ASF Standards · Hospital · Standard 18
Standard 18 — Sustainable Care
Criteria in this standard
18.1 — Environmental Impact Is Actually Reviewed at Strategic Level
18.2 — Staff and Patients Are Genuinely Informed of Sustainability Goals
18.3 — Sustainability Progress Is Actually Reported to Governance
18.4 — Procurement Genuinely Considers Responsible Stewardship of Resources
18.5 — Energy Use Is Monitored, With a Genuine Move Toward Renewable Sources
18.6 — A Genuine Carbon Footprint Baseline Exists
18.7 — The Hospital Genuinely Plans for Environmental and Climate Resilience
18.2 — Staff and Patients Are Genuinely Informed of Sustainability Goals
18.3 — Sustainability Progress Is Actually Reported to Governance
18.4 — Procurement Genuinely Considers Responsible Stewardship of Resources
18.5 — Energy Use Is Monitored, With a Genuine Move Toward Renewable Sources
18.6 — A Genuine Carbon Footprint Baseline Exists
18.7 — The Hospital Genuinely Plans for Environmental and Climate Resilience
18.1
Environmental Impact Is Actually Reviewed at Strategic Level
Standard
Hospital leadership undertakes a genuine, strategic-level review of the facility’s environmental impact and the sustainability of how it delivers care — not an assumption that environmental questions are someone else’s concern or a problem for another department.
In plain terms: Someone at the top of the hospital has actually sat down and worked out what the hospital’s real environmental footprint is and where it comes from — not left this as a topic nobody in leadership has ever formally addressed.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Adapted | Full | Full | Full |
Why this matters
A hospital that has never formally reviewed its environmental impact isn’t neutral on the question — it has simply never asked it. Hospitals are resource-intensive by nature: constant power draw, high water use, large volumes of single-use consumables, significant waste streams, substantial transport and supply chains. None of that is inherently wrong, but none of it gets smaller on its own either. Without a genuine strategic review, the hospital has no real starting point from which to improve, and every later sustainability effort — procurement, energy, carbon measurement — ends up disconnected from any actual understanding of where the hospital’s impact is concentrated.
What good looks like
- Leadership has conducted a genuine, documented review of environmental impact.
- The review identifies specific negative impacts from the hospital’s own activities.
- The review identifies realistic, actionable ways to mitigate those impacts.
Common failure modes
- No review has ever been conducted; environmental impact is simply not discussed at leadership level.
- A review exists but is generic, with no specific findings about this hospital’s own activities.
- Findings exist but identify no realistic actions, leaving the review purely academic.
Worked example
In practice
A 180-bed hospital where sustainability had never been a board-level topic.
BeforeEnvironmental impact had never appeared on a board or senior management agenda. Energy, water and waste were managed operationally by facilities staff with no strategic oversight, and nobody could say with any confidence where the hospital’s largest environmental impacts actually came from.
ActionThe CEO commissioned a strategic review, led by the facilities director with input from clinical, procurement, and finance leads, covering energy use, water, waste streams, and supply chain. The review identified sterile processing energy use, single-use surgical drape volume, and food waste as the three largest concentrations of impact.
AfterThe Monitor reviewed the completed strategic review document and interviewed the facilities director, who could describe the three priority areas and the reasoning behind them in specific, concrete terms. Verified.
If you are starting from zero — do this first
- Put environmental impact on a leadership agenda as a standing item, even briefly, to signal it is now a real topic.
- Assign a named lead — facilities, quality, or sustainability — to coordinate an initial review.
- Identify the two or three largest, most obvious sources of environmental impact as a starting point, not an exhaustive inventory.
The most common mistake: Treating environmental impact as a facilities-department operational matter rather than a genuine strategic question leadership has actually engaged with.
Self-assessment questions
1. Has leadership conducted a genuine, documented review of the hospital’s environmental impact, not left the question entirely unaddressed? — A real strategic review, not an assumption that this falls outside the hospital’s own responsibility.
Evidence: Strategic environmental review document
Evidence: Strategic environmental review document
2. Does the review identify specific negative environmental impacts arising from the hospital’s own activities? — Genuine, specific findings, not a generic statement of good intent with no actual content.
