Conﬁguration of an Integrated Quality-Social Responsibility-Performance Management System in the Hospitality Industry. Case Studies: Balneary Tourism Romania

: The introduction of quality, performance, and social responsibility systems in organizations that are open to learn and wish to permanently improve their activity ensures the sustainable development of those organizations. The purpose of this research is to investigate the characteristics of these three systems in order to identify the common impact areas and the existing interrelations, which would be able to facilitate an integrated approach and create an understanding of equiﬁnalities at the organizational level. Moreover, such an integrated approach highlights the role of economic and ﬁnancial analysis in the assessment of the quantiﬁable aspects and the direction in the assessment of the non-quantiﬁable ones. Through this, we intend to obtain a possible conﬁguration for an integrated quality–performance–social responsibility approach applied to 11 entities in different Romanian health resorts recognized for their natural healing factors. The research was structured on two levels: one addressing the phenomenological approach and one dedicated to the application of the European Foundation for Quality Management. The research presents economic and ﬁnancial data that are the processed results of a social survey regarding customer satisfaction as well as information from reports provided by internal and ﬁnancial audit missions. The conclusions of our results reveal three distinct situations: low quality, reduced performance, and stakeholder dissatisfaction; high performance, and partial stakeholder satisfaction; and appropriate quality, high performance, and adequate stakeholder satisfaction.


Introduction
Over the past few decades, economic theory has undergone a number of changes in the paradigmatic complex that characterizes the business environment as a response to the dynamics of the destructive effects induced under the imperative of individual incentive. Under the pressure of reality embodied in the huge entropies and imbalances caused by the natural and social environment, a new eco-socio-economic paradigmatic complex, the concepts of sustainable development, the application and preservation of the diversity, and the theory of social responsibility emerged. The development of organizational sociology has pointed out two distinct approaches of enterprises: as output generating systems necessary to society that are performance-oriented and as social and human systems integrated in global society with proper responsibilities arising from this position. The issue of social responsibility concerns the management of companies in general, and the relations with stakeholders in particular [1]. Defined as acceptance or as bearing of the consequences of their own actions, the concept of social responsibility implies a multitude of obligations towards its internal and external environment. The principles of social responsibility are transparency, ethical behavior, respect towards the expectations of stakeholders, respect towards law and rules, and respect for human rights. ISO 26,000 stipulates the concepts, tendencies, and characteristics of social responsibility; Sustainability 2021, 13, 7303 2 of 17 the principles and practices concerning social responsibility; integration and promotion of social behavior within the organization and into its sphere of influence; the engagements, communication, performance, and other information regarding social responsibility in the context of local diversity, in accordance with the international rules [2]. Tourism as the only possibility to capitalize on perennial resources can contribute sustainably to the creation of social added value and the reduction of imbalances under the constraint of avoiding environmental degradation.
In order to maintain and further develop, it is necessary for companies to be efficient in all aspects of their activity. Performance is a polyvalent concept that refers to achieving results and goals, the way to proceed, and behavior [3]. The complex nature of performance is revealed by the fact that it includes "components, products, consequences, impact, and it can also be related to efficiency, effectiveness, cost effectiveness or equity" [4]. The assessment of performance requires a systemic approach circumscribed by a theoretical perspective regarding organizations.
The understanding of major society imbalances following industrialism triggered the transition from considering profit as the main goal of organizations to including stakeholders in the reasoning. The actions of various categories of stakeholders (customers, employees, suppliers, community groups, governments, and some share-holders) regarding the encouragement of companies to assume a greater social responsibility generated contradictory responses. These were materialized either in the allocation of a greater measure of funds in this regard or in maintaining of position due to the inconsistency of these measures with efforts to maximize profits [5]. The relationship between social responsibility and corporate performance is a topic of debate. Empirical studies conducted on various samples reveal that social responsibility is negatively or positively correlated with the financial performance of firms [6,7]. The explanation of this relationship depends on its causality [8]. On the one hand, companies with superior performance have the sufficient resources to invest in employee relations (by ensuring health and safety at work, development of workers' skills, well-being and satisfaction of the worker and quality of work, social equity, and higher cost of labor) or community relations (creation of added value for the community, environmental safety and protection). On the other hand, financial performance depends on social performance through a positive reputation among consumers, a low risk of costly events (pollution, recall defective product lines, etc.), more transparency and a low risk of corruption, and a positive effect on productivity [1,8,9]. Research on this topic highlights the need to identify and promote those forms of social responsibility that can improve financial performance [10], while varying the types of social screens that are used [11,12]. The development of management systems that integrate social responsibility in order to ensure performance aims at implementing adequate strategies that incorporate appropriate organizational objectives and operational structures; appropriate management in order to achieve these objectives; and a responsible attitude to everyone involved [13].
