Measuring Climate Resiliency: A Virtual Roundtable Discussion
In February 2023, the Agency for Healthcare Research and Quality hosted a roundtable discussion to advance the science on how to identify or create climate resiliency measures for healthcare delivery organizations. This invitation-only, interactive roundtable discussion convened health system leaders and public health preparedness and resiliency experts to discuss how healthcare delivery systems are currently measuring, reporting, and acting on resilience. Dr. John Balbus, interim director of the Department of Health and Human Services (HHS) Office of Climate Change and Health Equity, facilitated the meeting.
- Michelle Dardis, M.S.N., M.B.A., P.M.P., The Joint Commission
- Robin Guenther, F.A.I.A., LEED Fellow, Perkins&Will and Health Care Without Harm
- Rachel Lookadoo, J.D., University of Nebraska Medical Center
- Kelly R. McKinney, M.P.A., NYU Langone Health
- Kalpana Ramiah, Dr.P.H., M.Sc., America’s Essential Hospitals
- Sohel Saikat, Ph.D., World Health Organization
- Renee Salas, M.D., M.P.H., M.S., Harvard T.H. Chan School of Public Health
- Elizabeth Schenk, Ph.D., R.N., F.A.A.N., Providence
- Walt Vernon, P.E., LEED AP, E.D.A.C., F.A.S.H.E., Mazzetti
Together, the group was asked to assess whether current measures exist that are appropriate for developing a facility-level measure or measure set of a healthcare facility’s ability to maintain core functions and services during and after a climate emergency (climate resiliency). If validated measures do not yet exist, what are the appropriate methods for developing and evaluating measures of facility-level climate resiliency?
It was clear during the meeting that consensus on measures is currently lacking, yet the group identified many potentially productive avenues to move the field forward. Key themes and conclusions from discussion included:
- Resilience is inherently a local, place-based challenge with threats and responses dictated by aspects including geography, care setting, and population characteristics. Given this variation, it may be difficult to develop meaningful common facility-level metrics other than “checkbox” process measures, like whether a facility engages in comprehensive preparedness planning. Relatedly, healthcare facilities do not exist in a vacuum. Climate events affect entire communities and regions, and so preparedness and resilience may be better conceptualized and measured at this level (with specific attention to the needs of particularly vulnerable groups).
- Nonetheless, a superset of facility climate resilience measures might prove useful to further test disruptions in operations (e.g., ICU shutdowns) and threats to good care (e.g., excessive wait times, damage to medications) from which organizations could select, depending upon their context. The relationship of these measures to existing, already-collected measures, such as patient safety measures, should be explored.
- Systems and facilities may need better conceptual frameworks that would guide the selection and development of resilience measures. The measurement purpose matters in measure development and implementation. It is critical to understand whether the purpose is accountability or quality improvement, as each has differing considerations and costs on implementation.
- Little to no research appears to be available evaluating the relationship between existing efforts to measure and increase resilience and actual outcomes in the face of climate events. It may be beneficial to conduct empirical research to identify characteristics of healthcare facilities that perform better than others during climate events and then work toward measures and guidance that predict resilience based on those traits. However, there are significant data and methodological challenges in conducting this type of research and making any causal inferences.
Information from this meeting will form the basis for further discussion among Federal stakeholders that work on health system resilience, helping to refine the health services research agenda on this topic and improve pre-existing HHS resilience tools and self-assessments. The important relationship between operational resilience and operational sustainability should also be considered in any such conversation.