Supina Mapon (Courtesy of DPR Construction)
Between 2020 to 2025, the National Centers for Environmental Information (NCEI) estimated an average of 23 U.S. weather and climate disasters per year, each causing at least $1 billion in inflation-adjusted damages. This same period also includes record setting years: 22 billion-dollar disasters in 2020 and 28 in 2023, highlighting a trend that such events are becoming more frequent and more expensive, fueled by development in high-risk areas, aging and vulnerable infrastructure, and severe weather patterns linked to a warming climate.
Hospitals are increasingly caught in the middle. Even as extreme heat, wildfire smoke, flooding, hurricanes, and grid disruptions become more common, many health systems are postponing resilience upgrades to focus on immediate cost pressures. Yet climate change is no longer a “rare event” problem—instead, it’s become a recurring operational threat that directly affects patient safety, care, and financial stability.
Robert Meyer (Courtesy of DPR Construction)
The return on investment (ROI) for resilience is compelling. The National Institute of Building Sciences found $6 of benefit for every $1 spent on federal mitigation grants. A separate U.S. Chamber of Commerce study reports $13 saved per $1 invested in resilience and preparedness. These returns reflect avoided downtime, reduced damage, and faster recovery—benefits that compound over the life of a building. Resiliency starts with understanding the specific risks a facility faces and making intentional trade-offs to keep it functioning when conditions deteriorate.
The following strategies highlight practical steps that health systems can take to translate resilience principles into actionable decisions.
1. Know the regional risks and regulations
The hazards facing one region may be entirely different from those in another. Many areas are now experiencing long stretches of extreme heat that were far less common in previous decades. Facility planners have responded by installing robust cooling systems, automated temperature controls, sun-resistant exterior materials, and onsite solar generation paired with battery storage. These strategies help maintain stable indoor conditions and reduce strain on the grid.
Regulatory frameworks are also evolving. Codes and standards, like International Building Code (IBC) and American Society of Civil Engineers (ASCE 7) structural hazard criteria, are beginning to limit the embodied carbon of building materials. Integrating these requirements early in design is far more efficient and less costly than retrofitting mid-construction.
When planning, consider assessing regional climate projections for the next 10-20 years, not just historical conditions, so infrastructure strategy reflects the hazards that are emerging in your area. In parallel, staying ahead of upcoming code and standard updates can reduce the risk of late-stage redesigns that can ripple through budgets and schedules. Because carbon constraints are increasingly woven into regulatory overlays, it helps to treat embodied-carbon considerations as a first-order design input; doing so early can prevent material substitutions and procurement delays later. Finally, resiliency shouldn’t live in a separate checklist. Embedding these requirements into capital planning and major maintenance standards makes them repeatable, fundable, and easier to implement consistently across the portfolio.
2. Building envelope is the first layer of protection
The building envelope should be designed for the conditions the site is most likely to face. In hurricane zones, the greatest risks come from wind and flying debris. Impact-resistant glazing systems, secure roofing assemblies, and anchored exterior components help prevent catastrophic breaches. In wildfire-exposed areas, embers, heat, and smoke pose the greatest risk. Ember-resistant vents, non-combustible exterior wall assemblies, and protected entry vestibules can significantly reduce infiltration and ignition.
While some of these strategies are enforced by local codes, many requirements represent only the minimum threshold or apply where similar weather events have occurred. Designing for both known hazards and low-probability, high-impact events give hospitals a stronger chance of protecting patients, staff, and critical equipment.
Consider evaluating the envelope as a true life-safety system by testing how it performs under multiple hazard scenarios—not only the most common regional threat, but also the low-probability, high-impact events that can overwhelm “code-minimum” assumptions. In many locations, that means selecting wall, roof, opening, and vent assemblies with proven performance across conditions, such as components tested for impact resistance alongside fire and ember exposure, so the hospital can maintain continuity of care by limiting breach, infiltration, and ignition when it matters most.