A peremptory condition for ensuring performance is quality. The increase in the importance of quality is mainly determined by the increase in competition based on quality, consumerism, and sustained media intervention as well as the sophistication of non-price factors [14]. Ensuring performance through quality becomes a source of competitive advantage. The implementation of quality management systems leads to an increase in credibility and trust regarding the products/services quality; coverage of the requirements of customers, business partners and law; a better understanding of the organization's processes, strong management commitment, unambiguous defining of responsibilities and authorities; appropriateness of internal and external communication; more efficient use of resources and reduction of non-compliance costs; and the creation of a framework for continuous improvement [15]. The change in preferences of tourist behavior and the growth of competitiveness for new tourist destinations have imposed the implementation of TQM by tourism companies [16]. The effectiveness of the implementation of this system in tourism must take into account the specificity of the sector and the nature of the phenomenon. Defining quality is a challenge. Quality is related to the process of creating value from the perspective of all those involved in the process with explicit manifestations, those that can be defined and quantified, as well as implicit ones, which can be difficult to evaluate due to the difference of perception and subjectivism. The qualitative design of tourism products takes into account management perceptions of customer expectations. Furthermore, discrepancies between real customer expectations and service quality can be amplified through the gap between the management's perceptions of customer expectations and service quality specifications [17]. Complementarily, because of the special nature of these interpersonal relations, the employee-tourist interaction can affect the quality of the services, with significant incidents in customer satisfaction and the subjective evaluation of performance. In the absence of a clear specification, there is no benchmark against which performance can be measured [18]. Product development from a TQM perspective involves processes aimed at customer satisfaction in the context of heterogeneity, variability in their requirements, and unpredictability of behavior by taking into account factors that are not under the direct control of the service provider [18].
Assuming social responsibility will improve the quality of process performance, providing sustainability and business excellence. Complementarily, the quality management system ensures the conditions for the implementation, monitoring, and continuous evaluation of the effects of social responsibility as well as sustainable development [19]. Business excellence implies the convergence of quality system requirements with stakeholder satisfaction, a binomial that contributes to the well-being of society. Business excellence aims at the performance of an organization that ensures sustainability, credibility, and public recognition through quality prizes with beneficial consequences. Business excellence implies leading external partnerships and managing internal resources in order to fulfill the undertaken mission, to support strategies and policies, and to ensure effective processes, creating added value. The assessment of excellence in business is based on certain relevant benchmarks, particularly those aggregated in models.
There is no approach in the literature that integrates quality social responsibility and performance with the development of systems for financial and non-financial indicators and for quantifiable and non-quantifiable variables with a particular focus on tourism. At the same time, the evaluation of performance in the tourism industry based on conventional financial indicators as profit is criticized because of short-term encouragement [20], the lack of "balance" between financial and operational measurements [21], and the lack of market orientation [22]. Tourism is a dynamic, highly competitive sector that offers product images that are extremely vulnerable to impact the expectations and subjectivity of each consumer and that has a variety of implications for the eco-socio-economic environment. This context requires the adoption of management systems aimed at creating synergies induced by the positive relationship between quality social responsibility financial performance based on models and appropriate scientific tools. The contribution of this study is to fill these gaps. The aim of this approach is to develop a holistic management system in tourism, with the configuration of a system of indicators that assess value creation and identifies situations of convergence and divergence for indicators in the satisfaction-contribution stakeholder relationship. The first section of this paper is dedicated to the presentation of the theoretical framework and the hypotheses of the approach. The data and the research methodology used in the empirical study are then presented, as are the results of the research and the discussions based on them. In the last section, the conclusions and the directions for future research directions are presented.

