Green Leadership and Environmental Performance in Hospitals: A Multi-Mediator Study

Green leadership is often praised for promoting sustainability, while hospitals in reactive or resource-constrained contexts lack the infrastructure to support leadership-led environmental change, indicating that leadership without operational capacity offers little impact. Moreover, the inconsistencies between green human resource practices and environmental performance suggest that green leadership might lead to symbolic gestures rather than real improvements without a robust environmental culture or internal accountability systems. Amid intensifying environmental regulations and sustainability mandates in healthcare, this study investigates how green transformational leadership addresses the contradiction between hospitals’ resource-intensive operations and environmental accountability. Drawing on Dynamic Capabilities Theory (DCT), the research highlights policy-driven imperatives for hospitals to build adaptive leadership models that meet sustainability goals. Using data from 312 junior doctors and nurses in private hospitals, analyzed via Partial Least Squares Structural Equation Modeling (PLS-SEM), the study identifies green attitude, green empowerment, and green self-efficacy as key mediators in enhancing environmental performance. Contributions of this study include (1) applying DCT to healthcare sustainability, (2) integrating psychological drivers into leadership–performance models, and (3) emphasizing nurses’ pivotal roles. The results of the study indicate that leaders who prioritize sustainability inspire staff to adopt eco-friendly practices, aligning with SDG 3, i.e., good health and well-being; SDG 12, i.e., responsible consumption and production; and SDG 7, i.e., affordable and clean energy. The findings provide actionable insights for hospital administrators and policymakers striving for environmentally accountable healthcare delivery.