Q&A with Elizabeth Mort, MD, MPH, Vice President, Chief Medical Officer for The Joint Commission

RamaOnHealthcare January 28, 2025

Healthcare leaders need to be prepared for handling environmental disasters.

Today, RamaOnHealthcare talks to Elizabeth Mort, MD, MPH, Vice President, Chief Medical Officer for The Joint Commission.

Elizabeth Mort, MD, MPH, Vice President, Chief Medical Officer for The Joint Commission

RamaOnHealthcare (ROH): Why did The Joint Commission issue a Sentinel Event Alert on environmental disaster preparation?

Elizabeth Mort (LM): The Joint Commission issued the Sentinel Event Alert in response to an increase in devastating climate events and alarming data that indicates such events will continue to occur more frequently and elevate more rapidly. Healthcare leaders need to be prepared for handling environmental disasters, and The Joint Commission strongly believes that sharing best practices and lessons learned supports planning processes. I am delighted to share key messages from the alert, with the goal to provide background on the issue and a framework to assist healthcare leaders successfully manage climate events. To best prepare, healthcare organizations should consider the following:

• Implement proactive risk management strategies.
• Identify steps to prepare for weather and climate-related disasters such as hurricanes, tornadoes, wildfires, floods and extreme heat.
• Establish a plan to rapidly evacuate or shelter in place everyone onsite (i.e., patients, healthcare workers and others).
• Prepare to respond with knowledge and a plan. Reaction time is typically limited, so it is important to construct a detailed plan with written procedures for when and how to shelter in place or evacuate (partially or completely).

ROH: Are environmental disasters on the rise? If so, why?

LM: Yes, environmental and natural disasters and their severity are on the rise. We see this though:

• Increased frequency and intensity:
  • More frequent and severe heatwaves and droughts dry out vegetation, making wildfires more likely and more intense.
  • Warmer ocean temperatures fuel more powerful storms and hurricanes.
• Changing weather and climate patterns:
  • Higher temperatures increase evaporation rates, leading to more intense and frequent rainfall events. This can cause more severe flooding, especially in areas that are not typically prone to such events like we saw this past year in central North Carolina after Hurricane Helene.
  • We are seeing impacts across the country from heat waves and wildfires in the Northeast, to sea levels rising and flooding in the Northwest, to increased hurricanes in the Southeast, as well as extreme heat, drought, and increased severe storms in the Midwest, and extreme temperatures and drought in the Southwest.
• Economic and Social Impact:
  • The economic costs of natural disasters are rising too. For example, in 2023, the U.S. experienced 28 separate billion-dollar weather and climate disasters, the highest number on record.
  • These disasters not only cause significant financial losses but also lead to displacement, loss of life, and long-term social and environmental impacts.
• Long-Term Trends:
  • Over the past few decades, the number of climate-related disasters has increased significantly. This trend may continue as weather patterns are seemingly becoming more erratic.

ROH: What emergency preparations does The Joint Commission currently require of its accredited healthcare organizations? What recommendations does it offer?

LM: The Joint Commission’s Emergency Management (EM) standards require healthcare organizations to establish a comprehensive EM program that provides a systematic analysis for planning and decision making. Our EM program structure is designed to help healthcare organizations respond to any type of emergency through an all-hazards approach. Environmental disaster preparation is one important category within an EM program.

The following preventative actions are required by The Joint Commission’s EM standards:

• Oversight and support of organizational leadership in keeping the EM program up to date, as they make certain that necessary policies and procedures are developed; enough resources are available before, during, and after an emergency/disaster incident; and the priorities of the EM program are fulfilled.
• A hazards vulnerability analysis (HVA), which enables organizations to continually evaluate their known risks and prioritize them to clearly understand their vulnerabilities and how best to prepare for, recognize, respond to, and recover from emergencies.
• An emergency operations plan (EOP) that is created after a healthcare organization evaluates and prioritizes potential risks and hazards. The EOP coordinates communications, resources and assets, safety and security, staff responsibilities, utilities, and clinical and support activities during an emergency.
• A continuity of operations plan (COOP) that will enable a health care organization (HCO) to maintain business, communications, information technology and physical infrastructure during and after a disaster.

In addition to the Joint Commission EM standards, the SEA offers additional recommendations for healthcare organizations to consider:

