Healthcare services contribute 5 to 10% of global carbon emissions and environmental burden on the planet. Sustainability in health care and laboratory medicine is gaining global momentum emphasizing a holistic approach to reduce carbon footprint, improve the delivery and quality of care, while optimizing operational efficiency and effectiveness. Digital transformation has the potential of achieving these goals simultaneously. Clinical laboratories should assess and mitigate their environmental impact through digital technologies. In this article, opportunities and challenges in establishing sustainable quality improvement in the clinical laboratory will be discussed with a focus on the redesign of the total testing process and digital transformation of routine quality assurance activities.