Article review of “Environmental Management Accounting in Private Hospitals”

Article review of “Environmental Management Accounting in Private Hospitals”

 

How to present this article in Harvard reference format?

Swalih, M.M., Ram, R. & Tew, E., 2026. Environmental Management Accounting in Private Hospitals: Navigating Competing Strategic Priorities for Sustainable Decision-Making. Business Strategy and the Environment, 0, pp.1–27. https://doi.org/10.1002/bse.70979

 

What are the key research issues the article wants to address?

The article addresses the following key research issues:

1.    Lack of research on sustainability negotiation in mission-driven yet commercially exposed service organizations, specifically private hospitals in developing economies. Despite private hospitals' significant environmental footprint, they are often overlooked in sustainability debates.

2.    How competing healthcare, commercial, and sustainability priorities shape the adoption and use of Environmental Management Accounting (EMA) in Indian private hospitals. This setting is underexplored in sustainability accounting, with a complex interplay of professional norms, commercial pressure, and emerging sustainability expectations.

3.    The interplay between institutional logics and managerial motivations—how structural pressures and individual motivations jointly influence EMA practices in private hospitals.

4.    The pragmatic and stepwise progression of EMA use in hospitals, starting from basic compliance and cost-efficiency motives towards strategic sustainability practices linking efficiency gains with competitive advantage and enhanced accountability.

5.    How EMA helps hospitals to navigate and reconcile competing institutional pressures, reframing organizational trade-offs as complementarities to facilitate sustainable decision-making.

These issues highlight a gap in literature regarding EMA's adoption in healthcare service sectors in developing countries and aim to understand the dynamics that influence sustainability accounting practices in such complex institutional environments [T1: page 1].

 

Describe two main theories employed in this article.

The article employs two main theories to analyze Environmental Management Accounting (EMA) practices in private hospitals:

1.    Institutional Logics Theory: This theory focuses on the broader systems of norms, values, and taken-for-granted rules that structure organizational behavior and influence how strategic priorities are interpreted and enacted. In the context of hospitals, multiple coexisting institutional logics—such as healthcare, commercial, cultural, and sustainability logics—affect decision-making in different ways. These logics may conflict or coexist, shaping the legitimacy and salience of EMA adoption and use. For example, commercial logics prioritize efficiency and profitability, which may conflict with sustainability goals focused on environmental stewardship. Institutional logics thus provide the structural context that frames which sustainability issues become important and which EMA uses are considered legitimate within these organizations [T4: page 4].

2.    Social Value Orientation (SVO) Theory: SVO theory explains individual differences in managerial motivation towards sustainability practices by distinguishing between prosocial and proself orientations. Prosocial motivations focus on collective welfare, cooperation, and long-term sustainability integration, leading to support for accountability and transformative environmental outcomes. Conversely, proself motivations prioritize self-interest and organizational gain, often focusing on efficiency, cost control, and reputational benefits. The theory helps explain why individuals within the same institutional environment may interpret and enact EMA differently, either instrumentally for efficiency or more transformationally for sustainability accountability [T4: page 4].

The study integrates these two theories to show how institutional structures (institutional logics) and individual managerial motivations (SVO) jointly shape EMA adoption, interpretation, and use for sustainable decision-making in private hospitals [T1: page 1; T4: page 4].

Highlight 2 main primary findings reported in this article.

Two main primary findings reported in the article are:

1.    Pragmatic Stepwise Adoption of EMA: Private hospitals initially adopt Environmental Management Accounting (EMA) primarily for regulatory compliance, legitimacy, and cost efficiency—reflecting pragmatic and proself motivations focused on operational requirements. Basic EMA tools such as energy, water, and waste accounting are used to meet immediate institutional and commercial pressures. As these practices become embedded, hospitals progressively evolve EMA into more strategic mechanisms that support wider sustainability actions, linking efficiency gains with competitive advantage, reputational benefits, and initiatives that complement core healthcare delivery [T1: page 1; T4: page 22].