Evidence: Review findings, specific to this facility
Evidence: Review findings, specific to this facility
3. Does the review identify realistic ways the hospital could mitigate those impacts, even partially? — A real, actionable finding, not analysis that stops short of identifying what could actually change.
Evidence: Documented mitigation recommendations
Evidence: Documented mitigation recommendations
Common reasons for a PARTIAL answer
- A review was conducted but findings are generic, not specific to this hospital’s actual operations. — A template review copied from elsewhere doesn’t reflect this facility’s real impact profile.
- Findings are specific but no realistic mitigation actions were identified. — Diagnosis without any proposed response leaves the review without practical value.
- The review happened once, years ago, with no plan to revisit it.
Implementation plan
| When | What |
|---|---|
| Week 1 | Place environmental impact on a leadership agenda and name a review lead. |
| Week 2-4 | Conduct an initial review covering energy, water, waste, and supply chain. |
| Week 5 | Identify and document the hospital’s top three concentrations of impact. |
| Ongoing | Revisit the review on a defined schedule as operations and facilities change. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Strategic review document | Reviews the actual environmental impact review for specific, hospital-relevant findings. |
| ASK | Leadership interview | Asks the review lead to describe the hospital’s top environmental impact areas and why. |
Supervisor tips
- Ask leadership directly what the hospital’s biggest environmental impact actually is. — A confident, specific answer reveals genuine engagement, not just a document on file.
- Check whether the review’s findings are specific to this hospital, not generic boilerplate. — Specificity is the clearest sign a real review actually occurred.
Evidence base
World Health Organization. Environmentally Sustainable Health Systems: A Strategic Document. Geneva: WHO; 2017.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
18.2
Staff and Patients Are Genuinely Informed of Sustainability Goals
Standard
The hospital’s approach to environmentally sustainable care, and its goals in this area, are genuinely communicated to staff and patients — not confined to an internal policy document nobody outside senior management ever actually sees.
In plain terms: Staff and patients actually know the hospital has sustainability goals and roughly what they are — not because it’s technically written down somewhere, but because someone actually told them.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Adapted | Full | Full | Full |
Why this matters
A sustainability strategy that lives only in a policy folder achieves very little. Staff are the people who actually decide, dozens of times a shift, whether to switch off equipment, use a reusable item instead of a disposable one, or report a wasteful practice — and they can only make those choices in line with hospital goals if they actually know what those goals are. Patients, too, increasingly care whether the facility treating them takes this seriously, and a hospital with genuine goals but no visible communication of them gets none of the credibility or staff engagement a real sustainability effort should earn.
What good looks like
- Sustainability approach and goals are genuinely communicated to staff, not confined to policy.
- The same information is genuinely available to interested patients.
- Staff asked directly can describe at least one specific sustainability goal.
Common failure modes
- A sustainability policy exists but has never been actively communicated to staff.
- Information is available internally but never shared with patients in any form.
- Staff asked directly have no idea the hospital has any sustainability goals at all.
Worked example
In practice
A hospital whose sustainability policy existed only as a PDF on the intranet.
BeforeA sustainability policy had been approved and filed on the intranet two years earlier. No staff briefing had ever been held. Interviewed staff, asked directly, had no idea such a policy existed or that the hospital had any specific environmental goals.
ActionA one-page summary of the three priority goals was created, presented at department meetings, posted in staff break rooms, and added to new-staff orientation. A short, plain-language version was added to the patient information booklet and hospital website.
AfterThe Monitor asked five staff members at random about sustainability goals; four could name at least one specific goal accurately. Verified.
If you are starting from zero — do this first
- Reduce the sustainability approach to a short, one-page, plain-language summary.
- Present it at a real staff meeting, not only post it somewhere.
- Add a short patient-facing version to existing patient information materials.
The most common mistake: Treating policy approval as equivalent to communication, when staff have never actually been told the policy exists.
Self-assessment questions
1. Is the hospital’s sustainability approach and its goals genuinely communicated to staff, not confined to a policy document? — Real, visible communication, not information technically available but never actually shared.
Evidence: Staff briefing materials, meeting agendas
Evidence: Staff briefing materials, meeting agendas
2. Is the same information genuinely available to patients who want it, not withheld as an internal-only matter? — Genuine patient-facing transparency, not sustainability treated as purely an internal concern.
