Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: JES has received consulting fees from Teleflex, AstraZeneca, and AlphaSights; honorariums for speaking on healthcare sustainability from the University of New Mexico, Columbia University, the University of Colorado, Harvard University, and the Institute for Healthcare Improvement; and travel reimbursements to speak on healthcare sustainability from the Canadian Anesthesiologists’ Society, Vizient, University of Colorado, and the Institute for Healthcare Improvement. Further details of The BMJ policy on financial interests are here: https://www.bmj.com/sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf. Provenance and peer review: Commissioned; not externally peer reviewed.