Chasing environmental sustainability in healthcare organizations: insights from the Italian experience

The findings suggest that organizations do not necessarily follow a linear or formalized pathway in adopting environmental sustainability practices. Instead, implementation often emerges from pragmatic and context-driven processes, even in the absence of strategic codification. This behavior reflects both the adaptability and the limitations of decentralized action, with risks of fragmentation and uneven progress. A national strategy-supported by standardized indicators, reporting systems, and financial incentives-could strengthen alignment, enhance scalability, and support healthcare organizations in embedding sustainability more systematically, while preserving flexibility for local innovation.