This paper analyzes organizational environmental performance and environmental management approaches in German hospitals. Based on data from an online survey and a subsequent cluster analysis, three groups of hospitals are identified: traditionalists, pragmatists, and environmentalists. The clusters differ regarding their organizational environmental performance, i.e., the environmental management elements adopted (policy, goals, structures, processes, and monitoring) and the environmental issues addressed (energy, water, material consumption, waste, emissions into water and air). The environmental management approaches hospitals adopt range from least to most active. Despite perceived stakeholder pressure being generally low, differences between the clusters can be observed. The most relevant stakeholders are internal ones, i.e., management and owners, rather than external ones. Furthermore, some organizational characteristics distinguish the clusters. This paper adds knowledge in the under-researched setting of hospitals and discusses managerial possibilities for the types of hospitals to increase their organizational environmental performance and to pursue a more holistic environmental approach.