Thailand has late experienced an economic over growing that has been coupled with rapid industrialisation and urbanisation. This growing has every bit anticipated, caused a important debasement in the huge natural home grounds and resources of this state. Furthermore, natural catastrophes have raised serious concern in the vicinity. With the increasing consciousness of planetary clime alteration and natural catastrophes in the developed universe, environmental protection and energy sustainability have emerged as issues of turning importance. Companies across all sectors try to develop merchandises and patterns with a minimized environmental load, in order to take portion in `` socially responsible '' patterns, and to set up their presence as innovators in the freshly formed niche of consumers with ecological concerns.
This is besides true for the Healthcare and Tourism industry, where concerns frequently rely on the unity and sustainability of the environment. However, while a figure of surveies exist for the touristry sector, there has been done about no research on green patterns in the infirmary industry. It is gratuitous to state that there is a high demand for infirmaries to prosecute in green patterns due to the big sum of waste generated but besides the theoretic behind the built-in committedness to a balanced coexistence of the patient with his environment in order to prolong a high degree of quality of life and public wellness. Furthermore, infirmaries that exhibit strong involvement in environmental issues and actively take part in eco-friendly patterns have the possible to distinct themselves from other concerns, therefore making a important competitory advantage.
There are no surveies up to day of the month that have measured the consumer attitudes towards green pattern in infirmaries nor their willingness to pay, should an environmental policy in healthcare direction is to take topographic point.
Aims
The intent of this survey is twofold: to research consumer attitudes towards assorted countries of green patterns in infirmaries and consumers ' willingness to pay for green infirmaries, and to foretell attitudes, subjective norm, and perceived behavioural control taking to the likeliness of consumers to actively seek and see green infirmaries.
The proposed research and rating survey will take at placing the consequence of different socio demographic features on the bing likeliness to take `` green '' health care, but will besides analyze the influence of attitudes, subjective norm and sensed behavioural control on the consumers ' purpose to see such infirmaries. Consumers who originate from public sector infirmaries will besides be compared against those from private attention.
Methods
Ajzens ( 1985 ) Theory of Planned Behavior will be used as a theoretical foundation to analyze the above planned outcomes. Data will be collected with the aid of a structured study questionnaire. The survey sample is anticipated to be ~500 and it will be provided by bing clients of take parting infirmaries. The study will be conducted in the waiting suites of the participating infirmaries, which will be both private attention and public attention infirmaries in Thailand.
Assuming that the population of Thailand is M and that M will see a infirmary at one point in their life-time, the survey sample will be divided among the private and public wellness sector. Hence with 250 at each side, the survey sample has been calculated to observe % of a one criterion divergence difference, with a power of 85 per centum and a significance degree of 5 % . This differentiation is made in order to avoid a systematic choice prejudice in the survey sample, since patients of the private sector are more likely to hold a higher socioeconomic degree and therefore either more environmentally led consciousness or a much greater willingness to pay for green tactics.
In order to stratify the survey population samples, descriptive statistics will be employed and multiple additive arrested development theoretical accounts will be used to analyse the study instrument 's consequences.
Use of findings
The analyses are anticipated to uncover the true figure of consumers that perceive the country of 'green infirmaries ' as of import. The analytical description of the factors underlying their behaviour will besides be provided and comparings will be made between consumers arising from different wellness backgrounds.
It is besides anticipated that the willingness to pay for green health care will be measured by the study instrument, and that this can function as a important managerial assistance in the way of the pertinence and sustainability of such theoretical accounts. Therefore, this research aims to function as an analytical and determination steering tool in the way of greener health care, based on consumer 's sentiments.
Aim
This survey will utilize informations obtained from a constructions study questionnaire directed at consumers of private and public infirmaries in Thailand to find their attitudes and behaviours towards Green Hospitals. The survey 's aims are:
To research consumer attitudes towards assorted countries of green patterns in infirmaries and consumers ' willingness to pay for green infirmaries harmonizing to socio-demographic factors and arising sector of health care used at the clip of the survey.
To foretell attitudes, subjective norm, and perceived behavioural control taking to the likeliness of consumers to actively seek and see green infirmaries in the hereafter.
