Ethical governance, compliance and systemic performance in public health services in Romania

The accelerated transformations generated by the COVID-19 pandemic, the digitalization of public services and the process of harmonization with European norms have highlighted structural vulnerabilities of the Romanian healthcare system and the limits of traditional administrative governance mechanisms. Although the period 2020–2025 was marked by the expansion of the regulatory framework and compliance tools, systemic performance, the quality of medical care, and the level of public trust remained below expectations. In this context, the study analyses the relationship between administrative compliance and ethical governance, starting from the premise that formal compliance with regulations is not sufficient to ensure institutional efficiency. Based on the Donabedian model and the literature on organizational culture, transparency and institutional accountability, the research highlights that dysfunctions such as communication deficit, punitive culture and underreporting affect the efficiency of compliance mechanisms and institutional response capacity. The methodology used is a qualitative, integrative one, based on the analysis of legislation, institutional reports and specialized literature relevant to the analysed period. The results indicate the need to overcome the paradigm of formal compliance and consolidate an ethical governance model oriented towards accountability, transparency and the patient's interest.