Advancing Hospital Sustainability: A Multidimensional Index Integrating ESG and Digital Transformation

The sustainable development of society requires the incorporation of environmental, social, and governance (ESG) principles. While ESG assessments are widely used in corporate settings, their application in healthcare settings, such as hospitals, remains underexplored. This study aimed to develop a comprehensive evaluation framework integrating ESG and digital transformation (DX) with traditional hospital efficiency and effectiveness assessments. Using open data, financial reports, and hospital website scraping, we applied a slack-based model (SBM) of data envelopment analysis (DEA) and super-efficiency SBM-DEA to calculate sustainability scores across four dimensions: overall sustainability, efficiency, effectiveness, and ESG/DX performance. Results showed that all three components—efficiency, effectiveness, and ESG/DX—were positively associated with overall sustainability. However, ESG/DX performance negatively impacted profitability in smaller hospitals, and improved effectiveness in rehabilitation hospitals was linked to higher operational costs. These findings suggest that while ESG and DX contribute to long-term sustainability, their short-term financial burden may challenge certain hospital types. The proposed index provides valuable insights for hospital management and policy development, aiming to advance ESG and DX initiatives in healthcare.