BACKGROUND AND LITERATURE REVIEW
This subdivision reviews the current relevant literature available on the current position quo of green patterns in infirmaries, hence making a background for this survey that will show the current demand for green infirmaries and the current accomplishments made or failures observed in already green health care disposals. This subdivision begins with basic background information on the first green infirmaries ' studies on mensural impact, patient satisfaction and organisational features and alterations observed. It incorporates a reappraisal on the consequence of green patterns at the industry degree every bit good as a elaborate reappraisal of countries that are of peculiar relevancy for the pertinence of these policies.
It besides includes a reappraisal on published methods for all validated instruments directed at the measuring of consumers ' attitudes towards health care, their influential potency and subsequent significance to healthcare direction. This is provided to clarify the power of such an grounds based attack, where consumers ' sentiments are valued for the devising of managerial determinations on health care policies. This background is necessary to solidify the importance and cogency of the present survey.
Finally, the theoretical background is reviewed. First the theory of planned behaviour is analyzed, which will function as a conceptual model for the mensural variables. Then hypotheses are developed, harmonizing to demographics and attitudes, subjective norms and sensed behavioural control. Already published information towards Green patterns in infirmaries is discussed and analyzed harmonizing to attitudes, subjective norms and sensed behavioural control.
Green Practices in Tourism Management
Research on the sustainability of tourer direction has focused on the development of environmental rules, translated as codifications of behavior or environmental policies ( United Nations Environment Programme ( UNEP ) , 1994 ; Williams, 1993 ) . The 2nd phase of the application of environmental policies as they translated into pattern has besides been achieved for the touristry industry. The 'greening ' of the operational activities of certain sectors of the industry provide with first-class illustrations of this phase ( World Travel & A ; Tourism Council, World Tourism Council, Earth Council, 1995 ) .
Hotel sustainability plans have concentrated on waste decrease, energy preservation, and H2O preservation. More sophisticated rejuvenation plans have
introduced the usage of organic nutrients, non toxic cleansing merchandises, and chemical-free plague direction techniques. Besides, emanation decrease in the transit sector has been an activity that environmental tourer policies have concentrated on.
Reports on the impact appraisal of the deduction of environmental policies in touristry are nevertheless few, and those focal point on the public presentation of a limited figure of international touristry corporations ( WTTERC, 1993 ) .Hence it is hard to reassign their findings to the wide scope of concerns in the wider health care and touristry industry.
Green Practices in Health
Contrary to their sibling ( the touristry industry ) , it is widely perceived that infirmaries are really immune to alter, both structurally and culturally. Their constellation, normally in concrete, frequently reflects the pattern of wellness attention and patient populations of past epochs. It is said that, alteration within the infirmary involves piecing the resources needed for high-quality attention, such as optimum usage of edifices, people and equipment, and forming them in a manner that provides high-quality attention ( Healy and McKee, Chapter 10 ) .
There is a broad scope of surveies that prove an aetiologic relationship between environmental maltreatment and diseases, such as dioxins and malignant neoplastic disease, pesticide and nutrient and the effects of relentless organic defilers. On the infirmary degree, toxin and mercury-containing medical devices, the broad usage of pesticides in and around infirmaries and the big sum of waste generated are all issues that stress the demand for an environmental policy in health care. It is in other words envisioned that a stiff environmental policy could even be a factor of high quality attention for hospital staff and patients.
In the last 10 old ages, there has been singular advancement in waste direction from an environmental wellness position. Hospitals have been placed in the frontline for infective waste direction, decreased chemical usage, advancing usage of healthy nutrients and advancing nurse leading in environmental stewardship.
Given besides the seemingly increasing trouble of run intoing turning demand for good infirmary attention, infirmary directors have turned to Green Hospitals for better results. aˆ¦ '' About a twelve groups began building `` green '' infirmaries several old ages ago, and other groups are now following their lead '' the Medical-News study in 2006. Inventions include solar panels, permeable pavement stuff to filter chemicals from rainwater overflow, H2O conserving lavatories, gum elastic floors, eco-friendly systems for disposing of medical waste, latex-free scrutiny baseball mitts, and cleaners without rough chemicals and reclaimable dissolvers.
Gary Cohen, executive manager of the Environmental Health Fund, said that although inventions ab initio cost more, they can cut down operating costs over clip ( Landro, Wall Street Journal, 10/4/06 ) .
The Luminary Project. ( 2005 ) . Nurses illuming the manner to environmental wellness. Retrieved April 30, 2007 from the universe broad web at: www.TheLuminaryProject.org.
