1. Climate Change Resiliency Planning in Canadian Hospitals
Taking the Lead
Climate Change Resiliency Planning in Canadian Hospitals
Kady Cowan & Stewart Dankner
PAHO Health Care Climate Change Resiliency Workshop
Montreal, September 8, 2015

2. Who Is UHN? Toronto, Ontario, Canada 3 acute care sites
4 rehab facilities
2 research towers
15,000+ staff and 1,200 beds
over 6.5 million ft2 of buildings

3. Prompt to Action Largest Hospital Group in Canada
Internal Energy and Environment department dedicated to sustainability since 1999
UHN is a founding member of the Canadian Coalition for Green Health Care and held Board Chair seat since 2007
Availability of the checklist was incentive to convene workgroup
Some senior leaders at UHN were supportive of this work

4. Process Proposal
Recruited workgroup members from the Emergency Management Committee
Identify climate risks
Conduct checklist assessment together
Discuss options for what would be useful to the organization beyond our resiliency score

5. Workgroup Members Internal and external collaboration
Convened workgroup with members across disciplines including external advisors from the City of Toronto and Toronto Public Health
Core internal team
Strategic planning, Facilities, Emergency Preparedness, Emergency Department, Patient Safety and Clinical Risk, Energy and Environment
Internal consultation
Nutrition Services & Infection Prevention and Control, Procurement

6. Objective and Approach
Know our climate change risks, vulnerabilities and dependencies
Decide how to address them
Agree on:
Weather parameters
Time horizon
Who to include in the process
What final product we want

7. Start with what we know Used City of Toronto climate model
Priority weather parameters are extreme heat and rain with extreme cold secondary
Time horizon of 5-10 years is maximum to keep administrative attention
Discuss what people, programs, departments are in place already at UHN to compliment this process
Themes emerged around Buildings, Patients, Staff and Culture

8. Complete the Checklist
Divide the checklist for independent research with the right people
Time to coordinate the process 5-8 days
Meet face-to-face 4 times to complete the checklist collaboratively
Time invested by workgroup members 2-3 days
Answered from the perspective of the current state

9. Score
Section
Score
Assessing risks to inform emergency management and risk reduction strategies
58%
Assessing risks to infrastructure and systems
59%
Risk management to reduce climate related risks
91%
Procurement of health care resources and supplies
68%
Notifications, Monitoring and Surveillance
74%
Clinical risk management
17%
Infrastructure and systems risk management
92%
Energy supply and use
94%
Sustainable health care and climate change mitigation
83%
average
71%
weighted average
75%

10. Process Lessons
Some of the wording in the questions was ambiguous and difficult to interpret
In many places we are doing things that contribute to resiliency but not because of climate change
Prompted us to think about how climate change changes our circumstances
Not all questions are going to apply to all organizations
There was an instinct to resolve the issues as they were identified. It was important to save those conversations for the next phase of planning

11. Resiliency Lessons
The resiliency score in each section illuminates where we need to concentrate our efforts going forward
Community collaboration is critical
Building organizational buy-in to address the findings from the checklist
We can demonstrate what we are already doing blends with climate change planning
We can raise the profile of climate change as an organizational priority

12. Already in Place Buildings Patients Staff Culture
Experience with 2003 blackout
Code grey
Annual facility condition index
Patients
Evacuations drills
Mass Causality preparations
Staff
Business continuity
Ebola preparations
Culture
Acceptance of bringing in new knowledge
Green Team

13. Gaps Buildings Patients Staff Culture
Buildings not designed to fit with a changing climate
Patients
Limited patient education on climate change
Staff
Personal preparedness and ability to cope with climate impacts
Culture
Generally not a year focus on planning

14. Outcomes
Plan to handle information revealed during the checklist process
Provide a strategic direction for master planning, capital planning and upgrades
Continue with workgroup and reporting mechanism to provide recommendations to EMC
Connection with the broader community