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This paper examines the level of sustainability disclosures provided by Spanish hospitals using exclusively the information revealed in their institutional websites. Based on different levels of disclosure, the authors try to find the possible reasons why some Spanish hospitals reveal more sustainability information than others.

To achieve this goal, the authors conducted a content analysis of the official websites of all Spanish hospitals identified by the Ministry of Health, Social Services and Equality.

The results reveal that Spanish hospitals seem to use sustainability disclosures for different legitimizing purposes. In general, the results indicate that Spanish hospitals may be driven by symbolic rather than substantive actions to achieve legitimacy from stakeholders.

Due to the lack of empirical research on the hospital sector, more research is required to improve understanding of why hospitals disclose sustainability information or not.

The purpose of this paper is twofold. First, it identifies whether sustainability reporting has become an institutionalized cultural norm in the daily routines and organizational practices of Spanish public hospitals. Second, it finds out why sustainability reporting has become (or not) an institutionalized norm in the Spanish public hospital field.

To accomplish the research aims, the authors have adopted a qualitative method approach by combining two main data sources: (1) a documentary analysis of reports published by 60 Spanish public hospitals that consistently maintained their commitment to this activity over the past 10 years; and (2) a semi-structured interview with seven hospital managers and with seven participants from professional organizations.

The authors have found that sustainability reporting has not become an institutionalized practice in the Spanish public hospital setting. Based on the notion of normativity, the findings indicate that the institutional conditions that support the emergence of a norm are not met (Bebbington et al., 2012). In particular, the lack of a coherent normative framework, the absence of congruence with previous similar practices and the lack of clarity in the norm explain why a reporting norm has not emerged. Currently, the societal context has not developed an appropriate discourse around the development of sustainability reporting in the Spanish public sector.

The contribution of this research is double: (1) From a practical level, this paper contributes to the accounting literature by analyzing the development of sustainability reporting practices in the public sector; (2) According to the notion of normativity, the novelty of this paper is to explore whether a sustainability reporting norm emerges in Spanish public hospitals.