National Society for Healthcare Foodservice Management. ( 2007 ) . About HFM. Retrieved April 13, 2007 from www.hfm.org/about.html
Bresnitz E.A. , Beckett W. , Chan-Yeaun M, Craig, T. , Gilman, M. , Harber, P. , et Al. ( 2004 ) . Guidelines for measuring and pull offing asthma hazard at work, school, and diversion. American Journal of Respiratory Critical Care. Medicine Series on-line. 169, 873-881. Retrieved March 22, 2007 from the universe broad web at: www.asthmaregionalcouncil.org/resources/documents/GuidelinesforAssessingandManagingAsthmaRisk.pdf
Green R. , Hauser R. , Calafat AM, Weuve, J. , Schettlet, T, Ringer, S. et Al, ( 2005 ) . Use of di ( 2-ethylhexyl ) phthalate-containing medical merchandises and urinary degrees of glandular fever ( 2-ethylhexyl ) phthalate in neonatal intensive attention unit babies. Environmental Health Perspectives. 113 ( 9 ) , 1222-1225. Retrieved April 30, 2007 from the universe broad web at: www.ehponline.org/members/2005/7932/7932.pdf
Health Care Without Harm. ( 2007 ) . How to be after and keep a quicksilver thermometer exchange. Retrieved April 30, 2007 from the universe broad web at: www.noharm.org/library/docs/Going_Green_How_to_Hold_a_Mercury_Thermometer_.pdf
Health Care Without Harm. ( 2006 ) . Hazards to asthma posed by indoor wellness attention environments: A usher to identifying and cut downing debatable exposures. Retrieved March 22, 2007 from the universe broad web at: www.noharm.org/details.cfm? type=document & A ; ID=1315
Health Care Without Harm, News Release ( 2003 ) . New study: 100 % of reacting infirmaries use pesticides in or around installations. Retrieved April 30, 2007 from the universe broad web at: www.noharm.org/details.cfm? type=document & A ; id=867.
Health Care Without Harm ( n.d.a. ) Food: The issue. Retrieved April 30, 2007 from the universe broad web at: www.noharm.org/us/food/issue.
Health Care Without Harm, ( n.d.b ) . Medical waste: The issue. Retrieved January 13, 2007 from the universe broad web at: www.noharm.org/us/medicalwaste/issue.
Williams, P.W. ( 1993 ) Environmental concern pattern: Ethical codifications of behavior for touristry. Hospitality Trends 7 ( 1 ) , 8-11.
World Travel & A ; Tourism Council, World Tourism Organization, Earth Council ( 1995 ) Agenda 21 for the Travel and Tourism Industry: Towards Environmentally Sustainable Development. London: WTTC.
World Travel & A ; Tourism Environment Research Centre ( WTTERC ) ( 1993 ) Travel & A ; Tourism: Environment & A ; Development. Oxford: WTTERC
United Nations Environment Programme ( UNEP ) ( 1988 ) Environmental scrutinizing. Industry and Environment 11 ( 4 ) , 12-18.
- ( 1994 ) Environmental Codes of Conduct for Tourism. Paris: UNEP, Industry and Environment. Ward-Whate, L. , Bloomfield
Healy, J. ( 1998 ) Social welfare Options: Delivering Social Services. Sydney: Allen & A ; Unwin.
Edwards, N. and Harrison, A. ( 1999 ) The infirmary of the hereafter: planning infirmaries with limited grounds. A research and policy job, British Medical Journal, 319: 1361-3.
Mentions
Chung, J. W. , and Meltzer, D. O.A Estimate of the C footmark of the U.S. wellness attention sector.A JAMA. 302 ( 18 ) :1970-1972, Nov. 11. 2009
Zhu, H.A First eco-friendly infirmary energy works installed. Epoch Times.A Nov 4, 2009.
Clark, A.A Deirdre Imus 's mission to green up toxic infirmaries. GreenBiz.com.A Oct. 29, 2009.
Gilbert, M.A Washington Co. schools, infirmary traveling green.A The Herald-Mail. Oct. 24, 2009.
