Factors and determinants of value- and business-driven sustainability initiatives in health care organizations: intrinsic differences and extrinsic similarities

• DOI: https://doi.org/10.1108/CG-03-2019-0078
• Pages: 806-823
• Date: 11 June 2019
• Published date: 11 June 2019
• Author: Rocio Rodriguez,Göran Svensson,Nils M. Høgevold,David Eriksson
• Subject Matter: Strategy

Factors and determinants of value- and

business-driven sustainability initiatives in

health care organizations: intrinsic

differences and extrinsic similarities

Rocio Rodriguez, Göran Svensson, Nils M. Høgevold and David Eriksson

Abstract

Purpose –The purpose of this paper is to compare the similarities and differences relating to

sustainability initiativesbetween health-care organizations. The aim isto provide a framework of factors

and theirdeterminants to enable a profiling of organizationalsustainability initiatives.

Design/methodology/approach –Based on an inductive approach,judgmental sampling was applied

to select relevant health-careorganizations. Informants were identified according to theirknowledge of

their organizations’sustainability initiatives.

Findings –Several factors and their determinants for characterizing differences and similarities were

found. The results also reveal that organizational sustainability initiatives are either value-driven or

business-driven.

Research limitations/implications –The reported frameworkof factors and their determinants serves

the purpose of profiling organizational sustainability initiatives. Opportunities for further research are

provided.

Practical implications –This paper provides managerial guidance for characterizing the differences

and similaritieswith respect to organizationalsustainability initiatives in relationto other organizations.

Originality/value –This study establishes a framework for characterizing organizational sustainability

initiatives. It also contributes to reveal whether organizational sustainability initiatives are value –or

business-drivenand considers intrinsic-orienteddifferences and extrinsic-orientedsimilarities.

Keywords Spain, Sustainability, Health care, Business-driven, Value-driven

Paper type Case study

Introduction

Discussing the obligations of organizations toward society, Bowen (1953, p. 6) stated that

“It is the obligation of businessmen to pursue those policies, to make those decisions, or to

follow those lines of action which are desirable in terms of the objectives and values of our

society.” It has since been recognized that pressure from outside actors, such as

customers, limits the ability of organizations to escape blame for misconduct (Eriksson and

Svensson, 2015). There are certainly outside-in arguments on how organizations should

take responsibility. By contrast, there is little knowledge about initiatives with regard to the

value base upon which those initiativesare taken.

One expectation that society and outside actors have of organizations is that they be

sustainable. This can be seen in consumer actions against companies perceived as acting

in an unsustainable manner. For example, Greenpeace pressured Lego out of a

collaboration with Shell. It is also apparent in regulations such as the UK Modern Slavery

Rocio Rodriguez is based

at Krisitiania University

College, Oslo, UK.

Go

¨ran Svensson is based

at Oslo School of

Management, Oslo,

Norway. Nils M. Høgevold

is based at Department of

Marketing, Oslo School of

Management, Oslo,

Norway. David Eriksson is

based at The School of

Engineering, Jo

¨nko

¨ping

University, Jo

¨nko

¨ping,

Sweden.

Received 24 April 2018

Revised 10 September 2018

22 December 2018

1 March 2019

4 March 2019

23 March 2019

15 April 2019

Accepted 16 April 2019

PAGE 806 jCORPORATE GOVERNANCE jVOL. 19 NO. 4 2019, pp. 806-823, ©EmeraldPublishing Limited, ISSN 1472-0701 DOI 10.1108/CG-03-2019-0078

Regulation Act. Sustainability is often defined in line with the definition of sustainable

development, as suggested by (WCED, 1987,p.43):“[...] development which meets the

needs of the present without compromising the ability of future generations to meet their

own needs [...]”. It is commonly accepted that this includes the so-called triple bottom line

(TBL) of economic, environmentaland social performance (Elkington, 1997).

Carroll (1991, p. 42) argued that the basis for responsibility should be business-driven. In

his model, businesses should, in order, be profitable, follow the law, be ethical and be a

good corporate citizen. There are examples of companies which try to construct a strategy

that has high performance in all dimensions, but they still often face problems with the

economic dimension (Tate and Bals, 2016). For example, Wong (2014) focused on non-

financial risk management system as the path for companies to move closer sustainable

development. Fairphone is an interesting example of a company which has turned

conventional business models on their heads, in attempting to be sustainable in all

dimensions. For example, they use crowdfunding to pay for production, refuse purely

economic investors and design their products for easy repair and disassembly, while also

contributing to better conditionsin the mining industry (Eriksson and Svensson, 2016a).

In this present research, we turn our attention to an area which has previously been

overlooked in the sustainability literature, that is, the nature of the driving forces behind

sustainability initiatives. When, for example, social dimensions are added to a conventional

business approach, these are shoehorned into an already established system, which is

barely capable of achieving the desired outcomes (Karjalainen and Moxham, 2013). In this

line, Lacy et al. (2009) focused on the importance of training employees in sustainable

knowledge, skills and behaviors. As such, the research objective is to compare similarities

and differences between value- and business-driven sustainability initiatives. Value-driven

includes those organizations which are not based on the notion of maximizing profits but

working toward a goal-based primary on other values. Business-driven includes those

organizations that focus first and foremoston profit maximization.

The aim of this paper is to provide a framework of factors and related determinants to

enable a profiling of sustainability initiatives in organizations.The relevance of this study lies

in two principal contributionsto existing theory and previous studies:

1. It contributes to framing factors and determinants of value- and business-driven

sustainability initiatives in health-care organizations.

2. It contributes revealing intrinsic differences and extrinsic similarities between health-

care organizations.

When investigating sustainability initiatives, we concentrate on those actions that are

dedicated to improving environmental and social performance of organizations. This study

focuses on hospitals, as providing a health-care service has a high impact on the

environment. The desire to mitigate one’s impact on the environment is being treated by

each organization and each nation with a range of different policies (Ryan-Fogarty et al.,

2016). This study also focuses on this area of hospitals because of the observation that

“[...] patients look carefully for detailed information [...][...] before selecting a healthcare

service provider [...][...] healthcare service providers should understand more the

importance of sustainable hospitalservicescape designs [...]”Hamed et al. (2017).

Theoretical framework

Overview of sustainability

Sustainability is centered on the TBL and covers the economic, environmental and social

dimensions of performance (Elkington, 1997;WCED, 1987). Economic sustainability is

perhaps the oldest dimension in the literature and is referred to as a hard and traditional

dimension (Winter and Knemeyer, 2013). One benefit of researching economic

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