Driving ESG-oriented practices on customer retention in health-care service: evidence from an emerging economy

Purpose This study aims to investigate the role of environmental, social and governance (ESG) practices in shaping patient perceptions and behavioral outcomes within the context of private general hospitals in Vietnam. Besides, this study examines the mediating role of customer loyalty in the relationships between hospital image or hospital reputation and customer retention. Design/methodology/approach Drawing on a quantitative, survey-based approach involving 433 customers who have used or are considering non-emergency health-care services, this study examines the independent effects of each ESG dimension on hospital image and reputation, using structural equation modeling. Findings Governance plays the most pivotal role in enhancing hospital image and reputation. These perceptual constructs, in turn, significantly strengthen customer loyalty and drive retention. However, the mediating effect of customer loyalty weakens under conditions of low patient trust, indicating that ESG perceptions alone may not sustain retention without relational reinforcement. Practical implications The study provides actionable guidance for private hospital leaders and executives, emphasizing ESG, especially governance as a strategic lever for building trust, reputation and patient retention. Originality/value The study offers empirical insight into how sustainability-oriented hospital strategies – especially environmental practices – may shape trust, loyalty and long-term engagement. By advancing an integrated theoretical framework, this research contributes to both health-care marketing and sustainability literature, offering practical implications for hospital administrators aiming to enhance competitive positioning through ESG-driven value creation.