Climate Change Adaptation Strategies in Hospital Settings: Protocol for a Scoping Review

This project is a scoping review that aims to systematically identify and map definitions, strategies, and, in particular, indicators used to monitor and assess hospital adaptation to climate change. Hospitals are critical components of health systems and are increasingly exposed to climate change-related extreme weather events such as flooding, heat waves, storms, wildfires, and heavy rainfall. Although adaptation and resilience are frequently referenced in policy and research, there is currently no comprehensive synthesis of indicators that can be used to measure and assess hospital adaptation to climate change. Existing reviews in the healthcare sector predominantly focus on climate change mitigation, while adaptation and especially its measurement remains insufficiently examined. The primary purpose of this review is to address this gap by providing a structured overview of how hospital adaptation to climate change is defined and operationalized in the literature, with a particular emphasis on the indicators and approaches proposed to monitor and evaluate adaptation strategies and measures. The review seeks to answer how hospital adaptation is conceptualized; which adaptation strategies and measures have been reported; which indicators have been suggested to assess adaptation; what data sources and measurement techniques are used; and which other sectors and actors are identified as essential for hospital adaptation. In addition, the review will examine the geographical origin of the available literature and explore whether the distribution of evidence corresponds to regions most severely affected by climate change. The scoping review will include peer-reviewed and grey literature published from 2010 onwards in English or German, encompassing all study designs, including qualitative, quantitative, mixed-methods, and conceptual sources. Eligible sources must explicitly define or describe hospital adaptation strategies or measures related to climate change-associated extreme weather events, or propose or apply indicators to assess such strategies and measures. Data will be systematically extracted using a standardized charting form to capture information on adaptation strategies, indicators, adaptation dimensions, and data sources. The findings will be synthesized through descriptive mapping, tabular and graphical presentation, and narrative analysis to identify patterns, gaps, and areas of convergence and divergence in the existing evidence. The expected outcome of this project is a comprehensive mapping of indicators and assessment approaches used to measure hospital adaptation to climate change. By consolidating and categorizing these indicators, the review aims to support future research, inform the development of monitoring and evaluation frameworks, and contribute to evidence-informed decision-making for climate-resilient hospital systems.