Toward Sustainable Healthcare: Investigating Circular Economy Practices, Industrial Ecology Tools, and ISO Standards and Certification

The healthcare sector’s substantial involvement in ecological detriment, with contributions to pollution and emissions of greenhouse gases associated with global warming, has frequently been disregarded. This environmental impact highlights the pressing need for sustainability implementation within the sector. To this end, the research objectives of the Thesis concern (1) the investigation of the Circular Economy (CE) practices within the healthcare sector, recognizing the necessity of CE for reaching sustainability; (2) the suggestion of a combined model of Material Flow Analysis (MFA) and Environmental Risk Assessment (ERA), for establishing a practical and sustainable waste management system in healthcare facilities; (3) the provision of an overview of the literature on ISO standard implementation within the healthcare organizations, since they have emerged as a promising approach to enhancing performance, quality, and sustainability in the sector; (4) the demonstration of practical implications and benefits of integrating ISO standards and JCI accreditation in a real case study. To achieve these research objectives, the study begins with a systematic and bibliometric literature review of CE practices in the healthcare sector. This analysis reveals an important gap regarding the lack of integrated methodologies for waste management that consider environmental risks. Building on these findings, a hybrid ERA-MFA model is developed, offering an innovative management framework for sustainability. This integrated approach enables healthcare facilities to monitor material flows, track the environmental risk associated with waste treatment and implement targeted strategies for waste reduction. Furthermore, through a semi-systematic literature review of ISO standards implementation in healthcare, the research identifies drivers and barriers, with ISO 9001 emerging as particularly prominent. To validate these theoretical findings and demonstrate practical applications, a case study examines the concrete benefits derived from the combined implementation of ISO standards and JCI accreditation. Through the implementation of CE practices, as well as the novel ERA-MFA model for waste management and the ISO standards and JCI implementation, this thesis demonstrates how healthcare organizations could potentially achieve environmental, social, and economic sustainability across their processes.