Quality Meets Sustainability

A Rising Imperative in Healthcare Compliance 

Written by Dr. Stacey R. Atkins, PhD, MSW, LSW, CPC, CIGE 

This article explores the relationship between healthcare quality and sustainability, presents the rationale for adopting a “Triple Bottom Line” approach, and offers strategies for embedding ecological and social responsibility into compliance-driven quality improvement.

Introduction

Healthcare quality has long been measured through the lens of clinical outcomes, patient safety, and regulatory compliance. Yet, a new imperative has emerged—one that integrates environmental stewardship and social responsibility into the very definition of quality. This paradigm shift recognizes that sustainable healthcare is no longer a peripheral concern, but rather a fundamental component of ethical, compliant, and effective care delivery.

For healthcare organizations and compliance professionals, the integration of sustainability into quality frameworks represents both a timely opportunity and a professional responsibility. 

Defining Sustainable Healthcare

The healthcare sector is responsible for an estimated 8.5% of total greenhouse gas emissions in the United States (Health Care Without Harm, 2020). Hospitals are resource-intensive, operating 24/7 with significant consumption of energy, water, pharmaceuticals, and plastics. 

Sustainable healthcare is the practice of meeting present health needs without compromising the ability of future generations to meet theirs. It requires balancing three interdependent domains:

1. Economic sustainability – managing healthcare resources efficiently to ensure affordability and equity of access.

2. Social sustainability – promoting health equity, reducing disparities, and strengthening community partnerships.

3. Environmental sustainability – reducing the healthcare sector’s ecological footprint by minimizing waste, energy use, and emissions (Sustainable Healthcare, 2025).

Embedding sustainability within quality initiatives is both an ethical and a compliance imperative.

Quality and the Triple Bottom Line

Traditional quality improvement models—such as Donabedian’s framework of structure, process, and outcomes—have largely focused on clinical performance and patient safety. While essential, this lens is incomplete in today’s context of global health challenges. The Triple Bottom Line (TBL) expands quality assessment to include three metrics:

• Clinical outcomes (health, safety, compliance)
• Environmental outcomes (carbon footprint, waste reduction, resource efficiency)
• Social outcomes (equity, workforce well-being, community health impact)

By incorporating the TBL into compliance frameworks, healthcare organizations can ensure that quality improvement is not only patient-centered, but also community-centered and planet-centered. This expanded view aligns with both ethical principles and federal regulatory trends that increasingly emphasize population health, social determinants of health (SDoH), and health equity.

Why Sustainability Matters for Healthcare Compliance

Regulatory and Policy Drivers

Recent policy developments underscore the growing expectation for healthcare organizations to consider sustainability:

• Centers for Medicare & Medicaid Services (CMS) has prioritized health equity and community impact in value-based care models, indirectly encouraging sustainable practices.
• The Joint Commission has begun incorporating sustainability questions into accreditation surveys, particularly in areas of waste management, climate preparedness, and resilience planning.
• World Health Organization (WHO) emphasizes planetary health and urges member states to align healthcare delivery with environmental responsibility (WHO, 2021).

Compliance specialists can anticipate that sustainability metrics may eventually intersect with reimbursement, accreditation, and public reporting; similar to how quality measures evolved from voluntary to mandatory over the past two decades.

Risk Management and Cost Savings

Ignoring sustainability can increase compliance risk in areas such as waste disposal, pharmaceutical management, and energy inefficiency. Conversely, organizations that integrate sustainability often realize cost savings. Studies show that hospitals implementing energy efficiency programs save an average of $3 per square foot annually (Practice Greenhealth, 2022). These savings can be reinvested into quality improvement, creating a positive feedback loop between sustainability and compliance.

Integrating Sustainability into Quality Frameworks

1. Governance and Leadership Oversight

Boards and compliance officers should embed sustainability goals into governance structures. Policies must explicitly address environmental stewardship, community engagement, and equity. Leadership buy-in is essential for aligning sustainability with compliance and risk management functions.

