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This study sheds new light on why healthcare organisations are having difficulty responding to the growing pressure from stakeholders to proactively address their responsibility to deliver high-quality services without harming the environment. Basing our work on past research on stakeholder pressure and environmental barriers, we conceptualise and empirically test the effect of the interplay between stakeholder pressure and internal barriers on healthcare organisations’ adoption of proactive environmental strategies (PESs). To test the proposed hypotheses, a survey was carried out among medical directors of Italian healthcare organisations in 2012. Our results show that the lack of commitment to environmental issues within the organisation represents the main barrier to healthcare organisations’ implementing PESs. Furthermore, the difficulties in evaluating the impacts of advanced environmental practices negatively moderate the influence of stakeholders on developing PESs. Our findings contribute to extending previous knowledge on PESs in two ways: (i) focusing on the healthcare sector, our study investigates the phenomenon in a research context that has been largely overlooked in the sustainability literature; and (ii) cross-cutting previous research on stakeholder pressure and internal barriers, the study conceptualises and tests a more complete framework for understanding the adoption of PESs

Proactive Environmental Strategies in Healthcare Organisations: Drivers and Barriers in Italy