PurposeClimate change is one of our time’s most pressing global environmental challenges, and environmental innovation is critical to addressing it. This study aims to investigate the relationship between environmental innovation and carbon emission in the healthcare industry in Europe while also examining the moderating role of environmental governance.Design/methodology/approachData for this study were collected from publicly listed healthcare companies in ten European countries spanning the years 2012–2021. The selected countries encompassed Belgium, Denmark, France, Germany, Italy, Netherlands, Spain, Sweden, Switzerland and the United Kingdom. The research encompassed all healthcare companies for which data were accessible, resulting in a comprehensive dataset comprising 1,210 companies. The authors collected data from multiple sources, including annual reports, the World Bank and Eikon databases, to ensure a robust and extensive dataset.FindingsThe results of this study indicate that environmental governance plays a significant moderating role in the relationship between environmental innovation and carbon emission within the healthcare sector in Europe, but when combined with high levels of environmental innovation, strong environmental governance leads to enhanced efforts to reduce carbon emissions. This combination also contributes to meeting the expectations of a broader range of stakeholders and maintaining legitimacy.Practical implicationsThe study’s findings have practical implications for healthcare regulators, policymakers and various stakeholders. It underscores the importance of integrating solid environmental governance and innovation to address climate change challenges in the healthcare sector effectively. This integrated approach not only helps reduce carbon emissions but also contributes to achieving sustainable outcomes while satisfying a wider range of stakeholders.Originality/valueThis study adds to the existing body of knowledge by highlighting the significant role of environmental governance as a moderator in the relationship between environmental innovation and carbon emission in the healthcare industry. The research findings provide valuable insights for academics, practitioners and decision-makers, emphasizing the need to combine governance and innovation for sustainable outcomes in healthcare sectors.