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If the global healthcare system would be a country, it would be the fifth largest emitter. Hence various health care systems worldwide have committed themselves to become carbon neutral. In Europe, Germany as an economy and the German healthcare system produces by far the most emissions. This has a significant impact on the health of the population in Germany, Europe and worldwide. It leads to Disability Adjusted Life Years (DALYs) as well as premature deaths. To reduce global climate change related damages, disasters and negative health outcomes, Germany has committed itself through various treaties to become carbon neutral and to transform the healthcare system towards net zero until 2030. The article highlights crucial steps for hospitals how this can be achieved. Important management tools are the SWOT analysis, the PDCA cycle, the DHOW model and the sustainable Balanced Score Card. Hospitals should establish Key Performance Indicators for Scope 1, 2, and 3 emissions and monitor them on a monthly basis. Important action areas are energy sources, insulation of buildings, waste, water consumption, nutrition, transportation, chemicals, pharmaceuticals, climate education and leadership. Leadership should be executed as a top-down as well as a bottom-up approach to involve all relevant stakeholders including staff and patients.