Enablers for, and barriers to, implementing environmental sustainability initiatives in hospitals in South Africa
The global threat of climate change is one of the most crucial environmental issues facing the world in modern times. Every organisation doing business has a duty to stem this tide, and the health care industry - hospitals in particular - is no exception. However, in trying to implement environmental sustainability initiatives, organisations are faced with a number of challenges, and unless drivers of and barriers to sustainability are identified, there will likely be a disconnect between the desired outcomes of policies on environmental sustainability. This study, set within the hospital industry, sought to identify what hospitals are doing to curb this environmental scourge, and in the same vein identify various enablers of and barriers to the implementation of environmental sustainability initiatives in South Africa. Following a literature review identifying some of the initiatives implemented in other industries and hospitals in other countries, and a review of factors that enable and hinder the implementation of sustainability initiatives, this thesis undertook qualitative enquiry among the private and public hospitals in the Gauteng region of South Africa. Use was made of semi-structured interviews, where a questionnaire was used to guide the researcher’s interview process. A total of 17 respondents were interviewed covering ten hospitals of which three were private institutions. Data collected was analysed using the coding technique and was compared and contrasted to the literature in a process of explanation building. It was possible to identify six categories of initiatives being implemented: policy initiatives, water conservation, energy conservation, green built environment, behavioural and organisational structure initiatives. It was also possible to elicit a total of five enablers and six barriers in the study that were all coded into themes. The five enablers were: compliance to policy (both internal and external policy); top management support; availability of suitable equipment; an enabling iii human resource strategy and availability of guidance documents. The six themes that formed barriers were: lack of demand from stakeholders; lack of a conducive organisational culture; inadequate resources; infrastructural challenges; unclear policy guidance and technical and information challenges. Furthermore, in contrast to some of the literature findings only four enablers were identified as being relevant to the study and these were organisational support, clear policy; regulatory enablers and traceability. Of the barriers, knowledge deficiency, lack of staff motivation and lack of funding emerged as the most inhibiting. The main recommendation from this study is the need to develop a policy on environmental sustainability in hospitals that will, through a consultative process, guide actions of all parties involved in sustainability. This policy should take into account the findings from this research on enablers and barriers. Further, more work needs to be done in understanding the initiatives that would work in a hospital environment, including creating models to measure the impact of any initiative or even making an investment case before such implementation. Internal strategies are needed to maintain any momentum created on sustainability, such as support from top management, a clearly communicated organisational strategy, staff motivation and, indeed, allocation of appropriate resources to the environmental sustainability cause. It is proposed that the government, especially the National Departments of Health, of Environmental Affairs and of Public Works, should promulgate enabling legislation and a framework which would encourage the implementation, monitoring and evaluation of environmental sustainability initiatives in South Africa.
Environmental sustainability, Hospitals