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ObjectivePhysical and mental well-being are threatened by climate change. Since hospitals in high-income countries contribute significantly to climate change through their greenhouse gas (GHG) emissions, the medical ethics imperative of ‘do no harm’ imposes a responsibility on hospitals to decarbonise. We investigated hospital stakeholders’ perceptions of hospitals’ GHG emissions sources and the sense of responsibility for reducing GHG emissions in a hospital.MethodsWe conducted 29 semistructured qualitative expert interviews at one of Germany’s largest hospitals, Heidelberg University Hospital. Five patients, 12 clinical and 12 administrative employees on different levels were selected using purposive maximum variation sampling. Interviews were transcribed verbatim and analysed using the framework approach.ResultsConcerning GHG emissions, hospital stakeholders perceived energy and waste as most relevant emission sources followed by mobility. Climate change mitigation in general was considered as important. However, in their role as patients or employees, hospital stakeholders felt less responsible for climate change mitigation. They saw providing best possible medical care to be the top priority in hospitals and were often concerned that patients’ health could be jeopardised by climate change mitigation measures.ConclusionPerceptions of most important emission sources did not coincide with those in literature, highlighting the need to inform stakeholders, for instance, about pharmaceuticals as important emission source. A frequently perceived conflict between reducing emissions and providing high-quality medical care could be eased, if reducing emissions would not only be justified as a contribution to mitigation, but also as a contribution to preventing ill health—a basic principle of medical ethics.

To mitigate the negative (health) consequences of climate change, the Paris Agreement demands a radical reduction of greenhouse gas (GHG) emissions. The health sector contributes considerably to climate change worldwide. In Germany it is responsible for 6.7% of national GHG emissions. The transition to low-carbon hospitals requires detailed knowledge of the amount and sources of GHG emissions. This study aimed at capturing the status quo of GHG emission reporting by German hospitals and at examining characteristics of the reports. Therefore, we performed a grey literature review with pre-defined inclusion and exclusion criteria. The search strategy comprised hand-searching specific databases, targeted websites and web search engines via a standardized set of search terms. We found 232 German hospitals reporting their GHG emissions, representing 12% of all hospitals. Yet, only 62 hospitals (3%) met the inclusion criteria for further analysis. These reports do not comprise all energy-related GHG emissions, omit GHG emissions occurring up- and downstream of hospitals and mainly include CO2, but leave out other GHG. Consequently, there are severe gaps regarding GHG emissions reports of German hospitals. If Germany wants to comply with the Paris Agreement, hospitals need to be obliged to follow a standardized methodology to report and reduce GHG emissions.