Welcome to Health Care Climate Change Resiliency Mentoring Webinar #6 Cohort #2 Infrastructure/System Risk Management, Energy Use Building Capacity, Sustainable Health, Mitigation (Q65-78) May 9, 2018 Canadian Coalition for Green Health Care

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Welcome Cohort # 2 Members Organisation City PR Champion Job Title 1 Halton Healthcare Milton/Oakville ON Kassondra Stockman Emergency Preparedness Advisor 2 Horizon Health Network Fredericton NB Blaine Lynch Regional Director Facilities, Engineering & Property Mgt. 3 Fraser Health Vancouver BC Rick Molnar Manager, Facilities Maintenance and Operations 4a Thunder Bay Regional Health Sciences Centre Thunder Bay Ann-Marie Heron Executive Director of Capital Planning & Operations 4b Ann Porter Manager, Nutrition and Food Services 4c Allan Korol Manager - Physical Plant Maintenance & Operation, Biomedical Engineering 4d Kathryn Shewfelt   4e Randy Mehagan Manager - Housekeeping, Laundry, Linen, Portering 4f Fraser Pennie Emergency Preparedness & Enterprise Risk Management, Consultant 5 Interlake-Eastern Regional Health Authority Selkirk MB Jay Ferens Regional Director of Disaster Management 6 Jason Mushaluk Regional Coordinator – Disaster Management 7 William Osler Health system Etobicoke Eddie Camilleri Corporate Energy Manager 8 TRANE Toronto Matthew Sharp Project Development Leader - Cpmprehensive Solutions 9 Markham Stouffville Hospital Markham Allan Kelly Manager, Plant Maintenance 10a Mary Yacoumidis Quality Assurance Associate, Facilities Services 10b Maria Pavone Director, Facilities and Support Services, Food Services 11 Trillium Healthcare Partners Mississauga Jen Wynne Sr. Analyst, Environmental Sustainability Program Lead 12 Hôpital Glengarry Memorial Hospital Alexandria Louise Quenneville Emergency Preparedness Coordinator 13a Childrens Hospital of Eastern Ontario - CHEO Ottawa Kim Greenwood Facilities Manager 13b Curtis Lavoie (Dr) Emergency Room Physician 14 Chartwell’s The Wynfield Long Term Care Home. Oshawa Shelly Rainford Environmental Services Manager 15 Hotel-Dieu Grace Hospital Windsor Richard White Director of Facilities and Support 16 Jason Schneider Supervisor, Environmental Services

Session Overview Housekeeping updates Any questions from last webinar? Infrastructure/System Risk Management, Energy supply and use (Q53-64) 3. TODAY - Building Capacity to Adapt to Climate Change: Sustainable Health and Mitigation (Q65-78) Prepare for Session #7 – May 30, 2018 Discussion – challenges, successes, lessons learned Questions (please prepare questions in advance) Exit Survey End of Mentoring Session

1. Housekeeping THANK YOU to those who submitted ENTRY Surveys. http://greenhealthcare.ca/mentoringcohort THANK YOU to those who submitted ENTRY Surveys. EXIT Surveys coming soon.

2. Review Items Log into Checklist http://greenhealthcare.ca/mentoring Contact us if you wish help to review any previous slides Don’t panic if it isn’t all coming together or is delayed Reach out to your fellow mentees Reminders Resource Guide – NOW AVAILABLE http://greenhealthcare.ca/mentoring-resource-guide Facilitator Slide Deck – SOON Editable w/LOTS of resources Does anyone want to do a ppt presentation to new team members?

2. Review Items Preparing Health Care Facilities for Climate Change – Resource Guide “Publications” Section at: http://greenhealthcare.ca/mentoring http://greenhealthcare.ca/mentoring-resource-guide Does anyone want to do a ppt presentation to new team members?

