The financial performance of public hospitals is a critical factor in improving the quality of life and promoting public health. This research paper focuses on financial analysis, a discipline centered on the evaluation of financial statements, to assess the financial health and performance of an organization. Through a variety of analytical methods and comprehensive financial analysis of four public hospitals in the 5th Regional Health Authority over the period 2012–2022, it aims to offer a comprehensive understanding of an organization’s economic condition. In the context of healthcare institutions, financial analysis is not merely a tool for measuring efficiency; it is also essential for evaluating how financial resources are allocated and utilized to provide medical services. We analyzed financial statements using liquidity and activity ratios, performance metrics, and the Altman Z-score, which estimates the likelihood of corporate bankruptcy, to generate a single composite score indicating thehospitals’ financial condition. The findings aim to inform healthcare managers and administrators by identifying areas of strength and weakness in financial management, thereby supporting more effective and informed decision-making within the public healthcare sector.

Different economic and social actors pressure firms to undertake initiatives to protect the natural environment and minimize their negative impacts on society. In turn, firms have responded to these pressures, incorporating a variety of sustainability practices. The literature has put emphasis on examining the proactive and regulatory-driven motives behind firms’ decisions to adopt sustainability management practices. It concludes with various typologies that classify firms into categories. Although the nature of such classifications has great merit for scholars and practitioners, there are drawbacks that can play a critical role in the decision of stakeholders. To enhance the effectiveness and reliability of such typologies, this paper develops a typology matrix to classify firms into four behavior types, namely reactive, proactive, innovative, and progressive, based on various sustainability criteria. It is based on scoring measurement systems to extract quantitative information from corporate social responsibility reports. The proposed methodology was applied to a sample of the top 25 chemical firms according to their sales. The findings show that the majority of the examined firms were classified as reactive and only four firms were classified as progressive, which indicates that the sampled firms adopted a passive approach toward the implementation of sustainability practices.

Healthcare sustainability has become increasingly important due to the sector’s environmental footprint and the growing emphasis on environmental, social, and governance (ESG) criteria. This study examines ESG awareness, sustainability reporting readiness, and the association between sustainability-oriented leadership climate and employee green behavior in Greek healthcare organizations. A cross-sectional survey was conducted among 379 healthcare professionals employed in public hospitals and private clinics in Greece. Data were analyzed using descriptive statistics, exploratory factor analysis, correlation analysis, non-parametric group comparisons, and hierarchical regression. The findings indicate limited ESG awareness and weak institutionalization of sustainability reporting across the sampled organizations. The analysis also identified two distinct and reliable constructs, leadership climate for sustainability and employee green behavior. These constructs were positively associated, and leadership climate for sustainability remained a significant predictor of employee green behavior after controlling demographic and occupational characteristics, although the overall explained variance remained modest. The study contributes empirical evidence from the Greek healthcare sector by linking ESG awareness and sustainability reporting readiness with perceived leadership climate and employee green behavior, while identifying leadership climate for sustainability as one relevant organizational condition associated with employee-level green behavior.

This study explores the sustainability dynamics of Greek small and medium-sized enterprises (SMEs), focusing on key enablers and barriers to sustainable practices. The motivation for this research arises from the growing importance of SMEs in achieving national and European sustainability goals, especially in light of recent policy developments, such as the EU Corporate Sustainability Reporting Directive. Despite their economic significance, Greek SMEs often face resource limitations and institutional challenges that hinder the integration of sustainability into their operations. To address this gap, the article adopts a mixed-methods approach, including structural equation modeling of data from 124 SMEs, case studies, interviews, and spatial mapping, to examine the economic, environmental, and social impacts of sustainability efforts. Geographic Information Systems-based spatial analysis was employed to map sustainability performance, revealing spatial patterns tied to different sustainability dimensions. The results reveal that external pressures (regulations, stakeholder expectations) and internal enablers (leadership commitment, organizational culture) are critical determinants of sustainable practices, while financial and bureaucratic barriers remain key obstacles. Spatial mapping further illustrates regional disparities in sustainability performance across Greece. Findings highlight how geographic context influences sustainability uptake, offering practical insights for SME managers and policy makers aiming to improve sustainable performance across regions. The article's integrated methodological framework contributes to advancing understanding of how sustainability can be more effectively embedded in SMEs operating within diverse socioeconomic and geographical contexts.

