ASF Standards · Ambulatory · Standard 27

Standard 27 — Sustainable Care

7 criteria · 2 core · 5 standard-level · Version 1.0 · Aligned to ISQua EEA Principle 6, 6th Edition

Criteria in this standard

27.1 — Environmental Impact Is Genuinely Assessed, Not Assumed Negligible
27.2 — Clinical Waste Is Genuinely Segregated and Responsibly Disposed
27.3 — Procurement Genuinely Considers Environmental Impact
27.4 — Energy and Resource Use Are Genuinely Monitored and Reduced Where Possible
27.5 — Patients and Staff Are Genuinely Engaged in Sustainability Practice
27.6 — The Clinic Genuinely Plans for Climate-Related Operational Risk
27.7 — Sustainability Commitments Are Genuinely Reviewed, Not Static

27.1

Environmental Impact Is Genuinely Assessed, Not Assumed Negligible

Standard

The clinic genuinely assesses its environmental impact — energy use, waste generation, water consumption — rather than assuming its small footprint compared to a hospital makes real assessment unnecessary.

In plain terms: The clinic has actually looked at its own real environmental footprint — not just assumed that being small means it doesn’t need to check.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A single ambulatory clinic’s environmental footprint is genuinely smaller than a hospital’s, but “smaller” is not the same as “negligible” or “not worth assessing” — and the assumption that small size exempts a facility from real environmental accountability is itself the problem. With hundreds of ambulatory clinics operating within a health system, their combined genuine impact is significant even when any one facility’s footprint looks modest in isolation. A real, if proportionate, assessment is what distinguishes genuine environmental responsibility from an assumption resting on relative scale.

What good looks like

The clinic has genuinely assessed its own environmental impact, appropriately scaled to its size.
The assessment genuinely covers energy, waste, and water, not a single easy metric.
The assessment is genuinely revisited periodically, not conducted once and forgotten.

Common failure modes

No assessment has ever been conducted, justified by the clinic’s small size.
Only one easy-to-measure dimension, like electricity cost, is tracked as if representative.
A single assessment from years ago is treated as still current.

Worked example

In practice

A 12-provider ambulatory clinic with no prior environmental review.

BeforeNobody at the clinic had ever formally looked at its energy use, waste volume, or water consumption — these were simply operating costs paid monthly, with no one examining what they actually represented or whether they could be reduced.

ActionA simple, proportionate self-assessment was conducted using utility bills and waste collection records from the past year, giving the clinic its first real baseline figures across all three dimensions.

AfterThe Monitor reviewed the baseline assessment document and confirmed it covered energy, waste, and water with real, specific figures rather than estimates. Verified.

If you are starting from zero — do this first

Pull the last 12 months of utility bills and waste collection invoices.
Compile a simple one-page baseline covering energy, waste, and water.
Set a date to revisit this baseline annually.

The most common mistake: Treating clinic size as a reason real assessment isn’t worth doing, rather than simply a reason to scale the assessment proportionately.

Self-assessment questions

1. Has the clinic genuinely assessed its own environmental impact, not assumed its small size makes this unnecessary? — A real, documented assessment, not an assumption based purely on facility size.
Evidence: Environmental baseline assessment document

2. Does this assessment genuinely cover energy, waste, and water, not a single dimension treated as representative? — Real, multi-dimensional coverage, not one easy metric standing in for the whole picture.
Evidence: Multi-dimensional assessment data

3. Is the assessment genuinely revisited periodically, not conducted once and left unexamined? — Real, periodic review, not a static assessment assumed to remain valid indefinitely.
Evidence: Review schedule and updated records

Common reasons for a PARTIAL answer

Energy use is tracked but waste and water are not. — A genuinely complete picture requires all three dimensions, not the easiest one alone.
An assessment was done once at opening but never repeated since. — A clinic’s operations and impact change over time; a static baseline grows stale.

Implementation plan

When	What
Week 1	Gather 12 months of utility and waste data.
Week 2	Compile a baseline document covering all three dimensions.
Annually	Revisit and update the baseline.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Baseline review	Reviews the environmental baseline for genuine, multi-dimensional coverage.