2. Review Items 2020 Health Care Climate Challenge Champions Awards Canadian Coalition for Green Health Care GOLD- Climate Leadership University Health Network GOLD- Climate Resiliency GOLD- Climate Leadership Synergie Santé Environnement SILVER- Climate Leadership Does anyone want to do a ppt presentation to new team members? Collectively, the 2017 Climate Champions and other reporting participants have committed to reduce their greenhouse gas emissions by 16 million metric tons of CO2e.

3. Review Items: HC Resiliency Checklist Section Subsection Questions Risk Assessment Assessing risks to inform emergency management and risk reduction strategies 14 Assessing risks to infrastructure and systems 5 Risk Management Risk Management to Reduce Climate-Related Risks 21 Procurement of Health Care Resources and Supplies 4 Notifications, Monitoring, and Surveillance 3 Clinical Risk Management Infrastructure and Systems Risk Management 8 Energy Supply and Use Building Capacity Sustainable Health Care and Climate Change Mitigation Total Questions: 78

3. Checklist: Instructions This checklist includes closed and open-ended questions. For each question in the checklist, please respond using the spaces provided. You may require additional resources when responding to questions. Please use the following answer key to help guide your responses: “Yes” indicates commitment to action. Action needs to be completed or in progress. “Somewhat” indicates that action is planned but concrete action has not yet been taken. “No” indicates that no action is planned or that no action has been taken. “I don’t know” indicates that not enough information is available to respond.   After each question, there is a text box for comments. Please use this space to provide additional information. For example, you may wish to document discussion points, reasoning for responses and/or to indicate if others should be consulted to help answer the question. In this next section you will start to use the the climate change risks you have identified.

3. Checklist: General Information ADVICE Concentrate on going through the thought process May not have all answers as of yet Don’t get discouraged Speed and covering ground isn’t everything Take your time … gradually influence sustainable change through actions of your team and organisation Remember to document how climate change is impacting your site (photos, videos, written notes, newspaper clippings) Document conversations w/key stakeholders (Emerg. team, facilities team, public officials, incident reports) In this next section you will start to use the the climate change risks you have identified.

3. Resiliency Checklist Outline Part 1: Assessing risks to inform emergency management and risk reduction strategies (Q 1-14) Part 2: Assessing risks to infrastructure and systems (Q 15-19) Part 3: Risk Management to Reduce Climate-Related Risks (Q20-40) Part 4: Review Risk Management, Resources, Procurement, Notification, Surveillance, Clinical Risk Management (Q 41-52) Part 5: Infrastructure/System Risk Management, Energy Use (Q53-64) Part 6: Building Capacity to Adapt to Climate Change (Q65-78)

3. Building Capacity to Adapt to Climate Change (Q 65) . A climate resilient health care facility recognizes and commits to sustainable practices that benefit the hospital and broader community. Examples of areas of sustainable management include energy efficiency, water conservation, environmentally responsible purchasing and food system sustainability. Does your health care facility undertake any of the following measures to be more sustainable?

3. Building Capacity to Adapt to Climate Change (Q 65) Climate Risk Yes Somewhat No I don’t know a. Establish health care facility CEO and senior management support and buy-in   b. Develop sustainability goals and action plans c. Secure funding for the implementation of sustainability measures d. Build awareness among staff, patients and visitors of the importance of being a sustainable health care facility e. Track sustainability performance (e.g. by identifying indicators of performance measurement, conducting a sustainability assessment, setting targets) f. Implement strategies and activities to continuously improve sustainable management g. Learn about new ways to be more sustainable (e.g. by assessing sustainable practices of suppliers, how to implement energy efficiency activities) h. Assess and revise sustainability strategies to incorporate new information and improve efforts to reach targets or achieve goals i. Build partnerships in the community with likeminded organizations or agencies to contribute to a resilient community j. Seek out funds for sustainability initiatives k. Undertake or invest in research on sustainable practices l. Report sustainability results to the public m. Other (please specify): _______________________

