Health Facility Planning & Design in a Changing Climate

In 2020, BC’s health authorities released the Climate Resilience Guidelines for BC Health Facility Planning and Design (version 1.1) to help ensure that climate risks are identified and reduced to acceptable levels in the early phases of a major capital project (approximately 10 years) such that the next 50-100 years of operations are set up well to manage residual, new and compound risks. The guidelines are intended to better equip BC’s health facilities and health system stakeholders with the data and information needed to help ensure that the present and increasing challenges of climate change have minimal impact on the health system’s ability to deliver services to the public. Their development was compelled by the fact that health facilities and services across British Columbia are already facing challenges from climate change that lead to strains, disruptions and cascading impacts on patients, health staff, and communities of care as a whole. The document is intended to guide the planning, procurement and implementation phases of a Design-Build project. Where needed, key elements may be modified and improved upon to serve other facility types, procurement models, and existing facilities. Lessons learned in implementing the guidelines will inform future iterations. The guidelines were developed with the input, support and guidance of an industry Task Force, a multidisciplinary Advisory Committee, a BC Health Authority Working Group, and a Steering Committee over an 18 month period. Special thanks to Integral Group and BC Housing for technical and financial support.

Understanding and Assessing Impacts

Health care facilities in BC face a multitude of challenges from a changing climate, including an increase in overall temperatures and extreme heat events, wildfires and air quality concerns, and more frequent and intense storm events. For example:

  • Increasing daytime temperatures will be experienced at all facilities. By 2080, the number of days warmer than 25°C will be four times greater than in the past, requiring an increase in operational costs for cooling.
  • Days above 30°C will increase dramatically at every site. Facilities may experience a surge in patient visits due to heat stress.
  • Warm nights will increase significantly by 2080. The ability of patients to heal may be reduced.
  • More frequent and intense storms will occur, and flood risks will increase with 1m sea level rise by 2100.

The set of hazards deemed to be of greatest relevance to projects in BC and explored within the Resilience Guidelines includes:
1) Warming temperatures and extreme heat;
2) Air quality impacts;
3) Flooding;
4) Power outages; and
5) Chronic stressors, specifically water shortage and drought, moisture and humidity, freeze/thaw cycles, snowfall, and wind.

Underlying these risks is the constant risk of seismic events and pandemic events. While these are not climate hazards, they have the potential to compound with the climate risks above. The Guidelines therefore consider potential synergies and conflicts of designing for climate resilience and designing for facility resilience more broadly. Both direct and cascading impacts of climate change can hinder the ability of health care facilities to provide community care by presenting in the following risks: Health services disruptions and supply chain disruptions from increased strain as extreme events (e.g. flooding, wildfires, heat waves) lead to an increase in hospital visits. Higher operational costs, including increased energy costs and necessary staff overtime, will reduce the ability of facilities to provide care. Infrastructure damage and energy system impacts: Physical damage to facilities from storms and flooding can threaten building integrity and compromise sanitary conditions. Increases in air contaminants from wildfire activity, pollen and other sources can infiltrate through building envelopes, impacting the ability of HVAC systems to maintain adequate indoor environmental quality. Increasing temperatures and greater variability in conditions will place increased strain on equipment, leading to mechanical failure and unexpected equipment purchases. Off-site infrastructure and resource demands: Strain on municipal sewer infrastructure from increasing precipitation, for example, can lead to bacterial outbreaks placing additional pressure on hospitals. Damage to utilities and roads from extreme weather events can impede supply chains and the ability of people to reach the facility.

Identifying Actions

The Resilience Guidelines are designed to be easy to use for all involved parties, including Health Authorities, Compliance Teams, and Project Proponents. The primary steps involved in improving facility resilience and the key roles and expectations of each major actor involved are summarized in the Process Diagram (Figure 1), and fall under one of three broad phases: Planning and Design, Procurement and Implementation.

