Journal of Resource Management and Decision Engineering In Press 2025 12 11 Designing an environmental accounting model with an emphasis on waste management to improve performance sustainability (Case study: Hospitals covered by the Ministry of Health) Designing an environmental accounting model with an emphasis on waste management to improve performance sustainability (Case study: Hospitals covered by the Ministry of Health) 1 14 EN Journal Article 2026 03 01 <p>In recent years, environmental accounting has become a strategic tool for managing sustainability costs in organizations. Hospitals face a serious challenge in the systematic recording and reporting of environmental costs due to the production of hazardous waste. Lack of native accounting model in public hospitals has led to the concealment of real waste management costs and reduced financial transparency in sustainable performance appraisal, so the purpose of this study is to design an environmental accounting model with emphasis on waste management to improve performance sustainability (Case study: hospitals covered by the Ministry of Health). The research method was mixed, qualitative and quantitative and first, qualitative data were collected. Then, based on the findings of the qualitative stage, a tool was made to enable quantitative data collection and generalization. In order to obtain qualitative data, according to targeted sampling of snowball type, 16 elites, accounting professors, accountants, managers and doctors of hospitals under the auspices of the Ministry of Health were selected and conducted by semi-in-deep interviews and open-ended questions and based on thematic analysis and findings. At this stage, the model of environmental accounting model was developed with emphasis on waste management to improve performance sustainability (Case study: hospitals covered by the Ministry of Health). In order to explain the model based on the findings of the qualitative method, the initial questionnaire in the quantitative design, validity and reliability of this tool was reviewed by referring to the opinion of experts and managers and approved after corrections. Statistical population in the quantitative section, accountants, managers and physicians of hospitals under the auspices of the Ministry of Health were selected as 106396 and the statistical sample according to Cochran's formula, a sample of 383 people was selected and distributed and collected by random sampling method. Quantitative data were analyzed and processed with the help of PLS software. According to the paradigm model, environmental accounting components with emphasis on waste management to improve the sustainability of hospital performance in six categories of causal factors including 6 components; Factors affecting environmental accounting with 3 dimensions (strategic indicators, uncertainty indicators, commitment indicators and senior management); Environmental accounting with 3 dimensions (social legitimacy, accounting information system, control and monitoring); Waste management with 6 dimensions (separation of waste at the source of production, collection of waste sectors, waste transportation, temporary waste storage, waste disposal, manpower status); Factors affecting performance stability with 7 indicators; Performance stability with 4 indicators; and environmental accounting results with emphasis on waste management to improve performance sustainability with 3 dimensions (improving and optimizing environmental processes with an emphasis on waste management, cooperation with HSE (Health, Safety and Environment), Financial Implications); were identified.</p> https://journalrmde.com/index.php/jrmde/article/download/272/259