Ergoecology Factors Influencing Healthy and Sustainable Workplace in Healthcare Organisation

Abstract

Ergoecology in sustainable healthcare refers to incorporating the aspects of ergonomics, which emphasises tailoring the healthy workplace to the abilities and constraints of healthcare employees, and ecological considerations, which consider the overall environmental impact of healthcare activities. The purpose of this study is to identify ergoecology factors influencing healthy and sustainable workplaces in the context of healthcare organisations and to develop a conceptual model. Literature review and opinions of healthcare experts have opted to identify the factors influencing ergoecology in healthcare organisations. The identified factors were face-validated by the healthcare experts. Scheduled interviews and closed-ended questionnaires were employed to collect data for this research. This research employed total interpretive structural modelling (TISM) and matrix multiplication applied to classification (MICMAC) analysis. TISM methodology is utilised to better comprehend how the components interact with one another, and why. MICMAC analysis is employed to prioritise factors and categorise these factors into four categories: driving factors, autonomous factors, dependent factors, and linkage factors. It is observed that analysis of surroundings and the adoption of ecological and ergonomic measures have strong driving power, but weak dependence. These factors are key factors and are termed as independent factors of ergoecology in healthcare for a healthy and sustainable workplace. The structural model and methodological approach are employed in a healthcare organisation; this approach can be extended to different industries in the future. This study helps to understand the concept of ergoecology and the influencing factors for ergoecology in the context of healthcare organisations. Ergoecology concept not only benefits the environment and the health of healthcare employees but also boosts productivity within the healthcare industry. In this study, the total interpretive structural modelling and matrix multiplication applied to classification analysis for healthcare is proposed as an innovative approach to address the ergo-ecology concept in the context of healthcare for a healthy and sustainable workplace to improve productivity within the healthcare industry.

1. Introduction

During the 20th century, occupational health was conceptualised and developed on a global scale [1]. Occupational health and safety issues are common in healthcare facilities [2]. Healthcare organisations are vital in delivering necessary medical care, support, and services to communities and individuals. These organisations represent the foundation of the healthcare system and are crucial to wellness promotion, disease prevention, and providing healthcare to those in need. Recognising the distinctive ways that healthcare professionals are trained and socialised is essential to creating healthy work conditions in the industry [3]. Workplace health is a global trend and a key component of national policy since it helps to improve employees’ health, organisation productivity, and competitiveness on a global scale. The workplace has a significant impact on employees’ physical and emotional health [4]. Healthcare organisations play a crucial role in promoting sustainability in addition to delivering necessary medical services and treatment. In accordance with the sustainability movement, it is critical to use ecological and ergonomic viewpoints to create initiatives for environmental protection and the creation of sustainable service designs [5]. Ergoecology aims to focus on real sustainable dynamics between systems, often known as system coexistence or co-dependence [6]. The ultimate objective of ergoecology is to reduce the distinction between natural and built environments for a sustainable workplace. García–Acosta [5] developed a conceptual idea that elaborates on ergoecology impact on the direction that ergonomics takes in the future.

According to the International Labour Organisation (ILO), despite the global commitment to occupational safety and health (OSH) established in the 2030 sustainable development goals (SDGs), incidents of work-related accidents and illnesses continue to be prevalent. The ILO particularly emphasises the direct impact of OSH on SDG, which aims to ensure the health and well-being of people across all age groups. Workers, companies, societies, and economies as a whole target to have a safe and wellness-promoting workplace [7]. Ergoecology in a healthcare organisation is an integrated approach that integrates the concepts of ergonomics with ecological sustainability. It focuses on streamlining healthy workplace procedures to improve patient care, support the well-being of healthcare workers, and reduce the negative impact of healthcare operations on the environment. Maintaining the health and safety of working populations has become a growing issue of concern as a result of the rapid globalisation and technology advancements that have sparked changes in the workplace over the last 20 years [8]. Research in the field of ergoecology can aid in the transition to a greener economy and healthy workplace. This study is an attempt in this direction to understand the concept of ergoecology and the influencing factors for ergoecology for a healthy and sustainable workplace in the context of healthcare organisations. Ergoecology concept not only benefits the environment and the health of healthcare employees but also boosts productivity within the healthcare industry.

The objectives of this research are: (a) identify the ergoecology factors for a healthy and sustainable workplace in healthcare organisations; (b) analyse the inter-connections among the ergoecology factors using total interpretive structural modelling and (c) classify and rank these factors based on the factors dependence and driving power by using matrix multiplication applied to classification analysis. To achieve these objectives, four research questions (RQs) are set: RQ1: what are the factors influencing ergoecology in healthcare organisations? RQ2: how do the factors influence one another as well as the healthcare organisation as a whole? RQ3: which factors drive others and which factors depend on others? And RQ4: can the priority of each of these factors be measured?

