The health sector contributes significantly to greenhouse gas emissions, and these emissions translate into health harms such as respiratory and cardiovascular disease. For example, U.S. healthcare–related air pollution and greenhouse gases were estimated to account for the loss of 388,000 disability-adjusted life years in 2018. Sustainability and patient safety both focus on protecting health. Experts argue that environmental harm should be treated as another dimension of patient harm, and organizations like the Joint Commission Journal on Quality and Patient Safety highlight sustainability as part of quality improvement.

Healthcare systems can integrate sustainability into safety culture by tracking environmental metrics alongside traditional safety indicators. Including emissions, waste, and resource use in dashboards or safety rounds signals that environmental stewardship is as important as preventing falls or infections. Analysis of U.S. healthcare impacts shows how environmental metrics can serve as meaningful measures of harm.

Sustainable Quality Improvement (SusQI) is a framework developed in the United Kingdom that integrates environmental, social, and economic sustainability into traditional quality improvement. It operationalizes the principles of the triple bottom line by evaluating interventions across three domains: environmental (e.g., greenhouse gas emissions, waste, material use), social (e.g., patient safety, equity, community health), and economic (e.g., efficiency and cost savings). This approach ensures that quality improvement initiatives deliver benefits not only for clinical outcomes but also for broader public and planetary health. The framework is supported by the Centre for Sustainable Healthcare, UK.