The publication of ‘Our Common Future’ (1987) and increasing pressures on reducing waste and costs in manufacturing and services have generated growing research on environmental performance measurement. Developed countries and emerging economies such as Brazil have been faced with these issues while seeking alternative ways to reduce the environmental impact of operations and improve the quality of processes and results. The healthcare sector, particularly hospitals, have struggled to find new frameworks to measure and monitor their environmental performance. Considering this context, the current study sought to develop an alternative framework drawn from literature review, best practices, field studies and legislation. An environmental performance measurement framework and process were applied in six philanthropic hospitals in the South of Brazil. A total of 69 goals were established by the six hospitals and later deployed in 65 strategic, 67 tactical and 53 operational actions. In terms of outcomes, 57,97% of all goals were achieved and ongoing targets encompass 36,23%; only 2,9% of all goals could not be achieved. Overall, the framework was deemed feasible, usable and useful for managers. According to case study participants, the framework allows the generation of meaningful indicators while creating a culture of sustainability and commitment to established goals.