Q&A: Jonathan B. Perlin, MD, PhD, MSHA, MACP, FACMI, President & CEO of The Joint Commission Enterprise

RamaOnHealthcare October 29, 2023

Sustainable Healthcare Certification – The Joint Commission

Today, RamaOnHealthcare welcomes and talks with Dr. Jonathan B. Perlin, President and CEO of The Joint Commission Enterprise. Previously, as President, Clinical Operations and CMO of HCA Healthcare, Dr. Perlin led clinicians, data scientists, and researchers in developing a new health system model for improving care across 189 hospitals and achieved national recognition. Previously, Dr. Perlin was Undersecretary for health in the United States Department of Veteran Affairs. He has co-chaired initiatives on digital health, combating opioids, and climate change.

Dr. Jonathan B. Perlin, President & CEO of The Joint Commission Enterprise

RamaOnHealthcare (ROH): We recently reported on The Joint Commission’s announcement of its new voluntary Sustainable Healthcare Certification (SHC) program for U.S. hospitals, effective Jan. 1, 2024. Can you please tell us what made you offer this certification?

Dr. Jonathan Perlin (JP): The Joint Commission acted upon requests from healthcare organizations to accelerate their sustainable practices and reduce greenhouse gas (GHG) emissions. The voluntary Sustainable Healthcare Certification (SHC) is available to both Joint Commission-accredited and non-accredited U.S. hospitals and critical care hospitals.

ROH: What is The Joint Commission’s goal for this certification?

JP: We are providing a national framework to support hospitals in their healthcare sustainability initiatives to “Go Greener!” The Joint Commission’s SHC provides structure, rigor, and accountability for decarbonization efforts to guide those efforts. It confers recognition on those organizations that meet the requirements while enabling benchmarking both by individual organizations and collectively.

ROH: How does the certification process work, from application to evaluation and final certification?

JP: Any interested hospital or critical access hospital may submit a pre-application form via The Joint Commission website. Beginning Jan. 1, 2024, applications may be submitted. The timeline to achieve certification varies by individual healthcare organization and depends on its readiness. Once The Joint Commission receives an application, the hospital then undergoes a virtual certification review (not on-site).

Additionally, The Joint Commission created the Sustainable Healthcare Certification Resource Center to help healthcare leaders and staff educate themselves on decarbonization and prepare to achieve certification.

ROH: What are the key criteria and standards that hospitals need to meet to obtain the Joint Commission’s SHC?

JP: We wanted to set a bar that is not insurmountable and for it to be as inclusive as possible. The criteria may be relatively easy for some healthcare organizations that are well into their sustainable journey, but it is a great starting place for hospitals that are beginning their journey.

Our new SHC provides a framework for hospitals to:

• Set priorities by leadership and governance.
• Create baselines to measure and document findings.
• Develop skills to reduce waste and (GHG) emissions.

The certification program offers standards to measure and reduce GHGs and engages organizational leadership in developing action plans with goals to reduce at least three key sources of GHG emissions or waste.

Criteria for hospitals or critical access hospitals (Joint Commission accredited or non-Joint Commission accredited) to apply for certification include:

• Must be in the United States, operated by the U.S. government, or operated under a charter of the U.S. Congress.
• Compliant with applicable federal laws, including applicable Medicare Conditions of Participation.
• At time of review, needs baseline emissions data for three GHG emission sources and an action plan to reduce.
• At the time of recertification, needs 24 months of data and demonstrate a reduction of three GHG emission sources.

ROH: How did The Joint Commission arrive at the standards that form the basis of this certification?

JP: The Joint Commission convened a technical advisory panel, made up of volunteer experts from healthcare organizations, to recommend and help set the scope and requirements.

We then held a public comment period. Through the process, we determined the national standards and elements of performance and decided on a voluntary certification.

ROH: What are the potential benefits for hospitals that achieve the Joint Commission’s SHC?

JP: Hospitals and health systems that prioritize decarbonization not only improve their environmental standing but drive lasting, meaningful benefits, including:

• Cost savings
• Operating efficiencies
• Competitive advantage in recruiting and retaining staff
• Resilient facilities
• Healthier communities and staff
• Healthcare equity and patient safety

To help better understand, listen to success stories from leading healthcare leaders on how sustainability has positively impacted their organization in a video vignette series on The Joint Commission website.

ROH: How does the Joint Commission define sustainability within the context of healthcare for this certification program?

