Bridging the gap between heat action plans and practice: a qualitative study on the implementation of heat protection measures in German hospitals

Abstract Aim To examine the implementation and feasibility of heat protection measures in German hospitals and to assess gaps between recommended heat action plans and routine practice. Subject and methods A qualitative study combined a comparative analysis of four model heat action plans for hospitals and five institution-specific plans with semi-structured expert interviews with hospital representatives responsible for heat protection ( n = 7). Selected literature on the effectiveness of heat protection measures was additionally reviewed to contextualize the qualitative findings. Interview data were analyzed using thematic analysis. Results Substantial gaps were identified between recommended measures, their inclusion in institutional plans, and their actual implementation. Existing heat action plans covered technical, organizational, and personal measures but placed greater emphasis on patient protection than employee protection. Across hospitals, implementation was incomplete and often limited to low-threshold interventions. Frequently implemented measures included drinking water provision, ventilation, and adaptation of food supply, whereas resource-intensive technical measures were less common. Major barriers were financial constraints, staff shortages, and limited awareness of heat-related risks. Facilitating factors included internal cooperation, exchange between institutions, and occupational safety regulations. Conclusion The main challenge of hospital heat protection appears to lie less in generating further recommendations than in implementing existing ones. Low-cost organizational measures, such as heat warning communication, hydration strategies, flexible clothing rules, and adapted workflows, may offer feasible starting points for immediate adaptation and should be complemented by long-term investments in climate-resilient infrastructure.