-codes: O13 Q Q0 Q2 Q3 Q5 Q56 (search for similar items in EconPapers)
Date: 2025
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