Sustainability management control in healthcare organizations - current state and future directions

Environmental, social, and governance (ESG) considerations are increasingly vital for healthcare organizations (HCOs), which face rising pressures from climate change, limited financial resources, and regulatory obligations towards HCOs’ engagement for ESG-matters. Environmentally, the healthcare sector contributes around 4.4% of global CO₂ emissions, underscoring the urgency of green transformation. This study systematically reviews the academic literature to identify which types of sustainability management controls (SMCs) are used to support ESG-matters in HCOs and outlines avenues for future research. The review is global in scope and includes all types of HCOs. Drawing on strategic stakeholder and legitimacy theory, the most widely applied theories in ESG-accounting, this study explores the instrumental and socio-political dimensions of SMCs. The findings reveal a dominant emphasis on environmental sustainability, with cultural and administrative controls being the most frequently discussed, while cybernetic, planning and strategy, and reward and compensation remain under explored. The study highlights the lack of strategic-operational integration and offers a conceptual framework to guide researchers, practitioners, and policymakers in embedding ESG-driven management control systems more effectively.