In the context of healthcare organisations, this research integrates two major significant fields: “ergonomics and ecology” to contribute to the body of knowledge of OSH and sustainability literature in healthcare. Ergoecology was discussed as a concept with principles and has been made attempts in other sectors. There is a lack of theoretical framework for ergoecology. This study fills this gap by developing a theoretical framework using TISM; by concentrating on healthcare organisations. This specifically enables specified insights and decisions that can be implemented in the crucial settings of healthcare organisations. The primary contribution of this study is developing a theoretical framework of ergoecology factors that assist healthcare organisations in improving sustainability practices and operations while upholding a safe and healthy workplace. The study further moves into an in-depth by employing TISM and MICMAC analysis to comprehend the identified ergoecology factors and provides a structural depiction of factors interrelationship contributing to the existing literature. Ranking and classifying the identified factors based on the driving and dependence power adds a practical dimension to the healthcare field by pointing out the key factors to be taken into consideration during implementation.

A recurring subject in today’s organisation is the rising concern over workplace sustainability, safety and health, particularly in the healthcare sector. This study addresses this concern by providing healthcare practical implications on how to coordinate healthcare activities and operations with global sustainability objectives while maintaining the well-being of healthcare employees. The present study focuses on a variety of studies, such as ergonomics, ecology, sustainability and healthcare management. This interdisciplinary approach helps to advance ergoecology research by fostering a comprehensive understanding and assisting with policy advocacy and formulation in the healthcare industry. The research aligns with the ILO, considering the world’s commitment to OSH in the 2023 SDS goals.

The paper is organised into six sections. Section 2 elaborates a literature review on ergoecology in healthcare organisations and identified factors definitions, followed by Section 3 presents the research methodology. Section 4 presents the results and discussion. The managerial discussion of this study is presented in Section 5. Finally, Section 6 concludes by pointing out the key findings, the limitations and the future research directions.

2. Literature Review

The World Health Organisation (WHO) has recently been concerned about the occupational health and safety of the global labour force due to the alarming global prevalence of occupational diseases and injuries [8]. According to WHO a healthy workplace, is one where employees and managers work together to apply a continual improvement approach to safeguard and promote the health, safety, and well-being of all workers as well as the sustainability of the workplace [9]. The importance of enhancing the working conditions for personnel in healthcare organisations has grown in recent years [10].

A healthy work environment has frequently been defined with an emphasis on the physical, emotional, and organisational factors that affect employees’ health, frequently from the perspective of the organisation’s current issues [11]. A safe and wellness-promoting workplace environment is crucial for sustainable growth since it directly affects the possibility of societal and economic advancement. In order to promote employee and family health and to fulfil the mandate of providing prevention-focused, high-quality, and affordable care to patients and communities, healthcare systems and workplaces present special challenges and opportunities [12]. Taking a sustainable and healthy workplace into account, scientific concepts, and principles of ergoecology, and factors that are associated with the ergoecology concept in healthcare organisations are reviewed and briefly presented here in the following sub-sections.

2.1. Ergoecology Definitions and Principles

Ergoecology is a discipline that relates the ergonomic system to environmental factors, stressing the relationships between ecological-geographical aspects and human activities [13]. Environmental factors (ecology) and ergonomics are both predicated on a comprehensive understanding of their respective fields of study. This is defined as a systematic study of humans and their relationships with the environment by analysing their activities to identify the impact (positive or negative) [5,14]. In order to achieve a balance between sociotechnical systems and ecosystems, organisations should investigate how ergonomics and ecology effectively collaborate. Ergoecology aims to create harmonious relationships between man-made or sociotechnical systems and natural systems, giving each system equal weight. In reality, disregarding the environment while taking human beings into account would be an infringement on humanity [14]. It requires the creation of a network of professionals and philosophers from various domains in order to completely tackle the difficulties that occur in the interconnections between social and technical and ecological resources. Ergoecology will be able to distinguish itself as an innovative area of practical study.

Secondly, sustainability is a key component of ergoecology. The goal of ergoecology, which is based on the idea of ecological sustainability, is to attain equilibrium in a variety of aspects such as political, social, cultural, economic, and technical sustainability. Researchers [13,15,16], have explicitly drawn connections across disciplines between the science of ergonomics and the more general topic of ecology. It created scientific and technological fields such as ergonomics and environmental management systems. Where, ergoecology aims to focus on real sustainable dynamics between systems, often known as system coexistence or co-dependency [6]. Ergoecology thus aims to achieve eco-productivity and eco-efficiency of the ergonomic system in relation to the ecological-geographical environmental factors through the use of sustainable energies, materials, and information, which will bring about a dynamic equilibrium and an environmental balance [16]. In order to establish, evaluate, minimise, inhibit, govern, and resolve the influences (positives and negatives) that result from such an interaction, ergoecology is a scientific and technological field that uses a systemic approach to examine the connections between people and their environment, specifically through their activities. Ergoecology may represent the boundary while also establishing connections between ergonomics and ecology [17].

