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PURPOSE. A predicted increase in climate change-related extreme weather events will present hospitals with new health-related and physical risks which were not originally anticipated in building and infrastructure designs. Markus et al.'s building systems model is used to analyse a range of adaptive strategies to cope with such events. The paper aims to discuss these issues.\ud\udDESIGN/METHODOLOGY/APPROACH. Focus group interviews were conducted with a wide range of hospital stakeholders across three case study hospitals in Australia and New Zealand which have experienced extreme weather events.\ud\udFINDINGS. It is concluded that effective adaptive strategies must balance responses across different organisational sub-systems. Contrary to previous research, the findings indicate that hospital managers do see hospital infrastructure as an important component of disaster response. However, it is the least adaptable of all response subsystems, making other options more attractive in the heat of a crisis.\ud\udRESEARCH LIMITATIONS/IMPLICATIONS. A focus on three case studies allowed the researchers to explore in-depth the experiences of stakeholders who had experienced extreme weather events. While producing highly valid results, the inherent limitation of this approach is the lack of breath. So further case studies are needed to generalise from the results.\ud\udPRACTICAL IMPLICATIONS. Recommendations are made to improve the adaptive capacity of healthcare facilities to cope with the future health challenges of climate change risk.\ud\udORIGINALITY/VALUE. By acknowledging that no one group holds all the knowledge to deal with extreme weather events, this paper capture the collective knowledge of all key stakeholders who have a stake in the process of responding effectively to such an event. It shows that hospital adaptation strategies cannot be considered in isolation from the surrounding emergency management systems in which a hospital is embedded

Managing the health risks of extreme weather events by managing hospital infrastructure