The list of sustainability issues that can pose risks to people, society, and healthcare organizations (HCOs) has been steadily growing over the last decade. HCOs and related industries are responsible for greenhouse gas emissions, pollutants, and unsustainable practices with a substantial death and disability footprint. There is an urgent need for health care transformation that advances quality, safety and value in order to address the public health crisis arising from healthcare pollution and to the meet rapidly moving deadlines to avert climate change. Sustainability initiatives are yet further linked with diversity, equity, inclusion, and justice, with HCOs being asked to disclose their commitments to these as part of “good” environmental society and governance (ESG) practices. In this paper, we review approaches to embed sustainability as a core strategy in HCOs and discuss implementation from the standpoint of a three-lens political, strategic, and cultural framework. We discuss solutions to embed sustainability and to facilitate buy-in, and provide a pathway to operationalize sustainability initiatives.