In the absence of uniform regulations, the outsized environmental impacts of the U.S. healthcare sector conflict with its mandate to improve and protect population health. This study sought to assess approaches to environmental sustainability and transparency among early-adopters of sustainable healthcare initiatives, to understand the example they might set for the broader industry.

We identified signatories of the Department of Health and Human Services’ Healthcare Sector Climate Pledge as a likely group of early adopters, to whom we distributed a survey on goals, progress, reporting, and organizational approaches pertaining to various facets of environmental sustainability, in addition to reviewing their public websites.

Among the sample population, both progress and transparency were lacking. Survey response rates were poor and demonstrated no consistent pattern in approach to sustainability. Survey respondents showed greater progress on decarbonization as compared with renewable energy, water usage, and waste reduction.

Though limited by a poor response rate, the survey findings demonstrated little reason to expect efficient progress in the U.S. health sector across four main areas (carbon emissions, renewable energy usage, water usage, and waste management). Findings demonstrate limited secondary evidence of environmental improvement, including publicly stated goals, transparent sustainability data, and contact information for sustainability staff. The results did not provide sufficient successful examples to create a blueprint for wider efforts. More progress is required to meet the environmental aspirations of the health sector, and protect public and planetary health.