Background: Cardiothoracic surgery is among the most technologically advanced and resource-intensive medical specialties, placing it at the intersection of rapid digital innovation and growing demands for environmental sustainability. Addressing these parallel pressures requires integrated strategies that reconcile clinical excellence with ecological responsibility. Methods: This narrative review synthesizes PubMed-indexed literature published over the past two decades, supplemented by relevant policy documents and guidelines. The review examines digital transformation and sustainability initiatives in cardiothoracic surgery through the lens of the twin transformation framework, which conceptualizes digitalization and sustainability as interdependent and mutually reinforcing processes. Results: Key domains of digital transformation include artificial intelligence and big data-driven decision-making, robotic and minimally invasive surgical techniques, digital twins and simulation-based training, telemedicine and remote monitoring, and interoperable electronic health records. Sustainability-related themes encompass the substantial environmental burden of operating rooms, green surgical practices, sustainable procurement, and hospital-level decarbonization strategies. Emerging evidence suggests that aligning digital technologies with sustainability objectives can improve clinical outcomes, enhance operational efficiency, and reduce environmental impact. However, current evidence is largely derived from pilot studies and single-center experiences. Conclusions: Twin transformation offers a coherent and forward-looking framework for the future evolution of cardiothoracic surgery, demonstrating that digital innovation and sustainability can be synergistic rather than competing goals. While significant challenges remain—including high implementation costs, limited long-term data, and fragmented regulatory frameworks—integrating digital health technologies with sustainable practices represents a promising pathway toward high-quality, efficient, and environmentally responsible cardiothoracic care.

In a digitalized hospitality industry, managing online reputation has become a strategic priority for hotel enterprises aiming to strengthen customer trust and competitive advantage. This study investigates the strategic management of online reputation in the Greek hotel industry, emphasizing the growing importance of environmental sustainability. Drawing from established literature and empirical insights, the research addresses a gap in previous studies by focusing specifically on how sustainability-related content affects online brand perception in the Greek context. It explores how Greek hotel managers monitor, evaluate, and respond to user-generated reviews across platforms such as TripAdvisor, Booking.com , and Expedia. It highlights six key dimensions of hotel reputation management, including review monitoring, industry benchmarking, and responsiveness to customer feedback. The research also delves into how environmental and sustainability-related comments influence hotel reputation, customer loyalty, and brand value. Particular attention is given to whether and how managers act upon customer feedback related to green practices—such as energy efficiency, waste reduction, and plastic use—and the perceived benefits of these actions on market performance. Through a detailed questionnaire targeting Greek hotel operators, the study uncovers both the challenges and opportunities in aligning reputation management with sustainability goals. The research results provide critical information on best practices for integrating environmental responsibility into online reputation strategies. Implications are offered for hotel managers, industry associations, and policymakers seeking to enhance digital and environmental strategy alignment in hospitality sector in Greece. This dual focus on digital engagement and ecological awareness positions hotels to enhance guest satisfaction while promoting long-term environmental stewardship.

