Adapting and mitigating: an exploratory Delphi approach to climate change impacts on healthcare institutions in Switzerland

Climate change is increasing morbidity and mortality, exacerbating the imbalance between care needs and available resources. Peer-reviewed literature and international frameworks have emphasized the importance of health system resilience in the face of this growing stressor. Because effective action plans must be tailored to specific national, regional, or local contexts, this study focuses on Switzerland-a Central European country with a high-performing acute care system that is notably energy-intensive and heavily reliant on fossil fuels and imported supplies. Given that temperatures in Switzerland are rising faster than the Northern Hemisphere average, adapting the healthcare system and reducing its energy consumption are critical challenges. The study provides a systematic overview of the anticipated impacts of climate change on the Swiss healthcare institutions and explores their adaptation and mitigation needs. Employing a Delphi approach with ten international climate experts across three phases-semi-structured interviews with thematic analysis, prioritization, and final consensus-we developed a concise conceptual model comprising seven dimensions: (1) Health problems related to climate change, (2) Changing care needs and expectations, (3) Impacts on the functioning of healthcare institutions, (4) Vulnerability of healthcare institutions to the physical impacts of climate change, (5) Contextual factors, (6) Adaptation measures, and (7) Mitigation measures. A typology of items was created for each dimension. Of the 114 final items, 102 were deemed important with strong consensus. The findings complement existing evidence and aim to support healthcare institutions in assessing their external and internal environments to enhance resilience.