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Purpose – This chapter frames the topic of organizing for sustainable health care in terms of the environmental trends that have rendered current health care approaches unsustainable, the embeddedness of health care in society's triple bottom line, and the need to build adaptive capability within the complex health care ecosystem.

Design/methodology/approach – We synthesize documented trends and empirical findings regarding the viability of current approaches to health care, and provide a theoretically framed treatment of the adaptation process in the complex health care system that can lead to the emergence of sustainable approaches.

Findings – There is a misfit between current approaches to delivering health care and the requirements and trends in contemporary society. Fundamental transformation is required that entails a broadening of purpose, a future orientation, and a rethinking of how health care adds value and how it is embedded in society.

Originality/value – By reconceptualizing health care reform as intricately related to societal sustainability and the triple bottom line, we open the possibility of transcending a narrow focus on reengineering to create more efficient organizations and work processes that consume fewer resources and deliver greater value. We invite health care practitioners and scholars to rethink all the connections in the health care ecosystem, and the need to build in self-organizing capabilities and adaptive capacity. The cases in this book provide knowledge from systems engaged in fundamental transformation, analyzed through the lenses of theoretical frameworks that help us better understand essential dynamics involved in creating sustainable health care systems.