Hemingway, S.A A new shadiness of infirmary viridity. Burlington Free Press. Oct. 18, 2009
Cole, B.A Wisconsin infirmary saves green by traveling green. HealthLeaders Media. Oct. 5, 2009
Guenther R. Sustainable architecture for wellness: a mentality displacement. Guest column. Health Environments Research & A ; Design Journal. 2 ( 4 ) :3-9, Summer 2009
Dunlop, D.A Healthcare 's green enterprise: the healthy infirmary motion. Alternate Health Journal. Aug. 3, 2009
Wu, J.A A Environmental conformity: The good, the bad, and the super viridity. Journal of Environmental Management. June 30, 2009. [ Epub in front of print ]
Levy, J. , Funk, P. , and Cheney, K.A A The cogeneration option: salvaging money and the planet.A Healthcare Deisgn Magazine.A May 27, 2009
BaldwinA G. How green was my infirmary. Health Data Management. 17 ( 4 ) :82,84, 86, Apr. 2009
Harris, N. , and others.A Hospitals traveling green: a holistic position of the issue and the critical function of the nurse leader.A Holistic Nursing Practice. A 23 ( 2 ) :101-11, Mar./Apr. 2009
Greene, J. Energy. Online auctions touted as a manner to cut down costs, go green. HospitalsA & A ; Health Networks. 83 ( 1 ) :17, Jan. 2009
Crisp, N. , and Donaldson, L.A Material Health: A Resource Flow and Ecological Footprint of the NHS.A Material Health, 2009
Hackenbrach, J.A A Mandates and available inducements for constructing green health care facilities.A Healthcare Design.A 8 ( 12 ) :16-18, Dec. 2008
Gehant, D.A Hospitals and the environment.A Frontiers of Health Services Management.A 25 ( 1 ) :3-10, Fall 2008
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Appendix: Outline of the proposed thesis
Abstraction
Recognitions
Vita
List of Tables
List of Figures
Chapters:
1. Introduction... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
1.1. Statement of the Problem... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
1.2. Aims of the Study... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
1.3. Definitions... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
1.4. Background and Setting... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
1.5. Significance... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
2. LITERATURE REVIEW AND EMPIRICAL MODEL... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
2.1. Literature Reappraisal... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
2.1.1. Green Practices in Healthcare and Tourism Management... ... ... ... ... ... ... ... ... ... ..
2.1.2. Customers... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
2.1.3. Industry... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
2.1.4. The Impact of Green Practices... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
2.1.5. Areas of Green Practices... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
2.1.6. Research Questions... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
2.2. Theoretical Model... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
2.2.1. Theory of Planned Behavior... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
2.3. Hypothesiss Development... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
2.3.1. Demographics and Attitudes... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
2.3.2. Demographics and Subjective Norms... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
2.3.3. Demographics and Perceived Behavioral Control... ... ... ... ... ... ... ... ... ... ... ... ... ...
2.3.4. Attitude towards Green Practices in Hospitals... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
2.3.5. Subjective Norm on Green Practices... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
2.3.6. Perceived Behavioral Control of Visiting Green Hospitals... ... ... ... ... ... ... ...
3. Procedure... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
3.1. Research Design and Subject Selection... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
3.2. Result Measures... ... ... ... ... ... ... ... ... ... ... ... ... ..viii
3.2.1. Independent Variables... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
3.2.2. Dependent Variable... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
3.3. Data Analysis... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
4. Consequence... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
4.1. Internal Consistency Reliability... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
4.2. Demographic Characteristics... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
4.3. Green Areas... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
4.4. Correlation of Importance of Green Areas with Demographic Characteristic... ...
4.5. Willingness to Pay... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
4.6. Hypothesiss aa‚¬ '' Linear Arrested developments... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
4.6.1. Demographics on Attitudes... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
4.6.2. Demographics on Subjective Norm... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
4.6.3. Demographics on Perceived Behavioral Control... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
4.6.4. Attitudes, Subjective Norm, and Perceived Behavioral Control on Intention
4.7. Multicollinearity... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
4.8. Linear Regressions Split by Hospitals... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
4.8.1. Attitudes by Hospital... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
4.8.2. Subjective Norm by Hospital... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
4.8.3. Perceived Behavioral Control by Hospital... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
4.8.4. Forecasters of Behavioral Intention by Hospital... ... ... ... ... ... ... ... ... ... ... ... ... ... .
4.9. Qualitative informations... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
5. SUMMARY AND DISCUSSION... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
5.1. Drumhead... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
5.1.1. Research Questions... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
5.1.2. Theory of Planned Behavior... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
5.2. Deductions... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
5.3. Restrictions... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
5.4. Future Research... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
