【GHI Column – Part 2】The 7 Steps to Implement GHI — From Measurement to Board Reporting

In Part 1, we introduced the overall framework and philosophical background of GHI (Global Health Impact), newly established in JCI 8th Edition.

GHI does not ask whether a hospital is “environmentally conscious.”

It asks whether a system to manage environmental impact has been established and is being operated effectively.

So where should your organization begin?

When hearing “GHI implementation,” some may feel concerned:

• Will we need to collect an enormous amount of data?

• Will large-scale capital investment be required?

However, the essence of GHI implementation is not to build something entirely new from scratch.

Rather, it is to integrate an environmental management perspective into existing frameworks of governance, quality management, and risk management.

In this article, we outline seven practical steps for implementation, focusing primarily on GHI.01 (Governance) and GHI.03 (Measurement and Reduction).

Understanding the Overall Structure of GHI.01 and GHI.03 Implementation

GHI implementation progresses through the following flow:

1. Baseline calculation

2. Hotspot identification

3. Strategy development

4. KPI design

5. Monitoring system

6. Board oversight

7. Annual reporting

These seven steps are not simply a checklist.

They represent the management cycle itself:

Measure → Analyze → Plan → Execute → Report

In that sense, implementing GHI is equivalent to building an “environmental version” of QPS (Quality Improvement and Patient Safety).

Step 1: Baseline Calculation (Understanding the Current Situation)

The first priority is not to develop a perfect strategy immediately, but to understand the current state.

Key Decisions

• Base year (most recent 12 months)

• Organizational boundary (what to include)

• Scope 1 / 2 / 3 coverage*

(*Scope definitions will be explained in a separate upcoming column.)

Minimum Data to Collect

• Electricity consumption (kWh)

• Fuel consumption (city gas m³, diesel liters, etc.)

• Water consumption (m³)

• Waste volume (kg)

• Renewable energy consumption (if applicable)

• Clinical items such as anesthetic gases (kg or bottle count)

Basic Formula for CO₂e Calculation

CO₂e (carbon dioxide equivalent) = Activity Data × Emission Factor

Activity data refers to the actual quantities used, consumed, or emitted by the hospital — the data listed above.

An emission factor represents the amount of CO₂e emitted per unit of activity.

For example:

If the emission factor for electricity is 0.45 kgCO₂e / kWh and electricity consumption is 100,000 kWh:

100,000 × 0.45 = 45,000 kgCO₂e

Emission factors must not be defined independently by each hospital. They should be based on publicly or internationally recognized sources. Because these factors vary by region and year, it is important to use the most current definition applicable to your country or region.

Equally important is the ability to explain:

• Why that specific factor was chosen

• That it has been applied consistently

Emission factors also differ depending on whether a location-based or market-based method is used. In principle, location-based calculation is recommended. However, if increasing renewable energy usage becomes part of your reduction strategy, it is advisable to calculate emissions using both methods.

(*Location-based and market-based approaches will be covered in a future column.)

Tools such as AKDN (free tool) and SAT (paid integrated tool) can support calculations. However, it is strongly recommended to fully understand the logic behind factor selection, calculation methods, and data sources. During surveys, you must be able to clearly explain your methodology.

Step 2: Identify Hotspots

Identify the top three to five largest emission sources.

• Is electricity the largest contributor?

• Is procurement (Scope 3)?

• Anesthetic gases?

• Waste?

Determining these focus points forms the starting point for strategy development.

It is essential to compare Scope 1, 2, and 3 comprehensively before deciding on focus areas. While Scope 3 is often the largest source in many industries, healthcare institutions tend to have high electricity dependency due to 24-hour operations and heavy HVAC demand. Avoid assuming Scope 3 is always dominant — compare all scopes objectively.

Step 3: Strategy Development – Setting Targets

Once the current state is properly understood, the next step is to establish targets.

A three-layer structure clarifies accountability from executive management to departments to frontline operations:

Executive-Level Target

Example: Reduce total emissions by X% by 2030

Department-Level Targets

Example: Reduce electricity intensity by X%; reduce infectious waste by X%

Initiative-Level Targets

Example: LED installation rate; renewable energy ratio; waste segregation compliance rate

Step 4: KPI Design – Determining How to Evaluate and Follow Up

Outcome KPIs (Most Intuitive)

• Total emissions (tCO₂e)

• Emissions by Scope

However, simply reducing hospital activities to lower emissions would defeat the purpose. The objective is to maintain hospital functions, safety, and quality while improving efficiency.

In such cases, intensity-based KPIs are useful.

Intensity KPIs

• tCO₂e per patient-day

• kWh per bed-day

Outcome and intensity KPIs reflect results. To improve these results, daily operational progress must also be tracked.

Process KPIs

• Renewable energy ratio (%)

• Water-saving volume (m³)

• Training participation rate (%)

• Supplier evaluation rate

These indicators provide evidence that measurement and improvement are actively taking place.

Step 5: Monitoring Structure

A two-tier time structure is recommended:

• Monthly: Operational meetings

• Quarterly: Executive review

Dashboard visualization is encouraged, combining:

Data + Root Cause + Next Action

This structure enables an effective PDCA cycle.

Step 6: Board Oversight

At least once per year, the Board should review:

• Baseline results

• Year-over-year comparison

• Key challenges

• Next-year plan

Meeting minutes must be documented. This is one of the areas emphasized during JCI surveys.

Step 7: Annual Reporting and Updating

Disclose results externally and update targets accordingly.

This demonstrates that the PDCA cycle is functioning. It is important not to overlook this step.

Summary of Part 2: GHI Is Not “Environmental Activity” — It Is a Management Upgrade

GHI elevates environmental initiatives from optional add-ons to core hospital operational standards.

The key to success in GHI.01 and GHI.03 is systematizing:

• Governance

• Measurement

• Strategy

• Monitoring

The seven steps introduced here focus primarily on implementing GHI.01 (Governance) and GHI.03 (Measurement and Reduction). However, GHI compliance does not end there.

In Part 3, we will focus on Scope 3 and sustainable procurement (GHI.04), which often represent the largest share of greenhouse gas emissions, and introduce practical, implementable approaches.

If you would like to receive immediate notification when Part 3 is released, please enter your email address in the “Subscribe to our info” section at the bottom of the page.

Note: This column is based on publicly available information and current survey trends regarding the newly introduced GHI chapter in JCI 8th Edition. As GHI is a new standard, interpretations and survey practices may evolve over time. The content may therefore be updated and should be used for reference purposes only.

Thank you for reading.

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