{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:22:52Z","timestamp":1786116172838,"version":"build-2736575974"},"reference-count":110,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Environ. Res. Public Health","IJERPH"],"abstract":"<jats:p>Healthcare services account for approximately 4\u20135% of global greenhouse gas emissions worldwide, and nearly 10% of emissions in the United States are primarily from general hospital operations, surgical and anesthetic care, and pharmaceutical and medical device supply chains. Healthcare services and operations also generate substantial plastic and chemical waste that pollute the environment and disproportionately affect vulnerable communities. Although global and national organizations have introduced decarbonization frameworks, adoption remains hindered by limited leadership engagement, competing institutional priorities, and insufficient regulatory accountability. This article synthesizes the published literature on the current landscape of healthcare sustainability, summarizes key policy frameworks, and identifies major barriers to implementation; these findings are then illustrated through sustainability initiatives at Stanford Medicine, a quaternary hospital system. These efforts are presented as implementation examples that other institutions may adapt to their own resources and contexts, to reduce emissions and ensure more sustainable healthcare delivery.<\/jats:p>","DOI":"10.3390\/ijerph23081028","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:08:02Z","timestamp":1786003682000},"page":"1028","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sustainable Healthcare: A Perspective on the Current Landscape, Frameworks, Barriers, and Implementation Model in a Quaternary Hospital System"],"prefix":"10.3390","volume":"23","author":[{"given":"Hubert","family":"Tuyishime","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amandeep","family":"Chawla","sequence":"additional","affiliation":[{"name":"Department of Supply Chain and Post Acute Care, Stanford Healthcare, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1528-9829","authenticated-orcid":false,"given":"Bryan","family":"Khoo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin G.","family":"Shea","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1177\/0091270004273680","article-title":"Origin and uses of primum non nocere\u2014Above all, do no harm!","volume":"45","author":"Smith","year":"2005","journal-title":"J. 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