Evidence: Patient-facing information materials
Evidence: Patient-facing information materials
3. Can staff asked directly describe at least one specific sustainability goal the hospital is working toward? — Tests whether communication actually reached staff, not just whether it was technically issued.
Evidence: Staff interview
Evidence: Staff interview
Common reasons for a PARTIAL answer
- Staff communication happened once, at policy launch, with no reinforcement since. — A single mention long ago is easily forgotten by the time it matters.
- Information reaches clinical staff but not support or contracted staff. — Genuine communication should reach everyone whose daily choices affect sustainability.
- Patient-facing information exists but is hard to find or rarely noticed.
Implementation plan
| When | What |
|---|---|
| Week 1 | Create a short, plain-language summary of sustainability goals. |
| Week 2 | Present it at real department meetings across clinical and support staff. |
| Week 3 | Add a patient-facing version to existing information materials. |
| Ongoing | Reinforce periodically, including in new-staff orientation. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| ASK | Staff interview | Asks staff at random whether they can describe a specific sustainability goal. |
| DOCUMENT | Patient materials review | Reviews patient-facing materials for genuine inclusion of sustainability information. |
Supervisor tips
- Ask a support-services or contracted staff member, not only clinical staff, about sustainability goals. — Genuine communication reaches everyone, not only the department that wrote the policy.
- Ask a patient in the waiting area if they’ve seen anything about the hospital’s sustainability efforts. — A real, visible presence is the clearest test of genuine patient-facing communication.
Evidence base
NHS England. Delivering a Net Zero National Health Service. London: NHS England; 2022.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
18.3
Sustainability Progress Is Actually Reported to Governance
Standard
Progress against the hospital’s environmental sustainability goals is genuinely reported to governance on a defined schedule — not tracked informally by whoever happens to care about it, with no real visibility at the level that sets institutional priorities.
In plain terms: The board or governing body actually sees real data on sustainability progress on a regular schedule — not a topic that exists only at the enthusiasm of one individual with no real institutional visibility.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Adapted | Full | Full | Full |
Why this matters
Sustainability initiatives that depend entirely on one enthusiastic individual tend to disappear the moment that person moves on, exactly like any other initiative without real institutional backing. Reporting progress to governance is what converts a personal project into an organisational commitment — it means resourcing decisions, capital investments, and strategic priorities can actually take sustainability progress into account, and it means the effort survives staff turnover because it is now a standing item the institution itself tracks, not a passion project tied to one person’s tenure.
What good looks like
- Progress is genuinely reported to governance on a real, defined schedule.
- Governance actually reviews this progress, not just receives it passively.
- A documented instance exists of a governance decision informed by this data.
Common failure modes
- Sustainability tracking exists informally with no real reporting line to governance.
- Reports are submitted but never discussed or genuinely reviewed.
- No decision has ever visibly been influenced by sustainability progress data.
Worked example
In practice
A hospital where sustainability tracking was an informal side project of the facilities manager.
BeforeThe facilities manager tracked energy and waste data in a personal spreadsheet, shared informally with colleagues but never presented to the board. When she went on extended leave, tracking stopped entirely for four months.
ActionSustainability progress was added as a standing quarterly board agenda item, with a one-page dashboard prepared each quarter covering energy, waste, and procurement metrics against the hospital’s stated goals.
AfterThe Monitor reviewed board minutes showing four consecutive quarters of genuine sustainability review, including one instance where a capital budget request for LED lighting was approved with explicit reference to the sustainability dashboard. Verified.
If you are starting from zero — do this first
- Add sustainability progress as a standing governance agenda item, even quarterly.
- Build a simple one-page dashboard covering the goals identified in the strategic review.
- Ensure whoever currently tracks the data isn’t the only person who could present it.
The most common mistake: Letting sustainability tracking remain the informal, personal effort of one enthusiastic staff member, with no real institutional reporting line.
Self-assessment questions
1. Is progress against sustainability goals genuinely reported to governance on a real, defined schedule? — A real reporting cadence, not tracking that exists informally with no genuine visibility upward.
