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Joint Commission CEO talks about new sustainability program for hospitals

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In an interview with Chief Healthcare Executive, Dr. Jonathan Perlin discusses the effort, the growing urgency to address climate change, and the new opportunities for health systems.

Dr. Jonathan Perlin says the Joint Commission doesn’t get many requests for additional certification programs.

“It's rare that the Joint Commission gets asked for more standards,” says Perlin, the president and CEO of the Joint Commission.

Image: The Joint Commission

The Joint Commission has launched a new certification program on sustainability. Dr. Jonathan Perlin, the president and CEO, says he hopes the program helps hospitals reduce their carbon footprint and help their bottom line.

Still, the commission, which accredits thousands of healthcare organizations on a variety of health and safety issues, has just launched a voluntary certification program on sustainability. Perlin says he has heard from clinicians who pushed for a program to help hospitals do better on environmental issues.

Hospitals and health systems have only been able to apply for the program since Jan. 1, but Perlin says the early response from health systems and leaders has been encouraging.

“We've had inquiries literally every day, including one framed as a New Year's resolution,” he says.

In an interview with Chief Healthcare Executive, Perlin talks about his hopes for the program, and why he feels so strongly that hospitals and health systems must take sustainability seriously.

“It really is in the context of the first adage of health care: do no harm,” Perlin says. “And as a completely inadvertent consequence of trying to do the best for individuals and society, health care, it turns out, is harming the environment.”

Moving the needle

Most clinicians say they want their hospitals and health systems to be actively engaged in efforts to reduce climate change, according to a survey released by the Commonwealth Fund last month.

President Biden’s administration has made reducing emissions a key priority, and federal officials have pushed for health systems to reduce waste and emissions. Federal officials say the U.S. healthcare industry produces 8.5% of America’s carbon emissions.

Undoubtedly, hospitals and health systems must improve their sustainability efforts. Each day, a hospital produces a ton of waste per every 100 beds, Perlin says.

“Hospitals, our surgical procedures, etc., are very energy-intense,” he says. “We use some materials that are pretty toxic to the environment and we tend to generate a lot of waste.”

The Joint Commission’s certification program is designed to help hospitals in a number of ways. It’s intended to offer a roadmap for hospitals and health systems that have new or modest sustainability initiatives, Perlin says.

The program also has value for hospitals with more robust environmental programs, because it offers a mechanism to show their communities - and their staff - that they are serious about sustainability.

“I think we can help to move the needle in terms of reducing the impact of health care on the environment, but it helps organizations set priorities and frame the sustainability program,” Perlin says. “It helps organizations that have made that commitment, enunciate that commitment in a way that gets the attention of workers.”

“Our framework helps them set priorities for leadership and governance, create basic operations, approach some baseline measures and document findings and develop some skills,” he adds.

In addition to mounting federal pressure, hospitals and health systems should recognize other business factors at play. Healthcare leaders say health system boards are asking more questions about sustainability efforts.

“Invariably, there will be Securities & Exchange Commission regulation,” Perlin says. While that would have an immediate impact on for-profit systems, he says that would likely spur a trickle-down effect on nonprofit health systems.

“The astute leaders recognize that there's a governance responsibility that's going to be sort of enforced in the not-too-distant future,” Perlin says.

Changing conversation

More healthcare leaders are recognizing they need to take action on sustainability. Dozens of larger hospitals and health systems have pledged to meet the Biden administration’s goals on curbing emissions. Health systems are moving with greater urgency, in the wake of events such as the Canadian wildfires that blanketed much of the nation in smoke and the heavy flooding in Vermont last year.

“The connection between resilience and sustainability is overwhelming whatever reluctance or skepticism might have existed,” he says. “I see a totally different change in tenor over the past year.”

More leaders are taking action and talking more seriously about reducing harm to the environment, Perlin says.

Health leaders are also looking at climate change through the lens of health equity, and the greater impact of climate change on those with lower incomes and in distressed communities.

“It connects directly to the issue of health and tropical diseases like dengue and chikungunya, which were footnotes when I trained, are endemic in all of the United States,” Perlin says.

“In terms of health equity, the people who are most vulnerable for bad health outcomes are least able to compensate for extreme heat or flooding risk, depending on where they live, or changes in their culture, fisheries, etc.”

Some are also looking at sustainability measures from a bottom-line perspective. Health systems can find ways to save money by reducing the amount of waste they produce.

“It's also very practical,” Perlin says. “None of us could escape the smell of smoke in half the country last year with wildfires, so there's a visceral understanding. But it ties to the two major pain points of contemporary healthcare organizations after the height of COVID: workforce and finance.”

If hospitals and health systems are looking to do more on sustainability, they are likely to find allies in young people who are gravely concerned about climate change. Younger clinicians are among those who pushed the commission for a sustainability program, Perlin notes.

As a bonus, health systems can also show younger workers they care about one of their main concerns, and simultaneously improve their chances of retaining those workers in the long run.

“If you think about the sort of disenfranchisement that's been palpable throughout health care that's been associated with the attrition, you get to a root cause. It's really a feeling of not being able to make a difference,” Perlin says. “And so if young people have identified an issue that they want to address, inviting them in to be part of the solution engages them in a durable way, which ties directly to reduction of turnover.

“So it is a secret weapon and force multiplier in addressing sustainability.”

Rare opportunity

Hospitals and health systems also have another incentive to ramp up their efforts on sustainability, Perlin says. The federal government, through the Inflation Reduction Act, offers billions of dollars in funds and tax credits on projects such as improving energy efficiency in existing facilities and designing new construction projects, the National Academy of Medicine says.

Perlin says the Inflation Reduction Act offers “unprecedented, really once-in-a-lifetime opportunities to recapitalize aging infrastructure, with more energy efficient infrastructure on a timetable where the return on investment is literally under two years.”

With federal funds and tax credits available, hospitals need to take advantage, Perlin says. And he says the opportunities aren’t solely for large systems with big budgets.

“Even if I had a difficult operating budget, this is a capital expense that can be returned, and then plowed into operations shortly after the investments are made,” he says. “So it's really an extraordinary opportunity.”

Perlin says he’s heartened by the way that healthcare leaders are looking at climate change and their own need to take action.

“It's moved from being a moral issue that people want to address to a practical issue that they have to address,” Perlin says.

To learn more

Check out the Joint Commission’s Sustainable Healthcare Resource Center for tools and advice on reducing emissions and waste and doing better for the environment.

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