CR4HC Case Study: Northern Light Health

Northern Light Health: Resilient Care for Rural Populations

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Hospitals in Maine face unique healthcare delivery challenges because of the state’s distinct population and geography. Maine is a largely forested state crossed by rivers and dotted with island communities.  Forty percent of Maine’s nearly 1.4 million residents are located within a single county, with the remainder dispersed across the expansive geography of the state (Maine Department of Health and Human Services, 2024). Additionally, Maine is recognized as the state with the oldest median population in the United States, with 22% of residents over age 65 (Population Reference Bureau, 2021). Maine’s hospitals have large service areas and provide care to diverse populations(Maine Hospital Association, 2024). Patients in Maine’s rural communities may need to travel long distances to access health care.

Northern Light Health’s members include 10 of the 36 hospitals in Maine, including locations in urban Portland, remote Greenville, and coastal Blue Hill (Northern Light Health, 2023a).  Northern Light understands that the communities it serves are already experiencing health effects from climate change (Northern Light Health, 2023b).  The system signed the  Health and Human Services (HHS) Health Sector Climate Pledge in 2023 and began the process of developing  a Climate Resiliency Plan, which describes the effect of climate change on the network’s facilities and patients, identifying vulnerabilities and defining plans to enhance resiliency (Assistant Secretary for Health, 2022; Northern Light Health, 2023b).  

Tailoring Resiliency to Meet Geographic and Community Needs  

The planning effort kicked off with a prospective planning process to identify and address vulnerabilities to natural disasters, and other disruptions, across Northern Light’s health delivery system. Signing the HHS Climate Pledge motivated Northern Light Health to consider these resiliency planning activities through a climate lens, which required broad interdisciplinary collaboration. Representatives from diverse disciplines such as emergency preparedness, facilities management, food service, supply chain, community health, health equity, and more convened to discuss various aspects of organizational resilience in the face of climate change. Drawing upon their professional experience, strategic partnerships, and climate and demographic models, the team identified critical areas for consideration including infrastructure required to provide support to a variety of geographic locations and populations served (such as mitigating projected vulnerabilities in essential transportation systems). The system-wide climate resiliency plan was developed over a six-month period in 2023 and will continue to be revised as new data are identified. The team plans to revisit the document regularly and revise various components as new threats emerge.  

The climate resiliency planning process has led to Northern Light incorporating prospective risk assessment into infrastructure investment decisions, helping to ensure that it can continue to provide uninterrupted service during climate-related disasters and extreme weather events. The health system works alongside FM Global, a property and casualty insurance company, to identify and remediate such vulnerabilities across its facility portfolio.  FM Global links climate vulnerability assessments with reductions in annual insurance premiums to encourage facilities to direct funds saved toward climate resiliency measures. The assessments for Northern Light Health identified campus-specific vulnerabilities, such as high winds and floods, and recommended specific remediation measures. The process highlighted the fact that many building standards and regulations are becoming obsolete, because they rely exclusively on historical weather trends. For example, requirements for HVAC (heating, ventilation, and air conditioning) units in hospitals are rapidly becoming obsolete in some parts of the country as temperature extremes and humidity increase. Prospective risk assessment has become increasingly necessary to future-proof building systems over the full lifespan of a new building. 

Northern Light Health tailored the implementation of its new climate resiliency plan to each facility’s unique geographic and demographic context. For example, a coastal facility such as Northern Light Mercy Hospital may prioritize improvements related to coastal storms and flooding. A facility serving remote rural populations, such as Northern Light AR Gould Hospital or Northern Light Sebasticook Valley Hospital, may focus on mitigating the risk of transportation infrastructure disruptions in the setting of severe weather events that could interrupt patients’ access to care. The Northern Light Health service area includes remote islands whose residents must rely on boats or helicopters to access mainland healthcare services, impacting transit time for emergency responders and patients seeking care. Access to healthcare from remote areas such as these is especially susceptible to weather-related disruption. Prospective risk assessment that considers the effects of climate change on the geographic distribution, frequency, and severity of storms is increasingly important to ensure that Northern Light’s healthcare facilities remain accessible. 

 Additionally, the priorities and cultural values of each of the communities served by Northern Light facilities are distinct—patients and employees represent diverse populations including immigrant groups, agricultural workers, urban and rural areas, and Indigenous communities.  

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one hospital that requires unique cultural considerations for its population and geography is Northern Light AR Gould hospital. Located in Aroostook County, its service area includes Mi’kmaq Nation Tribal lands (Mi’kmaq Nation, 2024). The hospital incorporates culturally appropriate practices into its facility operations, including developing a first-in-the-nation policy to allow for sacred smudging ceremonies, while ensuring the safety of patients, visitors, and staff.  

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Resiliency Plan in Action 

On December 18, 2023, shortly after Northern Light Health completed its initial resiliency plan, Maine experienced a devastating storm that was declared a federal disaster (Federal Emergency Management Agency, 2024). Following the storm, more than 400,000 people in Northern Light’s patient shed experienced power outages and roadway closures, which both increased danger for patients dependent on electric-powered medical equipment and limited their access to care (Russell & Terhune, 2023, p. 2). 

Northern Light Health personnel were able to tap into the recently strengthened interdisciplinary and inter-facility collaboration relationships they had developed through the resiliency planning process. As a result, emergency management personnel, facility operations staff, and clinicians were able to leverage emergency response resources and communication pathways described in the resiliency plan to provide continuous service to patients during the disaster and its aftermath. This experience proved the value of the health system’s multi-disciplinary resilience planning process.  

Establishing a Community of Resilience 

Northern Light Health is committed to raising awareness about the impact of climate change on health and healthcare and to working with community partners and healthcare organizations across the state. The health system has developed a monthly speaker series and a quarterly newsletter for employees called the Climate Chronicles, which highlight climate resilience activities at Northern Light facilities, including collaborations with community partners, as well as general education on sustainability-related topics and opportunities for employees to take action. 

Outward-facing communications activities include appearances on Healthy Living segments on local TV stations and a podcast miniseries produced by Northern Light Health, which seeks to inform the public about the population health effects of climate change and opportunities to increase community resilience.  

The system has also convened a voluntary statewide health care learning collaborative, the Maine Healthcare Climate Collaborative. The Collaborative includes representatives from major health systems in the state (Northern Light Health, Maine Health, Central Maine Healthcare, and Covenant Health) and small independent hospitals, as well as nursing homes, rehabilitation centers, and other elements of Maine’s healthcare network. The Collaborative meets monthly to discuss topics related to healthcare climate resilience protocols, processes, and policies. Northern Light Health shares information about partners such as FM Global with the Collaborative to provide practical examples of resources that healthcare organizations across the state can leverage to build resilience and better serve patients.