3. Building Capacity to Adapt to Climate Change (Q 66) Many jurisdictions in Canada have begun to address climate change by developing climate change plans and undertaking vulnerability assessments. Some of these initiatives may have roles for health care facilities or information that is pertinent to them. Is your health care facility aware of climate change adaptation or mitigation initiatives in your jurisdiction and how your health care facility could be involved? *Yes *Somewhat/Sometimes *No *I don’t know

3. Building Capacity to Adapt to Climate Change (Q 67) . Does your health care facility have an energy efficiency program? Please respond using the following scale: 1. Yes, an exemplary (e.g. award wining) program in place 2. Yes, a mediocre program in place but could use more resources/time 3. Somewhat, but the program has limited resources and could be improved 4. No 5. I don’t know

3. Building Capacity to Adapt to Climate Change (Q 67) Make Energy Efficiency part of the Business Case Facility Management – sell them on: Improved heating and cooling Better back-up power generators Finance Department – sell them on: Operational Cost Savings

3. Building Capacity to Adapt to Climate Change (Q 68) . Energy efficiency programs may include a variety of initiatives. Energy efficient initiatives contribute to resiliency by reducing future climate-related health risks (through GHG emission reductions) and reducing reliance on energy on a regular basis (to be better prepared when power supply is disrupted). Does your health care facility capitalize on any of the following energy-related resiliency opportunities?

3. Building Capacity to Adapt to Climate Change (Q 68) Resiliency activity Yes Somewhat No I don’t know a. Conduct energy audits   b. Set energy of GHG reduction targets c. Monitor or track energy use d. Evaluate energy reduction strategies e. Monitor cost-savings, GHG emissions reductions f. Educate staff, patients and visitors about energy reduction strategies (energy awareness campaigns), perhaps as part of an energy conservation program g. Design buildings using green design best practices (e.g. Leadership in Energy and Environmental Design), standards or guiding principles h. Install energy efficient equipment i. Install lighting control systems to minimize energy consumption (e.g. lights shut off automatically or are not used during daylight hours or in areas of the facility unused) j. Investigate the possibility of diversifying energy sources in your health care facilities jurisdiction (e.g. solar power, photovoltaic power, hydro-electric) k. Capitalize on energy use reduction incentive programs l. Design building according to local environment (e.g. considers natural landscape, slope of land, direction of the sun, whether building is located on a flood-plain) to reduce energy consumption m. Other (please specify): _______________________

3. Building Capacity to Adapt to Climate Change (Q 69) . A climate resilient health care facility contributes to community efforts to improve local air quality. Does your health care facility take any of the following measures to contribute to improving air quality in your community?

3. Building Capacity to Adapt to Climate Change (Q 69) Resiliency activity Yes Somewhat No I don’t know a. Learns about air quality initiatives in the community to identify its role in improving local air quality   b. Avoids the use of toxic chemicals whenever possible (e.g. in cleaning products and in products used in the hospital such as flooring and furniture) c. Plants greenery inside and outside the hospital d. Support local suppliers to reduce transportation mileage for supply delivery e. Supports (e.g. through policies or promotional messages) mass transit (public transit), carpooling or car sharing f. Supports (e.g. through policies or promotional messages) active transportation (walking, biking) as an optimal method of transport when it is safe to do so (e.g. if air quality is good, if it is not an extreme heat day) g. Implements tele-health (telephone or virtual patient encounters) wherever possible (especially if hospital is in a remote location) h. Learns how to minimize transport-related emissions by understanding how the facilities location / design impacts transportation uses i. Other (please specify): _______________________ How can your hospital contribute to improved air quality in the community you serve?