This study presents a bibliometric analysis of the evolving scientific landscape in Green Human Resource Management (GHRM) from 2000 to 2024. The aim is to identify key research trends, influential authors, thematic clusters, and the intellectual structure underpinning this rapidly growing domain, with particular focus on its intersection with sustainability, environmental performance, and organizational behavior. A systematic search of 1106 peer-reviewed articles indexed in the Scopus database formed the basis of the analysis. Two bibliometric tools, VOSviewer and Bibliometrix (R Studio), were used to conduct co-citation, co-authorship, and keyword co-occurrence analyses. The results reveal five dominant research clusters: (1) GHRM and organizational citizenship behavior for the environment (OCBE), (2) green training and employee engagement, (3) CSR and perceived environmental responsibility, (4) the AMO model as a theoretical foundation, and (5) green leadership and innovation. These clusters provide insights into how GHRM practices contribute to sustainable organizational outcomes. Additionally, recent studies highlight growing interest in green dynamic capabilities, digital transformation, and ESG compliance. This work offers scholars, HR professionals, and sustainability strategists a comprehensive overview of GHRM’s development, research gaps, and emerging directions. Its originality lies in the integration of bibliometric techniques to map fragmented knowledge and inform future research agendas.

Quality in social care is increasingly seen as a dynamic, participatory process based on dignity, autonomy, safety, and user-defined outcomes. Traditional inspection-led models no longer meet the complex, diverse, and ethical demands of today’s societies. This paper examines a shift in quality governance through a comparative study of four leading European agencies: HIQA (Ireland), the Care Inspectorate (Scotland), the Care Quality Commission (England), and Zorginstituut Nederland (Netherlands). These were selected for their institutional maturity and their innovative, systemic approaches to quality assurance. Drawing on documentary analysis and thematic synthesis, the study shows how these bodies move from rule-based oversight to person-centred, co-produced quality improvement. Despite varying legal frameworks, all embed user participation, integrate lived experience into regulation, and use outcome-based tools, such as patient-reported outcome measures (PROMs) and value-based benchmarking. Quality is reframed not as a technical metric but as a relational and ethical responsibility. The paper argues that this evolving model aligns with guidance from the Organisation for Economic Co-operation and Development (OECD) and the European Social Network, offering insights for national reforms that seek inclusive, rights-based, and responsive care systems.

In the face of escalating environmental challenges and shifting consumer expectations, integrating green skills into business strategies is vital, especially in tourism, where sustainability underpins competitiveness and long-term success. This study examines the role of Green Human Resource Management (GHRM) in promoting environmentally responsible practices among tourism enterprises in Greece. Using quantitative data from a convenience sample of 100 professionals, including managers and employees, across various tourism businesses, the research explores key GHRM components: green recruitment, training, performance management, rewards, and employee participation in environmental initiatives. Data were gathered via a structured questionnaire distributed through professional networks and tourism associations. Notable differences emerged between SMEs and larger firms, particularly in training efforts and reward systems. Demographic factors such as age, gender, and job position influence green behaviors and engagement levels. Findings reveal a growing emphasis on environmental awareness in recruitment and increased investment in green education and performance management. Many respondents reported active involvement in eco-friendly practices and expressed a strong emotional commitment to environmental objectives. The study concludes with implications for tourism managers and policymakers, offering insights applicable to similar tourism contexts beyond Greece.

Understanding the role of educators in promoting sustainable practices is crucial for fostering long-term environmental awareness, particularly within the school setting. This study analyzes the behavioral component of primary school teachers’ attitudes toward energy saving in Pella Prefecture, Greece. Simple random sampling was performed by using the email list of all teachers in the study area. We set the final sample at 150 emails, that corresponds to a representative 10

