“Superstorm Sandy showed us we were vulnerable to climate-driven extreme weather events. The storm and its aftermath caused us to intensely focus on resilient and sustainable design."
– Paul Schwabacher, P.E., Senior Vice President, Facilities Management
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KEY TAKEAWAYS
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The challenge
When Hurricane Sandy struck its Manhattan main campus in 2012, NYU Langone Health experienced a total loss of $1.4 billion in lost revenue and damaged facilities, equipment, and research – in addition to its staff and patients experiencing substantial stress.
Hospitals and health systems are at the front lines of climate-related disasters. As climate change increases the intensity, duration, and geographic reach of extreme weather events; development grows in high-risk regions; and communities struggle with weak infrastructure, health care organizations must strengthen their resilience. In 2023 alone, there were 28 confirmed weather/climate disaster events with losses exceeding $1 billion each to affect the United States. These events included one drought event, four flooding events, 19 severe storm events, two tropical cyclone events, one wildfire event, and one winter storm event. These events resulted in the deaths of 492 people and had significant economic effects on the areas impacted.
When Hurricane Sandy struck its Manhattan main campus in 2012, NYU Langone Health experienced a total loss of $1.4 billion in lost revenue and damaged facilities, equipment, and research – in addition to its staff and patients experiencing substantial stress. According to Federal Emergency Management Agency (FEMA) flood maps, Hurricane Sandy had a 0.2% annual probability of occurring and was rated as a 500-year storm when it happened, a weather event far more intense than the campus was built to handle. The industry standard for designing facilities is to withstand 100-year storms. Hurricane Sandy served as a wake-up call for NYU Langone’s staff across the health system at all levels. The flood and climate risk to the institution was much more significant than predicted by existing FEMA flood maps and other resources. More recents storms and flooding events are showing that FEMA’s flood maps are increasingly outdated due to climate change.
NYU Langone Health's story is featured in the report Safe haven in the storm: Protecting lives and margins with climate-smart health care.
Start your climate resilience planningSince the White House and HHS launched the "Health Sector Climate Pledge" in 2022, the health care sector has increasingly focused on climate resilience planning. To support that important work, Health Care Without Harm and Practice Greenhealth have collaborated with a cohort of health systems to co-create this guidance to assist those engaged in any stage of the resilience planning process.
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The solution
NYU Langone Health launched a strategic and proactive initiative to integrate climate resilience and sustainability into the institution's core operations.
Hurricane Sandy's destruction in 2012 compelled NYU Langone Health’s leadership to embrace resilience and sustainability. The health system embarked on a multifaceted strategy to fortify its infrastructure, enhance its emergency preparedness, and adopt eco-friendly practices. These initiatives strengthened the institution's capacity to withstand climate-related calamities, reduce its environmental footprint, and establish a benchmark for other health care institutions.
“The institution had to seek solutions that went above industry standards in health care and FEMA requirements at that time. This required creating an openness to the ‘what ifs’ and building a culture of resiliency within the decision-making process.”
– Kelly McKinney, Assistant Vice President of Emergency Management + Enterprise Resilience
NYU Langone's approach to enhancing resilience to climate change was more than just a reactive response to the devastation caused by Hurricane Sandy. Instead, it represented a strategic and proactive initiative to integrate climate resilience and sustainability into the institution's core operations. The comprehensive strategy involved a multifaceted approach that included:
Infrastructure design
NYU Langone integrates resiliency and climate preparedness objectives into its construction capital projects and master planning and design decisions. The institution’s design guidelines include an environmental sustainability section that dictates green building components that must be evaluated and considered for all eligible renovations and construction projects. These infrastructure standards prioritize sustainability performance early in the project planning process and support the institution’s goal of carbon neutrality by 2050.
The Real Estate Development & Facilities Department staff design facilities and campuses to protect critical and energy infrastructure by:
- Enhancing infrastructure capacity and redundancy (e.g., IT, energy, emergency generation)
- Hardening campus perimeters with flood protection, raising critical infrastructure, and planning for long-term risk management.