Evidence: Governance meeting agendas, sustainability reports
Evidence: Governance meeting agendas, sustainability reports
2. Does governance actually review this progress, not simply receive it as an unexamined item? — Genuine review, not a report circulated and filed without real engagement.
Evidence: Governance meeting minutes
Evidence: Governance meeting minutes
3. Is there a documented instance of a governance-level decision informed by sustainability progress data? — A real, concrete example, not a theoretical reporting line with no actual influence on decisions.
Evidence: Specific decision record referencing sustainability data
Evidence: Specific decision record referencing sustainability data
Common reasons for a PARTIAL answer
- Reports reach governance but minutes show no real discussion occurred. — Passive receipt isn’t the same as the genuine review the criterion requires.
- Reporting happened for a time but lapsed when the responsible person changed. — Genuine institutional reporting should survive individual staff turnover.
- No concrete example exists of a decision actually shaped by the data.
Implementation plan
| When | What |
|---|---|
| Week 1 | Add sustainability progress as a standing governance agenda item. |
| Week 2-3 | Build a simple, repeatable progress dashboard tied to stated goals. |
| Ongoing | Present and genuinely discuss progress at each scheduled interval. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Governance minutes review | Reviews minutes for genuine, recurring sustainability progress discussion. |
| DOCUMENT | Decision record review | Looks for a specific decision genuinely informed by sustainability data. |
Supervisor tips
- Ask a governing body member to describe the hospital’s current sustainability progress. — A confident, specific answer reveals genuine engagement, not a report skimmed and filed.
- Check whether reporting continued through any recent staff transition. — Genuine institutional reporting survives individual turnover; informal tracking doesn’t.
Evidence base
Institute for Healthcare Improvement. Leading Quality Improvement: Essential Skills for Healthcare Managers. Boston: IHI; 2016.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
18.4
Procurement Genuinely Considers Responsible Stewardship of Resources
Core
The hospital’s procurement and supply decisions genuinely take environmental and social responsibility into account — reducing wasteful use of supplies, considering supplier environmental practices, and reviewing single-use equipment decisions against genuine patient and staff safety requirements — not sustainability treated as irrelevant to purchasing choices actually made.
In plain terms: When the hospital buys things, it actually thinks about waste and supplier responsibility, not just unit price — while never once compromising patient or staff safety to do so.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Adapted | Full | Full | Full |
Why this matters
Procurement is where a hospital’s environmental impact actually gets decided, purchase order by purchase order — far more than any policy statement. A hospital buying disposable items it could safely use reusable alternatives for, sourcing from suppliers with no environmental accountability, or over-ordering with no real check on waste, is making a genuine environmental choice every time, whether or not anyone thinks of it that way. This is marked Core because it is the single point in hospital operations where sustainability intentions either translate into real purchasing behaviour or remain purely theoretical — and because the safety dimension is just as critical: an environmental choice that compromises infection control or patient safety fails this criterion regardless of its environmental merit.
What good looks like
- Supplier environmental and social responsibility practices genuinely inform procurement decisions.
- Wasteful use of supplies is genuinely reviewed and reduced where safely possible.
- Patient and staff safety is explicitly, verifiably protected in any single-use equipment reconsideration.
Common failure modes
- Procurement decisions are made on price and availability alone, with no sustainability consideration.
- Waste reduction is discussed but no real purchasing pattern has actually changed.
- Single-use equipment is reconsidered without genuine, verified safety review.
Worked example
In practice
A hospital whose procurement decisions were made entirely on unit cost.
BeforeProcurement selected suppliers purely on lowest unit price, with no questions asked about environmental practices. Significant packaging waste accumulated from over-individually-wrapped items with no review of bulk alternatives.
ActionA sustainability criterion was added to the supplier evaluation checklist alongside price and quality. Packaging waste was reviewed with the infection control team, and several items were switched to bulk packaging where this didn’t compromise sterility requirements, with the infection control lead signing off on each change.
AfterThe Monitor reviewed the updated supplier evaluation checklist, confirmed infection control sign-off existed for each packaging change, and interviewed the procurement lead who could describe the specific reasoning behind recent purchasing decisions. Verified.
If you are starting from zero — do this first
- Add an environmental/social responsibility question to the supplier evaluation process.
