Strategic Drivers and Institutional Challenges in Implementing Sustainable Practices in the United Arab Emirates (UAE) Healthcare
DOI:
https://doi.org/10.70301/CONF.SBS-JABR.2025.1/1.7Keywords:
Sustainability barriers; , sustainable healthcare, Organizational readiness, Sustainability adoption, UAE healthcare system, Change ManagementAbstract
This study investigates how knowledge, perceived barriers, and enabling resources influence the adoption of sustainable healthcare practices among professionals in the United Arab Emirates (UAE). Employing a mixed-methods design, quantitative data from 512 healthcare workers were analyzed using descriptive statistics, ANOVA, chi-square tests, and multiple regression models, while a qualitative case study of a mid-sized accredited hospital added contextual depth. Findings indicate that awareness of sustainability principles (β = 0.41, p < 0.001) and leadership visibility (β = 0.36, p = 0.002) are strong predictors of engagement, yet implementation is hindered by limited technical expertise, weak institutional coordination, and resource constraints, particularly in private-sector units lacking formal policy structures. Chi-square analysis confirmed a significant association between training availability and adoption (χ²(4, N=512) = 26.47, p < 0.001), while ANOVA revealed significant differences in adoption across institutional types (F(2, 509) = 8.62, p < 0.001). Despite this, 56.3% of professionals reported no formal participation in sustainability initiatives. Leadership visibility and departmental context significantly moderated these relationships, with structured leadership involvement, role-specific training, and dedicated sustainability positions identified as critical enablers. The case study further highlights disparities in analytical capacity and the influence of recognition systems on staff behavior. Drawing on SEST, RBV, TPB, and Kotter’s Change Model, this research proposes the Sustainable Reported Outcomes Measure for Healthcare Sustainability (SROMS), a conceptual framework to guide institutions within a Value-Based Healthcare model. Ethical approval was granted by the Swiss Business School Research Advisory Board. The findings contribute to international sustainability discourse and provide actionable guidance for advancing sustainable practices in healthcare institutions, it informed the development of the Sustainability Reported Outcomes Measure for Healthcare (SROMS), a sector-specific framework that integrates sustainability with quality and safety, offering a practical pathway for adoption in UAE healthcare and beyond.
References
Aboueid, S., Beyene, M., & Nur, T. (2023). Barriers and enablers to implementing environmentally sustainable practices in healthcare: A scoping review and proposed roadmap. Healthcare Management Forum, 36(6), 405–413. https://doi.org/10.1177/08404704231183601
Alkhaldi, M., Moonesar, I. A., Issa, S. T., Okasha, A., Albada, M., Chelli, S., & Takshe, A. A. (2023). Analysis of the United Arab Emirates’ contribution to the sustainable development goals with a focus on global health and climate change. International Journal of Health Governance, 28(4), 357-367. https://doi.org/10.1108/IJHG-04-2023-0040
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T
Barney, J. (1991). Firm resources and sustained competitive advantage. Journal of Management, 17(1), 99–120. https://doi.org/10.1177/014920639101700108
Calabrese, A., Forte, G., & Gabrielli, L. (2023). Greening healthcare: A systematic review of global best practices. Sustainability, 15(4), 2345. https://doi.org/10.3390/su15042345
D’Andreamatteo, A., Ianni, L., Lega, F., & Sargiacomo, M. (2015). Lean in healthcare: A comprehensive review. Health Policy, 119(9), 1197–1209. https://doi.org/10.1016/j.healthpol.2015.02.002
Eckelman, M. J., & Sherman, J. D. (2018). Environmental impacts of the U.S. health care system and effects on public health. PLOS ONE, 11(6), e0157014. https://doi.org/10.1371/journal.pone.0157014
Folke, C., Carpenter, S. R., Walker, B., Scheffer, M., Chapin, T., & Rockström, J. (2010). Resilience thinking: Integrating resilience, adaptability and transformability. Ecology and Society, 15(4), 20. https://www.ecologyandsociety.org/vol15/iss4/art20/
Geneva Sustainability Centre. (2023). Hospitals for a sustainable future: Tools for healthcare leaders. International Hospital Federation. https://www.ihf-fih.org (policy resource, based in Geneva).
Karliner, J., Slotterback, S., Boyd, R., Ashby, B., & Steele, K. (2019). Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action. Health Care Without Harm & Arup. https://noharm-global.org/documents/health-care-climate-footprint-report
Karliner, J., & Eckelman, M. J. (2020). Climate-smart healthcare: Low-carbon and resilient health systems. The Lancet Planetary Health, 4(2), e48–e50. https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30004-3/fulltext
Khan, M., Hussain, M., Gunasekaran, A., Ajmal, M. M., & Helo, P. T. (2018). Motivators of social sustainability in healthcare supply chains in the UAE—Stakeholder perspective. Sustainable Production and Consumption, 14, 95–104. https://doi.org/10.1016/j.spc.2018.02.005
Kotter, J. P. (1996). Leading change. Harvard Business School Press.
Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., … Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global Health, 6(11), e1196–e1252. https://doi.org/10.1016/S2214-109X(18)30386-3
Lenzen, M., Malik, A., Li, M., Fry, J., Weisz, H., Pichler, P.-P., … & Pencheon, D. (2020). The environmental footprint of health care: A global assessment. The Lancet Planetary Health, 4(7), e271–e279. https://doi.org/10.1016/S2542-5196(20)30121-2
Mastria, S., Vezzil, A., & De Cesarei, A. (2023). Going green: A review on the role of motivation in sustainable behavior. Sustainability, 15(21), 15429. https://doi.org/10.3390/su152115429
Ministry of Health and Prevention (UAE). (2021). UAE Statistical Annual Health Sector Report 2021. https://mohap.gov.ae/documents/37849/874734/UAE%2BStatistical%2BAnnual%2BReport%2B2021.pdf
Mitchell, R., Parker, V., Giles, M., & Boyle, B. (2019). The impact of team knowledge on healthcare sustainability initiatives. Journal of Health Organization and Management, 33(2), 175–191. https://doi.org/10.1108/JHOM-09-2017-0236
Olawade, D. B., Popoola, T. T., Egbon, E., & David-Olawade, A. C. (2025). Sustainable healthcare practices: Pathways to a carbon-neutral future for the medical industry. Sustainable Futures, 9, 100783. https://doi.org/10.1016/j.sftr.2025.100783
Ostrom, E. (2009). A general framework for analyzing sustainability of social-ecological systems. Science, 325(5939), 419–422. https://doi.org/10.1126/science.1172133
Radwan, A., & Khalil, H. (2021). Drivers and barriers to environmental sustainability in UAE hospitals. International Journal of Healthcare Management, 14(1), 34–41. https://doi.org/10.1080/20479700.2019.1704812
United Arab Emirates Ministry of Climate Change and Environment. (2017). National climate change plan of the United Arab Emirates 2017–2050. Ministry of Climate Change and Environment. https://www.moccae.gov.ae
United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development. United Nations. https://sdgs.un.org/2030agenda
U.S. Environmental Protection Agency. (2024, October). Technical support document: 2021 Emissions Modeling (EMismod). https://www.epa.gov/system/files/documents/2025-06/2021_emismod_tsd_october2024.pdf
World Health Organization (WHO) (2017) World Health Statistics 2017: Monitoring Health for the SDGs, Sustainable Development Goals. WHO, Geneva.
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