Analysis of regulatory compliance and environmental management in public hospitals: the case of hospital de especialidades Portoviejo, Ecuador

Abstract

Introduction: Hospital environmental management is critical for healthcare sustainability. Ecuador has an updated regulatory framework, but a gap persists between its formulation and effective application in public hospitals. Objective: To comprehensively evaluate the level of regulatory compliance and the effectiveness of environmental management implemented at the Hospital de Especialidades Portoviejo, Ecuador. Materials and Methods: Quantitative, non-experimental, cross-sectional, descriptive-correlational, field and bibliographic study. Population of 1,361 staff; stratified probabilistic sample of 300 valid records. A 44-item 5-point Likert questionnaire, regulatory checklist, and direct observation were applied. Analysis used SPSS v26; total Cronbach’s alpha = 0.982. Results: The global mean was 3.43/5 (≈68.6%), median 3.46, SD 0.75. The best dimension was training and commitment (3.51); the worst was hospital waste management (3.28), with low scores for segregation at source (3.20), integral waste plan (3.25/3.24), and financial resources (3.22). High positive correlations were found among dimensions (r = 0.746–0.830; p < 0.01). Managers perceived management better (4.16) than physicians (3.33). Training made a significant difference (3.63 vs 3.30; p < 0.001). Conclusions: A gap exists between the regulatory framework and its effective implementation. Environmental management is limited by insufficient resources, training, institutional control, and the absence of a formal environmental management system. Processes must be optimized, oversight strengthened, and a culture of compliance and environmental responsibility promoted.