News & Insights

Healthcare administrators face an increasingly complex challenge: advancing sustainability goals while still managing tight budgets, maintaining operations, and keeping patient care as the top priority. Two certification pathways now offer distinct approaches to this challenge.

LEED for Healthcare has long provided a globally recognized framework for designing high-performance facilities, with LEED v5’s April 2025 release bringing enhanced focus on decarbonization and resilience. The Sustainable Healthcare Certification (SHC) Standards, introduced by the Joint Commission in December 2024, takes an organizational approach—requiring ongoing measurement, improvement, and recertification rather than a single point-in-time assessment.

Understanding where each framework excels helps build a comprehensive sustainability strategy that delivers resilient facilities, operational efficiency, and measurable progress toward climate goals.

SHC essentials: organizational certification fundamentals

The SHC Standards require organizations to measure their greenhouse gas emissions from at least three sources and develop a plan for annual improvements. Meanwhile, the International SHC offers a broader framework for healthcare organizations seeking sustainability certification.

These international standards focus on environmental, social, and governance factors related to healthcare sustainability. Both standards allow healthcare entities to choose between two approaches: operating as a single healthcare organization (HCO) or as a centralized corporate system, with certification granted to either the individual organization or the entire corporate entity.

Key components of the SHC

Understanding how SHC structures its requirements helps clarify where it differs from LEED’s building-focused approach. The standards include:

1. Comprehensive Sustainability Framework:

• Both the US and International SHC Standards include measurable elements and performance expectations for a decarbonization framework, organizational integration, operational efficiency, improved health outcomes, and resilience and emergency preparedness.
• The SHC Standards are divided into chapters, each with specific intents and measurable elements to guide implementation.

2. Employee engagement and empowerment:

• The International SHC Standard encourages active participation of staff in sustainability initiatives.

3. Environmental resource management:

• The International SHC Standard focuses on reducing greenhouse gas emissions and optimizing resource use.

4. Resilience planning:

• Both SHC Standards emphasize infrastructure and service resilience to adapt to climate-related challenges.

Major differences between LEED and SHC

While both frameworks advance healthcare sustainability, they take fundamentally different approaches in scope, focus, and application:

Organization versus building

Initially, the SHC provides a framework for an entire organization operating as a healthcare company. In contrast, LEED is intended for a single healthcare building or campus, with a focus on space and system design.

Although LEED generally emphasizes design over organizational requirements, an exception exists for organizations contemplating the LEED for Operations and Maintenance Rating System, which lacks a healthcare-specific version.

ESG-aligned requirements

The SHC Standards highlight the importance of reducing carbon footprints and addressing climate change risks, requiring measurement of greenhouse gas emissions from at least three sources. Similar provisions are included in LEED’s fifth version, with a mandate to adopt LEED v5 updates after Q1 2026.

Additionally, some of the more notable LEED Pilot Credits on Resiliency and Triple Bottom Line Analysis align well with SHC requirements. The current LEED version provides requirements and options to reduce energy and water use, incorporate renewable energy and water reclamation, minimize landfill waste, and conduct embodied carbon analysis. Each of these significantly impacts the assessment and reduction of Scopes 1, 2, and 3 carbon emissions. LEED v5 also emphasizes analyzing pathways to achieve net-zero carbon, with the SHC requiring a plan for performance improvements and annual emissions data analysis.

Education

While LEED offers limited opportunities to educate occupants and the public about the sustainable features of a certified building, the International SHC program requires several key elements of education and engagement for staff throughout the entire organization.

Employee engagement

While the sustainability sector has been working to improve occupant engagement for nearly ten years, the International SHC program has elevated this effort by going beyond simply collecting occupant feedback. It now includes various areas where organization leaders are asked to create opportunities for staff involvement, such as implementing processes to gather staff ideas for reducing the carbon footprint.

Supply chain

The International SHC emphasizes supply chain management, which is not part of LEED, although it closely resembles the USGBC certification TRUE Zero Waste. While LEED for Operations and Maintenance considers supply chains, it focuses on purchasing products that prioritize recycled or bio-based materials or participate in certifications like Cradle to Cradle.

