Need for transparency: hospital sustainability disclosures

Purpose This study aims to develop a hospital-specific sustainability disclosure framework—environmental, social, governance and health (ESGH)—to quantify hospital sustainability disclosure quality and examine the conditions and mechanisms leading to varying levels of such disclosure. Design/methodology/approach This study employs a three-stage, mixed-methods approach. First, manual content analysis, guided by the ESGH framework, quantifies the extent and quality of sustainability disclosure using a sample of 250 hospitals across 28 countries. Second, the study employs fuzzy-set qualitative comparative analysis (fsQCA) to identify the configurations of antecedent conditions associated with high or low disclosure outcomes. Third, regression analysis is used to complement the fsQCA results by cross-verifying the causal configurations through fixed-effects probit models, ensuring methodological rigour and providing a comprehensive understanding of sustainability disclosure pathways. Findings The study finds that hospital sustainability disclosure remains inadequate, with an average disclosure score of 41.44, representing only 6.7% of the overall benchmark. Effective sustainability disclosure is influenced by factors such as larger hospital size, strong peer pressure and robust healthcare performance. In contrast, poorer sustainability disclosure is associated with small hospital size and weak peer pressure. Originality/value This study advances hospital sustainability research by introducing the ESGH framework, which integrates health as a core dimension of sustainability and addresses the limitations of generic environmental, social and governance models in healthcare. By combining textual analysis with empirical research, it offers theoretical advancements and practical guidance, enabling hospitals to tailor sustainability disclosure strategies to their specific operational contexts and regulatory requirements.