Literature Review
The interest in measuring the performance of managerial systems is highlighted by the existence of many studies and a large volume of research in the field. The main management systems of performance are the balanced scorecard (BSC) [23], the performance prism (PP) [24], and total quality management (TQM) [25]. BSC is a system used in the elaboration of and implementation of strategies, which implies the existence of a vision and the completion of four steps: the translation of the vision into operational objectives and sub-objectives; the communication of the vision related to individual performance; the elaboration of the business plan and the setting of the relevant criteria at the lowest possible level; and the monitoring of performance and learning criteria and the adjustment of strategies accordingly. BSC structures the performance indicators around four vectors: financial; customers; internal processes; people, innovation, and learning. Each one of them have specific objectives (financial: cost-effectiveness, cash flow, etc.; customers: market share, withdrawal rate, satisfaction rate, etc.; internal processes: assignment of activities to positions, assignment of processes to departments, redundancies, weakening, etc.; people, innovation, and learning: correspondence between expertise and attributions, satisfaction, learning opportunities etc.), measures to be applied, targets, and initiatives [23]. BSC has evolved from a multidimensional tool for strategic performance measurement, which includes financial and non-financial variables, to an integrated strategic management system based on value creation [26,27]. The main contribution of BSC consists of establishing a link between the different measures and the organization's strategy, allowing the evaluation of the efficiency of management actions at different levels [27]. A limitation of BSC is the poor presentation of causal linkages among the various perspectives [28]. "Financial performance can be improved by generating strategies that enhance sales, customer satisfaction and customer loyalty. Internal business processes can correlate positively with customers and finance, and customers are positively correlated with finance. Internal business processes can enhance the value creation process, and innovation and learning is an important component of this" [29]. Empirical studies reveal a direct relationship between leading measures in the learning and growth perspective and lagging measures in the financial perspective, with the determination of the following series of causalities: learning-production, efficiency-quality, customer service-profit, growth-sales [30]. The application of BSC in tourism is adequate by its characteristics of intangibility, heterogeneity, inseparability, and perishability of the service [31]. In order to adapt to the tourism industry specifically" it is necessary for the BSC to identify the categories of stakeholders and agents involved (residents, tourists and visitors, public and private organizations), to establish sector-specific indicators as well as to consider the investments in infrastructure and resources, the processes and activities, and the relationships that have effects on performance [27]. Internal factors, such as business scale, leadership capacity, resources for implementing the evaluation system, number of operating years of enterprise, capital structure, information accessibility, managerial experience, short-term debt ratio, cash conversion cycle, social relationship of enterprises, and external factors such as state policies on tourism, government support policies, the urban landscape, tourist sites, restaurants that effect tourism companies determine the application of BSC in the sense of evaluating performance in the same direction but at different levels [32]. In the industry, an integrative approach between sales and cost in BSC involving high fixed capacities and costs is needed [33]. Four key concepts drive performance in the tourism industry: the exercise of budgetary control to increase revenues, the improvement of customer relations in order to increase their quality and loyalty, the implementation of strategic management in internal business processes, and internal and external collaboration to ensure innovation and learning [22]. The development of BSC from a sustainable perspective in tourism implies the integration of institutional, economic, socio-cultural, and environmental perspectives [34].
PP is explicitly oriented to stakeholders, with a three-dimensional model where the upper facet represents the satisfaction of stakeholders (who they are and what they want) corresponds to their contribution (what the enterprise wants from the stakeholders) on the lower facet; the side facets are meant for strategies (what the necessary strategies are to meet the requirements of the stakeholders), processes (what processes must be operationalized to streamline the strategies), and capabilities (what capabilities are necessary for the processes). This model uses both benchmarking and value chain in the analyses destined to aid in improvements and optimizations [24].
TQM is a concept derived from the concept of scientific management developed by the Japanese, and it is oriented towards error reduction during the development of products/services and towards the optimization of the management chain and the full satisfaction of customers. TQM is a useful instrument in development and in maintaining operational systems at a level that is appropriate for the business [25], and is focused on stakeholders, respect for people, data management, and continuous improvement [35]. In the quality management approach, quality aims at satisfying customers, total quality refers to the ability to achieve quality at low costs, and total quality management refers to obtaining total quality through the commitment of all those involved in the company's activity [36]. The strategies for the implementation of TQM are "activity-driven", and "results-driven", which have the delivery of short-and long-term results to the stakeholders in view [35]. The key pairs of principle actions used in the development of TQM are approach-management led; scope-companywide; scale-everyone is responsible for quality; philosophy-prevention not detection; standard-right the first time; controlcost of quality; and theme-continuous improvement [36]. The implementation of TQM involves the following stages: identification and preparation; management understanding and commitment; the scheme for improvement; and new initiatives, new targets and, critical examination [36]. The main difficulties in when introducing TQM are the "lack of top management commitment and vision, company culture and management style, flavour of the month type attitude, department-based thinking and actions, poor appreciation of the concept and principles of TQM, lack of structure for TQM activities. The main inhibitors in sustaining TQM are: time pressure, workload and resources; lack of top management commitment; company culture; departmental boundaries; organizational restructuring" [37]. The implementation of TQM involves changes in culture and organizational structure. In the tourism industry, TQM improves competitiveness, its effectiveness being ensured by taking into account the service package, the human aspects, and the measurement issues in service quality (the quantification of tangible and intangible aspects, setting standards, benchmarking, etc.) [18]. The research on the implementation of TQM in the tourism industry reveals the importance of quality self-evaluation by assessing the degree of matching of customers' needs and expectations, implementing strategies and their continuous review to improve processes, and conducting comparative studies to monitor competitive advantage in terms of quality [38], with emphasis on focusing on the quality of services and their continuous improvement, which includes areas such as guest retention and searching for best practices through benchmarking to ensure business performance [39]. The quality of tourist services can be measured using technical, functional, and company image dimensions [40]. Additionally, the promotion of the principles of business ethics ensures an increase in reputation and competitiveness, which is an essential dimension of TQM in tourism [41]. The model supporting the European Quality Award is considered a valid representation of TQM in the European context. It ensures an improvement in the total quality of tourist service organizations and the diminishing of the difference in perception between tourists and hotel managers [16,41,42].
