RECONCILING CONTROL, ACCOUNTABILITY, AND SUSTAINABILITY: A CONCEPTUAL SYNTHESIS OF MEDICAL WASTE GOVERNANCE, PERFORMANCE MEASUREMENT SYSTEMS, AND THE LEVERS OF CONTROL IN PUBLIC HOSPITALS
Keywords:
medical waste governance, performance measurement systems, levers of control, public hospitals, organizational control and accountabilityAbstract
Medical waste management has become an increasingly urgent governance concern for public hospitals, particularly in developing and emerging economies where institutional complexity, fiscal constraints, and regulatory ambiguity persist. Although improper waste handling poses severe public health risks, the persistent failures observed across hospitals cannot be explained through technical or operational lenses alone. This conceptual paper synthesizes three major bodies of literature—medical waste governance, performance measurement systems (PMSs), and Simons’ Levers of Control (LoC)—to develop an integrated understanding of how organizational control architectures shape managerial attention, accountability, and environmental performance. The review shows that weak PMS design, fragmented control systems, and inconsistent enactment of control levers collectively contribute to the gap between formal regulatory expectations and actual waste-handling practices. It also highlights empirical anomalies and theoretical tensions within LoC research, particularly its assumptions regarding lever interactions and synergy when applied to resource-constrained, bureaucratic health systems. The Indonesian public-hospital setting illustrates how autonomy and dependence coexist, complicating efforts to institutionalize effective waste governance. By consolidating dispersed insights from multiple disciplines, this paper advances a more comprehensive and context-sensitive explanation of medical waste governance and offers a foundation for future empirical research on the interplay between PMSs, control levers, and environmental stewardship in public healthcare.References
Akkajit, P., Romin, H., & Assawadithalerd, M. (2020). Assessment of knowledge, attitude, and practice in respect of medical waste management among healthcare workers in clinics. Journal of Environmental and Public Health, 2020, Article 8745472. https://doi.org/10.1155/2020/8745472
Albertini, E. (2019). The contribution of management control systems to environmental capabilities. Journal of Business Ethics, 159(4), 1163–1180. https://doi.org/10.1007/s10551-018-3810-9
Ali, M., Wang, W., Chaudhry, N., & Geng, Y. (2017). Hospital waste management in developing countries: A mini review. Waste Management & Research, 35(6), 581–592. https://doi.org/10.1177/0734242X17691344
Amhalhal, A., Anchor, J., Tipi, N. S., & Elgazzar, S. (2022). The impact of contingency fit on organisational performance: An empirical study. International Journal of Productivity and Performance Management, 71(6), 2214–2234. https://doi.org/10.1108/IJPPM-01-2021-0016
Ananth, A. P., Prashanthini, V., & Visvanathan, C. (2010). Healthcare waste management in Asia. Waste Management, 30(1), 154–161. https://doi.org/10.1016/j.wasman.2009.07.018
Aung, T. S., Luan, S., & Xu, Q. (2019). Application of multi-criteria-decision approach for the analysis of medical waste management systems in Myanmar. Journal of Cleaner Production, 222, 733–745. https://doi.org/10.1016/j.jclepro.2019.03.049
Ayub, S., Iram, M., & Arif, M. (2021). Doctors’ perception regarding hospital waste management at Ghurki Hospital, Lahore. Pakistan Journal of Medical & Health Sciences, 15(4), 695–698.
Bandaso, A., & Ayuningtyas, D. (2019). Management of medical waste in developing countries: A systematic review. The 6th International Conference on Public Health, 7–14. https://doi.org/10.26911/the6thicph.01.25
Bawono, I. R., Restianto, Y. E., Tim Sub Direktorat Bimbingan Teknis Keuangan Daerah Periode 2016 dan 2017, & Ferani, N. A. (2017). Pengantar: Mengelola Keuangan BLUD (Badan Layanan Umum Daerah). Serial Materi Pelatihan Pengelolaan Keuangan Daerah (Vol. 4).
Borowy, I. (2020). Medical waste: The dark side of healthcare. História, Ciências, Saúde – Manguinhos, 27, 231–251. https://doi.org/10.1590/S0104-59702020000300012
Bourne, M., Mills, J., Wilcox, M., Neely, A., & Platts, K. (2000). Designing, implementing and updating performance measurement systems. International Journal of Operations & Production Management, 20(7), 754–771. https://doi.org/10.1108/01443570010330739
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
Creswell, J. W. (2014). Research design: Qualitative, quantitative and mixed methods approaches (4th ed.). Sage Publications.
