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Building a culture of sustainability in healthcare: Lessons from the evidence
by Dr Matt Sawyer
28 September 2026
As healthcare systems strive to reduce their environmental impact, many organisations are discovering that technical solutions alone are insufficient. The greatest challenge is often cultural rather than operational. While initiatives such as Green ICUs, waste reduction programmes, and sustainable procurement strategies can deliver measurable environmental benefits, their long-term success depends on an organisation’s ability to change behaviours, values, and ways of working. Evidence from healthcare sustainability, implementation science, and organisational change research offers important insights into how this cultural transformation can be achieved.
Early, visible success
One of the strongest themes emerging from the literature is the importance of achieving early, visible successes. Organisational change is more likely to gain acceptance when staff can see tangible benefits from relatively small interventions. The Green ICU Collaborative recently highlighted how momentum can be generated through “quick wins” that demonstrate value and build trust among stakeholders. Similar findings have been reported in evaluations of healthcare Green Teams, where small-scale projects produced environmental savings, reduced costs, and improved staff engagement, creating a foundation for broader sustainability programmes.
Leadership at every level
Leadership is another critical determinant of success. Research consistently shows that sustainable change requires support at multiple organisational levels. Executive sponsorship provides legitimacy and resources, while middle managers help remove operational barriers. Equally important are frontline champions who influence colleagues and translate organisational goals into day-to-day practice. Evidence from implementation science demonstrates that opinion leaders and local champions are among the most effective mechanisms for promoting the adoption of new practices in healthcare settings. Their influence is often stronger than formal directives because they are trusted by peers and understand local clinical realities.
Embedding sustainability into values and strategy
However, leadership alone is insufficient if sustainability remains a peripheral activity. Increasingly, researchers argue that environmental sustainability must become part of an organisation’s identity and strategic purpose. Rajagopalan and colleagues propose a “three-lens” framework incorporating political, strategic, and cultural dimensions of sustainability within healthcare organisations. Their work suggests that sustainability initiatives are more likely to endure when they are linked directly to clinical quality, patient safety, organisational values, and long-term strategy. Rather than being viewed as an optional environmental project, sustainability should become an integral component of how healthcare organisations define excellence.
Staff engagement
Staff engagement is equally important. Successful sustainability programmes are rarely imposed from above. Instead, they emerge through collaboration with clinicians, nurses, allied health professionals, and operational staff. An integrative review examining factors that facilitate successful environmental initiatives in healthcare identified staff engagement as one of the four most important enablers, alongside policy support, collaboration, and organisational commitment. When staff participate in designing solutions and understand how sustainability improvements benefit patient care, workflows, or resource utilisation, implementation becomes significantly easier.
Measurement and feedback
Measurement and feedback also play a crucial role in cultural change. Healthcare professionals are accustomed to using data to guide clinical improvement, and sustainability initiatives can benefit from the same approach. Evidence from implementation science shows that audit and feedback mechanisms consistently improve adoption of evidence-based practices. Providing regular information about carbon reductions, waste diversion, energy savings, or financial benefits reinforces the value of sustainable behaviours and helps maintain momentum. Visible reporting can also strengthen accountability and encourage healthy competition between departments or teams.
Integrate into what’s already there
Another important lesson is the need to integrate sustainability into existing organisational systems rather than creating separate structures. Studies suggest that sustainability programmes achieve greater success when embedded within established quality improvement, patient safety, and operational excellence frameworks. This integration reduces duplication, aligns environmental goals with existing organisational priorities, and increases the likelihood of long-term sustainability. Recent healthcare sustainability literature highlights approaches such as Green Lean Six Sigma, which combine environmental objectives with process improvement and quality enhancement.
Continuous journeys and the power of cultural transformation
Sustaining cultural change over time requires attention to organisational context. A systematic review of hospital-wide quality and safety initiatives identified three factors that consistently support long-term success: well-coordinated implementation, adaptation to local circumstances, and ongoing reinforcement after the initial intervention. The review grouped sustainability factors into three broad categories: people, processes, and organisational environment. These findings suggest that environmental sustainability programmes should not be viewed as one-off projects but as continuous journeys requiring nurturing, reinforcement, and adaptation.
Taken together, the evidence points towards a practical roadmap for organisations seeking to foster a culture of environmental sustainability. Successful programmes typically begin with executive support, empower frontline champions, deliver early measurable wins, engage staff in solution development, provide regular feedback, and embed sustainability into existing quality improvement structures. Most importantly, they frame sustainability not as an additional burden but as a means of delivering higher-quality, safer, and more efficient care.
As healthcare systems confront the growing health consequences of climate change, cultural transformation may prove to be the most important sustainability intervention of all. The evidence suggests that when passionate individuals are supported by effective leadership, robust implementation strategies, and an organisational commitment to sustainability, meaningful environmental change can become both achievable and enduring.
References
- Fontaine G, Vinette B, Weight C, et al. Effects of implementation strategies on nursing practice and patient outcomes: a comprehensive systematic review and meta-analysis. Implementation Science. 2024;19(68). doi:10.1186/s13012-024-01398-0.
- Law J, Dahlke S, Kalogirou MR. What Facilitates Green Team Success in Implementing Environmentally Sustainable Initiatives in Health Care. International Journal of Nursing Student Scholarship. 2023;10. Available at: https://journalhosting.ucalgary.ca/index.php/ijnss/article/view/77493
- Moon SEJ, Hogden A, Eljiz K. Sustaining improvement of hospital-wide initiative for patient safety and quality: a systematic scoping review. BMJ Open Quality. 2022;11:e002057. doi:10.1136/bmjoq-2021-002057.
- Powell BJ, Fernandez ME, Williams NJ, et al. Enhancing the impact of implementation strategies in healthcare: a research agenda. Frontiers in Public Health. 2019;7:3. doi:10.3389/fpubh.2019.00003.
- Rajagopalan S, Pronovost P, Al-Kindi S. Implementing a Sustainability Framework in Healthcare: A Three-Lens Framework. Healthcare (Basel). 2023;11(13):1867. doi:10.3390/healthcare11131867.
- Hoxha G, Simeli I, Theocharis D, Vasileiou A, Tsekouropoulos G. Sustainable Healthcare Quality and Job Satisfaction through Organizational Culture: Approaches and Outcomes. Sustainability. 2024;16(9):3603. doi:10.3390/su16093603.
- Warner MA, Kofke WA, Dhingra LK, et al. Implementing a Green ICU Pathway Across a Large US Health System: Lessons from the Green ICU Collaborative. Critical Care Explorations. 2025;7(1):e1450. doi:10.1097/CCE.0000000000001450.
