| The healthcare is a highly regulated sector and an important economic actor. According to the latest statistics, close to 10,6% of Canada's GDP is devoted to healthcare and the healthcare system is the third largest employer in the country with 1,9 million employees. Hospitals play a strategic and central role in the healthcare sector, are complex systems and, generate huge amounts of wastes that have adverse effect on human health and on the environment. It seems therefore rather pertinent to propose a framework for sustainable wastes management in the healthcare sector, and more specifically for the wastes generated by hospitals.;From on-site observations and interviews conducted during the field study, it also became evident that the typology of healthcare wastes as proposed in the literature should also include an important type of waste, namely electronic medical equipment. In fact, not only electronic medical equipment is omnipresent in hospitals but it is highly sophisticated and present severe environmental problems that do not seem to be covered by the actual regulatory framework. Finally, the coordinated continuum of wastes management activities that are under the responsibilities of the suppliers of electronic medical equipment could be validated. Such an approach builds on the product stewardship concept and avoids that environmental burdens are shifted from one stage of the product lifecycle to the next stage.;The results from the field research serve as valuable inputs to the survey design. The questionnaire was sent to North-American firms responsible for manufacturing electronic medical equipment. The total number of responding firms was 59 firms and the response rate was 6,7%. As the survey was conducted for exploratory purposes, this critical mass of firms although rather small is sufficient enough to carry univariate and bivariate statistical analyses. Results from the survey indicate that, with 156 full-time employees in average, the responding firms are highly internationalized. Their customers (i.e. hospitals) are sophisticated and demanding. Their products life cycle is approximately eleven years in average. More than half of these firms have implemented TQM programs but very few (3%) are certified ISO 14 000. The environmental initiatives undertaken by the suppliers of electronic medical equipment directly affect their own organizations, the hospitals, the wastes treatment and disposal organizations, and all the organizations previously mentioned. These initiatives are rather modest. The main drivers of the environmental initiatives are the customers' requirements (i.e. hospitals) and market opportunities while actual and projected regulations seem to play a moderate role. The impacts of these environmental initiatives for the suppliers of medical electronic equipment are mostly market driven opportunities and building environmental capabilities.;Relationships between firms' characteristics and environmental initiatives are weak but proactive environmental initiatives are significantly and positively related to an aggressive technology strategy, to demanding and sophisticated customers, and to alleged benefits, in particular some market driven and cost reduction opportunities. The strong and positive relationships between environmental initiatives and new knowledge and new competencies acquisition may indicate a self reinforcing phenomenon where the first environmental initiatives among suppliers of medical electronic equipment allow to build some environmental capabilities that will eventually translate into more proactive environmental initiatives, thereby generating a positive impact on the waste management activities of the organizations downstream (hospitals, wastes treatment and disposal organizations). The uptake of a sustainable healthcare wastes management is largely dependent on the actions of organizations located upstream.;A sustainable wastes management framework implies that healthcare wastes are minimized, even eliminated. It also requires strong product stewardship and adequate options at the end of product life cycle. It therefore points to a network of organizations that provides or arranges to provide a coordinated continuum of wastes management activities. A field study was conducted in order to obtain some preliminary empirical evidence on such network and gain insights into hospital wastes management. The main results from the field study are as follows. First, entities of the inter-organizational network for wastes could be identified and their respective roles could be outlined. The five broad groups of entities may be retained, namely the suppliers that provide the necessary inputs for hospitals' activities, the hospitals themselves which "consume" these inputs and transform them into waste, the waste treatment and disposal organizations that handle, treat, recycle and dispose of wastes. |