Phase 1: Planning & Design – This section provides an overview of planning and design in relation to the facility delivery lifecycle, focusing on the early stages where it is most cost-effective to reduce risk and where it is most feasible to maximize co-benefits. It also introduces the Climate Risk Assessment process, which is later described in detail. The Climate Risk Assessment process used in the Guidelines is informed by the BC Climate Risk Assessment Framework, ISO 14090, the PIEVC Engineering Protocol, the International Council for Local Environmental Initiatives Canada’s (ICLEI) Building Adaptive and Resilient Communities (BARC) approach, Australia’s CoastAdapt, among others. The Climate Risk Assessment comprises four key steps:
1) Climate Hazard Exposure Screen
2) Preliminary Climate Risk Assessment
3) Climate Risk Assessment Workshop
4) Climate Resilience Compliance Audit
Details for each step are outlined below including purpose, timing and responsibilities. Options and alternatives, such as a “quick starts” and short-cuts are provided in boxes throughout.

Phase 2: Procurement – Project & Consultant – This section provides an overview of key components and competencies required to enable climate risk assessment in planning and design. It outlines make clear expectations of Compliance Teams, Proponents and Consultants. The text within this section can be used to populate requests for proposals, contracts and scopes of work.

Phase 3: Implementation – Resources & Resilient Design Strategies. This section provides descriptions and links to resources to inform the Climate Risk Assessment process, along with recommended resilient design strategies to serve as a starting point for Design Teams.

Process Diagram (en Anglais seulement)

Process Diagram for projects following the Climate Resilience Guidelines for Health Facility Planning and Design.

Image of a sustainable urban rainwater management project in the City of Vancouver. The schematic includes incorporation of greenscaping as a way of not only beautifying the streetscape, but also to provide functional purposes such as rainwater management and small areas of habitat refugia. The image shows the integration of sustainable design with climate adaptation actions. Specific foci are on the inclusion of more city street trees, native plants, areas for pollinators, rain gardens, and the creation of common spaces for gathering.


Guidance for developing and implementing resilient designs is provided in Step 3 of the Climate Risk Assessment, where proponents plan and complete a Climate Risk Assessment Workshop. The workshop may integrate components of different methodologies (e.g. fault tree analysis, PIEVC Protocol analysis) to test whether a set of strategies and pathways is likely to achieve resilient design objectives (e.g. maintain thermal comfort in an extended heatwave), co-benefits (e.g. occupant health) and synergies (e.g. seismic resilience).
As the final step in the Workshop Part process, participants will conduct a high-level evaluation of generated strategies to highlight those strategies most worth pursuing. Workshop participants work collaboratively to brainstorm ideas to strengthen existing resilient design strategies, as well generate new strategies to fill in any identified gaps. Participants consider using the criteria applied in the Preliminary Climate Risk Assessment (Step 2) to evaluate strategies for:

  • Effectiveness in fulfilling the requirements and enhancing resilience;
  • Effort and/or resources required;
  • Costs (both operating and capital) and return on investment;
  • Synergies and co-benefits with other organizational priorities; and
  • Risk threshold.

Furthermore, the Resilience Guidelines provide the following recommendations when developing resilient design strategies and implementation pathways: • Consider multiple levels or scales concurrently • Anticipate interruptions and change • Allow for iteration and continuous improvement • Emphasize ‘no-regrets’ options and implementation pathways • Prioritize simple, flexible and durable design strategies • Cultivate synergies between strategies

Outcomes and Monitoring Process

Guidance for monitoring and evaluating implemented actions is provided in Step 4 (Climate Resilience Compliance Audit). The Climate Resilience Compliance Audit serves to inform how the Successful Proponent’s design sufficiently addresses climate risks and Project requirements, and confirm any equal-or-better alternatives. The intent is to establish a collaborative and iterative mechanism for the Successful Proponent, Health Authority, and Compliance Team (or Independent Climate Risk Auditor) to review the evidence base provided by the Successful Proponent and ensure that resilient design objectives are met.

Next Steps

The Resilience Guidelines is a living document intended to be revised and updated periodically. It is expected that this will be an ongoing “work in progress”, and as such, no “final” version is likely to be issued.


Link to Full Case Study

Additional Resources:

Further understand how climate information can be applied in decision-making by exploring the Health Module on