- Ensuring that construction projects adhere to green building features as dictated in the design guidelines
- Developing system-wide energy and decarbonization strategies
- Ensuring that building systems and equipment – including resiliency infrastructure like flood gates and ventilation controls – operate as intended
Emergency preparedness & risk management
Within NYU Langone’s annual hazard vulnerability analysis, climate change is included as a force multiplier of the institution’s key hazards that can have cascading impacts on the institution’s infrastructure and cause disruptions or pressure on clinical operations. The analysis features a section on climate change as an inherent risk that will, in many cases, increase the likelihood of future incidents. It also outlines climate change as a threat, especially in facilities prone to leaks and flooding where critical areas may be impacted. The risk severity of each hazard type is scored using a literature review of city-wide, national, and private reports; internal historic incident datasets; stakeholder surveys; and focus groups.
Operations & management
Establishing design standards and risk assessments requires collaboration across many institutional departments and Board of Trustee committees to ensure accountability and effectiveness. The Emergency Management and Enterprise Resilience (EM+ER) Department proactively tracks and assesses extreme climate events and has robust workforce communication in place so that all staff know their role and can implement safety measures. The EM+ER Department conducts workshops and tabletop exercises and trainings to practice and prepare for potential incidents such as natural or human-caused disasters and climate-driven events like flooding and power outages.
In 2023, EM+ER conducted 50 exercises and trainings at acute care locations, surpassing the Joint Commission's requirement of 8 per year.
The Office of Government Affairs tracks climate-related issues at federal, state, and city levels. The Board of Trustee committees on capital planning, audit, and environment of care indirectly address climate-related issues in their existing operations and goals.
Hurricane Sandy prompted NYU Langone to reimagine resilient and sustainable design and embrace opportunities for change as extreme weather events become increasingly frequent and intense. The staff had to work across departments to seek solutions that exceeded industry standards in health care and FEMA requirements, which required creating a culture of resiliency within the decision-making process.
Understanding why resiliency and sustainability are essential and how climate may impact operations is an important driver for embracing change and innovations and influencing current and future master planning and design.
Lessons learned
NYU Langone’s staff refer to the analogy of a laptop to understand and explain the lessons they’ve learned from their experiences.
The FEMA mitigation funds that NYU Langone received were spent to increase the resilience of its hardware, but the expansion of the EM+ER team and overhaul of the program addressed the deficiencies in its software: knowledge, processes, and procedures. These software enhancements and a 24/7/365 proactive approach to emergencies and disasters prepared the institution and its staff for a new climate reality.
By using less energy, health systems reduce exposure to utility interruptions and vulnerability to power outages during peak electrical demand.
Finally, staff learned the importance of understanding energy and greenhouse gas emissions reduction as resilience measures. By using less energy, health systems reduce exposure to utility interruptions and vulnerability to power outages during peak electrical demand. Addressing resilience in both infrastructure and operations allows an institution to prepare and react quickly during specific incidents while simultaneously ensuring the institution is not contributing further to climate change through increased emissions.
Several key ingredients led to NYU Langone’s success in its resilience efforts:
Collaboration across departments
NYU Langone recognized the importance of fostering a collaborative spirit among stakeholders. The institution engaged staff from different departments, including facilities management, engineering, and emergency preparedness, to ensure that resilience initiatives were integrated into the institution's overall operations. The collaborative approach facilitated open communication, shared responsibility, and a unified commitment to enhancing resilience.
Partnership with Practice Greenhealth
NYU Langone sought expert guidance and technical assistance from Practice Greenhealth. This partnership provided NYU Langone valuable insights, best practices from across the sector, and guidance to develop and implement resilience-enhancing measures.
Cultivating a resilience-driven culture
NYU Langone went beyond simply implementing resilience-enhancing measures; it instilled a culture of resilience within its decision-making process. The institution prioritized climate adaptation and sustainability goals alongside traditional health care priorities, ensuring that resilience considerations were embedded into every aspect of their work. This shift in mindset fostered a proactive approach to addressing climate-related risks and enabled NYU Langone to adapt and evolve in the face of changing environmental conditions.
Sustainability and resource management
Energy-efficient practices, reducing waste generation, and promoting recycling and composting reduced the institution's emissions impact and generated cost savings.
NYU Langone integrated sustainability principles into its operations to reduce environmental impact and contribute to a healthier planet beyond resilience measures. The institution implemented energy-efficient practices, reduced waste generation, and promoted recycling and composting. These efforts reduced the institution's emissions impact and generated cost savings and enhanced resource management.
