Management Controls for Promoting Sustainable Development in Austrian State-Owned Hospitals

Sustainability has become a critical issue as climate change, environmental degradation, and resource scarcity increasingly threaten ecosystems and human health. Accounting for 4.4% of global CO 2 emissions, the healthcare sector is central to addressing these challenges, while also needing to ensure high-quality care. Empirically, the study investigates the role of Austrian state-owned hospitals (SOHs) in implementing sustainability management controls (SMCs) to promote sustainable development (SD). This qualitative study, based on 13 interviews and a documentary analysis of non-financial reports and websites, explores SD implementation and the related management control practices in 10 Austrian SOHs. The findings show that SMCs are discussed selectively in Austrian SOHs, with a focus on the environmental dimension. Cultural controls dominate, followed by administrative controls, while cybernetic controls, strategy, and planning, as well as employee benefits, are underrepresented. Building on stewardship theory, three ideal-type stages were identified, namely the individual actor level (stage 1), the organizational level (stage 2), and the macro-objective SD commitment (stage 3). While the interview partners of the SOHs exhibit a strong individual commitment and there is emerging organizational stewardship for SD in SOHs, the macro-objective SD-stewardship has not been filled with life. In addition, with a framework for transitional steps in achieving a more comprehensive SMC system in SOHs, the paper offers practical insights for mission-driven hospitals improving their SD orientation.