2.    Shift from Proself to Prosocial Orientations with Sustainability Integration: With growing sustainability expectations and community pressures, EMA use in hospitals shifts towards more prosocial orientations that emphasize accountability, transparency, and sustainable development. Hospitals begin to employ more advanced and integrated EMA tools—such as carbon accounting, life cycle assessment, and integrated resource management—to support sustainability governance and public accountability. This shift reflects a transition from a primarily compliance and efficiency-driven approach to one aligned with longer-term environmental stewardship and strategic sustainable development [T1: page 1; T3: page 19; T4: page 22].

 

Describe 3 main claims of the article in terms of Toulmin's model of argument.

The article presents several claims about Environmental Management Accounting (EMA) in private hospitals. Using Toulmin's model of argument, which includes Claim (conclusion), Data (evidence), and Warrant (reasoning linking data to claim), here are three main claims:

1.    Claim 1: EMA can integrate sustainability into decision-making in private hospitals by aligning environmental stewardship with clinical and strategic priorities.

• Data: Hospitals prioritize patient safety and clinical effectiveness, often marginalizing environmental concerns, especially in resource-constrained developing countries. EMA practices such as biomedical waste management, infrastructure planning, and staff health and safety accounting help reframe sustainability as complementary to healthcare goals [T1, page 3; T6, page 21].
• Warrant: By embedding environmental data within critical operational and clinical routines, EMA enables hospitals to bridge tensions between care quality and sustainability demands, turning potential conflicts into aligned priorities.

2.    Claim 2: Hospitals adopt EMA incrementally, moving from pragmatic, compliance-driven uses towards more integrated systems supporting innovation, accountability, and competitive advantage.

• Data: Initially, hospitals use basic EMA tools (energy, waste, water accounting) for regulatory compliance and cost reduction. Over time, they extend EMA use to include advanced tools (life cycle assessment, carbon management accounting) that support sustainability governance and reputation-building [T1, page 3; T4, pages 19-20; T6, page 21].
• Warrant: This progression illustrates an organizational learning and strategic development path where short-term operational benefits lead to more substantive, transformative sustainability outcomes, reflecting a move from proself to prosocial motivations.

3.    Claim 3: EMA serves as a hybrid accounting technology that mediates competing institutional logics (clinical, commercial, sustainability) allowing hospitals to balance patient care, financial considerations, regulatory compliance, and environmental responsibilities.

• Data: The study shows EMA is used to address regulatory requirements (state sustainability logics), commercial goals (profitability, efficiency), healthcare mandates (patient-centered care, professional ethics), and cultural expectations. This multifaceted use reflects a hybrid accounting role bridging pragmatic and critical sustainability accounting traditions [T2-T3, pages 5-6; T4, page 19; T6, page 21].
• Warrant: EMA's flexibility and integration of diverse environmental and economic measures facilitate reconciliation among institutional tensions, thereby enabling sustainable decision-making that is ethically grounded and strategically viable.

These claims form the core argumentative structure of the article, supported by empirical data and theoretical framing.

 

Describe 2 main research limitations of the study.

·        The article identifies two main research limitations:

1.    Limited Generalizability Due to Context-Specific Focus: The study provides an in-depth understanding of EMA adoption within a specific set of private hospitals in a developing country context. This focus may limit the generalizability of the findings to other industries, geographical regions, or different types of healthcare organizations such as public hospitals. Thus, the external validity of the results could be constrained [T5, page 23].

2.    Potential Biases from Reliance on Self-Reported Data: The research data are largely derived from interviews and self-reported information by hospital managers. This reliance may introduce biases affecting the accuracy, objectivity, and completeness of the findings. Such biases could influence the interpretation of how EMA practices are adopted and used within the hospitals [T5, page 23].

The article suggests that future research could address these limitations by expanding the range of organizational contexts studied, employing quantitative methods, conducting comparative and longitudinal studies, and integrating additional theoretical perspectives [T5, page 23].