Constructing a framework of climate-resilient hospitals: systematic review of adaptation domains and indicators

Abstract Introduction Climate change poses significant threats to human health and healthcare infrastructure. Hospitals, as essential health service providers, must address these growing challenges while also reducing their environmental impact. Existing adaptation strategies remain fragmented and insufficient. Objective This study aimed to construct a comprehensive framework to guide hospitals in adapting to climate change, with a focus on identifying key domains and actionable indicators. Methods A systematic review was conducted in 2024, and the search strategy was rerun in January 2025 (no new eligible studies were identified) using international (PubMed, Scopus, Web of Science, Google Scholar) and Iranian (SID, Irandoc, Magiran, IranMedex) databases. Eligible studies (2000–2024) were assessed for quality using the QATSDD tool, and thematic synthesis was used to extract key adaptation domains and indicators. Results From 5,851 initial records, 30 studies met the inclusion criteria. Seven key domains and 165 indicators for hospital climate adaptation were identified: sustainable infrastructure, energy management, greenhouse gas emission reduction, leadership and governance, waste management, workforce capacity building, and education and awareness. Conclusion The purpose of this study is to systematically investigate the factors and indicators influencing hospital resilience and adaptation to the impacts of climate change. Furthermore, the findings of this systematic review will assist managers and policymakers in developing frameworks to enhance resilience, reduce environmental impacts, and align healthcare systems with global climate initiatives, such as the Paris Agreement. This review protocol was prospectively registered in PROSPERO (CRD420251001110). Clinical trial number Not applicable. Registration This review was registered in PROSPERO (CRD420251001110). Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251001110 . The datasets used and analyzed during the current study are available from the corresponding author on request.