Climate resilience planning

Introduction to climate resilience planning

Hospitals play a critical role in any climate action plan by developing a climate resilience plan that ensures their continued operation and ability to support public health as climate change exacerbates health disparities and heightens the risk of a widespread health crisis. Since the White House and HHS launched the “Health Sector Climate Pledge” in 2022, the health care sector has increasingly focused on climate resilience planning. Health Care Without Harm and Practice Greenhealth are prepared to support these efforts and offer this guidance, co-created with a cohort of health systems, to assist those engaged in the resilience planning process.

Why plan?

Health care is on the front lines of the climate crisis. As climate events increase in frequency, duration, and intensity, hospitals and health systems face growing vulnerabilities that impact their ability to provide 24/7 care—especially to community members most in need. The pressures on operations, supply chains, capital expenses, and beyond make the costs of health systems being ill-prepared for climate events undeniable (To learn more, read "Safe Haven in the Storm," Health Care Without Harm, 2018).

The health impacts of climate change are being felt right now, particularly by underserved communities, such as communities of color, who are most vulnerable and traditionally underrepresented. These groups already experience higher rates of health disparities. There is a health equity imperative for health care systems to act now to reduce the impacts on patient populations and other community members. “In taking up the mandate to address climate, health, and equity collectively, health institutions will be reimagined—not simply as decarbonized versions of themselves, but as anchor institutions within healthier, more resilient, and more equitable communities” (To learn more, read "Tackling Climate and Health Disparities," Health Care Without Harm, 2022).

Health care organizations can use the climate resilience planning process to:

• Prepare for climate change impacts unique to their service areas.
• Improve and further integrate existing emergency preparedness plans.
• Build equitable community engagement into their planning processes.
• Prioritize among potential interventions to increase climate resilience.
• Comply with the resilience planning element of climate pledges like the HHS Health Sector Climate
• Pledge.

Planning guidance

Emergency operations plan

To comply with the national accrediting body, The Joint Commission, hospitals must have an Emergency Operations Plan (2022). The Joint Commission standards require these plans to include hazard vulnerability assessments, communication, patient care, security, utilities, disaster recovery, training, and more (Hospital Reference Guide). While climate-related emergency management topics like natural disasters, infectious diseases, and power systems are required, they are not specifically framed within the context of climate change.

An Emergency Operations Plan is a logical starting point for health systems to begin drafting their resilience plan, addressing broader climate vulnerabilities to enhance facility, community, and public infrastructure resilience.

Community health needs assessment

Another appropriate starting point for this work is through a system’s Community Health Needs Assessment (CHNA), which non-profit hospitals must complete every three years (To learn more, visit Delivering Community Benefit: Climate and Health Toolkit, Practice Greenhealth). Similar assessments are conducted at for-profit managed care organizations as well. CHNAs reveal the most pressing health concerns within a community, providing critical information for integrating health equity into climate resilience planning. To deepen your community engagement process, consider the principles outlined in Anchored by Health Care: Strategies for Health Systems, (Health Care Without Harm, 2023)

Merging and expanding Emergency Operations Planning and Community Health Needs Assessments with the responsible departments collectively establishes a more cohesive understanding of the risks to the hospital and the communities it serves.

In July 2023, the Office for Climate Change and Health Equity (OCCHE) released the following statement: "There is no required method or template for developing a climate resilience plan, but we encourage you to review the recently published Climate Resilience Plan Elements for Health Care Organizations, a document OCCHE developed to explain the key elements of climate resilience plans for health care facilities." In addition to OCCHE’s elements, Health Care Without Harm and Practice Greenhealth recommend considering the following guidance when identifying the core components of a climate resilience plan.

The landscape of climate resilience is constantly evolving, partly due to the nature of climate change itself, as well as the shifting resources and guidance on what constitutes a climate resilience plan across industries. While the health sector has been developing Emergency Operations Plans for years, climate resilience planning is relatively new. An effective resilience plan should address the unique needs of the community and the specific risk profile of the health system based on its geographic location, among other factors.

Health Care Without Harm and Practice Greenhealth recommend aligning the core components of a climate resilience plan with our three-pillar model for climate-resilient health systems and communities: health care facility resilience, public infrastructure resilience, and community health resilience.

Climate resilience plans should consider:

• The leadership, governance, and staffing within the health system.
• How to center health equity and justice, addressing environmental determinants of health from your risk assessment to the involvement of people and processes.
• The unique needs of the patient population and surrounding community, informed by geographic location.
• Extending the sector's caring mission to the community.
• Up-to-date climate and health research.
• Protection of human health and the ecosystem.
• Financing the implementation of the plan.

Apply framework

While the final product of the resilience plan will vary across health systems, all systems establishing climate resilience plans can follow a similar process. Health systems should use OCCHE’s Climate Resilience Plan Elements for Health Care Organizations and Health Care Without Harm’s three-pillar climate resilience framework to apply tools and methodologies from the climate and health field (see “Resources”) to their unique circumstances, while also drawing from exemplars in sectors outside health care. Additionally, facilities in large health systems that span diverse geographic areas with varying social vulnerabilities face different needs. System-level plans must be flexible enough to accommodate region-specific climate resilience, factoring in diverse geographies and communities.

Prioritize community engagement

Because climate change disproportionately impacts the health of vulnerable communities, it is essential to include these communities not only as a core “end user” of climate resilience planning but also in the plan’s development. To meet the needs of a community, one must first ask the community what it needs—in other words, “by the community, for the community” (To learn more, visit the National Academy of Medicine resource Assessing Meaningful Community Engagement, 2022). Therefore, health systems should first engage in stakeholder mapping exercises and take steps to include representatives of frontline communities before any “official” planning begins. Partnering for resilience: A practical guide to community-based disaster planning (Health Care Without Harm, 2022) showcases a successful approach to community-based partnerships and offers a methodology for partnering with the community in the process of establishing a climate resilience plan, including ready-to-use templates and sample materials.

Design the process

Across the literature, a combination of the following steps commonly guides the creation of a climate resilience plan:

(Adapted from USGCRP, 2021

While working through the steps above, we suggest hospitals utilize the following guiding principles for meaningful communication and collaboration, articulated in more detail in Anchored by health care: Strategies for health systems (Health Care Without Harm, 2023):

Evaluate and revise

The final step in developing a climate resilience plan is to establish a schedule for evaluation and revision; climate resilience plans should be “living” documents—not static. Not only will climate impacts, risks, and communities change over time, but a health system will also learn from its experiences in deploying its plan. Updating the climate resilience plan at regular intervals (e.g., every three years) will facilitate a more robust health system response over time, ultimately leading to healthier and more resilient patients and communities.

Health Care Without Harm and Practice Greenhealth have integrated their own climate resilience planning guidance with the plan elements suggested by OCCHE to create this recommended climate resilience plan outline for health care organizations.

Please note that we expect this work to evolve and shift as we learn from one another, and we will revise this outline based on those learnings.

Recommended plan outline

A number of excellent federal resources are highlighted in several resilience planning content areas. One in particular deserves specific attention from planners: "The U.S. Department of Health and Human Services' Sustainable and Climate Resilient Health Care Facilities Initiative (SCRHCFI) is an effort to help assure the continuity of quality health and human care before, during, and after extreme weather events."

The resources on resilience elements and the associated checklists are valuable tools to guide resilience planning efforts.

Highlighted plans