- Identify the highest-volume sources of avoidable waste in current purchasing.
- Involve infection control explicitly before changing any single-use equipment decision.
The most common mistake: Changing a single-use equipment decision for environmental reasons without genuine, documented infection-control sign-off first.
Self-assessment questions
1. Do procurement decisions genuinely take supplier environmental and social responsibility practices into account? — A real, documented consideration, not a purchasing process blind to anything beyond unit price.
Evidence: Supplier evaluation criteria
Evidence: Supplier evaluation criteria
2. Is wasteful use of supplies — packaging, single-use items, unnecessary ordering — genuinely reviewed and reduced where safely possible? — Real reduction efforts, not an assumption that current purchasing patterns are already optimal.
Evidence: Waste reduction initiative documentation
Evidence: Waste reduction initiative documentation
3. Where single-use equipment is reconsidered, is patient and staff safety — infection control, manufacturer guidance — genuinely protected throughout? — Safety never compromised for an environmental goal, verified, not assumed.
Evidence: Infection control sign-off records
Evidence: Infection control sign-off records
Common reasons for a PARTIAL answer
- Sustainability is considered for new suppliers but existing supplier relationships are never reviewed. — A criterion applied only going forward leaves the bulk of existing procurement unexamined.
- Waste reduction ideas are discussed but no actual purchasing change has occurred. — Discussion without a real, implemented change doesn’t meet this criterion.
- A single-use item was changed without formal infection control review beforehand.
Implementation plan
| When | What |
|---|---|
| Week 1 | Add sustainability criteria to the supplier evaluation process. |
| Week 2-3 | Identify the largest sources of avoidable procurement waste. |
| Week 4 | Review candidate changes with infection control before any implementation. |
| Ongoing | Periodically reassess existing supplier relationships, not only new ones. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Supplier evaluation review | Reviews procurement criteria for genuine inclusion of sustainability factors. |
| DOCUMENT | Infection control sign-off review | Confirms safety review genuinely occurred before any single-use equipment change. |
Supervisor tips
- Ask procurement staff to describe a recent purchasing decision shaped by sustainability considerations. — A real, specific example confirms genuine practice, not a policy that exists only on paper.
- Check that infection control, not procurement alone, signed off on any single-use change. — Safety sign-off from the right discipline is non-negotiable regardless of environmental merit.
Evidence base
World Health Organization. Compendium of WHO and Other UN Guidance on Health and Environment. Geneva: WHO; 2021.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
18.5
Energy Use Is Monitored, With a Genuine Move Toward Renewable Sources
Standard
The hospital genuinely monitors its use of electricity, gas, and other fuel sources, and takes real steps toward reducing reliance on fossil fuels where this is practically possible — not energy use left entirely unmeasured and unmanaged as a fixed, unexamined operating cost.
In plain terms: The hospital actually tracks how much energy it uses and from what source, and has genuinely tried at least one real step toward using less fossil fuel — not treating the power bill as a cost nobody ever actually examines.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Adapted | Full | Full | Full |
Why this matters
Energy use is one of the most measurable, most immediately actionable parts of a hospital’s environmental impact — and one of the easiest to simply never look at closely, since the bill arrives and gets paid regardless of whether anyone understands what’s driving it. A hospital that genuinely monitors its energy use, broken down by source and area, can identify real opportunities most facilities never discover simply because nobody looked: outdated lighting, equipment left running unnecessarily, inefficient heating and cooling scheduling. None of this requires large capital investment to start — it requires someone actually paying attention.
What good looks like
- Electricity, gas, and fuel use are genuinely, ongoingly monitored.
- At least one genuine, concrete step toward reduced fossil fuel reliance has been taken.
- Renewable energy feasibility has been genuinely assessed where options exist locally.
Common failure modes
- Energy bills are paid but usage is never actually tracked or analysed.
- Energy reduction is discussed as an aspiration with no concrete action taken.
- Renewable energy is assumed impractical without any real feasibility assessment.
Worked example
In practice
A hospital that had never broken down its energy use by source or area.
BeforeMonthly utility bills were paid without review. Nobody could say what proportion of energy use came from lighting, HVAC, or medical equipment, or whether usage was trending up or down over time.
