Innovative health technology deployment represents the primary challenge within the sustainability of public health systems. On one hand, new technologies may potentially improve access to care and the quality of services. On the other hand, their rapid evolution and broad implications on existing procedures increase the risk to adopt technologies that are not value for money. As a consequence, Health Technology Assessment (HTA) is a critical process at each level of the National Health System. Focusing on the organisational level, this paper explores the current practices of Hospital-Based HTA (HB-HTA) in terms of management, control and behaviours of various actors involved. Among several tasks, decision-makers are appointed at managing the conflict of interest around health technology development, that could pave the way for corruption or other misleading behaviours. Accordingly, the purpose of the study is proposing a new strategic framework, named Health Technology Balanced Assessment (HTBA), to foster hospital-based health technology management aimed to align strategy and actions. The conceptual model is developed on three perspectives (clinical, economic and organisational) to make the actors involved in the assessment (clinicians, health professionals, hospital managers and patients) aware of the impact of new technology on the value chain. Besides supporting the decision-making process, such a tool represents support for the internal control system as a whole. By promoting structured evaluation, it increases transparency and accountability of public health organisations. Moreover, in the long run, the framework proposed will be useful to reach selected United Nations Sustainable Development Goals (UN SDGs) to enhance the quality of healthcare in the future.

This paper investigates the investor reaction to audit reports containing a going concern modification (GCM) in the Italian market following new amendments regarding auditing regulations and public financial information disclosures. We applied the event study (ES) methodology to short event windows considering Italian listed companies during the period 2009–2015. Our findings partially contradict previous studies revealing a systematic negative impact of GCMs, especially when a GCM is attached to unqualified opinions. We clearly observe that Italian auditors have a strong higher propensity to issue a GCM than to express a qualification. Moreover, we find other interesting results that contradict the mainstream literature, detecting a stronger negative reaction in the case of recurring GCMs and when the modification is issued by non-Big 4 auditing firms. These differences could be explained considering the environmental characteristics of the Italian market such as the ownership structure, governance mechanisms and accounting culture, where minority investors act against ownership in accordance with the type II agency problem. Our empirical results suggest that the domestic and international regulatory amendments during the study period have increased the value relevance of GCMs and the usefulness of financial disclosures. This study might be of interest to practitioners and regulators in regard to contributing to the introduction of further regulatory interventions that will enhance both the informativeness of audit reports and awareness of investors in regard to going concern uncertainty.

Purpose: The increasing responsibility of organisations towards society and the environment has inverted the relationship between accounting and accountability, leading to accountability-based accounting systems. This study aims to explore the debate on accountability for climate change within the integrating thinking (IT) perspective. Ascertaining the most significant trends in the debate around purposes and performance that characterise climate mitigation engagement and their connections, the study would explore if and to what extent organisations are tackling climate actions.Design/methodology/approach: A narrative review of the extensive academic literature developed from the Kyoto Protocol to date was performed. After selecting a representative sample, papers were analysed with the support of a new analytical framework that involves three dimensions – answerability, enforcement and outcome – and governance schemes that emerge from the involvement of the private and public sector and civil society. With the support of NVivo software, themes arisen were analysed and coded. Key items were labelled, creating specific nodes and synthesised into the proposed framework.Findings: A “silo approach” largely characterises the debate on accountability for climate change. The most significant reasons behind the shortcomings of extant climate actions may be retrieved firstly in the weakness of the motivations that guide organisations to operate in a climate-friendly way.Social implications: This study underlines the need for a 360° integrated approach for strategically tackling climate actions.Originality/value: This study would represent a further step towards an integrated approach for studying organisations behaviours in the “climate war”, embracing the connectivity between purposes and outcomes, capitals and the relationships amongst the various stakeholders.

Recently many European countries have incurred crises in public finance despite the fact that EU institutions have pushed the national governments toward the sustainability of public finance with compulsory and voluntary rules regarding fiscal governance. This paper investigates the relations between the quality of fiscal governance and the financial virtuosity of national fiscal policy. We proposed a general framework for analyzing the fiscal governance issue and we empirically tested the correlation between the dimensions of fiscal governance and the budgetary performance of EU countries. The results showed a positive correlation between the quality of fiscal governance in the EU countries and financial surplus in the period concerned. However further investigations are needed and an effort should be made to collect uniform data on fiscal governance in the European Union.

Purpose: As financial firms incorporate impact strategies more extensively into their operations, they are asked to sustain their impact claims and thus face increased risks of regulatory scrutiny and lawsuits from private and public parties. The lack of reliable frameworks to measure impact gives rise to phenomena like impact washing, leading to litigations. This article aims to explore the main factors contributing to the impact litigation risk and the mechanisms employed by practitioners in the impact investing field to navigate and address this challenge.Design/methodology/approach: We conducted semi-structured interviews involving three impact investors and three impact lawyers with specific knowledge of ESG and impact controversies, adopting the Gioia Methodology for the analysis. We triangulated such information with the analysis of secondary data.Findings: The “great noise” around the impact investing world and the rise of impact washing, the lack of shared standards for measuring impacts and the misalignment of interests among actors involved in the initiatives constitute a potential “litigation bomb”. Such a scenario is detrimental to an investment strategy, which has the potential to tackle societal issues.Originality/value: This study represents an initial effort to connect the academic debate on impact litigation with the expert’s active “on-field” standpoints. The identified and validated drivers of impact litigations provide valuable insight to enhance the governance and accountability of impact investing. Implementing Impact Measurement and Management (IMM) tools, participatory governance models, clear impact-focused contracts and a proactive approach could serve as prospective solutions to mitigate the risk of disputes.

Environmental audit (EA) is a systematic process of collecting and objectively evaluating information, whether certain environmental activities are in compliance with audit standards, criteria, and control systems. Due to the former use of the Soviet Union regime, Central Asia, with vast resources and a growing population, is still confronting a number of environmental issues. The increasing number of businesses in Central Asian countries has an impact on the local environment and the population’s health. As a response, EA is one of the instruments that businesses may use to improve their environmental performance, protect nature, and ensure public-health safety. This paper, after providing a scoping review concerning the academic literature, investigates, by using secondary data, the current trends and challenges in practical application of EAs in five Central Asian countries. Our findings point out a list of shortcomings in applying the EA tools in Central Asia, which mainly derive from implementation, legislative, and resource gaps. Thus, the road towards a concrete implementation of EA is still far from being achieved. The study ends with some pieces of advice for EA policy makers and opens up avenues for future research, which can also be applied outside Central Asia.