6.1. Interpretation of Total Interpretive Structural Modeling (TISM) Digraph
Referring to
Figure 2, there are seven levels. Their interpretation is provided in the subsequent paragraphs, presented in reverse order.
Level VII: In this level, a single readiness factor is present: design principles (F4). Design principles (F4) influence green buildings (F1) when healthcare facilities are constructed with the incorporation of sustainable ergonomic concepts. By incorporating green ergonomics concepts, a hospital may develop solutions that enhance patient safety while also minimizing negative environmental effects. As a result, the healthcare organization’s facilities would be capable of satisfying the requirements of the surroundings, staff, and patients. Furthermore, F4 has an influence on the field of ergoecology (F2). It is clear that healthcare organizations should adopt design principles as standards in order to implement green ergonomics. This will help address the concept of ergoecology and promote environmentally friendly and healthy workplaces. By doing so, healthcare professionals’ effectiveness and well-being can be optimized, while also focusing on environmental sustainability. Design principles (F4) also have an influence on audit working practices/risk assessments (F3) by establishing a framework for monitoring and auditing work practices in a healthcare organization. This framework evaluates the current level of practice and the desired standard level. Risk assessments are crucial for evaluating the potential risks associated with different departments within healthcare institutions based on the services they provide. Additionally, the influence of F4 on ecological resilience (F5) is evident and can be realized by using the concepts of green ergonomics in healthcare organizations and other industries. Adhering to ergonomic design principles enables healthcare organizations to enhance their ability to handle disruptions and reorganize during periods of change, while still effectively continuing their everyday operations. Green ergonomics fosters ecological resilience by maintaining the work setting’s capacity to tolerate disruptions without altering its structure or operation, hence promoting environmentally friendly ergonomics. As for professional practice (F6), F4 influences it by fostering an understanding of green ergonomics and involving experts in promoting environmentally friendly development structures in healthcare. It also addresses the actions and behaviors of healthcare professionals in relation to green ergonomics operations and how these practices are integrated into the services provided. The design guidelines serve as the fundamental principles for implementing environmentally friendly ergonomics, requiring the involvement of all professions. F4 also has an influence on sustainable indoor environments (F7), which can be achieved by establishing a sustainable interior environment in healthcare organizations. Design principles enable the implementation of solutions that safeguard human health, enhance quality of life, mitigate stress, and avoid injuries. In addition, F4 has an influence on the culture of patient safety and the atmosphere of safety (F8) and should be considered when addressing environmental issues through local or regional solutions. This involves assessing the specific needs of the local community, devising an optimal design solution using collaborative methods, and meeting those needs by utilizing the available local resources to establish a culture and climate of patient safety. The study by Norton et al. [
31] highlighted the impact of F4 on the natural environment for promoting well-being. It also emphasizes the significance of outdoor spaces for enhancing health and underscores the need to understand ergonomics as a field dedicated to well-being [
17,
18]. Lastly, F4 has a significant influence on occupational health and safety (F10) as all healthcare workers, including practitioners, are exposed to occupational hazards. The implementation of green ergonomic design principles, which prioritize the well-being and safety of occupants while also addressing environmental sustainability concerns, can effectively reduce the associated risks and hazards.