ActionThe facilities team began tracking monthly electricity and gas use against a baseline, broken down where meters allowed. Older fluorescent lighting in non-clinical corridors was replaced with LED fixtures, and a local solar feasibility assessment was commissioned for the facility’s roof space.
AfterThe Monitor reviewed six months of tracked energy data showing a real, measured reduction following the lighting change, and the solar feasibility report, even though installation hadn’t yet been decided. Verified.
If you are starting from zero — do this first
- Start logging monthly energy use from existing utility bills, even without granular metering.
- Identify one low-cost, low-risk efficiency change — lighting is often the easiest starting point.
- Ask a local renewable energy provider for a basic feasibility assessment, even if implementation isn’t imminent.
The most common mistake: Assuming renewable energy or efficiency improvements are automatically impractical without ever actually commissioning a real assessment.
Self-assessment questions
1. Is the hospital’s use of electricity, gas, and other fuel sources genuinely monitored, not left entirely untracked? — Real, ongoing monitoring, not energy treated as an unexamined fixed cost.
Evidence: Energy use tracking records
Evidence: Energy use tracking records
2. Has the hospital taken any genuine, concrete step toward reducing fossil fuel reliance where practically possible? — A real, specific action, not a stated aspiration with no actual change behind it.
Evidence: Documented energy efficiency or reduction initiative
Evidence: Documented energy efficiency or reduction initiative
3. Where renewable energy options exist locally, has the hospital genuinely assessed their feasibility? — A real assessment, not an assumption that renewable transition is automatically impractical.
Evidence: Renewable energy feasibility assessment
Evidence: Renewable energy feasibility assessment
Common reasons for a PARTIAL answer
- Energy use is monitored but no action has followed from what the data shows. — Measurement alone, with no resulting change, only partially meets the intent.
- A reduction step was taken once but monitoring hasn’t continued since. — Genuine, ongoing monitoring is what this criterion actually requires.
- Renewable feasibility was assumed negative without ever being formally assessed.
Implementation plan
| When | What |
|---|---|
| Week 1 | Begin logging monthly energy use from existing utility data. |
| Week 2-4 | Identify and implement at least one low-cost efficiency improvement. |
| Month 2 | Commission a basic renewable energy feasibility assessment. |
| Ongoing | Continue tracking usage and reviewing trends over time. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Energy tracking review | Reviews actual logged energy use data over a meaningful period. |
| DOCUMENT | Feasibility assessment review | Reviews any renewable energy feasibility assessment commissioned. |
Supervisor tips
- Ask facilities staff to show real energy use data, not just describe intentions. — Actual tracked data is the clearest evidence genuine monitoring is occurring.
- Ask whether a renewable energy assessment has ever actually been commissioned. — Distinguishes a genuine assessment from an assumption that renewables aren’t viable.
Evidence base
International Energy Agency. Healthy Energy, Healthy People: Energy Efficiency in Healthcare. Paris: IEA; 2021.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
18.6
A Genuine Carbon Footprint Baseline Exists
Standard
The hospital has carried out a genuine assessment of its carbon footprint — even based on a minimal dataset such as energy use alone — to establish a real baseline for monitoring and reducing greenhouse gas emissions, not treating carbon impact as something too complex to ever actually measure.
In plain terms: The hospital has actually calculated, even roughly, how much greenhouse gas its operations produce — a real starting number, not an assumption that this is too technical to ever attempt.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Adapted | Full | Full | Full |
Why this matters
A carbon footprint baseline doesn’t need to be sophisticated to be genuinely useful — a reasonable estimate based on energy use alone is a real, legitimate starting point, and far more valuable than no baseline at all. Without even a minimal baseline, a hospital has no way to know whether any sustainability effort it undertakes is actually reducing emissions or not — every subsequent initiative operates blind. ISQua EEA explicitly recognises that organisations will have different scope and resources for this, and a minimal, honest baseline fully meets the intent here; waiting for a perfect, comprehensive carbon accounting system before starting is itself the failure mode.
What good looks like
- A genuine carbon footprint assessment exists, even a minimal one based on energy use.
- The baseline is genuinely used to monitor change over time.
- A realistic plan exists to extend the assessment as resources allow.
