Driving Excellence in Environmental Health Development in Hospitals: A Case Study of Medical Waste Management in Mahasarakham Province

Abstract

Purposes : To examine the model and outcomes of driving the development of environmental health in hospitals toward sector-specific excellence, focusing on medical waste management in Mahasarakham Province.

Study design : Action research.

Materials and Methods : Key informants were environmental health and medical waste management personnel from 13 hospitals, totaling 20 participants. The study was conducted from January 2023 to October 2025 (B.E. 2566–2568) in three phases: Phase 1 situational analysis; Phase 2 implementation of development activities based on the P-A-O-R framework of Kemmis and McTaggart, comprising four main steps: (1) Planning, (2) Action, (3) Observation, and (4) Reflection, conducted over three cycles; and Phase 3 evaluation. Data collection instruments included standard operating procedure (SOP) checklists, a situational data collection form, focus group discussion guidelines, and a satisfaction assessment questionnaire. Quantitative data were analyzed using frequency, percentage, median, and range. Qualitative data were analyzed using content analysis.

Main findings : The operational driving model comprises nine stages: (1) policy-driven mobilization (2) capacity building of personnel (3) establishment of support systems (4) utilization of effective communication mechanisms (5) preparedness prior to assessment (6) targeted empowerment visits and supervision; (7) documentation preparation and encouraging the assessment process (8) knowledge sharing and scaling up  and (9) lesson learned extraction and evaluation. Implementation of these stages resulted in seven hospitals (53.8%) achieving the GCHC “Challenging Level” accreditation in medical waste management, thereby meeting the development targets of Mahasarakham Province and the Ministry of Public Health. Furthermore, the province recorded the highest number of hospitals meeting the criteria within Health Region 7.

Conclusion and recommendations : Key success factors included clearly defined goals; aligned and facilitative evaluation criteria; continuous development; mentoring and peer-support systems; knowledge-sharing activities; and a strong network of practitioners. It is recommended that this model be scaled up to hospitals outside the Ministry of Public Health system and that future studies examine outcome indicators related to costs and waste volume reduction.