Level VI: This level has two factors: F1 (green buildings) and F2 (ergoecology). The influence of F1 on F2 is evident through the promotion of healthier and more efficient work conditions, resulting in positive outcomes from ergoecology. Implementing green building practices in healthcare organizations can boost productivity, decrease absenteeism, and improve employee happiness and satisfaction by prioritizing the health and well-being of staff members. In addition, F1 influences F3 (audit working practices/risk assessments) when green buildings are built utilizing energy-efficient construction techniques, which have the potential to decrease energy expenses. Green buildings have the potential to impact and shape the protocols and regulations governing audits. This has the potential to improve the evaluation of energy use and provide suggestions for enhancing the efficiency of healthcare activities. The influence of F1 on F5 (green buildings on ecological resilience) also fosters sustainable ecological resilience practices within healthcare organizations’ operations. Healthcare organizations develop crucial ecological resilience by integrating uncertainty response strategies focused on the environment as well as effectively responding to and forecasting emergencies. F1 also has an influence on F7 (sustainable indoor environments), F8 (patient safety culture and safety climate), and F9 (natural environment for wellness). One specific way in which this influence is observed is through the integration of natural lighting systems into green buildings. This integration serves to decrease the reliance on artificial lighting, resulting in improved lighting conditions, reduced ocular fatigue, and enhanced well-being for workers. Green construction thus improves indoor settings by prioritizing the health of healthcare personnel and patients as well as implementing sustainable operations. Lastly, F1 influences F10 (occupational health and safety) as green buildings can mitigate stress and fatigue by limiting temperature changes and maintaining a comfortable temperature range.
As for F2, this concept of ergoecology has a significant influence on the design of green buildings by prioritizing the needs of building inhabitants. Green buildings can be designed to optimize health and well-being through the implementation of ergonomic assessments. F2 also exerts an influence on F3 (audit working practices/risk assessments). Here, ergoecology places a substantial emphasis on the importance of design and operation in healthcare, thus advocating for auditors to conduct risk assessments and ergonomics reviews. The influence of ergoecology on ecological resilience (F5) further enhances the ecological resilience of healthcare environments by advocating for resource-efficient and environmentally friendly design concepts for healthcare facilities. F2 also exerts an influence on F6 (professional practice). This can be recognized via the importance of human factors in promoting building energy efficiency. The understanding of ergoecology inspires healthcare personnel to embrace energy-saving behaviors and reduce their environmental footprint through the development of user-friendly building systems and technologies. Meanwhile, the impact of ergoecology on sustainable interior settings, specifically the relationship between F2 and F7, highlights the crucial role of indoor environmental quality in promoting individuals’ health and overall well-being. Additionally, F2 exerts an influence on F8 (patient safety culture and safety climate), recognizing the importance of assessing patient safety culture, which involves analyzing the attitudes, perspectives, and behaviors of healthcare workers in this domain. Ergoecology can help improve patient safety culture and the safety climate by identifying specific areas where ergonomic strategies can be implemented to enhance patient safety results. One way to achieve this is by promoting the evaluation of patient safety culture considering ergonomic aspects. Similarly, ergoecology (F2) influences the natural environment in healthcare (F9) settings by promoting the development and utilization of surroundings that enhance the health and well-being of patients, staff, and visitors. To cultivate a soothing, salubrious, and motivating ambiance, healthcare organizations should focus on incorporating outdoor areas, interior foliage, therapeutic gardens, and ample natural illumination. Green buildings can mitigate the likelihood of occupational injuries and enhance the health and well-being of everyone working in and maintaining the building by promoting safe work practices, ergonomic designs, and suitable maintenance processes. Ergoecology recognizes the importance of human elements in risk assessment. Auditors can identify potential risks and hazards that may be overlooked in traditional risk assessments by considering the interactions between building occupants and their environment. For example, if a workstation requires uncomfortable body positions or repetitive motions, an inspector may consider these ergonomic hazards.
Level V: F3 (risk assessments and audit work practices) is the only factor present at level five. F3 influences F5 (ecological resilience) as in the event of any unanticipated disruptions, risk assessments and audit work procedures assist the healthcare organization in determining the system’s adaptability to maintain regular healthcare operations. F3 also influences F6 (professional practice) by assessing the safety operations founded on quality control and risk management in healthcare organizations, which fosters informed professional practice and continuous development based on the current situation and a standardized level. Assessing the degree of assurance to improve the quality of methods contributes to the creation of sustainable interior environments, an enhanced quality of life, and high-quality services by healthcare organizations. Similarly, F3 influences F7 (sustainable indoor environments) and F8 (patient safety culture and safety climate). A healthcare organization can determine its commitment to patient safety and safety culture at a given moment and how to improve it for a higher quality of service by auditing the working practices. Further, F3 influences F9 (natural environment for wellness) as assessing risks and working practices in healthcare organizations aids in determining awareness of the context of nature and how the healthcare organization views the importance of the surrounding environments for health. All healthcare workers, including practitioners, are subject to occupational hazards. In this regard, F3 also impacts F10 (occupational health and safety) as it can examine possible dangers and safety procedures inside an organization, and focusing on employee well-being, wellness, and workplace safety may aid in the resolution of potential issues that may arise in the healthcare organization.