Supervisor tips

Ask to see actual figures, not a general statement that the clinic is “environmentally conscious.” — Specific figures distinguish a genuine assessment from a vague intention.

Evidence base

World Health Organization. WHO Guidance for Climate-Resilient and Environmentally Sustainable Health Care Facilities. Geneva: WHO; 2020.

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.

27.2

Clinical Waste Is Genuinely Segregated and Responsibly Disposed

Standard

Clinical and hazardous waste is genuinely segregated from general waste at the point of generation and disposed of through a responsible, verified pathway — not mixed waste streams justified by the clinic’s smaller volume compared to a hospital.

In plain terms: Medical waste is actually kept separate from regular trash, right from the moment it’s generated, and goes somewhere genuinely responsible — not mixed together because the clinic doesn’t produce as much as a hospital.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Lower volume does not change the genuine hazard properties of clinical waste — sharps, contaminated materials, and pharmaceutical waste carry real risk regardless of how much of it a facility produces, and improper disposal creates genuine environmental and public health risk whether it comes from a hospital or a single exam room. A clinic that relaxes segregation discipline because “we don’t generate much” is applying a volume-based justification to a hazard that doesn’t actually scale down that way.

What good looks like

Clinical waste is genuinely segregated at every point of generation.
The disposal pathway is genuinely verified, not assumed compliant.
Staff are genuinely trained with real, observable compliance.

Common failure modes

Sharps or contaminated materials occasionally go into general waste under time pressure.
A waste contractor is engaged but never actually verified as compliant.
Segregation rules exist on a poster but aren’t genuinely followed in practice.

Worked example

In practice

A clinic relying on informal waste segregation practices.

BeforeSharps bins were available but general waste bins were sometimes used for contaminated dressings during busy periods, and the clinic had never actually verified where its contracted waste disposal company took the clinical waste.

ActionClearly labeled, conveniently placed segregation bins were installed in every exam room, a brief refresher was delivered to all staff, and the disposal contractor’s licence and final disposal site were directly verified and documented.

AfterThe Monitor observed correctly segregated bins during a walkthrough and reviewed the documented verification of the disposal contractor’s licence. Verified.

If you are starting from zero — do this first

Check every exam room has clearly labeled, conveniently placed segregation bins.
Directly verify your waste contractor’s licence and disposal pathway, don’t just assume it.
Brief all staff on correct segregation practice.

The most common mistake: Assuming a contracted waste disposal company is compliant without ever directly verifying its licence or actual disposal pathway.

Self-assessment questions

1. Is clinical waste genuinely segregated from general waste at every point of generation? — Real, consistent segregation, not a practice that lapses under time pressure.
Evidence: Direct observation, bin placement

2. Is the disposal pathway for clinical waste genuinely verified? — A real, verified pathway, not an assumption resting solely on a vendor’s claims.
Evidence: Contractor licence verification record

3. Are staff genuinely trained in correct segregation, with real, observable compliance? — Real, demonstrated staff practice, not rules that exist only on a poster.
Evidence: Training record, observed compliance

Common reasons for a PARTIAL answer

Segregation is good in theory but lapses during busy periods. — Genuine, consistent practice should hold up under real operational pressure.
A contractor is used but its disposal pathway has never actually been verified.

Implementation plan

When	What
Week 1	Audit and correct bin placement and labeling across all exam rooms.
Week 2	Verify the waste contractor’s licence and disposal pathway directly.

How the Monitor verifies this

Method	What	Detail
ASK	Direct observation	Observes segregation practice during a walkthrough of exam rooms.
DOCUMENT	Contractor verification	Reviews documented verification of the disposal contractor’s licence.

Supervisor tips

Check a bin at random during a busy period, not just at a quiet moment. — Genuine compliance holds under real pressure, not just when things are calm.

Evidence base

World Health Organization. Safe Management of Wastes from Health-Care Activities. Geneva: WHO; 2014.

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.

