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
Who Is UHN?
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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
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
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
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
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
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
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
Score
Section
Assessing risks to inform emergency management and risk
reduction strategies
Score
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
Clinical risk management
74%
17%
Infrastructure and systems risk management
Energy supply and use
92%
94%
Sustainable health care and climate change mitigation
83%
71%
75%
average
weighted average
58%
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
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
Already in Place
• Buildings
– 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
Gaps
• Buildings
– 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 20-40 year focus on planning
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