How hospital environmental managers learn compliance: A learning process model

Recent national media coverage of hospital mismanagement of hazardous materials and waste has brought the practices of all hospitals into public scrutiny. Many people are amazed to learn that there is no national training or accreditation program for environmental management in hospitals. Hospitals are held to the same standards for hazardous materials management as are corporations in the industrial sector. Rural hospitals are particularly challenged because they have few resources. Overall, small hospitals need much improvement, but there are also examples of where individuals have done exemplary innovative work in improving environmental management.;In this study I investigated the challenge rural hospitals face to improving environmental management practices by inquiring into how environmental managers in small rural hospitals in New Hampshire learned to do their job and maintain their skills. I used the constant comparison coding method from grounded theory to generate key categories and concepts that could explain the personal and systematic challenges these individuals face. Using these concepts, I developed a learning process model that demonstrates how the managers initially learned how to do their work and how they went to on to maintain their skills. In cases where individuals excelled and developed innovative practices in their organizations, I inquired into the factors that contributed to their success.;The purpose of the project was to document systematic challenges and obstacles that the managers need to overcome in their work. These can be used to promote recommendations that would enhance the environmental management practices of rural hospitals nationwide. One key obstacle is that hospital management emphasizes income generation over expense shedding and environmental managers have no billing capacity. Consequently, even though improved practices can save costs, the capital needed for these changes is difficult for the managers to secure. Another key obstacle is the regulatory climate of fear under which managers work. The EPA regularly issues threats and warnings without providing managers with the assistance and advice they need to do their jobs well. These and other findings point out the need for training and assistance programs that will help managers do their jobs better.