The Healthier Hospitals Initiative (HHI) is a national campaign to implement a completely new approach to improving environmental health and sustainability in the healthcare sector that was kicked off April 3, 2012.

Ten of the largest U.S. health systems, comprising more than 500 hospitals with more than $20 billion in purchasing power, worked with Health Care Without Harm (HCWH), The Center for Health Design, and Practice Greenhealth to create HHI as a guide for hospitals to reduce energy and waste, choose safer and less toxic products, and purchase and serve healthier foods.  

With 10 sponsoring systems as anchors, the initiative seeks enrollment of at least 2,000 hospitals in Canada, the United states, and the District of Columbia over the next three years to implement sustainable operations.

Through a partnership with the Institute for Healthcare Improvement, HHI will gather data on the financial and environmental impact of specific environmental sustainability programming.

As a comprehensive, sector-wide initiative, HHI is fully consistent with and builds upon the Centers for Medicare and Medicaid Services (CMS) Triple Aim—better health, better care, and lower costs, and will institute frameworks and implementation tools that can be used by every healthcare facility in the nation, for no charge.

Over the years, hospitals have been making progress in their environmental sustainability programming. Today, the results of these programs have yielded a body of evidence that demonstrates superior environmental performance and cost-savings within these institutions.

The launch coincides with the release of Health Care Without Harm’s Research Collaborative “Creating a Culture of Sustainability: Leadership, Coordination, and Performance Measurement Decisions in Health Care,” a report examining the outcomes of environmental sustainability initiatives at eight healthcare systems in the United States, authored by Tonya Boone, PhD.

The research focuses illuminates organizational factors that contributed to the programs’ achievements and cost-savings.

From leadership engagement to healthier foods, less waste to safer chemicals, and leaner energy to smarter purchasing, early-adopting healthcare systems are making a positive impact. It’s time for these successes to be documented and shared with the rest of the sector.

And that’s where HHI comes in. “HHI will help reinvent hospitals as community anchors for health and sustainability by demonstrating how to reduce their climate footprint, detox their supply chain, and serve healthier foods and beverages,” says Gary Cohen, president and executive director, Health Care Without Harm.

The HHI challenges
Six challenges form the basis of the three-year initiative. Enrollees commit to at least one challenge area over the three years in order to participate. The challenges have three levels, and enrollees can choose to participate in one, two, or all three levels of a specific challenge area. Each one has detailed metrics and an implementation plan that can be adapted by any hospital in the country.

The 10 sponsoring health systems are committed to two of the challenges—some are addressing a challenge across the entire system while others are identifying challenges on a site-by-site basis. 

The six challenges (engaged leadership, healthier food, leaner energy, less waste, safer chemicals, and smarter purchasing) were developed collaboratively among the sponsoring health systems and work groups made up of industry experts from Health Care Without Harm Work Groups and Practice Greenhealth, with consult from the Institute for Healthcare Improvement.

The challenges were carefully crafted with a balance of a critical need from an environmental and health perspective, but framed in a way to ensure achievability and success for facilities committed to the challenge. The resulte was specific, measurable, and standardized interventions and associated measures that will demonstrate financial and environmental value.

Why the Healthier Hospital Initiative?

  • Data shows that approximately 75%1of all healthcare costs are for the treatment of chronic diseases. By addressing the root causes, participants can reduce the burden of chronic disease. 
  • There is widespread agreement that the current healthcare system is not economically sustainable and that significant changes need to be made in healthcare delivery. HHI will help participants reduce the cost burden and shift savings towards patient care. 
  • A growing body of research shows a direct correlation between the environment and the very conditions that hospitals treat, including respiratory diseases, cancer, diabetes, and others. By reducing their environmental impacts, participating hospitals will be protecting the health of their patients, employees and communities. 

The Healthier Hospital Initiative’s six challenges include a baseline and three levels within each challenge. Sponsoring health systems have committed to two challenges in the three-year initiative and enrolled hospitals must commit to a minimum of one challenge. To see the full challenge language, visit the HHI website at

Businesses & HHI
Healthcare facilities rely on business partners to help them achieve their environmental goals. Business partners, group purchasing organizations, associations, and others can participate in HHI. Businesses with expertise in a specific HHI challenge can get involved a number of ways.

