With record-breaking temperatures increasingly becoming the new normal across Canada, and catastrophic wildfires and floods a not-too-distant memory, the time for climate resilience planning was yesterday. Globally, we have seen 1.1 °C of warming since pre-industrial times, and Canada is warming faster than the global average, due to its northern latitude.
At the 2022 Canadian Healthcare Engineering Society (CHES) British Columbia chapter conference in Whistler, I was joined by Craig Dedels, manager of Climate Risk and Resilience for Vancouver Coastal Health, and Jolene McLaughlin, Sustainability director at EllisDon, in a session titled, ‘Planning and designing for climate resilience in health facilities’. We unpacked and demystified how to integrate climate resilience into healthcare facilities, and showed how sector leaders could drive meaningful change in the collective efforts for a resilient, low-carbon future. Here is a summary of that session to inspire healthcare design teams to consider their shared responsibility in building a climate-resilient Canada.
A call to action
Climate resilience in the healthcare sector in Canada begins with the health authorities. The Energy and Environmental Sustainability (EES) team is a regional collaborative that supports Fraser Health, Providence Health Care, Provincial Health Services Authority, and Vancouver Coastal Health in the transition toward low-carbon, climate-resilient, and environmentally sustainable, health systems in British Columbia. The EES team categorises these efforts into seven interrelated focus areas: climate change; energy and carbon; materials; transportation; water; food, and leadership and innovation. The strategic framework – presented as an infinity symbol (Figure 1) to reflect the work as a journey that requires continual improvement – acts as a guide to support staff in enacting transformation across the healthcare sector
Developing climate resilience guidelines
The events of the past few years have shown how climate-related hazards are already impacting health infrastructure, operations, and supply chains, creating challenges for healthcare workers and the communities they serve. However, while it has been clear that there’s an immediate need to take action within the healthcare sector, where to begin has yet to be identified.
In 2019, Integral Group began working with the EES team to create the Climate Resilience Guidelines for B.C. Health Facility Planning and Design (see Figure 2). Launched in late 2020, after more than a year of multi-sector collaboration with health organisations, industry experts, and others, the guidelines provide planners and designers with information necessary to identify and address the key impacts of climate change on new healthcare facilities.
Overall, the guidelines help users in identifying potential strategies to manage risk and enhance resilience; strategising site planning, facility design, equipment selection, or long-term operations, and prioritising measures that work synergistically to advance goals for the facility – making the most of resources, strengthening health service delivery, and enhancing livability for users.
Lessons from the field
Design teams have begun to apply these guidelines to different stages of the design process – from planning, to procurement, to implementation, of various acute and long-term care projects across the province. They include Cowichan District Hospital, Royal Columbian Hospital, and St. Paul’s Hospital. The process has resulted in tangible successes, such as using future climate projections to limit overheating, and enhanced filtration approaches to account for increasing instances of wildfire smoke. These projects have also served to build internal and industry capacity to understand how changes in climate are likely to impact healthcare facilities, and how to address them.
Planning: Cowichan District Hospital
The Cowichan District Hospital replacement project in Duncan, British Columbia, involves construction of a new community hospital on a nine-hectare greenfield site in a relatively undeveloped rural area on Vancouver Island. Integral Group was asked to conduct a highlevel exposure screen and climate risk assessment to identify the main hazards and impacts that could threaten the facility, and to establish strategies necessary to mitigate them. Working to identify these issues at an early stage allowed the team to define resilience objectives and criteria that could be considered throughout the project, acting as a touchstone to ensure their meaningful integration into design outcomes. The study also showcased the value of multistakeholder interviews and workshops, which enabled the consultant team to acquire in-depth knowledge of health authority protocols and initiatives relevant to the owner, harness the design team’s diverse and deep technical expertise, and pinpoint local governments, First Nations, and other external groups, who could bring valuable insight into the work.
Procurement: Royal Columbian Hospital
The Royal Columbian Hospital redevelopment in New Westminster is one of the largest healthcare projects in the province’s history, consisting of a multiyear, three-phase approach to transform the entire facility. EllisDon was selected as the design-builder for Phases 2 and 3, construction of the acute care tower, and hospital expansion, with a climate risk assessment being a key element of the project scope. The design-build team was joined by hospital Planning and Operations team members in a two-day workshop to identify the most significant hazards, and determine how the design might perform in the future. After setting the stage with future climate scenarios, the team worked through a series of activities to prioritise risks based on their likelihood of occurring, and the consequences should they take place. With key risks identified, the groups looked to solutions, using cross-representation to help evaluate options from different perspectives. Risk mitigation measures deemed low-cost and high reward were prioritised for review by all workshop participants. In the end, a list of measures that could improve the overall climate resilience of the building was developed for consideration – including both design and operational solutions to support the longevity of the asset.
Implementation: St. Paul’s Hospital
Once climate risk assessments are complete, it falls to the project team to integrate the resilient design strategies necessary to address the highest risks into the actual design and construction of the facility. The new St. Paul’s Hospital in Vancouver, a large-scale redevelopment of a major acute care complex, is emerging as a prime example of sustainability and climate resilience integration
Using the owner’s statement of requirements as the basis, the climate resilience compliance team developed two tools to help implement design goals through an iterative cycle aligned with LEED (Leadership in Energy and Environmental Design) review practices.
The first consisted of a self-assessment checklist that outlined all resilience-related requirements, and created a feedback mechanism for the design team to ensure that those requirements have been met and provide evidence for each item. The Compliance team’s role was to assess the adequacy of each response, to determine if more information was needed before final review and sign-off.
The second tool was the Resilience Summary Report that details how climate resilience was incorporated into the final design. This was essential in obtaining relevant input from each design discipline to provide a holistic picture of the project, and build a clear narrative for further communications. By keeping the owner’s needs at the fore of each design stage, the team maintained climate resilience continuity through the design process.
Key conclusions
Overall, the experience has shown that each team member has a critical role to play in the successful design and construction of climate-resilient facilities. Healthcare authorities are key in pushing for greater facility resilience by creating or leveraging standards, and developing benchmarks for climate resilience in the healthcare sector. Their involvement throughout the process as resilience champions, coupled with clinical stakeholder engagement, is vital to the success of resilient facility design
Project managers must consider climate resilience early and iteratively throughout the project lifecycle to meaningfully inform design decisions, while engaging a diverse, cross-disciplinary, and well-informed team to mitigate risks. Design-build teams need to engage in the project assessment process to understand the context and implications of different design choices. It’s imperative that they acknowledge that old standards are not suited for future climate conditions, and that collaboration is critical to everyone’s success.
Resilience teams must be involved throughout the process – from developing the statement of requirements, to ensuring proper measurement, documentation, and compliance. They are there to provide climate information and guidance, and to help define and navigate what elements should be considered across all disciplines.
This article, titled ‘Adapting to Climate Change: Guidelines for planning and designing resilient healthcare facilities’, first appeared in the Autumn 2022 issue of Canadian Healthcare Facilities, the magazine of the Canadian Healthcare Engineering Society. HEJ thanks the author, CHES, and the magazine’s publisher, MediaEdge, for allowing its re-publication here