Health systems worldwide are under pressure to simultaneously address rising costs, climate change, and health inequalities. This study proposes a new holistic policy for sustainable Primary Health Care (PHC) that combines the strategic use of Diagnosis Related Groups (DRGs) with environmental and finance sustainability practices. The model was developed through an extensive literature review and assessment of current policy frameworks such as Corporate Sustainable Reporting Directive and European Sustainability Reporting Standards (CSRD/ESRS), and aims to bridge the gap between clinical effectiveness, social protection, financial efficiency, and environmental responsibility. By moving away from the traditional, hospital-centered, one-dimensional focus of health care, the model reorients the health care system toward a multidimensional-holistic use of all available health resources, creating a resilient and sustainable health system that is aligned with environmental sensitivity and social protection under optimum financial efficiency. Integrating DRGs into PHC increases transparency and efficiency in resource allocation, reduces health inequities, and promotes financial sustainability. At the same time, the adoption of green health practices and the incorporation of those practices in the DRGS, such as the use of cost of energy and renewable energy and cost of waste and waste reduction practices, accelerates the achievement of the Sustainable Development Goals (SDGs). By improving preventive services, reducing avoidable hospitalizations, and establishing flexible, sustainable financing mechanisms, population health outcomes can be significantly improved. The findings suggest that a sustainable, adaptive, and dynamic PHC resilience system can serve as a central pillar for achieving health for all, reducing inequalities, strengthening social justice, and promoting planetary health, offering a transformative pathway to a greener and more equitable future for health care. These findings may inform health policy makers, sustainability officers, and primary care planners seeking to design integrated and accountable PHC systems.

Climate change is considered one of the greatest threats to environmental sustainability, human health and social well-being worldwide. The healthcare sector is one of the main actors with a strong negative environmental footprint, being responsible for about 4% of global emissions, and is also considered one of the costliest sectors, with healthcare spending absorbing about 10% of global economic output. This article examines the environmental costs of the healthcare system in Greece, with a focus on public hospitals. The data analysis methodology was based on linear ordinary regression (OLS) models to calculate environmental costs related to energy consumption, waste management and water consumption. Data was collected through the Ministry of Health's platform (BI Health) and analyzed using Stata software. The main findings suggest that environmental costs are a significant part of total operating costs, particularly in university and specialist hospitals. Factors such as the number of beds, the existence of special units (e.g. ICU) and the use of natural gas have a significant impact on environmental costs. The study offers a mathematical model for predicting environmental costs, which can help hospital administrators to make decisions about sustainable practices. This model could provide an important opportunity for practical application to make targeted decisions such as investing in sustainable technologies, improving energy efficiency and enhancing waste management, leading to cost-effective and environmentally sustainable practices.

The healthcare sector faces significant challenges related to resource constraints, environmental impacts and increasing demand for services. This study examines how the integration of circular economy principles and organizational behavior can enhance the sustainability of healthcare systems. By implementing circular economy practices - such as waste reduction, material reuse and recycling - healthcare organizations can optimize resource use and minimize their ecological footprint. In addition, the role of organizational behavior is critical, as effective leadership, employee engagement and a supportive culture can lead to the adoption of sustainable practices that align with the organization’s mission. An integrated approach that combines circular economy strategies with supportive organizational practices enhances system resilience, reduces dependence on finite resources and promotes broader environmental and social sustainability goals. This study scrutinizes the critical role of organizational behavior in terms of management’s perception of climate change, the way a health organization operates in relation to staff mobilization and the views of its own staff always with climate change in mind and its effects. An analysis of a sample of 379 health professionals through a relevant questionnaire from the public and private sectors of the healthcare industry in Greece revealed a significant degree of detachment of the administrations from environmental concerns, with the simultaneous absence of motivation of the staff on corresponding issues, while negative was the health workers’ overall perception of climate, showing significant challenges in communication in addition to education and awareness within the organization. Overall, this research provides a window into the adoption of Organizational Behavior and Circular Economy principles by healthcare organizations in order to ensure their sustainability.

Primary healthcare (PHC) is essential for improving health outcomes and achieving the United Nations Sustainable Development Goals (SDGs), particularly Goal 3, which emphasizes universal health coverage and the importance of preventive care. PHC provides a broad range of services, including preventive, diagnostic, and therapeutic care at the local level. This approach helps manage health issues early, reducing the need for costly and complex interventions and improving overall population health. Moreover, strengthening primary healthcare is vital in the sustainable development era for improving health outcomes and achieving sustainable health care system, which focuses on universal coverage and preventive care. Emphasizing prevention and community engagement will lead to a more equitable and efficient sustainable healthcare system. The new challenges like funding gaps, workforce shortages, and better sector coordination can enhance PHC effectiveness. Key steps include investing in infrastructure, modernizing training, management of the energy and waste policies, and fostering partnerships with various stakeholders. The main scientific question that this paper investigates is the current situation for the implementation of sustainable development policies in primary health care and proposes the best solutions for a holistic sustainable health system.