Thirdly, the green ergonomics objective is to sustain ergonomic systems and environmental systems so that they can coexist indefinitely into the future because their sustainability relies on each other. Ergoecology seeks to bridge the gap between these two systems, whereas green ergonomics attempts to create mutual benefit between social, economic and natural systems. Thus, accomplishing the goal of ergoecology also means achieving the goal of green ergonomics, and vice versa [18]. Subsequently, factors that are associated with the ergoecology concept in healthcare organisations are reviewed and presented here in the following sub-section.

2.2. Factors Influencing Ergoecology

The influencing factors associated with the ergoecology concept in healthcare organisations are [5,14,17,19]: analysis of surroundings, systematic integration of ergonomics concepts and practices, dynamic balance between organisation and resources, dynamic balance between ergonomic and environmental systems, adoption of ecological and ergonomic measures, guarantee a safe and healthy working environment, recognition of interdependence within the system, and maintaining diversity with equity. The list of identified factors, their code and references are presented in

Table 1. Identified factors influencing ergoecology in healthcare.

Factors	Description	References
F1	Analysis of surroundings	[5,17]; experts’ opinion
F2	Systematic integration of ergonomic concepts and practices	[5,11]; experts’ opinion
F3	Dynamic balance between organisation and resources	[14]; experts’ opinion
F4	Achieve a dynamic balance between ergonomic and environmental systems	[14]; experts’ opinion
F5	Motivation behind the adoption of ecological and ergonomic measures	[14]; experts’ opinion
F6	Guarantee a safe and healthy working environment	[14]; experts’ opinion
F7	Recognition of interdependence within system	[14]; experts’ opinion
F8	Maintaining diversity with equity	[14]; experts’ opinion

, and the details of each factor are also presented below.

Analysis of surroundings (F1): By placing more attention on the political, economic, socio-cultural, and technological (PEST) components, healthcare organisation can better manage the external aspects that affect the investigation of relationship systems and their environments. Environmental issues have a significant negative impact on the lives of people and a significant barrier to economic growth. The environmental behavior of an individual is influenced by the awareness and knowledge of the environment [20]. Understanding how the environment affects the ergonomics system’s synergy is the goal of the analysis of ‘surroundings’ [5,17]. In the context of healthcare ergo-ecology, the analysis of surroundings refers to evaluating the external elements that can affect the adoption of ergonomic and ecological practices within a healthcare institution.

Systematic integration of ergonomic concepts and practices (F2): It is the systematic integration of ergonomic concepts and practices into the management and operations of healthcare organisations. It entails proactively identifying, evaluating, and controlling ergonomic risks as well as implementing plans to improve the healthy working environment, tools, and procedures in order to support employee efficiency, safety, well-being and to protect the environment. Political, legal, and economic/financial considerations have the biggest impact on the integration of ergonomic concepts, practices, and ergonomics management [19] in an organisation.

The dynamic balance between organisation and resources (F3): To achieve a dynamic balance between organisation and the resources available, healthcare organisations must be aware of the changes, oscillations, and periods of recuperation of ecosystem services and biodiversity and their reserve constraints [14] because deterioration of natural resources has become a serious global problem [21]. Researchers also presented a comparative analysis of green economy, environment and health [22]. In the context of healthcare, it describes the continuous integration and the optimisation of the objectives, approaches, and resources that are accessible for the healthcare organisation to support ergoecological activities.

Achieve a dynamic balance between ergonomic and environmental systems (F4): Healthcare organisations must maintain a dynamic balance between ergonomic and environmental systems to function properly [14]. The sustainability point of view describes an organisation’s propensity to maintain an internal equilibrium in response to changes in its environment [14,23]. It means that for an organisation to continue operating at its best, it must utilise self-regulating control mechanisms to adapt to changes in its external conditions and also modify according to the surrounding environment [23]. The fundamental idea behind this is the preservation of the nature of the system via development and progress.

Motivation behind the adoption of ecological and ergonomic measures (F5): Understanding the ultimate objectives and desired results of integrating ergonomic and ecological concepts [14] in healthcare entails the goals of improving patient care, reducing environmental impact, and increasing general well-being in addition to establishing a safer and healthier work environment. It involves investigating the motivations or intents behind the adoption of ecological and ergonomic measures within a healthcare institution.