Monitoring and continuous improvement
NYU Langone established a system of monitoring and evaluation to assess the effectiveness of its resilience initiatives and identify areas for improvement. The institution regularly reviewed its resilience plans, conducted risk assessments, and analyzed data to ensure its strategies aligned with its evolving needs and the changing climate landscape.
The results
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NYU Langone Health's comprehensive strategy to enhance resilience to climate change significantly safeguards both patients and staff. Infrastructure upgrades - such as raised floors, perimeter barriers, and flood doors - reduce the risk of damage to buildings from rising sea levels and storm surges. Additionally, comprehensive disaster response plans and extensive staff training ensure the institution can effectively respond to climate-related disruptions, minimizing their impact on patient care and staff safety.
NYU Langone’s commitment to environmental sustainability also significantly reduced the institution's environmental footprint. Energy-efficient practices, such as using renewable energy sources, have contributed to substantial reductions in greenhouse gas emissions. Waste reduction and recycling initiatives minimized the institution's environmental impact while conserving valuable resources. These efforts also yielded financial benefits for NYU Langone Health. Energy efficiency measures led to substantial savings on energy costs, while waste reduction and recycling efforts reduced waste disposal expenses. These cost savings demonstrate the economic viability of sustainability initiatives and underscore their alignment with the institution's overall financial goals.
The benefits of resilience are manifold, including avoiding loss of life and mitigation of reputational risk. When Hurricane Sandy struck the Manhattan main campus in 2012, the estimated mitigation cost was $589 million, with an additional $1.13 billion provided by FEMA to support recovery and future-proofing. Following this incident, the EM+ER expanded its mission to include resilience and business continuity planning, added the School of Medicine and offsite locations to its scope, expanded its team to 13 staff from 2 staff, and created an executive leadership position. NYU Langone now holds annual protocol reviews and exercises on coastal storm preparedness to ensure all relevant staff understand their role during incidents.
“We now embed resilience into all aspects of our planning and design, our emergency preparedness procedures, and our comprehensive hazard vulnerability analyses – while increasing our energy efficiency work to mitigate our contribution to climate change”
– Paul Schwabacher, P.E., Senior Vice President, Facilities Management
The Manhattan main campus has since been redesigned with resiliency as a priority to address the vulnerabilities Hurricane Sandy brought to light. The 3.5 million square foot campus includes ten interconnected buildings ranging from hospitals and research facilities to classrooms and administrative offices. The campus is supported by an 11 MW capacity combined heat and power plant and 26 MW of emergency power. To protect research operations, NYU Langone installed an alarm system that detects temperatures outside the normal range for all freezers and refrigerators, conducted resiliency and hazard assessments of all labs, and placed critical equipment on emergency power.
The campus also features a comprehensive flood barrier system, with perimeter barriers, pumps, and flood doors to prevent storm surges from entering the facilities. The robust HVAC controls in Kimmel Pavilion’s patient care areas on this campus also allowed the hospital to respond quickly during the COVID-19 pandemic and to switch patient rooms to negative pressure on demand, illustrating how resiliency measures can strengthen clinical care capabilities during extreme weather events and pandemics alike.
Altogether, these efforts led the institution to achieve the U.S. Green Building Council's Performance Excellence in Electricity Renewal (PEER) certification at the platinum level in 2018. PEER is an ongoing performance-based certification, and the campus was recertified at the highest Platinum level again in 2023. NYU Langone’s Manhattan main campus continues to be the first medical campus in the world to achieve both USGBC PEER and LEED at the platinum level.
About NYU Langone Health
NYU Langone is a leading academic medical center with over 51,000 full-time staff and 11.3 million outpatient visits per year. The health system has more than 13 million square feet of space and serves the New York City metropolitan region and southeastern Florida. NYU Langone consists of NYU Grossman School of Medicine and NYU Grossman Long Island School of Medicine, both part of NYU, and more than 300 locations throughout the New York metropolitan area, including six inpatient facilities. NYU Langone is a large and complex organization committed to addressing health equity issues and providing care to all patients, regardless of their socioeconomic status. The medical center is a leader in innovation and research and constantly works to improve its quality of care. NYU Langone is ranked #3 in the nation and #1 in New York State on U.S. News & World Report’s 2022-2023 “Best Hospitals Honor Roll.”