Theories concerning organizations and their management confirm essential changes, from the classical vision to the modern approach of the organization involved in a permanent process of learning and innovation in order to efficiently achieve its goals. In this context, several business excellence models were developed: • Australian Business Excellence Framework (ABEF)-implemented in Australia, the model takes into consideration seven categories: leadership, customers and other stakeholders, strategy and planning, people, information and knowledge, process management-implementation and innovation, results, and sustainable performances [43]; • Malcolm Baldrige National Quality Award (MBNQA)-used in over 25 countries including the U.S.A. and New Zeeland, the model is configured on three main elements: strategy and action plans, an organizational system and the results ac- cording to which it is assessed on whether the performance criteria are met. The seven categories of criteria include decisive factors (1-6) and results (7), developed around 19 sub-criteria with scores between 15 and 115 points: leadership-125p., strategic planning-85p., customer and market orientation-85p., human resources orientation-85p., process management-85p., business results (4-50p.), and information and analysis (4-85p. The Deming Award (Japan Quality Award Premium) (JQAP)-used in Japan and the countries in Southeast Asia, the model is based on eight criteria: leadership and social responsibility-150p., strategic planning-50p., information management-50p., human resources-50p., customers and market-100p., value development-100p., results-400p., learning process-50p. [47]; • Singapore Quality Award Model (SQAM)-applied in Singapore, the model aims at: management (vision and leadership), systems (strategies, human resources, development and learning, environment, process), and results (organization results, customer satisfaction) [48].
Based on these insights, the following hypotheses are proposed: Hypotheses 1 (H1). There are distinct orientations and common approach areas for the three systems, quality, performance, and social responsibility, facilitating the adoption of an integrated system at organizational level; Hypotheses 2 (H2). Return on sales, occupancy, penalties/profit, return of seasonal employees, productivity index, and taxes/value added allow the evaluation of the performance from the stakeholder's perspective, configuring the coordinates of qualitative, non-quantifiable aspects;

Hypotheses 3 (H3).
There is interconditionality between social responsibility and performance: performance systems, quality, and social responsibility reinforce one another. The field's specificity may induce factors that influence the interconditionalities.

Materials and Methods
The research aims to handle integrated quality, social responsibility, andperformance management systems at the level of 11 entities in the hospitality industry in Romania and to emphasize the role of the economic and financial analysis in revealing correlations that are created during the implementation of such a system. The complexity of this issue requires qualitative and quantitative approaches.
The approach of complex concepts that belong to the social and the mental spheres and that raise interpretations and assessments of phenomena and processes were factors for the phenomenological and interpretative approach, as well as the use of inductive, deductive, and comparative qualitative interpretation methods, causal explanations and focus on mutual interdependencies and potentialities. The performance assessment is carried out on the basis of the Romanian business excellence model, which corresponds to the EFQM model.
The quantitative approach is achieved through the analysis of the economic and financial statements of 11 entities operating in the hospitality industry in Romania and includes information found in the internal and financial audit reports and the investigations and surveys carried out by means of a questionnaire among the internal and external partners of the organization. Sample construction was done by selecting a hotel from all of the important health resorts in Romania, homogeneous in terms of ownership and business.
The assessment of the decisive factors is carried out on the basis of 5 criteria, each having sub-criteria, and aggregation is carried out according to the weights recommended by the EFQM model for each criteria; items in the sub-criteria were given equal weight. The assessment of the results is carried out separately in line with the expectations of the stakeholders. The assessment of the qualitative aspects of performance regarding customer satisfaction were conducted via surveys based on questionnaires that included a number of 20 questions concerning the quality of facilities and services, using a Likert scale with 5 levels, and were conducted during the on-season and peak season, respectively, [49]. The questionnaire was made available to all tourists accommodated at the 11 selected Romanian hospitality entities in July 2019 (11,022 tourists) and October 2019 (3242 tourists). These months were chosen because they are characterized by the most intense tourist traffic during the peak season (July) and the off-season (October), respectively. 8266 tourists expressed their opinion in July and 2431 in October, with a total number of 9169 questionnaires to fully satisfy the validation criteria. The assessment of the satisfaction degree of the personnel, organization, and shareholders was carried out in line with the values of several relevant analysis indicators. Due to their differences in expression, the aggregation in a final result implied converting them into positioning indicators according to the reference considered relevant in each field and using the weights published by the EFQM model for each criterion.