Guarantee a safe and healthy working environment (F6): Any healthcare organisation operates and maintains its operations by utilising various types of material, energy, and knowledge of the natural environment to provide a healthy workplace. Because of this, healthcare must make sure that the utilisation of the resources does not result in waste or overuse while benefiting the community [14]. It reciprocates sustainability and guarantees a safe and healthy working environment.

Recognition of interdependence within the system (F7): Organisations can encourage the utilisation of ecosystem services, where there is a clear eco-dependence and interdependence between systems [14]. Understanding and acknowledging the connectivity and interdependence of various components within the healthcare organisation, such as employees, patients, processes, and the environment, is referred to as the recognition of interdependence. It acknowledges that decisions and activities linked to ergonomics and ecology in healthcare have effects on the entire organisation system in addition to individual components.

Maintaining diversity with equity (F8): Healthcare organisations need to be able to provide flexible and differentiated services for the communities as a whole, prioritising local demand and trends of globalisation. This is because healthcare organisations have internal and external staff with a variety of lifestyles [14]. Creating an inclusive workplace that honours and respects individual diversity, including but not limited to those related to race, ethnic background, gender, age, and disability, is a necessary step. Assuring equal access to opportunities, and fostering diversity in recruiting, promotions, and leadership positions are part of this.

The extensive literature review conducted for this study identified that there is a lack of a theoretical framework for the ergoecology concept. Particularly the ergoecology concept is not yet discussed in a healthcare setting. This study fills the gap by identifying ergoecological factors for a healthcare setting and developing a theoretical framework utilising the TISM approach.

3. Research Methodology

The present study is primarily focused on the healthcare organisation. A review of the body of literature and the input of healthcare specialists helped to identify the factors. The identified factors were face-validated by the healthcare experts. Conducted structured interviews utilising questionnaires with closed-ended questions to gather data for this study. A closed-ended survey was developed in order to examine the influence of the listed factors on one another through pairwise comparisons. The initial revision of the questionnaire involves both medical professionals and specialists in healthcare operations. After the questionnaire has been finalised, scheduled interviews are organised. Participants in the interview are healthcare professionals who are presently employed in hospitals. A total of 21 respondents were interviewed for this study. Healthcare professionals from various states of India were selected for the responses to the study. The respondents included nurses, hospital administrators and managers, medical doctors, and dieticians from various departments. The interview was conducted for one hour, where 10 min were spent to provide an overview of the study and the factors, remaining 50 min were allocated to respondent interview. In this research, we used a five-point Likert scale, where 0 stands for no-influence and 4 for very high-influence. For instance, if the response to does factor F1 influences factor F2 is yes, responders should rate from 1 to 4; if the answer is no, they should rate it as 0. After confirming the timing, we executed the interview via face-to-face or telephonic interview [24]. To prevent bias in interpretation, participant ratings were documented, coded, and made anonymous following each session. The interviewees’ confidentiality and anonymity are protected [24].

The objective of the research study is to identify ergoecology factors (refer to Table 1) and prioritise the factors. A total interpretive structural modelling approach was used in this study to investigate the linkages between the factors influencing ergoecology for a healthy and sustainable workplace in healthcare organisations. This is a mathematical approach based on the pairwise comparison procedure to form a hierarchical inter-relationship of elements [25,26]. Many scholars have used total interpretive structural modelling to examine how different factors interact, in industries such as manufacturing and service industries [25,26]. The flow of the adopted approach utilising total interpretive structural modelling for ergoecology in a healthcare organisation is presented here (refer to Figure 1).

To interpret and discuss the factors and the interactions that have an influence on healthcare organisations the following steps are adopted. The details of the step-by-step application of the total interpretive structural model [27,28] are discussed herewith.

Step 1: (Identification of the factors): Identifying the factors influencing the ergoecology for a healthy and sustainable workplace in healthcare organisations is conducted. This was determined through a review of the literature and guidance from experts in the healthcare field. The above Table 1 contains a list of the determined key factors.

Step 2: (Establishing inter-relationship between factors): To create the initial reachability matrix (IRM), contextual connections between the components are required. Twenty-one responses were gathered for this study, and the respondents included nurses, hospital administrators and managers, medical doctors, and dieticians from various departments. The selection of respondents was based on their capability to observe and understand the current practice of ergoecology in hospitals. The following

Table 2. Initial reachability matrix for factors influencing ergoecology in healthcare.

Factors $	F1	F2	F3	F4	F5	F6	F7	F8
F1	1	1	1	1	1	1	1	1
F2	0	1	1	1	0	1	1	1
F3	0	0	1	0	0	0	0	0
F4	0	0	1	1	0	0	0	1
F5	0	1	0	0	1	0	1	1
F6	0	1	0	1	0	1	1	0
F7	0	1	1	1	0	1	1	0
F8	0	0	1	1	0	0	0	1

Note: ^$ Refer to Table 1.

depicts the initial reachability matrix.

