How do performance monitoring systems support sustainability in healthcare?
Authors: Rouhana Rima , Van Caillie Didier 
Published: January 2025

Purpose
“Sustainability” in a health-care context is defined by the sustainable development goals (SDGs) adopted by the United Nations in 2015, and in particular the third SDG. Accordingly, this research summarizes seminal studies and draw on it to identify the waves of challenges affecting this sector. This study aims to contribute to the discourse on sustainability in health-care organizations (HCOs) by exploring the role of performance monitoring systems (PMS), such as the balanced scorecard (BSC).

Design/methodology/approach
To explore this issue further, the authors illustrate the transformation model of the HCOs, from inputs to outcomes. The authors rely on the systems and organizational analysis/behavior theories. They use a qualitative case study approach (the American University of Beirut Medical Center in Lebanon – AUBMC) to delve into the intricacies of PMS implementation in an HCO.

Findings
The authors’ findings underline the role of PMS in operationalizing sustainability within HCOs. By adopting a PMS, HCOs can facilitate the integration of environmental, social and economic factors into decision-making processes. HCOs can enhance their performance and create long-term value.

Research limitations/implications
Despite the important findings, this paper is not enough to “generalize” and “replicate” the results. However, this paper is able to highlight a road map for HCO’s managers. Furthermore, it does not take into account the impact of artificial intelligence on the design, implementation and analysis of the results produced by such a PMS.

Practical implications
This paper highlights the importance of strong leadership and a well-defined approach for HCOs to achieve sustainability. It highlights that sustainability is no longer just about reputation; sustainability can enhance organizational performance across various aspects. Leaders need to integrate sustainability into the organization’s mission, vision and values. Thus, implementing a PMS like the BSC is crucial. On the other hand, a focus on sustainability can attract and retain top talent who are increasingly concerned about environmental and social responsibility. Furthermore, sustainability efforts should consider patient needs. And finally, sustainability can drive innovation through developing new services, partnerships and technologies that reduce environmental impact and improve financial performance.

Social implications
This study highlights how adopting a sustainable approach in HCOs aligns with and supports achieving the UN-SDGs related to health care (SDG 3: Ensure healthy lives and promote well-being for all at all ages). The findings conclude on the HCO’s sustainability efforts to: improve access to quality care (by providing more efficient operations and resource allocation, potentially allowing HCOs to treat more patients and improve access to quality care − SDG 3.1, 3.8); encourage investments in preventative care programs and public health initiatives (by contributing to a healthier population and reducing treatment burdens − SDG 3.3, 3.4); support environmental responsibility (by reducing energy consumption and waste disposal in HCOs can lessen their environmental footprint and contribute to a healthier planet − SDG 3.9); focus on the employee well-being (by creating a more positive work environment with better air quality and potentially stress-reducing practices, potentially improving employee well-being − SDG 3.9); and innovate for better health care (sustainability can drive innovation in areas such as telemedicine, renewable energy sources for powering HCOs and developing environmentally friendly medical equipment − SDG 3.b).

Originality/value
This research contributes to the emerging field of sustainability in health care by providing empirical evidence of the role of PMS in achieving sustainability goals. The case study offers practical insights for HCOs seeking to improve their sustainability performance and highlights the potential of a PMS as a strategic management tool.