{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T10:56:48Z","timestamp":1774868208596,"version":"3.50.1"},"reference-count":112,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Administrative Sciences"],"abstract":"<jats:p>Hospitals play a central role in promoting health and well-being, yet they are also among the most resource-intensive institutions, contributing significantly to environmental degradation through high energy and water consumption, extensive waste generation, and reliance on single-use materials. This conceptual paper explores how principles of the circular economy and green economy can be integrated into hospital operations through a strategic Corporate Social Responsibility (CSR) framework, reframing sustainability as a strategic management issue rather than a compliance-driven activity. Drawing on environmental economics, sustainability studies, and institutional theory, the paper develops an integrated conceptual model structured around the environmental, social, and economic pillars of sustainability. Within this framework, four interconnected operational domains are identified: waste management and circular practices, energy consumption and renewable integration, sustainable procurement and circular supply chains, and economic and policy incentives. The social dimension explicitly encompasses healthcare staff and patients, addressing issues of workforce well-being, health education, safety, quality of life, and equitable care delivery. This advances theory by positioning strategic CSR as a function of circular and green economy, yielding a new model for hospitals, S-CSR = f(CE, GE). The paper also examines institutional and cultural barriers that constrain sustainability implementation and highlights the role of strategic leadership, governance, and system-wide innovation in overcoming these challenges. While not empirical, the study provides a theoretical foundation to inform future research, policy development, and strategic decision-making aimed at advancing sustainable, low-carbon, and resilient healthcare systems.<\/jats:p>","DOI":"10.3390\/admsci16040170","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T09:57:11Z","timestamp":1774864631000},"page":"170","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking Hospital Sustainability: Integrating Circular and Green Economy Principles Within Strategic Corporate Social Responsibility and Management Frameworks"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9064-8315","authenticated-orcid":false,"given":"Gianpaolo","family":"Tomaselli","sequence":"first","affiliation":[{"name":"Department of Health Systems Management and Leadership, Faculty of Health Sciences, University of Malta, 2080 Msida, Malta"},{"name":"Mater Dei Hospital, 2090 Msida, Malta"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4415-7942","authenticated-orcid":false,"given":"Gloria","family":"Macassa","sequence":"additional","affiliation":[{"name":"Department of Social Work, Criminology and Public Health Sciences, University of G\u00e4vle, 801 76 G\u00e4vle, Sweden"},{"name":"EPIUnit\u2014Instituto de Sa\u00fade P\u00fablica, University of Porto Medical School, 4050-600 Porto, Portugal"}]},{"given":"Karen Maria","family":"Borg","sequence":"additional","affiliation":[{"name":"Mater Dei Hospital, 2090 Msida, Malta"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8262-2828","authenticated-orcid":false,"given":"Jose Guilherme","family":"Couto","sequence":"additional","affiliation":[{"name":"Department of Radiography, Faculty of Health Sciences, University of Malta, 2080 Msida, Malta"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1541-1577","authenticated-orcid":false,"given":"Jonathan L.","family":"Portelli","sequence":"additional","affiliation":[{"name":"Department of Radiography, Faculty of Health Sciences, University of Malta, 2080 Msida, Malta"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3229-2549","authenticated-orcid":false,"given":"Karen","family":"Borg Grima","sequence":"additional","affiliation":[{"name":"Department of Radiography, Faculty of Health Sciences, University of Malta, 2080 Msida, Malta"}]},{"given":"Sandra C.","family":"Buttigieg","sequence":"additional","affiliation":[{"name":"Department of Health Systems Management and Leadership, Faculty of Health Sciences, University of Malta, 2080 Msida, Malta"},{"name":"Mater Dei Hospital, 2090 Msida, Malta"},{"name":"College of Social Sciences, University of Birmingham, Birmingham B15 2TT, UK"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1177\/0149206311436079","article-title":"What we know and don\u2019t know about corporate social responsibility","volume":"38","author":"Aguinis","year":"2012","journal-title":"Journal of Management"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"104560","DOI":"10.1016\/j.resconrec.2019.104560","article-title":"Quantifying hospital services by carbon footprint: A systematic literature review of patient care alternatives","volume":"154","author":"Alshqaqeeq","year":"2020","journal-title":"Resources, Conservation & Recycling"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"139547","DOI":"10.1109\/ACCESS.2025.3596189","article-title":"A systematic review and evaluation of sustainable AI algorithms and techniques in healthcare","volume":"13","author":"Alzoubi","year":"2025","journal-title":"IEEE Access"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.23919\/JCC.ja.2022-0681","article-title":"An intelligent SDN-IoT enabled intrusion detection system for healthcare systems using a hybrid deep learning and machine learning approach","volume":"21","author":"Arthi","year":"2024","journal-title":"China Communications"},{"key":"ref_5","first-page":"1","article-title":"Malta: Health system review 2017","volume":"19","author":"Buttigieg","year":"2017","journal-title":"Health Systems in Transition"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Badanta, B., Porcar Sierra, A., Fern\u00e1ndez, S. 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