3. Building Capacity to Adapt to Climate Change (Q 70) . Does your health care facility have a water conservation program? Please respond using the following scale: 1. Yes, an exemplary (e.g. award wining) program in place 2. Yes, a mediocre program in place but could use more resources/time 3. Somewhat, but the program has limited resources and could be improved 4. No 5. I don’t know

3. Building Capacity to Adapt to Climate Change (Q 70) Wasted H20 = Wasted Energy Get creative Harvest rainwater in tanks, cisterns and ponds Landscaping and Irrigation (food and vegetable gardens) Toilet flushing Could help meet LEED requirements Krembil Discovery Tower – University Health Network Water Harvesting Don’t wait for an emergency to start investigating new best practices

3. Building Capacity to Adapt to Climate Change (Q 71) . A water conservation program could include a variety of initiatives. A climate resilient hospital takes measures to protect its water supply and to conserve water which benefits the community. Has your health care facility adopted any of the following water conservation related strategies?

3. Building Capacity to Adapt to Climate Change (Q 71) Resiliency activity Yes Somewhat No I don’t know a. Conduct a water-use audit   b. Track of monitor water-use for performance measures c. Evaluate water reduction strategies d. Monitor cost-savings of water use reduction strategies e. Increase awareness about water conservation and reducing water use in the facility among staff, patients and visitors f. Implement water conservation practices in medical treatments (e.g. water-efficient machines and equipment such as dialysis) g. Install of low-flow shower heads h. Install of low-flush toilets i. Implement water conservation practices in laundering services j. Implement water conservation practices in landscape development and maintenance activities k. Collect rainwater for use in the hospital (e.g. irrigation) l. Educate staff, patients and visitors about water reduction strategies (water conservation awareness campaign) m. Other (please specify): _______________________ Partner w/Infection Control for added benefit.

3. Building Capacity to Adapt to Climate Change (Q 72) 72. Does your health care facility have a sustainable (e.g. recycling program) waste-management program? Please respond using the following scale: 1. Yes, an exemplary (e.g. award winning) program is in place 2. Yes, a mediocre program is in place, but could use more resources/time 3. Somewhat, but the program has limited resources and could be improved 4. No 5. I don’t know

3. Building Capacity to Adapt to Climate Change (Q 73) . Sustainable waste-management programs could include a variety of initiatives. Minimizing waste production can have co-benefits (cost-savings, environmental benefits, health benefits) and contributes to a climate resilient health care facility. Has your health care facility adopted any of the following sustainable waste management strategies?

3. Building Capacity to Adapt to Climate Change (Q 73) Resiliency activity Yes Somewhat No I don’t know a. Audit all waste streams: general waste, biomedical waste, and liquid and hazardous waste   b. Conserve and reduce resources (i.e. reducing food-service waste, optimize use of surgical kits) c. Purchase re-usable products and products that minimize waste production from vendors and suppliers d. Establish effective waste segregation practices to reduce waste sent for incineration on or off-site e. Waste segregation to minimize biomedical waste f. Compost food service waste g. Maximize recycling of waste where possible h. Alternative disposal and treatment technologies (e.g. anaerobic digestion of organic wastes, with recovery of materials and combustion of biogas) i. Other (please specify): _______________________

3. Building Capacity to Adapt to Climate Change (Q 74) . Reducing (resource conservation), re-using and recycling contribute to a climate resilient health care facility because of environmental and health benefits in the short and long-term. Does your health care facility reduce, re-use and recycle in any of the services listed below?

3. Building Capacity to Adapt to Climate Change (Q 74) Health care service or unit Yes Somewhat No I don’t know a. Patient Care/Wards   b. Laboratories c. Administrative Areas d. Patient Services: Diagnostic e. Patient Services: Clinics/Therapeutics f. Patient Services: Intensive Care Areas g. Common Areas h. Building and Medical Support Services i. Food Services and Cafeteria (food served for public or consumers) k. Kitchens (food preparation for patients) i. Other (please specify): _______________________ Investigate life-cycle cost analysis while working to move away from ‘business as usual.’