Demartini, C., & Trucco, S. (2017). Are performance measurement systems useful? Perceptions from health care. BMC Health Services Research, 17(1), 1–15. https://doi.org/10.1186/s12913-017-2022-9
Elgazzar, S., Tipi, N., & Jones, G. (2019). Key characteristics for designing a supply chain performance measurement system. International Journal of Productivity and Performance Management, 68(2), 296–318. https://doi.org/10.1108/IJPPM-04-2018-0147
Fahlevi, H. (2016). Understanding why the role of accounting is unchanged in Indonesian public hospitals. Journal of Accounting and Organizational Change, 12(2), 203–222. https://doi.org/10.1108/JAOC-03-2014-0020
Fukaya, Y. (2024). The synergetic effect of belief system, diagnostic control system, interactive control system on frontline employee behavior. Journal of Strategic Management Studies, 15(2), 89–100. https://doi.org/10.24760/iasme.15.2
Handayani, F., Basri, H., & Fahlevi, H. (2019). Does increasing public hospital financial autonomy improve performance? A study of Indonesian public hospitals. Management and Economic Review, 6(1), 1–13. https://doi.org/10.24818/mer/2019.06-01
Harmadi, S., & Irwandy, I. (2018). Technical efficiency of public service hospitals in Indonesia: A data envelopment analysis (DEA). Asian Social Science, 14(6), 81–90. https://doi.org/10.5539/ass.v14n6p81
Henri, J.-F. (2006). Management control systems and strategy: A resource-based perspective. Accounting, Organizations and Society, 31(6), 529–558. https://doi.org/10.1016/j.aos.2005.07.001
Henri, J. (2009). Taxonomy of performance measurement systems. Advances in Management Accounting, 17, 247–288. https://doi.org/10.1016/S1474-7871(08)17009-5
Kastberg, G., & Siverbo, S. (2013). The design and use of management accounting systems in process-oriented health care – An explorative study. Financial Accountability & Management, 29(3), 246–270. https://doi.org/10.1111/faam.12014
Kementerian Kesehatan Republik Indonesia. (2023). Profil Kesehatan Indonesia 2022.
Khan, B. A., Cheng, L., Khan, A. A., & Ahmed, H. (2019). Healthcare waste management in Asian developing countries: A mini review. Waste Management & Research, 37(9), 863–875.
Kodir, A., Tanjung, A., Rosyendra, M., & Saputra, M. (2021). Challenges of COVID-19 medical waste management in Indonesia: A multi-stakeholder perspective. Waste Forum, 49–114.
Kruis, A. M., Speklé, R. F., & Widener, S. K. (2016). The levers of control framework: An exploratory analysis of balance. Management Accounting Research, 32, 27–44. https://doi.org/10.1016/j.mar.2015.12.002
Lv, Y., Ma, G., & Ding, J. (2022). Evolutionary game analysis of medical waste disposal in China under different reward and penalty models. Sustainability, 14(8), Article 4658. https://doi.org/10.3390/su14084658
Malmmose, M. (2019). Accounting research on health care – Trends and gaps. Financial Accountability & Management, 35(1), 90–114. https://doi.org/10.1111/faam.12183
Mangindaan, D., Adib, A., Febrianta, H., & Hutabarat, D. J. C. (2022). Systematic literature review and bibliometric study of waste management in Indonesia in the COVID-19 pandemic era. Sustainability, 14(5). https://doi.org/10.3390/su14052556
Manupati, V. K., Ramkumar, M., Baba, V., & Agarwal, A. (2021). Selection of the best healthcare waste disposal techniques during and post COVID-19 pandemic era. Journal of Cleaner Production, 281, 125175. https://doi.org/10.1016/j.jclepro.2020.125175
Marshal, M., Sunaryo, N. C., Kurniawan, S. J., Herwendanasari, D., Hariyanto, E., & Andarini, S. (2021). Green hospital implementation in Indonesia: A literature review. Journal of Community Health and Preventive Medicine, 1(2), 32–41. https://doi.org/10.21776/ub.jochapm.2021.001.02.5
Martyn, P., Sweeney, B., & Curtis, E. (2016). Strategy and control: 25 years of empirical use of Simons’ levers of control framework. Journal of Accounting & Organizational Change, 12(3), 281–324. https://doi.org/10.1108/JAOC-03-2015-0027
Miles, M. B., Huberman, A. M., & Saldaña, J. (2014). Qualitative data analysis: A methods sourcebook (3rd ed.). SAGE Publications.
Mujiono, S. E. L. (2022). Analisis penerapan green accounting atas pengelolaan limbah medis pada Rumah Sakit Umum Daerah Dr. Haryoto Lumajang. Jurnal Akuntansi dan Keuangan, 27(2), 102–112. https://doi.org/10.23960/jak.v27i2.391
Mundy, J. (2010). Creating dynamic tensions through a balanced use of management control systems. Accounting, Organizations and Society, 35(5), 499–523. https://doi.org/10.1016/j.aos.2009.10.005
Neuman, W. L. (2014). Social research methods: Qualitative and quantitative approaches (7th ed.). Pearson Education.
