Optimizing hospital waste management in Morocco: a hybrid multi-criteria decision framework

• Reorients hybrid MCDM application from technology selection toward internal hospital process optimization. • Identifies segregation accuracy and regulatory compliance as dominant performance drivers in Moroccan hospitals. • It shows that behavior-centered interventions can generate stronger impact than high-cost technological upgrades. • Provides a pragmatic decision-support framework adapted to operational constraints in Moroccan healthcare institutions. Hospital waste management remains a critical operational and regulatory challenge, especially in health care systems where security risks, compliance pressures and resource constraints are all combined. Although multi-criteria decision making (MCDM) approaches are widely used in waste research in the healthcare sector, most studies focus mainly on the choice of treatment technology rather than on the priority of improving internal processes in hospitals. The study develops and applies a structured framework for decision support, integrating BWM and TOPSIS, to support improvements in hospital waste management in Moroccan health care institutions. Six evaluation criteria were developed by synthesis of literature and consultation with experts, and sixteen experienced experts were involved in the evaluation process. The hybrid framework allows expert judgement to be translated into a coherent prioritization of improvement strategies. The results show that the most important priorities are to reduce sorting errors, strengthen health and safety and ensure regulatory compliance. The most effective strategies were process-oriented interventions, in particular visual guidance and targeted training. By moving the focus from technology choice to internal operational optimization, the study shows how a pragmatic hybrid MCDM framework can be effectively adapted to health systems characterized by structural constraints and scarce resources and provides practical guidance for hospital administrators and policy makers in Morocco.