3. Building Capacity to Adapt to Climate Change (Q 75) 75. Does your health care facility have an environmentally responsible purchasing program? Please respond using the following scale: 1. Yes, an exemplary (e.g. award winning) program is in place 2. Yes, a mediocre program is in place, but could use more resources/time 3. Somewhat, but the program has limited resources and could be improved 4. No 5. I don’t know

3. Building Capacity to Adapt to Climate Change (Q 76) . An environmentally responsible purchasing program could include a variety of initiatives. Health care facilities can contribute to a climate resilient community by investing in environmentally responsible purchasing that can help reduce greenhouse gases and air pollution. Does your health care facility undertake any of the following environmentally responsible purchasing activities?

3. Building Capacity to Adapt to Climate Change (Q 76) Resilience Activity Yes Somewhat No I don’t know a. Have a “green” / sustainable procurement policy   b. Implement purchasing audits across departments / units to inform how purchasing can be more sustainable c. Collaborate with vendors or suppliers on strategies for how to reduce packaging and reduce un-needed supplies (i.e. surgical kit reviews) d. Purchase reusable products instead of the disposable products whenever possible e. Adopt green procurement protocols to screen all products for environmental benefits and alternatives using third party certified labeling programs such as EcoLogo, Green Seal Energy Star and EPEAT to guide selections where possible f. Learn about how purchasing can influence environmental and human health and builds awareness at the hospital g. Other (please specify): _______________________

3. Building Capacity to Adapt to Climate Change (Q 77) 77. Does your health care facility have sustainable food program? Please respond using the following scale: 1. Yes, an exemplary (e.g. award winning) program is in place 2. Yes, a mediocre program is in place, but could use more resources/time 3. Somewhat, but the program has limited resources and could be improved 4. No 5. I don’t know

3. Building Capacity to Adapt to Climate Change (Q 78) . Sustainable food programs could include a variety of elements. Does your health care facility undertake any of the following sustainable food activities?

3. Building Capacity to Adapt to Climate Change (Q 78) Resilience Activity Yes Somewhat No I don’t know a. Diversify food suppliers to include local food vendors   b. Consider the feasibility of establishing on-site food gardens (e.g. greenhouse, roof top gardens) perhaps to raise awareness on the importance of using local food sources or to contribute to greening hospital landscape c. Procure local (as per your own definition) seasonal foods d. Participate in community initiatives that support farmers markets e. Communicate with food vendors about the desire to procure sustainable food products and assess vendors using sustainability criteria (e.g. organic, locally grown, seasonal products, vegetarian items) f. Other (please specify): _______________________ Your own on-site vendors (donut and coffee shops) could be a valuable source of support during climate incidents that stretch your own in-house food service resources.

4. Mentoring Schedule 12:00 AM EST / 9:00 AM PST Dates Topics Q #s #1 Wed Dec 6 Develop Site Team, Assess Local CC Risks, Feedback Loop, Resources #2 Wed Jan 17 Review Team Development & local CC Risks, Assess Climate-Related Risks 1-19 #3 Wed Feb 14 Review Risk Assessment Progress, Assess Risk Management 20-40 #4 Wed March 14 Review Risk Management, Resources, Procurement, Notification, Surveillance, Clinical Risk Management 41-52 #5 Wed April 18 Infrastructure/System Risk Management, Energy Use 53-64 #6 Wed May 9 Building Capacity, Sustainable Health, Mitigation 65-78 #7 Wed May 30 Review Building Capacity, Case Study Review, Exit Survey

4. Preparing for next Mentoring Call Review Challenges & Successes Update on individual progress What could we have done differently? What could we have done better? Request for testimonials - if comfortable Exit Survey coming your way in June

Funding for the Climate Change Mentoring project is provided by: An agency of the Government of Ontario, the Ontario Trillium Foundation (OTF) is one of Canada’s largest granting foundations. With a budget of over $136 million, OTF awards grants to some 1,000 projects every year to build healthy and vibrant Ontario communities. For more information, please visit: www.otf.ca 

Questions? Contact Your Mentors: Stewart Dankner stewart.dankner@uhn.ca Ed Rubinstein edward.rubinstein@uhn.ca Linda Varangu linda@greenhealthcare.ca Kent Waddington kent@greenhealthcare.ca