CSR in the health sector, due to the specific aspects of the service provided, has a more pronounced social and human component than organizations in other areas.

Looking at the levels of accountability in organizations stated by Preston and Post (1975) and Grunig (Grunig and Hunt, 1984, 2003, Grunig, 1992), we could say that accountability of health care organizations, specifically hospitals, involves the so-called “public responsibility” as well as a “social responsibility”. Health care per se represents a guarantee of social welfare and of improved living standards. Health care professionals, and therefore the organizations for which they work, are not only committed to healing, remedying and looking after patients and assuming the consequences, but also to do this properly and always following the principles of a calling to serve people, a vocation of social service, of respect towards the patient and of ethics, specific to social responsibility.

3.2.1. The social component of health care and CSR

The health service provided to people by hospital is in and of itself an exercise in CSR, seeing as the patient is the main target of social responsibility in health care, for which some hospital administrators refer to it as patient centred social responsibility (Redaccion Medica, 2014). The emotional and social impact of health care, the high level of specialization of health care professionals and the direct contact of employees with patients are “elements that compel those responsible for communication in hospital centres to think about a new concept of CSR adapted to the hospital structure, while respecting the essence of the organizational social responsibility. This new concept must be based on three main aspects: the primary value of interpersonal communication, the increased role of the patient and the commitment towards scientific knowledge” (Medina, 2012a: 82). “To medically and emotionally satisfy the patient is one of the main actions of CSR that may be taken in a hospital. Therefore, training employees in interpersonal communication skills must be among the CSR initiatives carried out by a hospital” (Medina, 2012a: 83).

But if we put the focus on public health care, we must necessarily refer to the framework of social responsibility in the public sector, which has been strengthened over the last decade. When approaching SR in the public sector, we will find that it has been the subject of divergent comments by some authors, for whom public institutions “already were of public interest”. While it is acknowledged that “doing things right from a regulatory and quality-oriented point of view isn’t enough, given that the manner in which this is performed also has an economic, social, environmental, occupational and reputational impact that must be administered, seeing as it is also of public interest and part of the accountability that must be assumed by institutions before society” (Canyelles, 2011: 84). In this sense, “the public administration has two approaches to CSR: one, to promote good practices on a voluntary basis and another, to suggest the need to regulate on the matter” (Rodríguez Cala, 2017: 63) and “it is necessary that the organization of the institution itself incorporate SR in its management policies and procedures, involving the interested parties and thus attaining the directors’ commitment” (Rodríguez Cala, 2017: 65).

In this regard, social responsibility in public organizations may be defined as “those policies voluntarily established by public institutions that are oriented to the common good and to creating social value (with social, economic and