CR4HC Case Study: CommonSpirit

CommonSpirit: Mission-Driven Climate Resilience

Image

Introduction 

In 2019, the Catholic Health Initiatives and Dignity Health combined to form CommonSpirit, a nonprofit health system that is dedicated to serving the needs of more than 20 million patients across 21 states (CommonSpirit, 2021). CommonSpirit recognizes that the United States healthcare sector is a significant contributor to global greenhouse gas emissions and that climate change affects human health and well-being (CommonSpirit, 2022).  As one of the largest providers of Medicaid services in the United States, CommonSpirit recognizes the disproportionate burden that climate change places on populations who experience barriers to medical care and other unmet health-related social needs. Its commitment to climate action aligns with its mission to improve the health of the people it serves, especially at-risk populations (CommonSpirit, 2023). 

Recognizing the importance of proactive action, CommonSpirit has signed the Health and Human Services Health Sector Climate Pledge to achieve net-zero greenhouse gas emissions by 2040 and developed a three-pillar climate resiliency plan (Assistant Secretary for Health, 2022). The first pillar addresses buildings and operations, which accounted for 25% of the health system’s greenhouse gas emissions in 2019. CommonSpirit aims to reduce operational emissions by increasing the energy efficiency of existing buildings, requiring new construction to meet net-zero design criteria, and switching to renewable energy sources. It aims to reduce emissions generated by buildings and through daily operations by half by 2030. The second pillar targets the supply chain, which accounts for 71% of the health system’s greenhouse gas emissions. CommonSpirit is working with other industry leaders to signal demand for a net zero supply chain. It is also educating healthcare vendors on how to reduce product emissions. The third pillar focuses on building climate resilient communities. Activities include

• conducting climate vulnerability mapping across CommonSpirit’s 24 states, 
• prioritizing Climate Resilient Community strategies (Climate Resilient Communities, 2022), 
• including climate vulnerability questions in its Community Health Needs Assessments, 
• supporting state and federal initiatives to bolster healthcare’s response to climate change, and 
• implementing clinical interventions to protect at-risk patients from the health impacts of climate change. 

In addition to its three pillars of action, CommonSpirit has created a climate-informed framework to apply to all of its hospitals’ emergency response plans. The framework is refined by each hospital to reflect local resources and meet the specific needs of each community. This includes coordination with local partners and tailoring response plans to local climate hazards. For example, hospitals in Los Angeles may conduct heat drills, those in the Midwest may practice tornado drills, and those on the Gulf Coast may prepare for hurricanes. By being responsive to regional climate hazards, emergency response plans incorporate targeted interventions to safeguard both patients and staff. 

Image

Responding to Extreme Heat 

CommonSpirit’s Dignity Health California Hospital Medical Center (CHMC), located in downtown Los Angeles, serves as an example of increasing resiliency to extreme heat. 

The hospital is situated five blocks from Skid Row, which includes one of the largest populations of people experiencing homelessness in the United States. Lack of shelter and housing insecurity are risk factors for heat-related illness, due to increased exposure to extreme temperatures. In recent years, record-breaking heatwaves in Los Angeles have led to surges in healthcare usage and emergency visits at CHMC, particularly among at-risk populations such as housing insecure individuals. Extreme heat events also strain hospital infrastructure because building equipment can fail when it overheats. The hospital’s unairconditioned mechanical rooms on the roof operate crucial equipment such as elevators and communications systems, which can malfunction during heat waves, posing a threat to patient transport, safety, and care.

To better identify and address challenges related to extreme heat events, CHMC’s Emergency Management Team conducted an extreme heat drill in 2018, the first of its kind on the West Coast. The drill revealed critical gaps in preparedness, including the inability of backup generators to provide cooling on inpatient care floors. To mitigate future risks, the hospital added air conditioning to the rooftop elevator mechanical rooms and collaborated with nonprofit Health Care Without Harm to develop educational materials on extreme heat awareness in both English and Spanish (Health Care Without Harm, n.d.). It also partnered with the Los Angeles Regional Collaborative for Climate Action and Sustainability to launch a heat campaign that issues heat wave alerts to Los Angeles residents and provides information on how to access local cooling centers (places community members can go to escape the heat and access supplies such as fans and bottled water) (Los Angeles Regional Collaborative, n.d.). The hospital is remediating infrastructure vulnerabilities by upgrading backup generators, enhancing energy efficiency strategies, and installing on-site sources of alternative energy to ensure consistent temperature control on patient care floors during power outages. These measures also reduce the hospital’s demand on the regional power grid, thereby minimizing its contribution to heat-related rolling brownouts and blackouts. 

Lessons learned from the extreme heat drill proved invaluable during subsequent emergencies, such as the COVID-19 pandemic and the threat of hurricane damage in 2023. The hospital ultimately avoided hurricane damage, but a sister hospital experienced power loss, prompting patient evacuations. CHMC not only maintained normal operations during the event but also accepted additional patients, demonstrating the value of its investment in developing a culture of operational and community resilience. 

Building Resilience Through Collaboration 

CommonSpirit Hospitals prioritize collaboration and community engagement to enhance preparedness and resilience in times of crisis. Its Incident Command Center, a central coordination hub during emergencies, brings together representatives from various hospital departments (e.g., purchasing, facilities, nursing, patient care, admitting, and patient discharge) to ensure that patients and providers are connected to the resources that they need. By fostering interdisciplinary collaboration among departments at every phase of emergency management, CommonSpirit ensures a cohesive and effective response to emergencies. 

In addition to internal collaboration, CommonSpirit values community partnerships, understanding their role in building strategic relationships that keep the community safe and enhance access to healthcare services. It works alongside local organizations to increase climate resilience, decrease greenhouse gas emissions, and provide essential services to local communities. For example, the Hope Street Margolis Family Center serves as a vital component of CommonSpirit’s Community Benefits Program. The Family Center supports families in need by providing essential food items and baskets, facilitating community communication, and offering childcare services. Moreover, the Family Center serves as a community hub, offering after-school care and adult education and serving as a meeting place for the community.  Partnerships such as these help to build community trust, mitigate psychosocial factors that can modulate the risk of climate-related health hazards, and create conduits for communication and delivery of essential services during and after disasters.