27.3

Procurement Genuinely Considers Environmental Impact

Core

Procurement decisions genuinely factor in environmental impact alongside cost and clinical suitability — not sustainability treated as an afterthought with purchasing decided purely on price.

In plain terms: When the clinic buys supplies, it actually thinks about environmental impact as one real factor — not purely the cheapest option every time, with sustainability never actually weighed in.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Procurement decisions compound across every purchase cycle, and a clinic that never factors environmental impact into these decisions is, in effect, systematically optimizing away from sustainability on every order — not through any single bad decision, but through the consistent absence of the consideration entirely. This is marked Core because genuine sustainability commitment is tested precisely at the point of actual spending decisions, not in policy statements; a clinic can claim sustainability values while every real purchasing choice ignores them entirely.

What good looks like

Procurement genuinely weighs environmental impact alongside cost and clinical need.
A real, documented instance shows environmental considerations genuinely influencing a purchase.
Single-use consumables are genuinely reviewed for lower-impact alternatives.

Common failure modes

Purchasing decisions are made purely on price, with environmental impact never actually discussed.
A sustainability policy exists but has never genuinely changed a single purchasing decision.
Single-use defaults are never reviewed, even where safe alternatives exist.

Worked example

In practice

A clinic reviewing its supply ordering practices.

BeforeSupply orders were placed by whoever had time, chosen purely on unit price with no consideration of packaging waste, supplier sustainability credentials, or reusable alternatives where clinically appropriate.

ActionA simple environmental consideration was added to the supply reorder checklist, and a reusable alternative was identified and adopted for one previously single-use, non-critical item, with the decision documented.

AfterThe Monitor reviewed the updated checklist and the documented decision to switch to a reusable alternative. Verified.

If you are starting from zero — do this first

Add an environmental consideration line to your supply reordering checklist.
Identify one non-critical, single-use item with a viable reusable alternative.
Document the first real decision made with environmental impact considered.

The most common mistake: Holding a stated sustainability value that has never actually influenced a single real purchasing decision.

Self-assessment questions

1. Does procurement genuinely weigh environmental impact, not cost and clinical need alone? — Real, documented consideration, not an unexamined, purely cost-driven decision.
Evidence: Procurement criteria documentation

2. Is there a real, documented instance where a procurement choice was genuinely influenced by environmental considerations? — A concrete, real example, not a policy with no actual purchasing decision behind it.
Evidence: Specific purchasing decision record

3. Are single-use consumables genuinely reviewed for lower-impact alternatives where clinically safe? — A real, ongoing review, not single-use defaults left unexamined indefinitely.
Evidence: Consumables review record

Common reasons for a PARTIAL answer

Environmental impact is discussed informally but never actually documented as a factor.
A review of single-use items happened once but hasn’t become a recurring practice.

Implementation plan

When	What
Week 1	Add environmental consideration to the procurement checklist.
Week 2-3	Review current single-use items for viable, safe reusable alternatives.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Procurement record review	Reviews a real purchasing decision for documented environmental consideration.

Supervisor tips

Ask for one specific, real example, not a general statement of values. — A concrete example is the clearest test that this genuinely shapes real decisions.

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.

27.4

Energy and Resource Use Are Genuinely Monitored and Reduced Where Possible

Standard

The clinic genuinely monitors its energy and resource consumption, pursuing real, achievable reductions appropriate to its scale — not resource use left untracked because the facility is too small to warrant real attention.

In plain terms: Someone actually watches what the clinic spends on energy and resources, and real, practical steps are taken to use less where that’s genuinely achievable — not energy bills just paid without anyone really looking at the trend.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Energy monitoring doesn’t require sophisticated infrastructure — even a modest ambulatory clinic can track monthly consumption against prior periods and identify real, achievable efficiency opportunities, from LED lighting to equipment scheduling. The genuine failure here isn’t lacking a hospital-scale sustainability programme; it’s never actually looking at the numbers at all, which means even the simplest, cheapest improvements go unidentified and unrealized indefinitely.

