Climate resilience is an increasingly urgent issue for healthcare organizations of all sizes. The U.S. Department of Health and Human Services (HHS) has developed a “Health Sector Climate Pledge”, require signatories to develop and publish a climate resilience plan by the end of 2023 that enables “continuous operations” and anticipates the needs of “groups in their community that experience disproportionate risk of climate-related harm.”
Healthcare providers routinely conduct disaster, emergency preparedness and hazard mitigation planning, so why is there a need for a plan specific to climate resilience? There are key differences in developing a climate resiliency plan versus traditional emergency management and hazard mitigation planning. The most important difference is that the frame of reference becomes future oriented. Emergency management plans typically are based on your organization’s event history. However, global climate change and its effects make it increasingly unreliable to use past events as a guide to future conditions. This is where climate resiliency planning fits in.
Climate resiliency planning essentially is a different conversation about familiar topics. It considers the increased frequency and intensity of climate-related threats and risks, based on scientific projections, and their cumulative impact on operations, finances, community, etc.
A meaningful climate resiliency plan must incorporate a comprehensive climate risk assessment specific to your institution. Instead of focusing on recovery from a specific event, the climate risk assessment asks, “Is disaster X going to happen with greater frequency and/or intensity?” It also assesses how prepared your organization would be to flex its disaster recovery muscles in the context of the impacts of a changing climate.
Practical adaptation and resilience options that address the climate assessment risks are also vital components of any climate resiliency plan. Together with the climate risk assessment, these form the backbone of the resiliency plan.
Conducting the climate risk assessment
A climate risk assessment helps your organization understand the scope of climatic effects it likely will need to manage. HHS’ report Primary Protection: Enhancing Health Care Resilience for a Changing Climate outlines best practices and suggests five initial steps. We recommend including two additional distinct steps: inventorying assets and identifying resiliency actions.
1) Compile historic data and future projections
Any resiliency plan must be built on the best available data and information, both from the past as well as projected future conditions. This will help you understand what your institution will experience in its future. In addition to the best available scientific or engineering data, the use of information from other sources, including historic narratives and other qualitative research, helps to create a vision of relevant climate change-driven events, whether wildfires, floods, poor air quality alerts, etc. Considering changes in the frequency and severity of these events over time is also important.
HHS calls for healthcare organizations to “establish and map the intensity and probability of extreme weather events.” The range of potential natural hazards can be extensive. Keep your assessment manageable by focusing on hazards more likely to happen in your area and those with stronger effects. For example, provider networks in Phoenix may not need to allocate attention to changes to freeze/thaw cycles.
Your context determines the depth of your hazards assessment. If your healthcare organization is based in a region with a highly resilient power grid, it’s probably not worth researching utility providers’ health and alternate power sources. That said, do consider cascading effects, such as wildfires taking out multiple generating facilities or requiring power cut offs. For example, backup diesel generators can’t be refueled if local gas stations are without power. Your organization might have to arrange for fuel shipments to successfully maintain operations and serve your community during prolonged extreme events.
3) Capacity assessment
To understand your institution’s resilience, understanding and cataloguing your capacity is essential. Most healthcare organizations have internal resources to enhance their resilience, including staff, emergency preparedness committees, redundant systems, and back-up power supplies. Resources outside your healthcare campus could include community warming/cooling shelters as well as emergency response personnel who could provide immediate support during a primary systems interruption or supplement resources during extreme events that overwhelm first-line capacity.
4) Campus vulnerability assessment
HHS calls for healthcare organizations to detail the consequences campuses and buildings may experience when exposed to hazards. Consider all that could possibly go wrong across structures, utilities, mechanical systems, and transportation. Be sure to include communications with the hospital, IT systems, and Internet access. What if personnel can’t get to the hospital campus? How would your organization’s supply chain be affected if key roads were repeatedly impassable?
5) Community vulnerability assessment
Extend your thinking about campus issues to your community. If the community around your campus is less resilient, that will inevitably put pressure on your facility. Think about the strain on your personnel and resources if your organization saw repeated patient surges due to climate-influenced and other disasters and emergencies. Scope the impact of your campus and facilities repeatedly becoming shelters or community gathering points during multiple emergencies in a year.
Cataloging assets and practical resiliency options
Effective climate resilience planning requires the viewpoints and skillsets of engineers, architects, planners, and scientists. Simultaneously, it requires understanding options for addressing these effects from planning and policy perspectives. While it may be challenging to gather and synthesize these perspectives, doing so helps ensure your organization can effectively implement the resiliency plan it creates. These two steps help capture data from the different disciplines throughout your organization:
Inventory all assets affected by extreme weather events or stressed by ongoing climate change. It is important to catalog every single system the hospital requires to function, including power, water, electro-mechanical, clinical, and IT. While listing individual pieces of equipment is not necessary, do think through important components and classes of assets.