Distinctness and Commonness in the Approaches of the Quality Management, Performance and Social Responsibility Systems
In order to respond to the social responsibility concerns, the current management must consider time, quality, and performance management at the same time, with the organization being a common sphere of their application. All three concepts are an integrated system used for the sustainable development of organizations.
Even though they are complex management components that can be integrated in the organization's strategy, each one of these three systems has its own functions, characteristics, and distinct orientations: • Quality management is oriented to the customer and validates the organization's effort for quality and performance; the entire philosophy of quality management is focused on customer satisfaction by providing products and services that meet the customer's expectations and perceptions. These are used under the conditions of maximum security with minimal supplementary costs. To that end, quality standards require quality follow-up during the entire life cycle of the product, from design, production, distribution, sale, and utilization to its elimination; • Performance targets efficiency, efficacy, and effectiveness. Performance assessment is subjective, interpretative, and assessed in a certain context in line with certain relevant values and subjects. It refers to a result/action or a diversity of results/actions that are individual, related to team/organization/sector/system, or general. At the organizational level, the cost/benefit ratio will always guide performance management, as it determines the monetary and non-monetary remuneration of stakeholders; • Social responsibility involves two major components: the assumption and the identification and commitment to meet the expectations of stakeholders. The main expectations of society (population, community, authorities) are aimed at urban development, supporting education and art, cooperation with the local administration, paying taxes and contributions, and participating in the establishment of regulations. A major component of responsibility is the ecologic one. From this point of view, one can say that the stakeholder represents the planet and its entire population (primum non nocere), having obligations regarding the reduction of pollution, the parsimony of resource consumption, and the preservation of diversity as an imperative of sus- tainable development. Consumers' expectations are based on information, accurate treatments, and the quality and safety for products, services, and guarantees. The shareholders' allocation of capital into organizations involves expectations concerning business growth, wealth maximization, and the optimal remuneration of capital. The organizations' employees wish for good working conditions and remuneration, the on time payment of salaries and related debts, safety at work, freedom of speech, training opportunities, and perspective. Creditors ask for the discharge of obligations on time and the horizontally and vertically aggregated margin growth on the value chain.
The impact fields of the three systems coincide or intertwine. In this context, common characteristics of the three systems emerge: • They are orientated, and their final goal is to meet the expectations of stakeholders.
Even if the orientations of the three systems are distinct and well-established, we must notice the fact that there is an explicitly common target: the customer. Every good/service is created to be sold on the market, and organizations have the obligation to provide products that have been manufactured according to quality standards at the most favorable prices (performance); • They require the implication of top management. Leaders are those who actually have the vision of organizational growth. They elaborate strategies, establish goals, and organize the processes for their achievement; • Their common purpose is to create added value as a consequence of business performance and quality resulting in the quality-price ratio validated by consumers ( Figure 1). The added value ensures the direct remuneration of certain stakeholders: employees, the state (at central and local level), and financial creditors. According to the adopted strategies, the remaining value is destined for shareholders, employees, and organizational growth as well as to the payment of corporate tax. A part of it can be oriented to charity. In this case, the state becomes a partner in supporting the organization's initiatives; • They are process oriented. During the transformation of goods/services inputs into outputs, a series of productive, administrative and, leadership processes take place [50]. Quality management aims at the stakeholders' satisfaction during all of the transformation processes, orienting them towards the avoidance of losses and scrap (cost savings, quality growth). The models used in performance management (BSC, PP, TQM etc.) have components orientated to the processes of strategy implementation. Generally, they are classified as processes of production, generation and satisfaction of demand, and planning and leadership and are structured into sub-processes and activities. The value chain identifies five primary activities and four support activities. In all approaches, the management must guarantee the fact that the processes concern the application of strategies and the achievement of objectives through different measures: incrementalism or redesign, which will generate other processes, the performance of which must be monitored. The BSC model explicitly provides organizational measures as well (eliminating the redundancy of certain activities and informational circuits, the inappropriate establishment intro structures, and automation), with an impact on performance. Social responsibility intervenes from two points of view: one regarding the concern for the reduction or eradication of pollution within all processes and the other regarding the enduring of stakeholders' satisfaction through creative added value processes; • Continuous learning and improvement are major components, well-defined both in the quality and performance management. In a situation where it is acknowledged that there is no perfect method of organization, this principle, which is common to all three approaches, implies a continuous analysis of processes and activities in relation to the internal and external constraints as well as the dynamic adoption of decisions that ensures the achievement of objectives. Moreover, the continuous training of 1employees through new information, regulations, etc., is considered vital for the organization. The improvement of communication through adopting a common language, concepts, procedures, and regulations, all equally perceived and assumed, will lead to the elimination of errors, irregularities, and delays, reflected in the elimination of losses and the reduction of hidden costs; • They use a similar combinationof theories: the organizational theory, the system theory, the contingency theory, the strategic analysis (the most recent version of the quality standards explicitly affirms the necessity of enumerating the threats and constrictions in the assessment and prevention of risks; in this context, there is mention of the role of the internal audit in the verification of compliance with the established procedures and also of the efficacy and efficiency of organizational regulations, structures, and mechanisms), the stakeholders theory etc.; • They approach the organization as a distinct organism, different from all the others, and specifically adapt the instruments to each system. From the quality, performance, and social responsibility point of view, equifinality does not reject the diversity of the ways to achieve the specific objectives to each organization; • The interdisciplinary and multidisciplinary characteristics of the three systems generated by the complexity of these issues.