Common failure modes
- No carbon footprint assessment has ever been attempted, on the assumption it’s too complex.
- A baseline was calculated once and never used again to track anything.
- The minimal baseline is treated as a permanent ceiling, with no plan to ever extend it.
Worked example
In practice
A hospital that had assumed carbon footprint measurement was beyond its resources.
BeforeCarbon footprint had never been discussed, on the assumption that proper measurement required expertise and resources the hospital didn’t have.
ActionUsing a free, publicly available carbon calculator and the hospital’s existing energy use data, the facilities team produced a minimal baseline covering electricity and gas consumption, clearly documenting what was and wasn’t included in the estimate.
AfterThe Monitor reviewed the baseline document, confirmed it was being used as a comparison point in the following year’s energy report, and found a documented plan to extend the baseline to include waste and transport once resources allowed. Verified.
If you are starting from zero — do this first
- Use a free, publicly available carbon calculator with existing energy billing data.
- Document clearly what the baseline does and doesn’t cover.
- Commit, even informally, to revisiting the baseline annually.
The most common mistake: Waiting for a comprehensive, professionally commissioned carbon accounting system before attempting any baseline at all.
Self-assessment questions
1. Has the hospital carried out a genuine carbon footprint assessment, even a minimal one based on energy use? — A real, documented baseline, not an assumption that measurement is too complex to attempt.
Evidence: Carbon footprint baseline document
Evidence: Carbon footprint baseline document
2. Is this baseline genuinely used to monitor change over time, not calculated once and never revisited? — Real, ongoing tracking, not a one-time exercise with no follow-through.
Evidence: Year-over-year comparison data
Evidence: Year-over-year comparison data
3. Is there a realistic plan to extend the carbon footprint assessment as hospital resources allow? — A genuine forward plan, not a minimal baseline treated as a permanent ceiling on ambition.
Evidence: Documented extension plan
Evidence: Documented extension plan
Common reasons for a PARTIAL answer
- A baseline was calculated but is never actually referenced again afterward. — A baseline that is never revisited doesn’t function as a genuine monitoring tool.
- The baseline is accurate but its scope and limitations aren’t clearly documented. — Unclear scope makes future comparison unreliable.
- No plan exists to extend the baseline beyond its current minimal scope.
Implementation plan
| When | What |
|---|---|
| Week 1 | Gather existing energy billing data for the past 12 months. |
| Week 2 | Use a recognised carbon calculator to produce an initial baseline. |
| Week 3 | Document the baseline’s scope and limitations clearly. |
| Ongoing | Revisit annually and extend scope as resources allow. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Baseline document review | Reviews the actual carbon footprint baseline and its documented scope. |
| DOCUMENT | Trend comparison review | Confirms the baseline is genuinely used for year-over-year comparison. |
Supervisor tips
- Ask to see the baseline document and whether it’s been updated or referenced since creation. — A baseline that exists but is never used again doesn’t meet the genuine intent here.
- Accept a minimal, honestly-scoped baseline as fully meeting this criterion. — ISQua explicitly recognises resource constraints; don’t expect more than is realistic.
Evidence base
NHS Sustainable Development Unit. Carbon Footprint Update for NHS in England. Cambridge: SDU; 2022.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.
18.7
The Hospital Genuinely Plans for Environmental and Climate Resilience
Core
The hospital considers its resilience to major environmental, climate, or health emergencies that could disrupt service delivery — heatwaves, flooding, extreme storms, pandemic outbreaks — and plans a real range of actions in response, not assuming such disruptions are too remote to actually prepare for.
In plain terms: The hospital has a real plan for what happens if extreme weather, flooding, or another major environmental disruption hits — not an assumption that this won’t happen here, or that existing emergency plans already cover it without anyone actually checking.
| Facility category | Crisis | Transition | Small | Standard |
|---|---|---|---|---|
| Applicability | Adapted | Full | Full | Full |
Why this matters
Climate and environmental disruptions are not a distant, theoretical risk — heatwaves straining cooling systems and patients alike, flooding disabling ground-floor departments, extreme storms cutting power and supply chains, are events hospitals around the world are facing with increasing frequency. This is marked Core because the consequence of inadequate preparation isn’t abstract: a hospital caught unprepared by a major environmental emergency risks exactly the kind of care disruption and patient safety failure the whole rest of this standards document exists to prevent. A generic, unreviewed emergency plan that has never actually considered climate-specific scenarios doesn’t meet this intent — the hospital needs to have genuinely thought through its own specific vulnerabilities.