Nudurupati, S. S., Bititci, U. S., Kumar, V., & Chan, F. T. S. (2011). State-of-the-art literature review on performance measurement. Computers & Industrial Engineering, 60(2), 279–290. https://doi.org/10.1016/j.cie.2010.11.010
Parida, A., Capoor, M. R., & Bhowmik, K. T. (2019). Knowledge, attitude, and practices of biomedical waste management rules among healthcare workers in a tertiary care setup. Journal of Laboratory Physicians, 11(4), 292–299. https://doi.org/10.4103/JLP.JLP
Prayudi, M. A., Nurkholis, N., Saraswati, E., & Rusydi, M. (2023). Do vision and mission really matter? The management control experiences of reformed public hospitals in Indonesia. International Journal of Professional Business Review, 8(3), e01092.
Prayudi, M. A., Nurkholis, N., Saraswati, E., & Rusydi, M. (2024). Top management characteristics, performance measurement systems design and strategic change of reformed public hospitals in Indonesia. Australasian Business, Accounting and Finance Journal, 18(1), 44–60. https://doi.org/10.14453/aabfj.v18i1.04
Puška, A., Stević, Ž., & Pamučar, D. (2022). Evaluation and selection of healthcare waste incinerators using extended sustainability criteria and multi-criteria analysis methods. Environment, Development and Sustainability, 24(9), 12173–12196. https://doi.org/10.1007/s10668-021-01902-2
Ranjbari, M., Shams Esfandabadi, Z., Shevchenko, T., Chassagnon-Haned, N., Peng, W., Tabatabaei, M., & Aghbashlo, M. (2022). Mapping healthcare waste management research: Past evolution, current challenges, and future perspectives toward a circular economy transition. Journal of Hazardous Materials, 422, 126724. https://doi.org/10.1016/j.jhazmat.2021.126724
Republik Indonesia. (2015). Peraturan Presiden Republik Indonesia Nomor 77 Tahun 2015 tentang Pedoman Organisasi Rumah Sakit.
Rodríguez, R., Svensson, G., & Ferro, C. (2021). Assessing the future direction of sustainable development in public hospitals: Time-horizon, path and action. Health Policy, 125(4), 526–534. https://doi.org/10.1016/j.healthpol.2020.10.012
Saldana, J. (2011). Fundamentals of qualitative research. Oxford University Press.
Silva, A. R. M. V. e., Iwata, B. de F., dos Santos, M. do S. F., & Neto, J. M. M. (2023). Impacts and regulations of healthcare solid waste management during the COVID-19 pandemic: A systematic review. Sustainability, 15(19), Article 14462. https://doi.org/10.3390/su151914462
Simons, R. (1995). Levers of control: How managers use innovative control systems to drive strategic renewal. Harvard Business School Press.
Sisdyani, E. A., Subroto, B., Saraswati, E., & Baridwan, Z. (2020). Levers of eco-control and green behavior in medical waste management. International Journal of Energy Economics and Policy, 10(4), 194–204. https://doi.org/10.32479/ijeep.9342
Spanò, R., Cicellin, M., & Scuotto, A. (2018). Performance measurement design: A contingency perspective from the Italian regional healthcare services. Journal of Economic and Administrative Sciences, 35(1), 16–27. https://doi.org/10.1108/JEAS-06-2018-0076
Speklé, R. F., & Widener, S. K. (2020). Insights on the use of surveys to study management control systems. Accounting, Organizations and Society, 86, 101184. https://doi.org/10.1016/j.aos.2020.101184
Tseng, M. L., Ardaniah, V., Bui, T. D., Tseng (Aaron), J. W., Lim, M. K., & Ali, M. H. (2022). Sustainable waste management in the Indonesian medical and healthcare industry: Technological performance on environmental impacts and occupational safety. Management of Environmental Quality, 33(2), 549–569. https://doi.org/10.1108/MEQ-07-2021-0160
Widener, S. K. (2007). An empirical analysis of the levers of control framework. Accounting, Organizations and Society, 32(7–8), 757–788. https://doi.org/10.1016/j.aos.2007.01.001
Wouters, M., & Sportel, M. (2005). The role of existing measures in developing and implementing performance measurement systems. International Journal of Operations & Production Management, 25(11), 1062–1082. https://doi.org/10.1108/01443570510626899
Yin, R. K. (2003). Applications of case study research (2nd ed.). Sage Publications.
Yin, R. K. (2018). Case study research and applications: Design and methods (6th ed.). SAGE Publications.