Step 3: (Interpretation of relationship between factors): Here, the study attempts to comprehend how a selected factor influences other remaining factors in a given set of factors and provides an answer to the question of how.

Step 4: (Develop the final reachability matrix (FRM) after checking for transitivity): A transitivity check must be carried out before getting to the final reachability matrix. All entries in the initial reachability matrix with 0 should be subject to this check [29].

Table 3. Final reachability matrix for factors influencing ergoecology in healthcare.

Factors $	F1	F2	F3	F4	F5	F6	F7	F8	Driving Power
F1	1	1	1	1	1	1	1	1	8
F2	0	1	1	1	0	1	1	1	6
F3	0	0	1	0	0	0	0	0	1
F4	0	0	1	1	0	0	0	1	3
F5	0	1	1 *	1 *	1	1 *	1	1	7
F6	0	1	1 *	1	0	1	1	1 *	6
F7	0	1	1	1	0	1	1	1 *	6
F8	0	0	1	1	0	0	0	1	3
Dependence	1	5	8	7	2	5	5	7

Note: ^$ Refer to Table 1 and * represents transitive links.

contains the final reachability matrix.

Step 5: (Partition of the factors from final reachability into levels): The partition reachability matrix arrives from the final reachability matrix. The reachability set, antecedent set, and interaction set are the three divisions of the FRM. Repeated iteration is conducted to extract factors from each level starting at level 1, and this procedure continues until the partitioned reachability matrix is obtained [30,31] (refer to Appendix A,

Table A1. Iteration-1.

Factors	Reachability Set	Antecedent Set	Intersection Set	Level
1	1, 2, 3, 4, 5, 6, 7, 8	1	1
2	2, 3, 4, 6, 7, 8	1, 2, 5, 6, 7	2, 6, 7
3	3	1, 2, 3, 4, 5, 6, 7, 8	3	I
4	3, 4, 8	1, 2, 4, 5, 6, 7, 8	4, 8
5	2, 3, 4, 5, 6, 7, 8	1, 5	5
6	2, 3, 4, 6, 7, 8	1, 2, 5, 6, 7	2, 6, 7
7	2, 3, 4, 6, 7, 8	1, 2, 5, 6, 7	2, 6, 7
8	3, 4, 8	1, 2, 4, 5, 6, 7, 8	4, 8

,

Table A2. Iteration-2.

Factors	Reachability Set	Antecedent Set	Intersection Set	Level
1	1, 2, 4, 5, 6, 7, 8	1	1
2	2, 4, 6, 7, 8	1, 2, 5, 6, 7	2, 6, 7
4	4, 8	1, 2, 4, 5, 6, 7, 8	4, 8	II
5	2, 4, 5, 6, 7, 8	1, 5	5
6	2, 4, 6, 7, 8	1, 2, 5, 6, 7	2, 6, 7
7	2, 4, 6, 7, 8	1, 2, 5, 6, 7	2, 6, 7
8	4, 8	1, 2, 4, 5, 6, 7, 8	4, 8	II

,

Table A3. Iteration-3.

Factors	Reachability Set	Antecedent Set	Intersection Set	Level
1	1, 2, 5, 6, 7	1	1
2	2, 6, 7	1, 2, 5, 6, 7	2, 6, 7	III
5	2, 5, 6, 7	1, 5	5
6	2, 6, 7	1, 2, 5, 6, 7	2, 6, 7	III
7	2, 6, 7	1, 2, 5, 6, 7	2, 6, 7	III

,

Table A4. Iteration-4.

Factors	Reachability Set	Antecedent Set	Intersection Set	Level
1	1, 5	1	1
5	5	1, 5	5	IV

and

Table A5. Iteration-5.

Factors	Reachability Set	Antecedent Set	Intersection Set	Level
1	1	1	1	V

).

Step 6: (Design the interaction matrix): In this step, direct and significant transitive links are used to design the interaction matrix. Each entry in the interaction matrix represents significant interaction as 1. The significant link is extracted from the knowledge base in the form of an interpretive matrix using 1 entry in the cells [31,32]. It is depicted in

Table 4. Interaction matrix.

Factors $	F1	F2	F3	F4	F5	F6	F7	F8
F1	1	1	1	1	1	1	1	1
F2	0	1	1	1	0	1	1	1
F3	0	0	1	0	0	0	0	0
F4	0	0	1	1	0	0	0	1
F5	0	1	0	1 *	1	1 *	1	1
F6	0	1	1 *	1	0	1	1	0
F7	0	1	1	1	0	1	1	1 *
F8	0	0	1	1	0	0	0	1

Note: ^$ Refer to Table 1 and * represents significant transitive links.

