<![CDATA[This study aims to analyse the mechanism of Environmental Management Accounting (EMA) synergising Physical EMA (PEMA) and Monetary EMA (MEMA) as an awareness tool in fostering ecological consciousness and operational efficiency in a Specialised Hospital in East Java. Employing a qualitative single-case study approach, data were gathered through semi-structured in-depth interviews with six cross-functional key informants (managerial, finance, environmental, HR, medical, and non-medical staff), field observations, and document analysis. The findings demonstrate that PEMA has been effectively integrated through digital physical logging (Festronik), whereas MEMA remains consolidated within general operational expenses without a standalone green ledger. The transparency of physical information and an understanding of the cost consequences of hazardous waste treatment proved to function as a cognitive trigger for point-of-care staff. This manifests in disciplined infectious waste segregation, the adoption of a paperless culture driven by Electronic Medical Records, and the reduction of single-use plastics. This study concludes that EMA acts as a cognitive device that transforms institutional pressures into substantive ecological work behaviour, whilst optimising Triple Bottom Line performance through cost avoidance and environmental protection. Keywords: Awareness Tool, Environmental Management Accounting, Ecological Consciousness, Monetary EMA, Physical EMA, Specialised Hospital Abstrak Penelitian ini bertujuan menganalisis mekanisme Environmental Management Accounting (EMA) yang menyinergikan Physical EMA (PEMA) dan Monetary EMA (MEMA) sebagai awareness tool dalam membangun kesadaran ekologis dan efisiensi operasional pada Rumah Sakit Khusus (RSK) Jawa Timur. Pendekatan kualitatif studi kasus tunggal, data dikumpulkan melalui wawancara mendalam semi-terstruktur terhadap enam informan kunci lintas fungsi (manajerial, keuangan, K3L, SDM, medis, dan non-medis), observasi lapangan, serta analisis dokumen.. Hasil penelitian menunjukkan bahwa PEMA telah terintegrasi dengan baik melalui pencatatan fisik digital (Festronik), sedangkan MEMA masih terkonsolidasi dalam beban operasional umum tanpa akun mandiri (standalone green ledger). Transparansi informasi fisik dan pemahaman konsekuensi biaya pengolahan limbah B3 terbukti berfungsi sebagai pemantik kognitif (cognitive trigger) bagi staf di titik pelayanan (point-of-care). Hal ini terwujud dalam kedisiplinan pemilahan sampah infeksius, adopsi budaya paperless berbasis Rekam Medis Elektronik, dan reduksi plastik sekali pakai. Penelitian ini menyimpulkan bahwa EMA bertindak sebagai cognitive device yang mentransformasi tekanan institusional menjadi adopsi budaya kerja ekologis yang substantif, sekaligus mengoptimalkan kinerja Triple Bottom Line melalui penghindaran biaya (cost avoidance) dan perlindungan lingkungan. Kata Kunci: Sarana Peningkatan Kesadaran, Akuntansi Manajemen Lingkungan, Kesadaran Ekologis, EMA Moneter, EMA Fisik, Rumah Sakit Khusus]]>
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