Through Practice Greenhealth’s Environmentally Preferable Purchasing (EPP) Business Leadership Coalition, interested businesses can be part of the conversation around scrutinizing their own supply chain and, in turn, positively impacting the health of the sector. The Greening the Supply Chain Initiative is a place where manufacturers, services providers, and Practice Greenhealth membership facilities come together for information-sharing around products and services that will meet the changing needs of the healthcare sustainability community. 

Practice Greenhealth kicked off a mentor program as the educational vehicle for the Healthier Hospitals Initiative.  Through an application process, Practice Greenhealth business and facility members can apply to mentor on the specific HHI challenges.

The mentors will share their strategies through case studies, sharing calls and a forum so others can learn from their success and have an opportunity to ask questions and view helpful documents, such as policies and educational information.

Some of the challenges, like avoiding chemicals in furniture or casework, for example, offer an opportunity for increased engagement and collaboration among manufacturers, designers, architects, and facility representatives. Measuring the reduction of PVC and DEHP in medical devices requires team work and conversations among healthcare purchasers, group purchasing organizations, sustainability experts, and product manufacturers.

HHI and the Mentor Program, and the Greening the Supply Chain Initiative, are spaces where these conversations and these collaborations can take place—with the ultimate goal of healthier environments.


New website
The HHI website shares sponsoring healthcare leadership perspectives, case studies, upcoming news and events, and blogs and regular upd
ates to continuously celebrate progress. The website is for enrolling in HHI, identifying the challenge, and offering access to educational tools and other enrollees, with guidance in data collection and submission around the six challenges.

The HHI website will be a growing virtual community of organizations working together for a healthier future.

Six how-to guides
The guides will feature guidance on not only how to achieve the goals but how to capture data and submit to the Institute for Healthcare Improvements “extranet” site or through ENERGY STAR, for the energy challenge. Staff assistance is available every step of the way, whether for implementation guidance or for help with login or data submission.

Press kits will help enrollees to spread the word in their own community and tell their story of how pollution prevention and greening the supply chain is connected to a commitment to healthy environments for staff, patients, and the community.

HHI benefits
HHI provides hospitals an accessible way to improve the health of patients, workers, and communities, and to yield savings that support the delivery of quality care. By leveraging the influence and visibility of the healthcare sector, positive changes will be timely and meaningful, and will have reach far beyond the healthcare industry.

By implementing proven environmental practices as standard processes and procedures, hospitals can improve patient outcomes and workplace safety, prevent illness, create environmental benefits, and see significant cost-savings.   

HHI is an opportunity for collaboration, data collection, and a measured shift in markets and healthcare operations. There will be a story to tell at the end of the campaign. This is a story we’ll all want to read because it’s about a healthier community and hospitals as anchors in that community. By enrolling in HHI, any hospital or eligible business can be part of the story and a healthier future. Is your hospital part of the Healthier Hospital Initiative?

Learn more and join the initiative at

1. Health Education, “Preventing Chronic Disease is Critical to Controlling Health Care Costs.”


Sponsoring health systems

  • Advocate Healthcare*
  • Bon Secours Health System
  • Dignity Health*
  • Hospital Corporation of America*
  • Kaiser Permanente*
  • Inova Health System*
  • MedStar Health*
  • Partners HealthCare*
  • Tenet Healthcare
  • Vanguard Health Systems
  • Practice Greenhealth*
  • Health Care Without Harm*
  • The Center for Health Design*
  • Catholic Health Initiatives

* Founding sponsors

Advocate Health Care—Leaner energy challenge

  • Reduce fossil energy use as a means to improve/protect human health.
  • Reduce energy consumption 20% by the year 2015 with a 2008 baseline—as of 2011, energy reduced by 10.6% system-wide with savings of more $2.5 million in 2011 dollars. 
  • Improve reliability, efficiency, and conservation, and optimize operations.
  • Leverage utility incentives to fund projects and initiatives, more than $1.2 million received since 2010.
  • Reduce greenhouse gas emissions 20% by the year 2015 with a 2008 baseline.
  • Benchmark data at all sites.