• Continuous learning and improvement are major components, well-defined both in the quality and performance management. In a situation where it is acknowledged that there is no perfect method of organization, this principle, which is common to all three approaches, implies a continuous analysis of processes and activities in relation to the internal and external constraints as well as the dynamic adoption of decisions that ensures the achievement of objectives. Moreover, the continuous training of 1employees through new information, regulations, etc., is considered vital for the organization. The improvement of communication through adopting a common language, concepts, procedures, and regulations, all equally perceived and assumed, will lead to the elimination of errors, irregularities, and delays, reflected in the elimination of losses and the reduction of hidden costs; • They use a similar combinationof theories: the organizational theory, the system theory, the contingency theory, the strategic analysis (the most recent version of the quality standards explicitly affirms the necessity of enumerating the threats and constrictions in the assessment and prevention of risks; in this context, there is mention of the role of the internal audit in the verification of compliance with the established procedures and also of the efficacy and efficiency of organizational regulations, structures, and mechanisms), the stakeholders theory etc.; • They approach the organization as a distinct organism, different from all the others, and specifically adapt the instruments to each system. From the quality, performance, and social responsibility point of view, equifinality does not reject the diversity of the ways to achieve the specific objectives to each organization; • The interdisciplinary and multidisciplinary characteristics of the three systems generated by the complexity of these issues. These claims validate the hypothesis according to which there are common areas to approach in all three systems, quality, performance, and social responsibility, which facilitates the adoption of an integrated system (H1). Furthermore, a sine qua non condition is the implementation of quality standards in the achievement of performance and the fulfillment of requirements of social responsibility. On the other hand, we mention the fact that performance without social responsibility can only bring short-term benefits, affecting the system's sustainability.

Economic and Financial Analysis in the Assessment of Integrated Systems
The research presented in this paper concerned the economic and financial analysis of 11 entities in different health resorts, renowned for their many natural curing factors:  These claims validate the hypothesis according to which there are common areas to approach in all three systems, quality, performance, and social responsibility, which facilitates the adoption of an integrated system (H1). Furthermore, a sine qua non condition is the implementation of quality standards in the achievement of performance and the fulfillment of requirements of social responsibility. On the other hand, we mention the fact that performance without social responsibility can only bring short-term benefits, affecting the system's sustainability.
The determining factors reflect the quality and performance of the entire system involved in the accomplishment of the undertaken mission, the strategy for implementation, and the achievement of the goals being the premise for ensuring a high satisfaction degree for stakeholder expectations. The assessment of the determining factors was performed based on the results of the internal and financial audit missions, the discussions with partners, and through direct investigations as well as on criteria and sub-criteria divided into assessment prime factors. A Likert scale with 5 levels was used (level 5 corresponds to the maximum level of efficiency, effectiveness, and efficacy) ( Table 1). Based on the assessment of the considered factors, it is determined that the most performant entities are E3, E2, E6, E9, and E10, presenting the active involvement of managers, an appropriate customer-oriented structure of processes and added value, an efficient management of resources, and the development of partnerships that ensure the effectiveness of their own processes. The unsatisfactory involvement of the E8 manager and the lack of initiative in adapting to the customers' requirements and expectations generated unfavorable repercussions for the company and the shareholders.
Given the specifics of balneary treatment of the activity performed by the analyzed hotels and the importance of the natural health treatments as a motivation of the tourist activity, it is mentioned that the condition of the determining factors is not necessarily reflected in the results in an accurate manner. In this context, the economic and financial analysis is appropriate and relevant through the inclusion of certain explicative indicators that are specific to the field of activity, allowing for the assessment of performance in the two situations: quantifiable and non-quantifiable.
