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This study aims to explore the barriers and motivations to integrating environmental performance into balanced scorecards (BSCs).

This research adopted a qualitative case study approach with semi-structured interviews within an Australian public health service organisation. Secondary document analysis was performed using annual reports, strategic plans and website data.

The internal barriers creating resistance to incorporating environmental performance dimensions into the BSC include the existing role of environmental disclosure, insufficient sustainability BSC knowledge, lack of BSC champion support, organisational culture and limited environmental commitment practices. Solutions revealed to support decisions to integrate environmental performance in the BSC include recruiting sustainability expertise, articulating financial motivations and recognising external pressures.

The findings provide suggested actions for other organisations facing similar challenges regarding integrating environmental performance into a BSC.

In the current business environment, organisations face growing pressure to consider environmental performance in their BSCs. This study provides insights into the potential problems that prevent or delay the integration of environmental issues into BSCs.

This study provides evidence on how institutional and external factors influence barriers and motivations to embed environmental performance measures into a BSC. This study demonstrates how health-care organisations can effectively overcome barriers by modifying specific institutional artefacts. This is an important contribution to the body of knowledge because there is limited empirical research regarding integrating environmental issues into a public sector BSC that projects key organisational commitment indicators.