Processes versus snapshot-in-time

LEED provides an option for the building industry to incorporate more sustainable measures to reduce global greenhouse gas (GHG) emissions that meet the supply and demand curve. It’s often described as a rating system that provides a snapshot of the building the day it opens, and rarely how it continues to operate.

However, the same does not apply to SHC, which should be viewed as the main difference from LEED. SHC mandates recertification—typically every two years—based on 24 months of GHG emissions data, with the expectation that this new data demonstrates progress and improvement.

Recertification requires an organization to develop and execute processes that guide it towards a more sustainable and resilient future, with the ability to set targets and adjust these processes to achieve measurable goals. From this perspective, the SHC can be seen as more aligned with the USGBC’s PERFORM program or even the GRESB framework, especially for large portfolio owners.

Certification process

Both programs require documentation and calculations to demonstrate compliance with their respective standards. Project teams and organizations may encounter difficulties here, as successfully proving compliance depends on accurately documenting the strategies employed. This can be frustrating for organizations inexperienced with reviews by GBCI or the JC.

A major difference is that JC mandates participation in interviews during the SHC review, requiring leaders and staff to show their understanding of performance improvement plans and organizational goals. Consultants cannot serve as the main contact or interact with reviewers for SHC, so organizations must prepare their entire team for the JC review. In contrast, for LEED, consultants are permitted to handle both documentation and the overall review process.

Key similarities between LEED and SHC

Despite their different approaches, LEED and SHC share fundamental goals that make them complementary rather than competing frameworks:

Greenhouse gas reduction and resiliency

Both frameworks aim to reduce greenhouse gas emissions, optimize resource use, and promote energy efficiency. Both standards incorporate resiliency, helping facilities adapt to environmental challenges and maintain operations, even if LEED allows projects to opt out of including all these goals in the project design.

Health and wellbeing

From Equity and Access to Indoor Environmental Quality, the International SHC and LEED both focus on creating healing environments that improve air quality, reduce chemical exposure, implement infection control measures. They also both consider staff wellbeing while emphasizing reducing disparities in healthcare outcomes and supporting the health of surrounding communities. In fact, both standards prioritize indoor air quality as a critical factor for health and wellbeing.

Similar emphasis is also placed on biophilic design’s potential to improve mental health support. This stems from the belief that healthcare facilities should play a broader role in promoting societal wellbeing within their local community.

Stress reduction

Stress is a global health concern that significantly impacts healthcare workers. Both LEED and SHC address this challenge indirectly through environmental design strategies that create more comfortable, quieter, safer, and more aesthetically pleasing spaces for staff.

Where the International SHC focuses on infection control and ensuring safe working conditions, LEED addresses staff wellbeing through adequate ventilation, increased daylighting, and acoustic comfort. While these approaches differ in their mechanisms, both frameworks recognize that reducing environmental stressors in healthcare facilities contributes to better outcomes for the people who work there daily.

How Salas O’Brien can help

Navigating both LEED and SHC certification requires expertise that spans sustainable design, MEP systems, commissioning, and organizational sustainability management. Healthcare administrators need partners who understand how certification choices affect capital planning, operational budgets, and long-term portfolio performance.

As sustainability experts paired with healthcare design specialists, Salas O’Brien brings deep experience in both frameworks. Our team has guided hundreds of LEED for Healthcare projects through certification while staying current on evolving standards like LEED v5 and emerging programs like SHC. We understand the documentation requirements, the review processes, and the strategic decisions that determine which certifications deliver the greatest value for your organization.

Whether you’re planning a new facility, considering recertification for existing buildings, or developing an organization-wide sustainability strategy, we help you navigate these evolving standards to deliver resilient, patient-centered environments that advance your climate leadership goals.

Our integrated approach addresses:

• LEED certification strategy and documentation for healthcare facilities
• ESG reporting and decarbonization planning aligned with both frameworks
• Commissioning services that meet LEED requirements while supporting ongoing operational excellence
• Portfolio-level sustainability consulting that connects building performance to organizational goals

We help you build a comprehensive sustainability strategy that serves patients, staff, and communities while meeting the expectations of investors and stakeholders. Reach out to one of our experts to talk about your next project.

For media inquiries on this article, reach out to [email protected].