What good looks like

Energy consumption is genuinely tracked, not simply paid for.
The clinic has genuinely identified and pursued at least one real efficiency improvement.
Progress is genuinely reviewed periodically.

Common failure modes

Utility bills are paid with no one actually reviewing consumption trends.
No efficiency improvement has ever actually been identified or pursued.
An improvement was made once but progress since has never been reviewed.

Worked example

In practice

A clinic that had never reviewed its own energy trends.

BeforeMonthly electricity bills were paid by the office manager with no one ever actually comparing month-to-month or year-to-year usage, and the clinic still used older fluorescent lighting throughout.

ActionA simple spreadsheet was set up to track monthly consumption, revealing a clear trend, and a phased switch to LED lighting was initiated, starting with the highest-usage areas.

AfterThe Monitor reviewed the tracking spreadsheet showing genuine, ongoing monitoring and the documented LED conversion as a real, implemented improvement. Verified.

If you are starting from zero — do this first

Set up a simple spreadsheet to log monthly utility consumption.
Identify one low-cost, achievable efficiency improvement and implement it.
Review the tracking data quarterly.

The most common mistake: Paying utility bills without anyone actually looking at whether consumption is trending up, down, or flat over time.

Self-assessment questions

1. Is energy consumption genuinely tracked, not simply paid for with no real monitoring? — Real, ongoing tracking, not bills paid without genuine attention to trends.
Evidence: Consumption tracking record

2. Has the clinic genuinely identified and pursued at least one real, achievable efficiency improvement? — A real, concrete improvement, not a generic aspiration with no actual implementation.
Evidence: Specific improvement record

3. Is progress genuinely reviewed periodically? — Real, periodic review, not an assumption that efficiency improves passively.
Evidence: Review schedule

Common reasons for a PARTIAL answer

Tracking exists but has never actually led to a real improvement.
An improvement was made once but has never been followed up or reviewed since.

Implementation plan

When	What
Week 1	Set up basic consumption tracking.
Week 2-3	Identify and implement one achievable efficiency improvement.
Quarterly	Review tracking data for trends.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Tracking record review	Reviews the consumption tracking record for genuine, ongoing monitoring.

Supervisor tips

Ask to see the actual tracking data, not just a statement that energy use is “monitored.”

Evidence base

International Finance Corporation. Greenhouse Gas Emissions Reduction in Healthcare Facilities. Washington DC: IFC; 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.

27.5

Patients and Staff Are Genuinely Engaged in Sustainability Practice

Standard

Staff genuinely understand and participate in the clinic’s sustainability practices, and patients are genuinely made aware of relevant initiatives where appropriate — not a sustainability policy known only to management with no real staff or patient engagement.

In plain terms: Staff actually know what the clinic is doing to be more sustainable and genuinely take part in it — this isn’t just a management-level idea nobody else knows about.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Sustainability practices only actually function when the people carrying out daily operations understand and genuinely participate in them — waste segregation, resource conservation, and procurement choices all depend on frontline staff actually knowing what’s expected and why. A sustainability policy that exists only in a management document, never genuinely communicated or explained to staff, has no real chance of translating into actual practice, regardless of how well-intentioned the policy itself is.

What good looks like

Staff can genuinely describe at least one real sustainability practice the clinic follows.
Patients are genuinely made aware of relevant initiatives where appropriate.
Staff input on sustainability practice is genuinely sought and considered.

Common failure modes

Staff cannot name any specific sustainability practice when asked directly.
Sustainability initiatives are kept entirely internal, with patients never informed.
Sustainability decisions are made unilaterally with no real staff voice.

Worked example

In practice

A clinic where sustainability efforts existed but staff were largely unaware.

BeforeThe clinic manager had quietly switched to a more sustainable supplier for some items, but front-desk and clinical staff were unaware this had happened or why, and had never been asked for their own sustainability ideas.

ActionA brief team meeting introduced the supplier change and its rationale, a simple suggestion box was introduced for staff sustainability ideas, and a small sign in the waiting room noted the clinic’s switch to recyclable packaging where used.

