Welcome to Health Care Climate Change Resiliency Mentoring

Welcome to Health Care Climate Change Resiliency Mentoring
Webinar #3 Cohort #2 Review Risk Assessment Progress, Assess Risk Management (Q20-40) February 14, 2018 Canadian Coalition for Green Health Care

Call in via Internet or Phone for Audio
For slides log into: Local call-in numbers Brantford Montréal Ottawa Quebec Toronto Vancouver Winnipeg Access Code: # Mute/Unmute Phone: press *6

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 Objectives Housekeeping updates: Resiliency Mentoring Logo
Selfies Entry Surveys Review any questions from last webinar: Assessing Climate-Related Risks Discuss: Assessing Climate-Related Risks (Q 20-40) Prepare for Session #4: (Q 41-52) Review Risk Management, Resources, Procurement, Notification, Surveillance, Clinical Risk Management Reminder – Mentoring Call Schedule

1. Housekeeping Photo and Job Title/Organisation Entry Survey
Photo and Job Title/Organisation Entry Survey

2. Review Items Log into Checklist http://greenhealthcare.ca/mentoring
Understand your Climate Change impacts Develop Resiliency Adaptation Team Consider need for slide presentation on this project to your team: Facilitators PPT being updated by our new Climate Change Intern Does anyone want to do a ppt presentation to new team members?

3. Checklist: General Information RECAP
Record Resiliency Adaptation Committee names In the community that your health care facility services, what is the approximate size of the population? What types of services does your health care facility provide? Patient statistics (# inpatient beds, daily ER visits) 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 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. 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. 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)

3. Risk Management to Reduce Climate-related risks (Q 20).
Climate variability and change are expected to create new risks and exacerbate existing risks in the future. Does your health care facility continue to ensure that the following risk management elements are accounted for and adequate? Support and funding are important items to attain from senior management but may be difficult to get them for ‘climate change’ risks. BUT build a strong business case.

3. Risk Management to Reduce Climate-related risks (Q 20)
Resiliency Activity Yes Somewhat No I don’t know a. Establish health care facility chief executive officer (CEO) buy-in to support emergency management activities and projects to improve the robustness of your facility? b. Secure funding for the implementation of emergency measures to increase resiliency to future climate-related emergencies (e.g. have a budget for emergency preparedness, or to improve redundancy or robustness of infrastructure or systems) c. Ensure that there are staff dedicated to emergency or disaster management activities and facilities operations and maintenance Remember to view through a CLIMATE CHANGE lens.

3. Risk Management to Reduce Climate-related risks (Q 21).
Climate variability and change are expected to increase emergencies related to the hazards listed in Question 1. Emergency management programs need to be robust to reduce climate-related emergency risks. Please consider emergency management (or disaster planning) activities at your health care facility. Are the following items included in your emergency management activities?

3. RISK MANAGEMENT TO REDUCE CLIMATE-RELATED RISKS (Q 21)
Resiliency Activity Yes Somewhat No I don’t know a. Specification of whom at the health care facility is accountable for the emergency management (or disaster planning) program [or equivalent] b. Specification of leadership and roles and responsibilities (lines of authority) for emergency management (or disaster planning) activities c. Emergency management (or disaster planning) hazard identification, risk assessment and analysis of response capabilities d. Emergency management (or disaster) plan to guide emergency response protocols and procedures in the event of an emergency or disaster e. Inclusion of emergency colour codes in emergency or disaster response plans f. Support for the development and implementation of emergency management (or disaster) plans and protocols g. Exercises, evaluations and updating of the emergency management (or disaster) program h. Collaboration and coordination with other health care facilities in the community Remember to view through a CLIMATE CHANGE lens.

3. RISK MANAGEMENT TO REDUCE CLIMATE-RELATED RISKS (Q 22).
An all hazards approach is often used by health care facilities to respond to multiple different hazards. If your health care facility implements an all hazards approach to manage emergencies, does the approach incorporate considerations of how future climate variability and change may affect risk management? You shouldn’t have to do it all on your own Important to have multi-disciplinary groups collaborating and providing each other w/feedback.

Seek a clear consensus among multi-disciplinary groups. When anticipating and brainstorming for risks, it is good idea to go through the “What if” analysis. “Self check” and incorporate not only ‘one’ event but ‘multiple’ events happening concurrently so you are better prepared. Murphy’s Law: what CAN go wrong, WILL go wrong.

Climate-related events affect the health of patients, staff and visitors and may also impact availability or access to resources (e.g. power, water, food, supplies, and drugs). Consider the hazards listed in question 1. Does your facility have plans or protocols for the hazards that pose a risk in your region?