This paper presents a proposed circular economy (CE) model for hospital bio-waste management, using Athens as a case study to demonstrate its applicability in urban environments. The model incorporates waste segregation at the source, resource recovery methods such as composting and anaerobic digestion, and data-driven tools to enhance the efficiency and sustainability of healthcare waste management. The study investigates the transition from linear to CE practices, focusing on structured collection strategies, collaborative efforts between hospitals and municipal authorities, and continuous tracking of waste flows. A comprehensive analysis of bio-waste volumes from participating hospitals over a three-year period is conducted, utilizing multi-criteria decision-making (MCDM) tools such as TOPSIS to evaluate the system’s effectiveness. The results indicate a significant increase in hospital participation, improved waste separation, and optimized resource recovery, offering a scalable framework for other municipalities seeking to implement CE-based waste management practices in healthcare settings.

The definition of the term inclusive growth can be found in different political and scientific concepts, as several scientific and institutional articles define inclusive growth as a combination of social views with economic development and equitable management of natural resources through policy approaches. Literature research on the policies of international organizations reveals a general and growing recognition that economic growth alone does not provide equal opportunities to different segments of society and it is not possible without the development of international policies to reduce social inequalities, optimal management of natural resources and intergenerational justice. Deepening that study of the definition of the concept of inclusive sustainable development by international organizations, we find that it is defined in a broader concept of development, including various non-financial aspects of life, such as health, employment prospects and environmental issues with a focus on local communities and the Sustainable Development Goals.

The role healthcare systems can play in surmounting global challenges like climatic change and resource scarcity is large, considering the major social and environmental impact. The research investigates the role of organizational behavior in influencing the adoption of sustainability initiatives in Greek healthcare organizations in regard to climate change. The research surveys 379 healthcare professionals from the public and private sectors with regard to organizational attitudes toward climate change, the adoption of sustainable practices, and individual environmental perspectives. Results underline that health care administration is still cut off from environmental considerations, with limited employee involvement in such initiatives of sustainability. The major barriers were poor communication, lack of education, and inadequate awareness across institutions. The study also emphasized that healthcare organizations need to align their values with environmental strategy so they can work in unison toward seeking sustainability. These would be stimulating initiatives for more leadership and active staff who become involved in making meaningful contributions toward global sustainability from the healthcare sector.

The digital transformation process gained significant research interest in recent years especially related to achievements in sustainability goals. Even though there exists growing research regarding various aspects of digital transformation and sustainability procedures, a more detailed analysis is needed in different national environments. The proposed study empirically analyzes the Greek managers’ perspective on the relationship between digital transformation intensity and sustainability practices implemented. Almost 156 Greek senior managers from various organizational sectors were interviewed, while a synthetic index already developed from previous studies was used. Results indicate that Greek companies do not fully exploit digital technologies to further develop their environmental practices. A digital transformation strategy contributes effectively to environmental strategies in the case of reducing emissions of waste and avoiding environmental accidents, while in the rest of the cases, emerging technologies play a less important role and not as a part of a holistic digital strategy.

Work Integration Social Enterprises (WISEs) are one of the leading forms of Social Enterprises in Europe. The analogy of the Public Procurements that Greek Work Integration Social Enterprises (WISEs) acquire on the total monetary resources of the WISE, was connected to the ability of the WISE to develop job positions that are sufficient to keep the employ above the monetary poverty line and bring it closer to the concept of a full-time job. A response rate of 62.50