• Revisit and update emergency plans. Updating organizational emergency plans is important to determine additional kinds of disasters that a facility may be susceptible to including increased frequency and intensity of extreme weather events like hurricanes, floods, heatwaves, severe storms, and wildfires. HCOs should subsequently update EM programs and Emergency Operations Plans (EOPs) since updates to emergency plans may affect those.
• Establish and build collaborative relationships. Specifically with local, state and federal authorities, ambulance and other transportation providers, other local HCOs and home care facilities. These collaborative relationships are extremely valuable and ideally should be established and renewed in advance of an emergency. Pre-determining arrangements with other organizations can improve the timeliness of routing and triaging to other facilities if needed.
• Develop a resilient communications infrastructure. It is key for HCOs to develop not only primary communications determining how they would alert staff and other local HCOs of natural disasters but also alternative or back up communications plans for both incoming and outgoing communication if original plans become inoperable. This includes communication via not only landline and cell phones. But Voice over internet Protocol (VolP)phones, satellite phones, cloud-based messaging apps, cable and satellite television, walkie talkies, and ham radio.
• Plan how to meet essential needs and provide care to staff and patients. The Joint Commission requires HCOs to plan for up to 96-hours of sustainability of their resources. In some disaster situations, sustainability may need to be extended for a longer time. Whether sheltering-in-place or evacuating, it is important to develop a plan to meet essential needs and provide care (e.g., food, potable and non-potable water, linen, medications, infusion fluids, and other supplies) for everyone present. The plan should detail how to obtain, allocate, mobilize, replenish, and conserve resources, assets, and supplies when these become critical and challenging to obtain, especially during widespread, catastrophic events.
• Plan and practice how to evacuate and shelter in place. In addition to creating written procedures for when and how HCOs should shelter in place or evacuate, facilities should organize education and training to meet the risks identified in their HVAs. This includes staff, volunteers and others providing services in trainings so that everyone understands their individual roles, responsibilities, and actions. Such training can help decision-makers rehearse evaluating the balance between the risks of evacuating patients and staff versus sheltering in place and, additionally, better appreciate the timeline for decision-making in critical situations.

ROH: How has this Sentinel Event Alert on environmental disasters been received so far?

LM: We have witnessed an overwhelmingly positive reception to our alert by Joint Commission-accredited healthcare organizations. Since issuing the alert on November 13, 2024, we have seen an increase in the number of HCOs that have opened the alert compared to other communications. The access rate is currently 85.2% which indicates emergency preparation is high priority to them.

Recognizing that four out of five primary care clinics have been closed at least once in the past three years due to extreme weather events – often in time of community crisis – helps us understand that building resilience is clearly a patient safety issue and one that healthcare organizations take seriously.

ROH: How can healthcare organizations get on board with improving climate change to get to the root of what causes environmental disasters? Tell us about The Joint Commission’s Sustainable Healthcare Certification since we covered its launch last year.

LM: The Joint Commission often hears from healthcare organizations that seek help focusing on the root causes of the climate crisis by establishing a framework to accelerate their sustainable practices and reduce their greenhouse gas (GHG) emissions. In response, As RamaOnHealthcare reported last year, The Joint Commission launched its voluntary Sustainable Healthcare Certification (SHC) program that provides a framework to help organizations begin, continue or expand their decarbonization efforts and to receive public recognition for their commitment and achievements in contributing to environmental sustainability.

The goal is to enable organizations to implement practices that effectively adapt to the impacts of climate events, ensuring continuity of care and supporting recovery efforts within affected communities. The certification’s requirements establish needed structure, rigor and accountability to accelerate the industry’s growing sustainability efforts. The program includes setting priorities and governance for sustainability initiatives, creating baselines to measure three sources of GHG emissions, and developing an action plan to reduce them.

The Joint Commission also launched an online Sustainable Healthcare Resource Center. The Resource Center provides key strategies, tools, literature, videos and links to help organizations get started on sustainability, as well as innovative solutions for those that have already gotten started. It can assist hospitals as they prepare for SHC and serve as a forum to share and learn from others.

Additionally, Joint Commission International (JCI), in collaboration with the International Hospital Federation’s Geneva Sustainability Centre (GSC), announced a new international Healthcare Sustainability Certification (HSC). The HSC program, which became effective January 1, 2025, is available to healthcare organizations outside the United States and its territories that are accelerating their sustainable practices and seeking formal recognition. For the first time, this certification is available to any institution whether JCI accredited or not. The certification provides a framework to help healthcare leaders continue to advance their sustainability priorities and strengthen governance structures to gain successful results.

ROH: How many healthcare organizations have achieved The Joint Commission’s Sustainable Healthcare Certification?

LM: Currently, 120 healthcare organizations have achieved SHC, and 28 additional healthcare organizations are seeking to achieve it. Achieving Sustainable Healthcare Certification demonstrates a commitment toward responsible and ethical practices. It also positions organizations as mindful, responsible care providers in an increasingly environmentally conscious world. Hospitals and systems that prioritize decarbonization not only improve their environmental standing but drive lasting, meaningful organizational benefits including cost savings, operating efficiencies, staff retention and more.

Healthcare is one of the largest sectors in the United States and one dedicated to improving people’s health and well-being. The Joint Commission wants to work with the momentum of healthcare organizations leading the way in sustainability excellence and inspire and guide others that want to prioritize greener practices. These efforts align with The Joint Commission’s mission to enable and assure the highest standards of healthcare quality and patient safety for all.

In summary, preparing to successfully handle environmental disasters is considered priority work by healthcare leaders today. At The Joint Commission we are committed to providing programs, guidance, and sentinel event alerts to support healthcare organization leaders in their environmental disaster preparation journeys.

About Dr. Elizabeth Mort

Elizabeth Mort, MD, MPH is Vice President and Chief Medical Officer for The Joint Commission. She oversees a physician leadership council dedicated to healthcare safety issues and the identification of significant emerging trends, serves as a primary voice of patient safety and the key liaison between The Joint Commission and the healthcare safety community. She helps design services to further enhance quality and patient safety and works closely with Joint Commission’s survey organizations on accreditation processes. She received her Medical Degree from Harvard Medical School. She is an Associate Professor of both Medicine and Health Care Policy at Harvard Medical School, and publishes and speaks on quality, safety, and management topics.