JP: Climate change is not only an environmental issue, but it is a health issue. It also is a health equity issue.

Not everyone is equally at risk from the effects of climate change.

In fact, the individuals least able to compensate for the effects of climate change are those already burdened with adverse social determinants of health. This is why climate change is an environmental issue but also a health, healthcare equity, and social justice issue.

ROH: Are there any financial incentives or advantages associated with obtaining this certification, such as cost savings or increased patient trust?

JP: Investing in sustainability will ultimately boost patient safety and help hospitals’ bottom lines. For instance, hospitals can enhance patient outcomes by reducing chemical exposure and enhancing indoor air quality. Additionally, healthcare organizations can use existing tax incentives to finance renewable energy projects, leading to long-term cost reductions.

Cost savings may be realized by utilizing energy-efficient technologies and implementing waste management strategies.

Hospitals may take advantage of climate provisions in recently enacted federal law, which allows for new or expanded tax credits for energy-efficient facilities and incentives for equipment that can be used for renewable energy. For example:

• Tax-exempt hospitals are eligible for direct payments equal to the full value of tax credits.
• For-profit hospitals may monetize tax credits without tax equity financing by selling these credits for cash.

ROH: Can you provide examples of specific sustainability initiatives or practices that hospitals might need to implement to meet the certification requirements?

JP: For each domain of the certification, actionable strategies and tips that healthcare organizations can begin doing now and some that require more long-term commitment are available in the SHC Resource Center. For example:

Domain 1: Leadership and Oversight

Getting Started:

• Identify champions and/or key stakeholders.
• Appoint a leader responsible for activities to reduce GHG emissions.
• Start small and build momentum.
• Set a clear vision with defined targets/goals.

Long-Term Strategies:

• Allocate resources (financial and human) for long-term strategy.
• Develop policies that support decarbonization actions and interventions.
• Foster a culture of sustainability, walk the talk, and lead by example.
• Collaborate and partner with external stakeholders.

Domain 2: Assessment, Measurement & Improvement

Strategies and Practices:

• Conduct GHG inventory/audit.
• Perform building walkthrough analysis to identify low- or no-cost energy savings opportunities and estimate their potential.
• Conduct inventory on current supplies and waste assessment.
• Incorporate data collection and tools for implementing measurement activities.

Domain 3: GHG Reduction Strategies

• Transportation: Sustainable transportation solutions can drive efficiency while simultaneously reducing overhead costs and GHG emissions.
• Buildings & Energy Use: Energy-efficient systems can significantly curb the environmental impact of facilities, lowering carbon emissions and resource consumption.
• Anesthetic Gases: Effective maintenance of anesthetic supplies and equipment can reduce wasteful usage, lowering GHG emissions and costs.
• Waste: Understanding, identifying, and reducing waste streams is crucial for improving an organization’s environmental footprint and maintaining public health and safety.

ROH: Do you think you can make significant environmental progress with a program that is voluntary?

JP: Absolutely. As hospitals and systems are pursuing sustainability efforts, our voluntary SHC includes a framework for setting priorities by leadership and governance, including the board; creating baselines to measure and document findings; and developing skills to reduce waste and GHG emissions. We have also built a robust resources center to support these efforts.

ROH: The Centers for Medicare & Medicaid Services (CMS) has decided not to act on sustainability at this time. Why is The Joint Commission doing so?

JP: Climate change and air pollution is a health, health equity, and ultimate patient safety issue.

In terms of health, extreme heat exacerbates respiratory and cardiovascular disease, and climate change has made tropical diseases like chikungunya and dengue endemic at higher latitudes, like the United States. Even malaria is appearing in the southern U.S.

The people who are least able to compensate are those who are already socially vulnerable, may live in urban heat islands or areas at risk for flooding, and are unable to buy their way out of harm’s way.

Recognizing that four out of five primary care clinics have been closed at least once in the past three years because of extreme weather attributable to climate change – often in time of community crisis – building resilience is a patient safety issue.

ROH: Thank you for discussing The Joint Commission’s SHC program with RamaOnHealthcare.

JP: Thank you so much for the pleasure of speaking with you today. If you have any further questions, please reference The Joint Commission webpage dedicated to our Sustainability Healthcare Certification.

More Info about Dr. Perlin

Dr. Perlin enjoys photography and playing guitar when he gets a free moment.