Nganjuk Regional Hospital implements the eco-efficiency principle in its operation. It is carried out by focusing on three leadership profiles, facilities management, and the overall level of eco-efficiency practices in health services. This research uses a quantitative descriptive approach supported by data processing and literature study. Nganjuk Regional Hospital continuously improves its public health services by offering various health specialists. Its management and stakeholders are actively involved in making environmental improvements, enhancing employees' capacity, and paying attention to developing innovative health services. This research finds that public health services offered by hospitals increase the environmental cost, which, in consequence, elevates the level of the Eco-efficiency Ratio (EER). When this happens, the operation of a Nganjuk Regional Hospital will not be considered entirely environmentally friendly.