Embedding Climate Resilience into Healthcare

As climate change continues to intensify extreme weather events and air pollution, leaders in health are urgently working to ensure continuity of care in acute care settings. In a landmark contribution to climate-responsive health systems, Healthcare Management Forum published an article introducing the Climate-Resilient Acute Care Clinical Operations Framework (CRACCO), a pioneering tool co-developed by health system partners, including AbSPORU, and Dr. Bhavini Gohel, Clinical Assistant Professor at the Cumming School of Medicine and Section Chief for Medical Inpatients, Calgary health zone. The framework offers the first-of-its-kind guidance in Canada and a direct response to the climate change challenge — how do we integrate climate resilience into the very core of acute care clinical operations? It also comes as a direct response to the SPOR Refresh findings on addressing the critical impacts of climate change on health and healthcare systems.

AbSPORU’s Learning Health System (LHS) Team supported the development and success of the CRACCO Framework. AbSPORU’s LHS team served a central role in this collaborative effort, shaping both the conceptual foundation and knowledge mobilization tools.

A multi-level logic model was co-developed as a guide to effectively embedding climate change resilience practices into clinical operations across Alberta’s health system. In 2025, Dr. Ghoel and members of the LHS team published the article, “Climate-resilient acute care clinical operations: A framework that informs how operations within acute care build climate-resilient health systems.” featuring the Figure 1 graphic for the article (below) which, along with additional graphics and knowledge mobilization visuals, underwent scientific rigour and multiple revisions. The team produced a suite of knowledge mobilization visuals including a simplified version of the framework for use in presentations to increase uptake of the framework in more settings.

The collaborative contributions to the CRACCO Framework transformed it from a high-level vision into a practicable, actionable, and scalable tool that is currently informing climate resilience efforts within acute care settings. Its publication marks a significant step forward, positioning Alberta as a national leader in advancing climate-responsive health system strategies.

The framework has already garnered national attention. In the social network sphere, Craig Dedels, Regional Manager for Climate Risk and Resilience at Vancouver Coastal Health Authority, praised the work via a LinkedIn post, sharing positive remarks highlighting the article’s significance as a catalyst for action in translating research into meaningful system-level implementation.

The “Sextuple Aim” of a Learning Health System

The CRACCO framework supports the emergence of the ‘Sextuple Aim’, which adds environmental sustainability to the five traditional health system goals of patient experience, population health, cost containment, provider well-being, and equity. By embedding climate science and resilience into operational strategies—from reducing surgical waste to creating virtual care pathways—it closes the loop between evidence, implementation, and system improvement, which is core to a Learning Health System.

Early adoption by Alberta health-system partners has already shown positive outcomes:

• Surgical waste initiatives have lessened environmental impact without compromising safety;
• Virtual care and hospital-at-home programs have expanded access to services and reduced travel-related emissions;
• Sustainable Quality Improvement (SusQI) is reframing how quality and climate stewardship are approached together; and,
• Increased staff engagement in climate-related initiatives is fostering a culture of sustainability.

Equity and Patient Engagement Remain Top Priorities

At its forefront, the framework centers health equity and the patient voice. Because climate change disproprtionately affects equity-seeking populations, frameworks, such as CRACCO, must be co-designed with the populations that are most impacted. The “Bring Your Own Bag” initiative is referenced by the team as an example of enthusiastic public support for a low-waste, climate change related project that shows the public’s readiness to embrace climate-aware care when given the opportunity.

The CRACCO Framework takes a big step in the reimagining of acute care delivery in a warming world. It equips health systems with the tools to respond to climate change, not just as a risk, but as an opportunity to deliver smarter, safer, and more sustainable care.

Alberta leads in this space. The framework is scalable and evidence-informed, offering a compelling model for other jurisdictions to join us in building action and change in clinical operations in order to shape a more equitable and sustainable health system for generations to come.

The CRACCO Framework is one of several priority-driven research initiatives at the University of Calgary and supported by AbSPORU’s LHS Team.