For example, your IT checklist could include:
Software as a service (SaaS), cloud-based applications, and connections to off-site data centers;
Specialized equipment/functions, such as air conditioning for a server room.
Clinical asset checklists might include the above IT resources, but also include medical equipment, supplies, specific communication systems, operating room environmental controls, and more. Providers should also be thinking about key vendors necessary to maintain operations and challenging or even requiring these essential vendors to build their own climate resilience plans.
Identify concrete actions to enhance resilience to extreme weather shocks and climate stressors. ‘Feasibility’ is the watchword here. A healthcare provider threatened by rising coastal water or increasing river flooding probably won’t find constructing a seawall feasible on its own. However, the organization may find certain “softer” approaches more realistic. The “sponge city” concept – creating ways for unwanted water to quickly move away from the facility, using swales, permeable sidewalks, moving critical infrastructure located on lower levels, and water-retaining landscaping – is one emerging framework that reimagines resilience to floods. Other areas to consider:
Architecture. Make campus structures more defensive and sustainable. Emerging initiatives to create and promote climate-resilient building standards and codes can provide guidance backed by research, and existing guidance from FEMA and other organizations can be useful in going beyond existing building code requirements where appropriate.
Landscape architecture. Incorporate native and/or naturalized plants and hardscape structures to address local climate effects.
Planning. Create a resiliency overlay zone near facilities to encourage land use that may promote overall resilience.
Create a resilient community core. Develop a network of facilities outside your campus, such as places of worship and community centers, to build social networks and ties to engage during climate-driven events.
Power and communications. Support burying these lines whenever possible to reduce their vulnerability and move essential electrical infrastructure out of flood-prone basements.
Effective action can, and should, be planned on a variety of scales. For example, the Rockefeller Foundation’s 100 Resilient Cities initiative promoted “tactical resilience”, a strategy to empower property owners and small businesses to make localized but meaningful interventions to reduce flooding in a series of workshops with community leaders in Norfolk, Virginia. FEMA has published guides to assist homeowners in these kinds of interventions, most recently in its 2014 “Homeowner’s Guide to Retrofitting” which can be a source of ideas for providers.
Getting started with resiliency to benefit your organization and its community
Now more than ever, it is critical for healthcare organizations to develop climate resiliency so they can reliably fulfill their missions. Here’s how to get started.
Form a resiliency planning committee. Include representatives from emergency management, campus planning, sustainability, and other relevant areas to ensure the assessment, resiliency tactics, and overall plan accurately and completely reflect your institution’s context and issues. Identify community stakeholders in local government, peer institutions, and the general public as sources of input during various stages of plan development.
Gather existing plans and data. Collect plans, reports, and documentation from within your organization and from local, state, and federal sources. Look for preparedness plans, hazard assessments, flood plain maps, climatology reports, and historic loss data, among other data resources. Compile historic narratives and news stories where available, and consider interviewing long-term employees or community members who can provide additional angles to view past events.
Include current Community Health Needs Assessment. Improving your organization’s resiliency can enhance community health. Equity issues have a deep impact on the content in which your organization operates, from the demographics of your service area to the location of your campus and satellite facilities and more. Thinking about how your systemic resiliency efforts can serve your patients and community should be an integral part of their development process. Involve community representatives in this work.
A comprehensive climate risk assessment paired with smart and feasible resiliency options is foundational. Developing a plan that embraces the intention of the HHS pledge will help ensure your organization has the strength and flexibility required to endure the impact of climate change—on your campus and within the community you serve. Reach out to us to get started.
Adam Sachs, PE
Associate, Mechanical Engineer
Amy Pitts, MBA, BSN, RN
Medical Equipment Project Manager
Technology BIM Specialist
Angela Howell, BSN, RN
Senior Associate, Medical Equipment Project Manager
Anjali Wale, PE, LEED AP
Associate Principal, Senior Electrical Engineer
Arturo S Salud
Associate, Senior Electrical Designer
Austin Barolin, PE, CEM, LEED AP O&M
Senior Associate, Senior Energy Analyst
Chief Financial Officer
Bethany Beers, CCP, LEED AP BD+C
Associate Principal, Sustainability Practice Leader
Associate, Senior Electrical Designer
Brennan Schumacher, LEED AP
Associate Principal, Lighting Design Studio Leader