2. Data, Metrics, and Reporting

Compliance professionals are uniquely positioned to integrate sustainability metrics into existing reporting systems. For example:

• Environmental metrics: energy usage, emissions, recycling rates, pharmaceutical waste reduction.
• Social metrics: staff wellness, equity initiatives, community partnerships.
• Compliance metrics: adherence to environmental regulations and safety standards.

These metrics can be incorporated into existing dashboards, ensuring sustainability is monitored alongside clinical outcomes.

3. Workforce and Education

Staff education is critical. Training programs should link sustainability to ethical obligations and compliance standards. For instance, reducing unnecessary printing or improving medication disposal practices are not just “green initiatives”—they are compliance measures with real quality implications.

4. Partnerships and Community Engagement

Healthcare organizations cannot achieve sustainability in isolation. Collaborations with local agencies, waste management companies, and community health organizations create pathways for shared impact. Professional associations and educators can support this by curating best practices, facilitating dialogue, and providing compliance guidance.

The Role of Compliance Professionals in Leading the Movement

Compliance professionals and healthcare leaders are uniquely positioned to champion the integration of sustainability into quality frameworks. Potential initiatives include:

• Developing training modules on sustainable compliance practices.
• Publishing white papers that articulate the compliance case for sustainability.
• Creating model policies that align environmental responsibility with regulatory requirements.
• Advocating nationally for recognition of sustainability as a dimension of healthcare quality.

By doing so, compliance specialists reinforce their leadership in shaping healthcare education and practice, while also positioning themselves as stewards of ethical, socially responsible, and ecologically sustainable healthcare.

Challenges and Considerations

While the case for sustainability is strong, healthcare organizations will face several challenges:

• Resource limitations: Upfront investments in energy efficiency or waste management may strain budgets.
• Measurement complexity: Defining and standardizing sustainability metrics across diverse healthcare settings can be difficult.
• Cultural change: Shifting mindsets from a narrow focus on clinical outcomes to a holistic view of quality requires strong leadership and sustained education.

Compliance professionals must be prepared to address these barriers while emphasizing the long-term value of sustainability for patients, organizations, and society.

Conclusion

Quality and sustainability are no longer parallel pursuits; they are intertwined imperatives.

Healthcare organizations that fail to integrate environmental and social responsibility into quality improvement risk falling behind in compliance, accreditation, and ethical standards. Conversely, those that embrace the Triple Bottom Line will be positioned as leaders in an era where patients, payers, and policymakers demand accountability beyond clinical outcomes.

For healthcare leaders, educators, and compliance professionals, this is an opportunity to advance the field by positioning sustainability as a core dimension of compliance and quality. By doing so, they can help reshape the healthcare quality movement into one that is not only clinically effective but also socially equitable and environmentally responsible; a legacy that benefits patients today and generations to come.

About the Author

Dr. Stacey R. Atkins, PhD, MSW, LMSW, CPC, CIGE

Dr. Adkins is a Compliance Specialist working as a team member in the Education Department of the American Institute of Healthcare Compliance. Her career spans leadership roles with the Office of the State Inspector General, Department of Behavioral Health and Developmental Services, and HRSA, among others.

References

• Health Care Without Harm. (2020). Healthcare’s climate footprint. Retrieved from https://noharm.org
• Practice Greenhealth. (2022). The business case for environmental sustainability in healthcare. Retrieved from https://practicegreenhealth.org
• Sustainable healthcare. (2025). In Wikipedia. Retrieved from https://en.wikipedia.org/wiki/Sustainable_healthcare
• World Health Organization (WHO). (2021). WHO Manifesto for a healthy recovery from COVID-19: Prescriptions for a healthy and green recovery. Geneva: WHO.
• Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743–1748.
• The Joint Commission. (2023). Sustainability and accreditation: Environmental and emergency preparedness considerations. Oakbrook Terrace, IL.

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