AfterThe Monitor asked two staff members directly and both could describe the supplier change and its reasoning. Verified.

If you are starting from zero — do this first

Hold a brief team discussion explaining any current sustainability practices.
Create a simple channel for staff to suggest their own sustainability ideas.
Communicate relevant initiatives to patients where genuinely appropriate.

The most common mistake: Sustainability decisions made and known only at the management level, never actually communicated to the staff carrying out daily operations.

Self-assessment questions

1. Can staff asked directly describe at least one genuine sustainability practice the clinic follows? — Real, demonstrated staff awareness, not a policy known only to leadership.
Evidence: Staff interview

2. Are patients genuinely made aware of relevant sustainability initiatives where appropriate? — Real, visible communication, not initiatives kept entirely internal.
Evidence: Patient-facing communication

3. Is staff input on sustainability practice genuinely sought and considered? — Real, two-way engagement, not a top-down policy with no genuine staff voice.
Evidence: Staff suggestion record

Common reasons for a PARTIAL answer

Some staff are aware but awareness isn’t consistent across the whole team.
A suggestion channel exists but has never actually been used or promoted.

Implementation plan

When	What
Week 1	Brief all staff on current sustainability practices and rationale.
Week 2	Introduce a simple staff suggestion channel.

How the Monitor verifies this

Method	What	Detail
ASK	Staff interview	Asks a frontline staff member to describe a specific sustainability practice.

Supervisor tips

Ask a non-management staff member, not the clinic director. — Frontline awareness is the real test of genuine engagement.

Evidence base

Health Care Without Harm. Global Green and Healthy Hospitals Agenda. Reston: HCWH; 2020.

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.

27.6

The Clinic Genuinely Plans for Climate-Related Operational Risk

Core

The clinic genuinely considers climate-related risks to its own continuity of operation — extreme heat, power outages, supply chain disruption — and has a real, workable response, not an assumption that such risks only concern larger facilities.

In plain terms: The clinic has actually thought through what happens to patient care if there’s a heatwave, a power cut, or supplies don’t arrive — with a real plan, not an assumption that this only matters for big hospitals.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Climate-related disruptions — extreme heat events, grid instability, supply chain interruptions — affect facilities of every size, and an ambulatory clinic without backup planning may actually be more vulnerable than a larger hospital with redundant systems already in place. This is marked Core because continuity of outpatient care genuinely matters to the patients who depend on it, and a clinic that has never considered what happens during a real climate-related disruption risks an unplanned, chaotic response exactly when patients most need continuity.

What good looks like

The clinic has genuinely identified its specific climate-related operational risks.
A real, workable response plan exists for the most significant identified risk.
This plan is genuinely reviewed and tested.

Common failure modes

No climate-related risk has ever been formally identified or considered.
A risk is acknowledged but no actual response plan has been prepared.
A plan exists but has never been reviewed since it was first written.

Worked example

In practice

A clinic in a region with increasingly frequent summer power outages.

BeforePower outages during summer heatwaves had twice forced same-day appointment cancellations in the past two years, but no formal plan existed for how to respond when this happened again.

ActionA simple response plan was developed: a defined patient communication protocol for outage-related cancellations, a small backup power solution for critical refrigerated medications, and an agreement with a nearby clinic for emergency patient redirection.

AfterThe Monitor reviewed the documented plan and confirmed it had genuinely been tested in a tabletop exercise with staff. Verified.

If you are starting from zero — do this first

Identify the clinic’s most likely climate-related disruption based on its actual location and history.
Build a simple, workable response plan for that specific risk.
Walk through the plan with staff at least once.

The most common mistake: Assuming climate-related operational risk is a hospital-scale concern, overlooking the real, specific risks a smaller clinic faces too.