Level IV: The fourth level consists of a single factor, namely F6 (professional practice).
Professional practice demonstrates a collaborative approach, adaptability, and techniques that safeguard human health and enhance the quality of life by promoting sustainable indoor environments [
6]. Hence, it is apparent that F6 is a significant determinant of F7 (sustainable indoor settings). F6 (professional practice) signifies the commitment of professionals to comprehend patient interactions and uphold ethical values. It involves the application of specialized skills, critical analysis, and decision-making that contribute to the standards, principles, perspectives, and practices that define an organization’s commitment to ensuring patient safety (F7). The presence of a strong dedication to continuous development and the ability to adapt in order to enhance services are factors that help to understand the importance of the environment for human health and well-being. These factors are indicative of the influence of F6 on F9. Professional practitioners in health organizations use specialized knowledge, critical thinking, and sound judgment to identify the potential risks and hazards associated with hazardous work environments. These risks may have both short-term and long-term impacts on healthcare organizations.
Level III: Level three has two factors: F7, which pertains to sustainable indoor environments, and F8, which focuses on patient safety culture. The importance of sustainable interior environments (F7) becomes clear as they contribute to the sustainability and organizational restructuring of healthcare organizations throughout periods of transition, while also ensuring the ecological resilience of everyday healthcare operations (F5). F7 encompasses all aspects of a building’s interior, such as air quality, lighting, temperature, and ergonomics, and their impact on F8 (patient safety culture and safety climate). This is achieved by providing ecologically friendly solutions for the building’s surroundings. Furthermore, it represents the characteristic beliefs, perspectives, attitudes, and behaviors that exemplify an organization’s dedication to ensuring patient safety (F8). Moreover, F7 has a significant influence on F9, which pertains to the natural environment for promoting well-being. Through the establishment of a secure work environment that places emphasis on the welfare, health, and safety of workers, the focus is on identifying and addressing the potential hazards and risks associated with unhealthy work conditions in the short and long term. The influence of F7 on F10 (occupational health and safety) also leads to an improvement in the quality of services provided and enhances the productivity of healthcare professionals.
F8 influences both F7, which pertains to creating sustainable indoor environments, and F9, which focuses on establishing a natural environment for well-being. Healthcare professionals and other staff members within the organization collectively uphold a set of shared values, conventions, and beliefs, which influence their approach to patient care and their interactions within the healthcare setting. In addition, F8 has a significant influence on F10, which pertains to occupational health and safety. Healthcare organizations should prioritize the development of a robust patient safety culture and safety environment, focusing on the well-being of both healthcare staff and patients. Assessments of safety culture and the perception of healthcare professionals towards safety in their workplace, as well as the quality of services offered to patients, have to be duly considered.
Level II: Level two has two components, namely F5 (ecological resilience) and F10 (occupational health and safety).
F5 influences F9 (natural environment for wellness) by setting up a healthcare system to be able to handle disruption and organize itself while going through change and simultaneously maintaining everyday healthcare operations as well as establishing an understanding of the importance of the natural environment for health, including ergonomics knowledge and practice as a field concerned with well-being.
On the other hand, occupational health and safety (F10) primarily emphasizes the welfare, wellness, and safety of employees, as well as the natural environment for promoting good health (F9). This aspect significantly influences affects both healthcare personnel and patients.
Level I: Level one consists of only one factor, namely the natural environment for wellness (F9), which is directly relevant to the purpose of this research. This factor is the dependent variable of the research. This component is influenced by the other nine factors.