Examining the cause–and–effect linkages among eco-innovation enablers for advancing sustainable hospital infrastructure: An MCDM Approach

Eco-innovation is the creation and application of new or highly enhanced products, processes, services, or organisational processes that reduce environmental impacts and innovatively maximise resource use. In a hospital setting, eco-innovation helps sustain processes, buildings, and management systems, thereby creating greener, smarter, and more resource-efficient healthcare facilities. This paper appropriately uses a Multi-Criteria Decision-Making (MCDM) approach to identify and examine the causal links among the critical enablers of eco-innovation in sustainable hospital infrastructure. We identified 10 key enablers relevant to the healthcare sector through a literature review, in collaboration with domain experts. The proposed model utilises the Fuzzy Decision-Making Trial and Evaluation Laboratory (FDEMATEL) approach to address interdependencies and determine the causal nature of these enablers. Further sensitivity analyses were conducted to confirm the soundness and usefulness of the framework. The results indicate that Managerial Commitment and Leadership (EIE 1 ) and Financial and Economic Incentives (EIE 3 ) are the most effective enablers, forming the strategic base for eco-innovation adoption and diffusion within the Indian healthcare ecosystem. Digital Transformation (EIE 9 ) and Green Building Certifications (EIE 10 ), on the other hand, are the most impacted enablers, which are the material consequences of successful leadership, enabling policy processes, and purposeful investment of money. The capabilities of Indian hospitals can be enhanced through these interrelated enablers, shifting towards a more intelligent, eco-innovative, and resilience-based healthcare system rather than a compliance-driven one. The research provides a feasible decision-making framework for policymakers and hospital administrators. It supports the implementation of eco-innovation enablers and data-driven sustainability strategies, thereby increasing operational efficiency, patient well-being, and environmental performance.