Self-assessment questions

1. Has the clinic genuinely identified its specific climate-related operational risks? — A real, specific risk identification, not a generic assumption of low exposure.
Evidence: Risk identification document

2. Is there a real, workable response plan for the clinic’s most significant identified climate risk? — A genuine, usable plan, not a risk acknowledged with no actual response prepared.
Evidence: Response plan document

3. Is this plan genuinely reviewed and tested? — Real, periodic review and testing, not a plan assumed to remain adequate indefinitely.
Evidence: Testing/review record

Common reasons for a PARTIAL answer

A risk is identified but the response plan is vague or genuinely untested.
A plan exists for one risk but other genuinely significant local risks are unaddressed.

Implementation plan

When	What
Week 1	Identify the clinic’s most significant, specific climate-related risk.
Week 2-3	Build a workable response plan.
Week 4	Walk through the plan with staff.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Plan review	Reviews the response plan and any record of testing or staff walkthrough.

Supervisor tips

Ask about the clinic’s actual local climate risk history, not a generic risk category. — Specificity to the clinic’s own real location and history is the key test.

Evidence base

World Health Organization. Operational Framework for Building Climate Resilient Health Systems. Geneva: WHO; 2015.

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.

27.7

Sustainability Commitments Are Genuinely Reviewed, Not Static

Standard

The clinic’s sustainability goals and practices are genuinely reviewed and updated as circumstances change — not a document written once and never genuinely examined for whether it still reflects the clinic’s actual practice.

In plain terms: The clinic’s sustainability goals actually get revisited and updated over time — not written once and left to gather dust, disconnected from whatever the clinic is actually doing now.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Sustainability goals written at a single point in time inevitably drift from actual practice as circumstances change — new staff, new suppliers, new equipment, new local regulations. A document frozen at the moment it was written stops being a genuine reflection of the clinic’s real commitments and becomes, instead, a historical artifact disconnected from current reality. Genuine, periodic review is what keeps sustainability commitments actually meaningful rather than symbolic.

What good looks like

Sustainability goals are genuinely reviewed on a real, defined schedule.
A real, documented instance shows a goal genuinely being revised based on experience.
Responsibility for review is genuinely assigned to a specific person or role.

Common failure modes

A sustainability document was written once and has never been revisited.
Goals have remained identical for years despite changed circumstances.
No one is actually responsible for the review, so it happens informally if at all.

Worked example

In practice

A clinic whose sustainability goals had never been revisited since first written.

BeforeA one-page sustainability statement had been drafted three years earlier and filed away, with no one assigned to revisit it, and several of its specific commitments were no longer accurate given changes in suppliers and staff since.

ActionThe office manager was formally assigned annual review responsibility, and the first review genuinely updated two outdated commitments to reflect the clinic’s actual current practice.

AfterThe Monitor reviewed the updated document, dated and showing specific, genuine revisions from the original. Verified.

If you are starting from zero — do this first

Assign a specific named person responsibility for an annual sustainability review.
Compare the current document against actual current practice and update discrepancies.
Date each review so the record shows genuine, ongoing attention.

The most common mistake: A sustainability document that nobody is specifically responsible for revisiting, so it simply never gets reviewed.

Self-assessment questions

1. Are sustainability goals genuinely reviewed on a real, defined schedule? — A real, periodic review, not a goal document frozen at the point it was first written.
Evidence: Review schedule and dated records

2. Is there a real, documented instance of a sustainability goal genuinely being revised based on actual experience? — A concrete, real example, not goals that have never actually changed.
Evidence: Revision history

3. Is responsibility for this review genuinely assigned to a specific person or role? — A real, named accountability, not a review that depends on someone remembering to do it.
Evidence: Assigned responsibility documentation

Common reasons for a PARTIAL answer

A review schedule exists but hasn’t actually been followed consistently.
Review happens but produces no genuine changes, raising the question of its real rigor.

Implementation plan

When	What
Week 1	Assign named responsibility for annual sustainability review.
Week 2	Conduct the first genuine review against current actual practice.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Revision history review	Reviews the document’s revision history for genuine, dated updates.

Supervisor tips

Ask who is specifically responsible for the review, not just whether a review process exists. — Named accountability is what makes a review genuinely likely to happen.

Evidence base

United Nations Environment Programme. Sustainable Healthcare Facilities Guidance. Nairobi: UNEP; 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.

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