3. Prefabrication for fewer onsite vulnerabilities
Many hospitals are now using prefabrication as part of their construction approach. Beyond improving schedule certainty and reducing waste, it also minimizes exposure to weather during construction. When large assemblies are built in controlled environments, they remain protected until installation, reducing the risk of storm-related damage, rework, and delays. This approach also improves jobsite safety and maintains project momentum during unpredictable weather seasons.
Begin with a resilience-first prefabrication strategy by identifying the assemblies where offsite fabrication most meaningfully reduces weather exposure and protects critical performance, such as building-envelope panels, rooftop mechanical/electrical skids, or other large systems vulnerable to moisture, wind, and temperature swings during installation. Because prefabrication shifts risk from the field to the supply chain, plan logistics early so crane picks, laydown space, access routes, and staging areas remain workable through storm threats and seasonal disruptions. And as you evaluate modular options, prioritize systems that don’t just accelerate today’s delivery, but also enable future upgrades or expansions with minimal downtime supporting long-term adaptability as climate conditions and care demands evolve.
4. Powering hospitals through a blackout
If the grid goes down, hospitals need reliable additional sources of power to remain operational. Many hospitals now incorporate on-site solar generation and battery backup with emergency generators to support both short- and long-duration outages. In some regions, wind or geothermal systems can provide extra capacity. These systems work best when planned into the building from the start. Equipment must be sized for essential loads, maintenance access must be planned, and transfer systems should be easy to test and operate.
Match power generation methods to local site and climate conditions so the mix of solar, storage, generators—and, where feasible, wind or geothermal—can perform reliably during the same extreme events most likely to disrupt the grid. Because resilience depends on sustaining essential operations, size storage and long-duration capacity around critical loads and realistic outage durations, not best-case assumptions. Then design distribution, transfer, and control systems for safe, efficient maintenance and routine testing, with clear access and straightforward operating sequences, so the system is dependable throughout the facility’s life.
5. Reduce the cost of a potential hospital shutdown
The Cross Dependency Initiative (XDI) analyzed physical climate risk across 200,216 hospitals and estimated that one in 12 hospitals worldwide, including one in 16 in the United States, will face high risk of partial or total shutdown from extreme weather events by the end of the century. If a hospital closes, financial losses start immediately. Direct costs include repairs, equipment replacement, and restoring damaged areas. Indirect costs include moving services off-site, paying for temporary space, and losing patients to competing facilities.
Planners can start by pinpointing which departments and functions are most critical to maintain during an extreme event and align protection strategies for clinical, operational, and infrastructure accordingly so a disruption doesn’t cascade into a full shutdown. Modeling downtime scenarios can quantify the true financial exposure, capturing both the immediate direct costs (repairs, equipment replacement, remediation) and the indirect impacts of relocating services, leasing temporary space, and losing volume to competing providers. With that baseline in hand, evaluate available incentives, funding mechanisms, and insurance considerations that can help offset upfront investments and strengthen the business case for resilience upgrades before the next event tests the facility.
6. Anticipate change
Keeping a hospital operational during severe weather takes early planning, ongoing evaluation, and a willingness to make difficult financial trade-offs. Climate trends are constantly evolving, and facilities must be designed with adaptability in mind.
That commitment shows up in the basics done exceptionally well. Ongoing areas for improvement should include:
- Strengthening foundations where soil conditions and flood exposure demand it;
- Improving site grading and drainage so heavier rainfall events don’t overwhelm the campus;
- Upgrading envelopes and roofing to better withstand stronger storms;
- Elevating or hardening critical systems to reduce the chance of catastrophic loss;
- Reinforcing paving and access routes to maintain reliable ingress and egress during emergencies.
When these upgrades are prioritized through regular assessments and capital planning cycles, hospitals build lasting resilience—protecting patients, staff, and continuity of care, regardless of what the next season brings.
Supina Mapon is a healthcare strategist for DPR Construction in San Francisco and can be reached at [email protected]. Robert Meyer is a healthcare strategist for DPR Construction in Chicago and can be reached at [email protected].
