Objectives The healthcare sector lags behind other industries in efforts to reduce its environmental footprint. This study aims to better understand how those who design new health technologies (devices, technical aids and information technologies) perceive and address environmental considerations in their practice.

Methods We conducted in-depth interviews with engineers, industrial designers, entrepreneurs and clinicians (n=31) involved in the design, development and distribution of health innovations in Quebec and Ontario (Canada). A qualitative thematic data analysis identified similarities and variations across respondents’ viewpoints.

Results Innovators’ views emphasise the following: (1) the double burden of supporting patient care and reducing the environmental impact of healthcare; (2) systemic challenges to integrating environmental considerations in health innovation design, development and use and (3) solutions to foster the development of environmental-friendly health innovations. Although innovators tend to prioritise patient care over the environment, they also call for public policies that can transform these two imperatives into a single duty to care.

Conclusions Health innovators are uniquely positioned to tackle challenges and develop creative solutions. Policymakers and regulators should, however, actively steer the healthcare industry towards a more sustainable modus operandi by giving full attention to environmental considerations in health innovation design.