Sustainability accounting and reporting adoption across Italian public healthcare system: What role of the institutional pressures?

Background: This paper aims to understand whether and how the Italian healthcare context has embraced sustainability accounting and reporting practices. Specifically, it investigates if the sector has developed institutional pressures that drive public healthcare organisations toward the adoption of sustainability disclosure. Methods: The researchers employed document analysis as a qualitative research method for data collection and analysis. The research team analysed a total of 80 institutional and corporate documents, divided into 10 documents from the regional programming phase and 70 from the corporate monitoring phase. Results: The analysis shows that Italian healthcare organisations are lagging in adopting sustainability documents. Furthermore, the analysed disclosures do not refer to the United Nations Sustainable Development Goals (SDGs), as they are compiled according to national legislation designed well before the introduction of the SDGs framework. Discussion & Conclusion: The lack of institutional pressures across public sector organisations has hindered the development of a solid culture of sustainability reporting in the public healthcare sector. This research contributes at two levels: practically, it advances the accounting and reporting literature by examining the availability of such practices in the public sector; theoretically, it sheds light on the development and role of institutional pressures for sustainability reporting in Italian public hospitals.