Kelowna BC Flooding Example: Your health care facility experiences various forms of flooding events. But, when a boil water advisory is given out, is there enough bottled water within your facility? Are you going to outsource it from a supplier? How long will they take to deliver? Can they access the facility safely? Is there enough water for dialysis machine? Cooling towers? Is it safe for medical purposes? Are we able to get water in? Is the water issue a power issue, from aging infrastructure?

Utilise shared collateral/resource sharing! Essential to formalise shared agreements w/nearby or partnered hospitals so in case of emergency evacuations protocols are executed effectively. This is about long-term planning, sustainability and really looking at strategies that build resiliency for the future. Example: having back up energy supplies, ensuring important medical equipment is on emergency power sources, supplementary renewables, relocating major electrical infrastructure (generators - not having them on the bottom floor or first floor in case of a flooding event or making sure they stay waterproof etc.

Many health care facilities rely upon color codes to inform responses to an emergency. Whether your facility uses this system or a different one, is the emergency response system sufficient to guide responses to climate-related emergencies? CODE GRAY: Internal Infrastructure Failure CODE ORANGE: External Accident or Disaster

Climate change is expected to lead to longer periods of hot weather and more extreme heat events across Canada. Does your health care facility implement the following responses during an extreme heat event?

Resiliency Activity Yes Somewhat No I don’t know This is not a risk in my region a. Advise staff to closely monitor early indicators of heat illnesses and initiate appropriate treatment (check patient and room temperature, monitor fluid intake and output, pulse rate, and blood pressure) b. Consider indoor/outdoor temperatures when planning group activities c. Increase frequency of patient observations, especially of those at high risk d. Review clinical management of patients and residents most at risk either due to reduced mobility, chronic illnesses (pulmonary, cardiovascular, renal), and certain medications, social isolation, inadequate housing, or environmental factors (e.g. urban heat island, air pollution)

Long-term planning and adaptations in the event of extreme heat is essential. Do we have operable windows to increase ventilation? Are the right medical supplies (vaccines, medicines etc.) in the emergency chiller? Do we have enough power capacity to deal with the increasing influx of patients that are coming in with heat-related illnesses (heat stroke, heat edema, heat rashes, sun burns etc.) to provide adequate care and treatment? Is there proper communication between health care facilities and public health officials in advising the public (especially the most vulnerable: elderly, outdoor workers, etc.) to wear protective wear sunscreen and decreasing exposure to skin when outside? Population health (social determinants of heath) is really important and getting ahead of the curve and preparing for the scenarios on a long-term basis can be extremely beneficial.

Climate-related events may cause power-disruptions to occur at your health care facility. Does the emergency plan for your health care facility include actions to prevent or reduce health risks during a power-outage?

Resiliency Activity Yes Somewhat No I don’t know a. Secure and maintain generators and sufficient fuel supplies b. Ensure generators will function (e.g. fuel pumps are protected) c. Cool patients during extreme weather when there is no air conditioning d. Closely monitor and assist patients who are particularly vulnerable (e.g. infants, children, elderly) e. Secure adequate amounts of safe food for patients, staff and visitors f. Secure adequate amounts of safe water (e.g. for drinking, cooling systems, diagnostic and medical treatment) g. Secure and protect patient records h. Access needed pharmaceuticals

Medical Records Ongoing move to electronic patient records (EPR) and digital medical files exposes more vulnerabilities in terms of power disruptions. Utilising renewable energy, cogeneration supplies, being able to sustain off-grid for extended periods of time, (not hours but days) can be beneficial for health care facilities. It is important as well to have your medical records readily available - away from areas of moisture/flooding (i.e. NOT in the basement).

Building Design Moving towards new building design strategies where you are able to control power on different sections or floors of a building for better energy and power management CN Tower and how it was constructed in sections for electrical power to allow individual floor management). Utilise government/utility company funds for retrofits/renovations Ontario’s Microfit program saveONenergy

Contingency planning may become increasingly important for health care facilities with climate change if extreme weather results in more critical system (e.g. communications, electrical systems, water supply, resource supply, staff availability) disruptions or failures. Does your health care facility develop contingency plans if critical resources are limited or unavailable due to a climate-related emergency?

Emphasises is on supply chain management and the importance of know where your essential resources such as (i.e. medical supplies food and equipment is coming from (i.e. locally, provincially or even globally? Think Global An extreme weather event happens in Asia disrupting the supply of overseas critical medical supplies. UHN has to improvise to find alternatives source of supply. Take home message - planning is NOT good enough if you only account for local weather. MUST look at your supply chain and the location in which suppliers are located and ensure there is contingency plan or incorporate these ‘what if analysis’ with your emergency management plan.

