This paper examines the sustainability practices implemented by healthcare establishments, mainly Small and Medium enterprises (SMEs), We focus on identifying opportunities with challenges involved. This systematic literature analyses 47 studies that explore sustainability practices in the healthcare system globally. The finding from the studies reveals that healthcare organizations with SMEs adopt diverse measures like renewable energy, a reduction, and a response procurement in minimizing the impact on the environment and ensuring financial stability. The challenges SMEs face comprise limited financial resources, lack of expertise, with difficulties accessing information and support. Furthermore, we suggest opportunities for SMEs to enhance sustainability practices with partnerships with other organizations and investing in educating employees. Implementation of sustainability practices will improve the financial stability, and environmental impact, with the wellbeing of healthcare stakeholders. The empirical evidence, comparative studies with cross-disciplinary are needed in exploring the effectiveness of the different suitability practices, potential trade-offs, synergies between sustainability and other organizational goals, the effect of sustainability practice in the financial with non-financial performance on SMEs in healthcare establishment are positive, with cost-effectiveness, efficiencies operations, improving brand reputations and engaging the employee. Established factors like regulating frameworks and government initiatives play a major role in the influence of adopting sustainability practices with cultural factors.

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