What good looks like
- The hospital has genuinely considered its resilience to climate/environmental emergencies relevant to its location.
- A real plan exists for situational response that protects patient safety and care continuity.
- The plan is genuinely reviewed and updated, not static and unexamined.
Common failure modes
- No specific consideration has been given to environmental or climate emergencies at all.
- A generic emergency plan exists but was never adapted for climate-specific scenarios.
- A plan exists but hasn’t been reviewed or updated in years, regardless of changing conditions.
Worked example
In practice
A hospital whose emergency plan covered fire and security but not climate-specific risks.
BeforeThe hospital’s emergency response plan covered fire, security incidents, and mass casualty events, but had never specifically addressed heatwave response, flooding of ground-floor areas, or extended power loss during extreme weather, despite the region’s increasing frequency of severe storms.
ActionA climate risk assessment specific to the hospital’s location and structure was conducted, identifying flooding of the ground-floor emergency department and summer cooling capacity as the two highest-priority risks. Specific response protocols were added: a flood barrier and relocation plan for the emergency department, and a heat-response protocol with backup cooling arrangements.
AfterThe Monitor reviewed the updated emergency plan, confirmed it addressed location-specific climate risks with real response protocols, and found evidence of an annual review cycle already underway. Verified.
If you are starting from zero — do this first
- Identify the one or two climate/environmental risks most relevant to the hospital’s actual location.
- Check whether the existing emergency plan genuinely addresses these, or only generic incidents.
- Add specific, actionable response protocols for the highest-priority identified risks.
The most common mistake: Assuming a general emergency response plan already covers climate-specific scenarios without anyone actually checking whether it does.
Self-assessment questions
1. Has the hospital genuinely considered its resilience to major environmental or climate emergencies relevant to its location? — A real, specific assessment, not an assumption that such events are too remote to plan for.
Evidence: Location-specific climate risk assessment
Evidence: Location-specific climate risk assessment
2. Does a real plan exist for situational assessment and response that protects patient safety and continuity of care during such an emergency? — A genuine, actionable plan, not a general statement of intent with no real content.
Evidence: Climate/environmental emergency response protocol
Evidence: Climate/environmental emergency response protocol
3. Is the plan genuinely reviewed and updated, not written once and left unexamined as conditions change? — Real, periodic review, not a static document assumed to remain adequate indefinitely.
Evidence: Plan review schedule and revision history
Evidence: Plan review schedule and revision history
Common reasons for a PARTIAL answer
- A general emergency plan exists but has never been specifically checked against climate risks. — Generic coverage doesn’t confirm the hospital’s specific vulnerabilities are actually addressed.
- Climate risks are identified but response protocols remain vague or untested. — Identification without a genuine, actionable response plan leaves the gap unresolved.
- The plan was written once with no subsequent review as conditions or evidence changed.
Implementation plan
| When | What |
|---|---|
| Week 1-2 | Conduct a location-specific climate and environmental risk assessment. |
| Week 3-4 | Develop specific response protocols for the highest-priority identified risks. |
| Week 5 | Integrate these into the hospital’s existing emergency response plan. |
| Ongoing | Review and update the plan on a defined annual schedule. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Climate risk assessment review | Reviews the specific, location-relevant environmental risk assessment. |
| DOCUMENT | Response plan review | Reviews the emergency plan for genuine, specific climate-related protocols. |
| ASK | Staff interview | Asks relevant staff to describe the hospital’s response to an identified climate risk. |
Supervisor tips
- Ask whether the emergency plan names the hospital’s specific climate risks, not just generic incidents. — Specificity to this facility’s actual location and structure is the real test here.
- Check the plan’s last review date against how long ago it was first written. — A plan untouched for years, regardless of changing conditions, has likely gone stale.
Evidence base
World Health Organization. Operational Framework for Building Climate Resilient and Low Carbon Health Systems. Geneva: WHO; 2023.
ASF training courses on GMJ Academy →
Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.