Do officials representing your facility collaborate and coordinate with other health care facilities in your community to discuss risk management activities (e.g. determine lines of authority in an emergency)? Example: UHN is centralised supply hub for sterilization on University Avenue (Toronto). Consider developing partnerships between health care organisations. Conversely, if power were to be disrupted, what would happen to the other organisations that rely on this one supplier? Plans need to be written with clear lines of delegation and responsibility

Evacuations may be required if extreme weather damages a facility or creates conditions such that a hospital cannot deliver health care services. Does your health care facility include a regional approach to managing disasters if evacuations of two or more hospitals or facilities are necessary?

Do you conduct trial evacuation exercises? Ensure all medical staff know what their specific roles, where to go, which patients to prioritize for transport, to which hospital, and whether recipient hospital is prepared for incoming patients. What about rural hospitals? What contingencies or collaborations can they engage in with often limited options? Consider schools, colleges and universities to accommodate temporary influx of evacuated patients. Not every location has a neighbouring hospital that can help, so it’s all about planning and making best use of your available resources. Build resiliency through community engagement. Majority of Cohort #1 said they had not developed these relationships or exploited these resources, leaving ample room to improve.

In recent years, health care facilities in North America have been impacted by extreme weather events and will continue to be impacted by climate-related hazards. Health care facilities can learn from each other by sharing lessons learned and best practices. Does your health care facility collect best practices and lessons learned from other health care facilities that have experienced climate-related disasters?

Climate change may increase infectious disease risks in Canada by affecting the distribution and abundance of disease vectors and disease pathogens that can be transmitted to people. Does your health care facility implement strategies to reduce climate-related infectious diseases risks? Please specify strategies used. Infection Prevention/Control Team is essential in collaboration.

Resiliency Activity Yes Somewhat No I don’t know a. Implement routine risk reduction strategies (protection, cleaning, disinfection, sterilization) b. Undertake routine risk assessments (screening patients, client symptoms) to identify patients who may be infected c. Implement policies regarding routine hand hygiene d. Ensure that health care staff are aware of climate-related disease risks in your region (e.g. West Nile Virus, Lyme Disease, Encephalitis) e. Educate health care staff, patients and visitors on how to reduce risks of infectious diseases at the health care facility f. Regularly incorporate new information (e.g. best practices from government or accreditation bodies) on infectious disease risk management into plans and protocols

Tropical Diseases UHN’s Tropical Diseases group deals with infection control: tick borne (Lyme disease), vector borne diseases, and water-, air- and food-borne diseases. Education, awareness and screening are keys to prevention! Alerting the public of infectious outbreaks and encourage protective measures (i.e. wearing bug repellant, boosters, avoid stagnant water). Toronto is hotspot for tourists making some infectious diseases hard to control. Some care providers have become more efficient in containing epidemics and infectious diseases (SARS, Swine Flu, Tuberculous, Ebola, Measles, West Nile) Outbreaks offer opportunities to learn but often comes at price of human life. Ensure your staff is educated and aware.

A climate-related emergency may affect waste management practices at your health care facility. Does your health care facility have a contingency waste management plan if primary waste management processes are limited or unavailable in an climate-related emergency scenario?

UHN Waste Contingency Plans Waste backups CAN sometimes occur. Approximately 45,000 lbs of waste a day can be produced. Imagine not being able to dispose of your waste for a week or two. Implications that can arise may be dire! Failure to properly dispose of waste could disrupt delivery of critical health care services due to health and sanitation issues. Contingency plans for waste management include procuring outside vendors, having back up vendors, on-site garbage dumpsters, etc. This provides a great opportunity to introduce waste reduction programs.

Does your health care facility disaster plan include a protocol to receive external assistance from outside partners (e.g. other health care facilities, community, provincial agency, federal agency) in the event of climate-related emergency? Ensuring a healthy dialog with other nearby health care facilities and knowing how many resource they have available to assists in a climate-related emergency is important.

3. RISK MANAGEMENT TO REDUCE CLIMATE-RELATED RISKS (Q 34, Q35, Q36).
Does your health care facility have an evacuation plan to protect patients from a climate-related emergency or disaster? Are training exercises and drills to evaluate and validate disaster plans carried out at your health care facility regularly? If yes or sometimes, do the exercises include consideration of, or scenarios based upon climate related risks and hazards?