For the assessment of the results, customer satisfaction was considered as vital to ensure the company's global performance (Table 2). Based on the 9169 questionnaires that fully met the validity criteria, it was found that only E7 was assessed to be below average, while the other hotels benefited from a very good (E2, E3, E9) or favorable (E1, E10, E11, E6, E8) perception. The values of standard deviation indicate the relatively similar opinion of the tourists. The positioning index was determined by relating the score obtained by each hotel to 5, which was the reference value for performance.
The indicators highlight activity specific aspects. Thus, in spite of a low score given by the E7 customers, the occupancy was high, which reveals the impact of the tourist resort's attractiveness on performance as an exogenous variable (Hypothesis 3). The penalty level within profit is a benchmark for the quality assessment, as they generally represent fines imposed by the competent authorities in the event of failure to comply with the regulations regarding security and service quality. The highest value of this indicator at E7 is in line with the score given by the tourists (Hypothesis 2). Even if it presents high customer satisfaction, E2 has a high level of penalties generated by the late payment of the outstanding debts, indicating cash-flow issues with repercussions on performance.
In spite of the low incomes of the population, the high occupancy of approximately 61% at the sample level is explained through the subsidy policy of health tourism by the state (Hypothesis 3).
The hotel performance is significantly influenced by human resources, as it operates in the field of services (Table 3). * RW = ratio between the hourly average productivity at entity level and the hourly average productivity at country level; ** RC = ratio between the gross monthly average salary at entity level and the gross monthly average salary at country level.
The correlative approach between the requirements and the reward is relevant in the assessment of human resources satisfaction. The positioning index was determined in line with value 1, considered as reference for the satisfaction similar to the one at economic level. The negative values show low remuneration in tourism reported to the economic level, explained by the high volume of staff with a low level of professional qualifications. With the exception of the medical and administrative staff, the average wage is close to the national minimum wage. At the same time, there is high productivity compared to productivity at the economic level, mainly due to the work intensity and the high mark-ups. In spite of the dissatisfaction with human resources, the rate of return for the seasonal personnel in the tourist-receiving structures is high, which is dependent on the level of competition in the area, which determines the labor supply. It can be observed that E8 does not comply with the essential correlation between the average wage and productivity, triggering losses.
Tourism is par excellence dependent on the general growth of society. On the one hand, the precariousness of infrastructure conditions, municipal equipment, and living standards decisively influences tourist circulation. On the other hand, its low level is reflected in the insufficient satisfaction of societal expectations regarding tourist organizations (Table 4). The assessment of the company's contribution in this field is carried out through the positioning index, determined by reference to the existing financial legislation. The reference measure is the value of 20% for corporate tax, where sponsorships are under 0.5% of the turnover at the level of all entities. The data analysis reveals that only three hotels rise to the level of these expectations: E3, E6, and E10.
At the same time, it is mentioned that the high volume of taxes in the added value (approximately 20%) is determined by taxes on buildings and special large constructions that these entities must pay. The amount does not depend on activity performance, but only on the existing assets specific to the activity field and on the level of taxation imposed by local authorities, with major impact on the financial results and the shareholders satisfaction. On the other hand, it should be mentioned that even though it is payment in favor of society, penalties represent a sanction for non-compliance with regulations, which affects all stakeholders.
The remuneration of shareholders considered as investors in the risk capital in a business implies a complex analysis based on a system of indicators that arbitrates between present and future and between the shareholders and the other stakeholders. In this study, the analysis is limited to the fulfillment of expectations according to the profit per accommodation day, considered as an integrator indicator, which allows comparisons between entities, eliminating the limits induced by investment differences. The profit per accommodation day characterizes the efficiency of the use of the functioning capacity, emphasizing the correlation between effect-investment effort [51] (Table 5). The assessment of shareholder satisfaction shows significant variations of the profit per accommodation day, from values of 14.18 lei/accommodation day (E2) to losses (E8). Complementarily, the return on sales is presented as a consequence of the quality of management validated on the market, which reveals the performance of the activity, with the notification of the aspects related to both the turnover and the level and structure of the expenses. The positioning index was determined in line with the sample average of 6.82 lei/accommodation day. The return on sales reveals how efficiently the hotel generates profits from its top-line revenue. The differences between the correlations return on salesprofit/accommodation day are explained by the differences regarding the accommodation capacities and the efficiency of their use.
The aggregation of the research results allows the positioning of entities and the implementation of adequate measures in a dynamic process of continuous learning in order to develop the capabilities and improve certain processes (Table 6). The result indicators are benchmarks for manager assessment, the viability of strategies and policies, the efficiency of processes, and resource management. There is interconditionality between the quantifiable and non-quantifiable elements reflected in costeffectiveness and in the capacity of entities to overcome critical situations. The limitation of the introspection of the stakeholder satisfaction at the level of the relevant quantifiable indicators is offset by the inclusion in the analysis of additional indicators for assessing the non-quantifiable aspects of the results (Hypothesis 2).
