<![CDATA[Background: Sustainability has become a key priority in healthcare due to environmental impacts and increasing regulatory and stakeholder expectations. Public hospitals face institutional pressure to implement sustainability practices, yet the mechanisms translating these pressures into employee sustainability behavior remain unclear. Understanding organizational and individual processes is essential to improve sustainability implementation. Objectives: This study aims to examine the influence of institutional and stakeholder pressure on sustainability behavior and to evaluate the mediating roles of organizational engagement and individual mechanisms in a public hospital.Methods: A quantitative cross-sectional study was conducted among 163 employees at RSUD Inche Abdoel Moeis Samarinda, Indonesia, using stratified random sampling. Data were collected through structured questionnaires and analyzed using Partial Least Squares–Structural Equation Modeling (PLS-SEM) with bootstrapping to test direct and mediation effects.Results: Institutional and stakeholder pressure significantly influences sustainability behavior (β = 0.238, p < 0.001) and organizational engagement (β = 0.612, p < 0.001). Organizational engagement significantly increases personal involvement (β = 0.684, p < 0.001) and employee awareness (β = 0.641, p < 0.001), while coping capacity positively affects sustainability behavior (β = 0.291, p < 0.001). Organizational engagement (β = 0.178, p < 0.001) and individual mechanisms (β = 0.221, p < 0.001) significantly mediates the relationship. The model explaines 71.7% of the variance in sustainability behavior.Conclusion: Sustainability behavior in public hospitals is run by institutional pressure and strengthened by organizational engagement and employee readiness. Effective sustainability implementation requires translating external pressure into internal organizational commitment and employee-level capability. These findings suggest that hospital managers and policymakers should strengthen organizational engagement, employee awareness, and capacity-building initiatives to foster sustainable practices in daily hospital operations.]]>
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