.

Step 7: (Creating the digraph and the total interpretive structural model): This step involves creating a directed graph, also known as a digraph, using the interaction matrix and level partition data [33]. The digraph’s elements are arranged in ascending order, with references to the model’s top-level factors. The side of the appropriate links in the structural model illustrates the information from the interpretive matrix. This results in a complete interpretation of the structural model, including linkages and nodes. The suggested hierarchy-based approach helps to clarify the driving and dependent factors in this way. First-level components are positioned at the top of the graph because the factors in the digraph are ordered in ascending order, as represented graphically in Figure 2. Graphical cross-impact matrix multiplication applied to the classification approach is adopted to divide the variables into distinct categories such as driving factors, autonomous factors, dependent factors, and linkage factors. The details are here below.

Graphical Representation of Driving Power and Dependence Power of Each Factors Using Matrix Multiplication Applied to Classification Analysis

Graphical cross-impact matrix multiplication was applied to classify these factors, into four zones as follows [34,35,36,37,38]:

Autonomous factors as Zone-I, where factors that have weak dependence and weak driving power. Dependent factors as Zone-II, where factors that have higher dependence on other factors but lesser driving power. Thirdly, Linkage factors as Zone-III, here factors that have a strong dependence and strong driving power are placed. Finally, Driving or Independent factors as Zone-IV, where factors that have a strong driving power, but weak dependence are grouped.

4. Results and Discussion

To interpret and discuss the factors and the interactions that have an influence on healthcare organisations the above Table 2, Table 3 and Table 4 and Figure 2 are adopted. Subsequently, factors influencing ergoecology in a healthcare organisation are ranked and grouped/classified into four zones by employing the matrix multiplication applied to classification analysis. The detailed discussion of the outcome of the adopted approach is presented herewith.

4.1. Interpretation of Total Interpretative Structural Digraph

Level V: Level five has one factor, which is factor F1 (analysis of surroundings); and it is the motivation behind the adoption of ecological and ergonomic measures factor (F5). This helps in setting objectives, regulating decision-making processes, directing strategic thinking, and the assessment of healthcare surroundings. Healthcare organisations may more effectively link their actions and tactics with their intended goals or desired outcomes by taking into account external circumstances and comprehending the implications of ecological and ergonomic measures. Factor 1 is also influencing to guarantee a safe and healthy working environment (F6). Thus, by improving the flow of materials, resources, and information by analysing their impact on the environment, healthcare management can boost productivity, sustainability, and their system performance in providing quality care and a healthy environment. Analysis of surroundings (F1) also governs recognition of interdependence within the system (F7) and maintaining diversity with equity (F8). The analysis of surroundings is used to drive policies and actions aimed at increasing diversity in the workforce, addressing health inequities, and other goals, resulting in an inclusive healthcare system that stresses fairness in access to treatment and health outcomes.

Similarly, analysis of surroundings (F1) guides systematic integration of ergonomic concepts and practices (F2), where healthcare organisations can develop strategies, allocate resources wisely, and make informed decisions to create ergonomic and sustainable work environments that promote healthcare employee well-being and raise the standard of patient care by analysing the environment and understanding how these factors affect healthcare. Similarly, analysis of surroundings (F1) regulates the dynamic balance between organisation and resources (F3). This shows that healthcare organisations can gain insight and information about how external factors influence resource availability, allocation, and usage by analysing their environment. It ensures the resources are used effectively, that objectives are met, and is able to respond to environmental changes. Analysis of surroundings (F1) also helps to achieve a dynamic balance between ergonomic and environmental systems (F4). In this case, in order to stabilise and respond to changes, the healthcare organisation must alter its internal processes, procedures, and resource allocation as a result of policy and regulation changes.

Level IV: Motivation behind the adoption of ecological and ergonomic measures i.e., (F5) influences systematic integration of ergonomic concepts and practices (F2) in healthcare organisations to boost performance. The ecological and ergonomic measures also assist in the accomplishment of a dynamic balance between ergonomic and environmental systems (F4) and promote a culture of continual development within the healthcare industry. By routinely analysing outcomes, adjusting goals, and altering methods, healthcare organisations may react to change and maintain ecological and ergonomic measures. Whereas F5 shapes a safe and healthy working environment (F6) and has an impact on workflow design and optimisation. The motivation behind the adoption of ecological and ergonomic measures (F5) directs the exchange of things in a way that minimises waste, eliminates bottlenecks, and streamlines operations by knowing the desired objectives. In parallel, it is observed that the adoption of ecological and ergonomic measures (F5) acknowledges interdependence within the healthcare system (F7). It acknowledges that although various people and divisions within the healthcare system have their own objectives, there frequently exists an underlying goal that connects them. Healthcare organisations can promote a sense of interdependence and shared purpose, which will encourage interaction and collaboration toward a healthy and sustainable workplace in a healthcare organisation. In addition, by considering the ecological and ergonomic measures (F5), healthcare organisations may recognise the significance of diversity (F8) in the healthcare workforce and strive toward ensuring equitable access to healthcare services.