We mention the existence of factors that affect the intrinsic interconditionality of the integrated quality-social responsibility-performance management system. The attractiveness of the natural healing factors, the precariousness of the income of the Romanian population as well as the subsidization policy of the balneary treatment by the state counteracts the dissatisfaction of the stakeholders as a result of a low-quality organizational service as a whole. There are situations in which an entity has occupancy, return on sales, and profit per accommodation-day above average as well as a high degree of customer satisfaction (E2, E3) and situations in which, even though the occupancy, return on sales, and profit per accommodation day are high, the customer satisfaction is low (E7). Moreover, E7 has a low quality for the determining factors (Hypothesis 3).

Conclusions
The implementation of the integrated quality-performance-social responsibility system is facilitated by the approach of common areas and by the use of a similar theoretic and applicative language and instrumentation. The relevance of the economic and financial analysis in the assessments of the integrated quality-performance-social responsibility system lies in the capacity to provide relevant quantifiable elements as well as in the possibility to suggest information on the non-quantifiable ones in order to emphasize the interdependencies and correlations between both categories of information and the components of the three systems. The specificity of organizations can generate impact factors on the biunivocal dependencies of the assessment elements and the results of the analyzed entities in light of an integrated quality-performance-social responsibility system. The proposed multidimensional model in the configuration of a viable integrated quality-social responsibility-performance management system with a particular focus on tourism completes the gap in the literature. The pertinence of this conceptual model is supported by the takeover of a correlative system of some indicators treated separately in the literature. Thus, similar to The European Tourism Indicators System (ETIS) and other empirical studies in the field, we used occupancy and customer satisfaction [52,53] as assessment criteria. To evaluate performance based on management accounting systems focused on financial data, we used indicators such as return on sales, representation of the operational performance of a company in tourism [54,55], productivity, and profit per unit production [56]. As a condition of ensuring the quality of services provided, innovation in tourism has a strong and positive impact on the firm return on sales [57]. The labor turnover is a serious issue in the tourism industry, generated by the fluctuation of demand due to seasonality and the low level of wages, generating related costs, including direct related costs such as leaving costs, replacement costs, and transition costs and indirect related costs such as lost production, reduced performance levels, unnecessary overtime, and low morale [58].
The results of the empirical study highlight the fact that there are differences in perceptions of performance by stakeholders, depending on the assumption of social responsibility and the inclusion of high-quality standards, which creates specific configurations of the analyzed indicators. Most entities have a convergent relationship of factors, finding situations in which the degree of occupancy, return on sales, and profit per day accommodation above average are associated with a high degree of customer satisfaction (E2, E3), revealing the assumption of social responsibilities to stakeholders or situations in which all determinants have low values. However, there are also divergent situations in which despite the degree of occupancy, the return on sales and profit per day accommodation have high values and customer satisfaction is low (E7), which reveals the pressure for remuneration to the exclusive advantage of the owners.
In terms of practical implications, the proposed model provides professionals in the field with a useful tool to assess performance in order to increase it through appropriate policies, with synergistic effects at the level of individual, entity, and society. It is also possible to evaluate the method in which the management orients activity, either in the general advantage of the stakeholders, ensuring a sustainable development, or in a partial one with negative effects in medium and long term. The model can be used in sectoral analyses as well as in substantiating investment decisions, easily capturing deviations in the components that can alter the results and the adoption of counter-decisions. Comparing certain indicators from different components also allows for pertinent conclusions and effective interventions. We mention, in this sense, that a situation in which there is a low degree of customer satisfaction but there are no penalties for sanctioning poor quality signals possible acts of corruption. For academia and specialists in the field, this model can be integrated into the ongoing research of the management systems.
Romania has rich and diverse balneo-climatic resources, capitalized on for the treatment of a wide range of conditions, which the country recommends it as a tourist destination. Globally, the aging of the population and the alignment with the idea that preventive measures contribute to reducing health costs for states have made health tourism grow at a higher rate than tourism in general. The objectives of the European Spas Association are to promote spas and balneology in Europe, providing as many citizens and visitors with as many natural remedies as possible based on mineral water, landscape and climate [59]. For the Romanian tourism, the adoption of management systems based on complex evaluation tools, the correct substantiation of decisions, and the sustained involvement of stakeholders is particularly important in the development of imposing a strong company-communitystate nexus. The proposed model has applicability in any country, providing notification of specificities related to the investments, the development of the infrastructure, and the compliance with the regulations regarding the quality of the provided services of the selected entity.
Further research will be oriented towards ensuring the robustness of the model. Deepening of the indicators system will be done by using regression analysis that allows for the examination of the relationship between the variables of interest.