3. RISK MANAGEMENT TO REDUCE CLIMATE-RELATED RISKS (Q 34, Q35, Q36)
Ensure when your planning for contingency that climate is incorporated. Most hospitals will have emergency management plans in case of fire emergencies and usually when going through practice drills people are evacuated in sections. In a climate-related disaster, the case may arise where the entire building needs to be evacuated. Example: Kelowna BC and the unavailability of domestic potable water - an important issue that comes up in real day-to-day scenarios when city loses water or shuts its off due to a contamination issue. Sadly, we don’t always prepare adequately for these types of incidents.

Do you participate in activities (e.g. drills, committee meetings, planning exercises) in the community that enhance your ability to respond to a community wide, climate-related disaster? Does your city/town have access to provincial and municipal command centres that run in conjunction with the broader community?

3. RISK MANAGEMENT TO REDUCE CLIMATE-RELATED RISKS (Q38).
Is the broader community (e.g. fire, police, paramedics, public health) or persons knowledgeable about climate-related risks (e.g. climate experts) consulted, engaged, considered or invited to contribute when your health care facility’s emergency management program is tested, evaluated and updated?

3. RISK MANAGEMENT TO REDUCE CLIMATE-RELATED RISKS (Q38)
Partner with local emergency response groups (fire, emergency, policy) for better management. Educational resources are sometimes provided to personnel and can be beneficial to your organisation because they usually have annual trainings. Partnering provides an excellent forum to share resources and gives room to foster a healthy dialog of shared information.

Directly after a climate-related emergency or disaster, opportunities exist to raise awareness of climate change impacts and to plan and implement actions to be more resilient to future climate-related events. Please indicate if your health care facility takes advantage of this opportunity via the following initiatives. Important to write/record all impacts to assist in determining if they are related to climate related events. Early planning for the next incident is key!

Resiliency Activity Yes Somewhat No I don’t know a. Develop after action reports that include how to be more resilient to climate-related emergencies or disasters in the future b. Secure financial relief to respond to immediate needs ( e.g. repair damages, care for patients, reimburse staff) c. Allocate disaster relief funds towards activities that increase resiliency (e.g. training, increase supplies, strengthen back-up systems) d. Allocate disaster relief funds towards activities that increase redundancy or robustness (e.g. making your health care facility safer from climate-related disasters) e. Seek out information or learn from others about how to reduce future risks from a similar type of event f. Other (please specify): _______________ Business Continuity is important during and after an event.

This question is for officials who manage emergency response protocols. Please consider if a climate-related disaster were to affect your health care facility tomorrow. Please indicate for each item below, how confident you are in the ability of the staff at your health care facility to respond effectively. Ensure that a climate lens is incorporated and find gaps that people have not yet exploited. It will be beneficial to have a business continuity plan.

Resiliency Activity Highly confident Somewhat confident Little confidence Not confident a. Assessing the incident situation accurately and efficiently b. Notification of staff and leaders in a timely manner c. Taking charge promptly d. Mobilizing staff promptly and effectively e. Determining if an emergency operations centre (EOC) is required in a timely manner f. Develop an incident action plan driven by clear objectives in a timely manner and that includes a clear and accurate assessment of the situation and contingencies to determine objectives, resources and actions g. Identifying resource requirements and assign roles and responsibilities effectively and timely h. Implement an operational business cycle that clearly specifies how key personnel involved in the emergency response meet to exchange information, identify issues, and set objectives and to expand the emergency management personnel and resources required as necessary i. Effectively demobilize and transition to recovery

3. RISK MANAGEMENT TO REDUCE CLIMATE-RELATED RISKS
Questions?

4. Preparing for next Mentoring Call
Review Risk Management, Resources, Procurement, Notification, Surveillance, Clinical Risk Management (Q41-Q52) Procurement of Health Care Resources and Supplies Notifications, Monitoring, and Surveillance Clinical Risk Management

5. Resources Climate Change Resiliency Mentoring
About Climate Change - CCGHC

6. Mentoring Schedule 11:00 AM EST / 8:00 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 To be confirmed 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

6. Case Study Organisation Case Study 500 words Quote from CEO or other C-suite member 1-2 Photos w/captions Permission from CEO to share DRAFT September 1 Formal 10 min Presentation September 13 LATER – Co-Branded Coalition Case Study

6. Case Study Content Climate Change Impacts in your organisation
Organisation intro How has organisation has been impacted by climate change incidents? How did you immediately respond the impact? What has organisation done to prepare for future incidents? Quote from CEO Plans for moving forward Lessons learned Contact info

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:

Questions? Contact Your Mentors:
Stewart Dankner Ed Rubinstein Linda Varangu Kent Waddington

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