Level III: At this level, it is evident that systematic integration of ergonomic concepts and practices (F2), and having guaranteeing a safe and healthy working environment (F6) and recognising interdependence within the system (F7) collectively influence to achieve a dynamic balance between ergonomic and environmental systems (F4). This highlight’s goal of integrating ergonomic concepts and practices to enhance human performance and well-being through creating healthy work environments, procedures, and equipment. In turn, it helps to make the best use of resources, including staff time, tools, and supplies. Healthcare organisations can effectively balance work and resource availability by the integration of ergonomic concepts and practices, ensuring that resources are allocated and used efficiently to support the provision of high-quality treatment. On the contrary, systematic integration of ergonomic concepts and practices (F2) guarantees a safe and healthy working environment (F6) by designing optimal workflows that maximise the exchange of materials, information, and resources. In addition, having a guaranteed safe and healthy working environment (F6) also influences the recognition of interdependence within the system (F7). This shows that healthcare organisations are interrelated and interdependent, which is encouraged by ergonomics and ecology management. It encourages the realisation that the interactions between many aspects have an impact on the efficiency and well-being of healthcare workers, patients, and the entire system. Integrating the ergonomic concepts and practices promotes a holistic viewpoint that recognises the interconnectedness of diverse stakeholders by taking into account the relationships between people, groups, departments, the healthcare system and the environment. Thus, healthcare organisations can build an inclusive and fair work environment that encourages diversity by implementing inclusive design techniques, such as adjustable workstations, different seating alternatives, and ergonomic tools that suit a wide range of users.

On the contrary, having a guaranteed safe and healthy working environment (F6) assures systematic integration of ergonomic concepts and practices (F2), dynamic balance between organisation and resources (F3), dynamic balance between ergonomic and environmental systems (F4), and recognition of interdependence within the healthcare system (F7).

Level II: Achieving a dynamic balance between ergonomic and environmental systems (F4) and maintaining diversity with equity (F8) exert influence on a dynamic balance between organisation and resources (F3) in a healthcare organisation. This, in turn, promotes and guides the allocation of resources and utilisation, by incorporating adaptation and flexibility and also ensuring sustainability to improve organisational efficiency. Healthcare organisations can efficiently manage their resources to satisfy the changing requirements of patients, the healthcare workforce, and the organisation while preserving stability and maximising outcomes by maintaining a dynamic balance.

Whereas ergonomic and environmental systems (F4) and maintaining diversity with equity (F8) do regulate each other via promoting an inclusive and equitable atmosphere that maximises the allocation of resources and their usages, diversity and equity in healthcare. This is also by creating cultural competence, minimising health inequalities, fostering representation and inclusion, fostering shared decision-making, and supporting healthcare staff well-being, and diversity with equality in healthcare.

Level I: Multiple factors influence to have a dynamic balance between organisation and resources (F3), which results in achieving a healthy and sustainable workplace in a healthcare organisation. Thus, healthcare management can adjust to changing market conditions by analysis of surroundings (F1). They adopt systematic integration of ergonomic concepts and practices (F2) that promote productivity and effective resource use. Focus on a dynamic balance between organisation (F3) and resources equilibrium and stability to ensure balanced ergonomic and environmental systems (F4). Similarly, adopt ecological and ergonomic measures (F5) and allocate resources in accordance with the goal of having a safe and healthy working environment (F6). The healthcare output-input operations are optimised by the exchange of matters. In addition, recognising interdependence within the healthcare system (F7) encourages and maintains diversity and equity (F8). Together, all these factors enable healthcare organisations to manage resources efficiently, adjust to change, and balance their requirements and the resources available to achieve a healthy and sustainable workplace.

4.2. Results and Interpretation of Matrix Multiplication

The factors influencing ergoecology in a healthcare organisation are ranked and grouped/classified into four zones by employing the matrix multiplication applied to classification analysis [28] (refer to

Table 5. Matrix multiplication applied to classification (MICMAC) rank for factors influencing ergoecology in healthcare.

Factors $	Driving Power	Dependence	Driving Power/Dependence	MICMAC Rank
F1	8	1	8.000	1
F2	6	5	1.200	3
F3	1	8	0.125	5
F4	3	7	0.429	4
F5	7	2	3.500	2
F6	6	5	1.200	3
F7	6	5	1.200	3
F8	3	7	0.429	4

Note: ^$ Refer to Table 1.

and Figure 3).

