Frontline workers have a great deal to contribute to improving environmental sustainability of their employers and the health of workers and patients. This article discusses a national project of the Healthcare Career Advancement Program, funded by the U.S. Department of Labor to support green jobs development. Implementation was accomplished through a labor/management collaboration between union locals and 11 employers in four regions throughout the United States. The project developed and implemented a model of training and education for environmental service workers and other frontline health-care workers in hospital settings that supported systems change and built new roles for these workers. It empowered them to contribute to triple bottom line outcomes in support of People (patients, workers, the community), Planet (environmental sustainability and a lower carbon footprint), and Profit (cost savings for the institutions). In the process workers more clearly articulated their important role as a part of the healthcare team and learned how they could contribute to improved patient and worker health and safety.

Previous work on the relationship between worker safety and patient safety has focused on nurses and physicians. 1 Safety climate and nurses' working conditions predict both patient injuries and nurse injuries, supporting the premise that these outcomes may be linked. 2 Less attention has been paid to other members of the health care team, including nursing assistants, orderlies, aides, food service workers, janitors and other environmental service workers, ward clerks, and others. (We use the term health care workers [HCWs] to include frontline hospital workers rather than "support personnel" or other terms that may unintentionally exclude them.) Engaging frontline HCWs in developing, implementing, and evaluating interventions to improve safety may improve patient as well as worker outcomes.