In above Figure 3, matrix multiplication applied to classification involves classifying the factors into four different zones: driving factors, autonomous factors, dependent factors, and linkage factors [34]. From Table 5 and Figure 3, it is evident that the dynamic balance between organisation and resources factor (F3) is ranked fifth in the matrix multiplication applied to classification analysis ranking, whereas the analysis of surroundings (F1) is ranked first. This suggests that the dynamic balance between organisation and resources (F3) is more dependent on other factors; Figure 3 and Table 5 list these factors. To better comprehend how these factors interact with one another, total Interpretive structural modelling is used to represent and arrange the components. It is a paradigm that clarifies the meaning of nodes and connections. The factors are categorised into autonomous, dependent, linkage and driving or independent factors using matrix multiplication applied classification analysis (refer to Figure 3), where no autonomous factors were identified. Whereas dynamic balance between organisation and resources (F3), dynamic balance between ergonomic and environmental systems (F4), and diversity with equity (F8), are the dependent factors. These factors are influenced when there is a change in the other factors. Policymakers should concentrate on preserving balance with these factors to guarantee a sustainable and safe workplace. Since these ergoecological factors change when influenced by the changes of other factors, policies should focus on the relationship between them which is essential. The linkage factors identified are systematic integration of ergonomic concepts and practices (F2), safe and healthy working environment (F6), and interdependence within the healthcare system’s direct and indirect components (F7). These linkage factors should be given top priority when establishing policies since they have catalytic effects on the healthcare workplace. Eventually, analysis of surroundings (F1) and adoption of ecological and ergonomic measures (F5) are the driving or key factors to have a healthy and sustainable workplace in a healthcare organisation. This recommends that the policies require to emphasise proactive strategies involving healthcare workplace and environmental analysis as well as environmental and ergonomic adoption practices. Healthcare organisations should also adhere to ISO standards 14001:2015 [39] and 45001:2018 [40] to guarantee international best practices and regulatory requirements, which can aid in attempts to adhere to OSH standards and guidelines in achieving SDG goals.

5. Managerial Discussion

According to scientists and environmental advocates, healthcare organisations are obliged to employ sustainable and green methods. To understand the concept of ergoecology and the influencing factors to achieve a healthy and sustainable workplace in a healthcare organisation; one needs to close the gap between naturally occurring ecosystems and human-made habitats. So, the interdependence of factors influencing ergoecology in healthcare organisations is examined in this research. The factors are prioritised from highest to lowest priority by using the matrix multiplication applied classification analysis and total interpretive structural modelling. The important factors that influence ergoecology in healthcare are the analysis of surroundings (F1) and the adoption of ecological and ergonomic measures (F5). Managers should subsequently prioritise balancing between ergonomic and environmental aspects (F4), try to diversify with equality in all directions (F8), integrate ergonomic concepts and practices (F2), guarantee a safe and healthy working environment (F6), and acknowledgment interdependence within the system (F7).

Here, total interpretative structural models give answers to the basic managerial questions [41] of what, how, and why, when it comes to achieving a healthy and sustainable workplace in a healthcare organisation. These aspects depict the factor relationships that are dependent on driving factors and provide a response to what? While the matrix multiplication used classification analysis answers the question of causation. Why, on the other hand, is explained by the interpretation of links [42]. Identification of factors influencing ergoecology in healthcare organisations is solved by conducting literature review and engaging experts. Likewise, matrix multiplication applied to classification and ranking approach and total interpretive structural modelling reveal the links between factors and their hierarchical levels interactions. Identification of these interactions yields insights into how ergoecology factors influence healthy and sustainable workplaces in healthcare organisation.

6. Conclusions

The study found that the analysis of surroundings and adoption of ecological and ergonomic measures are the key ergoecological factors influencing a healthy and sustainable workplace in healthcare organisations. The attention given to the well-being of the healthcare personnel is demonstrated by placing a high priority on analysis of the surroundings and incorporating sustainable ecological and ergonomic measures, which will reduce work-related challenges, boost job satisfaction, and enhance the quality of care offered. In conjunction, these two factors foster an integrated and synergistic interaction between a healthy and sustainable workplace and its ability to provide high-quality treatments, while simultaneously exerting an advantageous impact on healthcare operational and environmental footprint. The present study only focussed on the Indian healthcare industry. The study can be expanded to different geographical locations. Statistical methods such as structural equation modelling, and exploratory and confirmatory factor analysis can be used to assess this concept. Alternative approaches should be taken into account, such as “performing longitudinal studies” to look at the effects of ergoecology on healthcare efficiency and a sustainable workplace. Future researchers can also explore how ergoecology influences green transformation in healthcare or in other sectors.