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Filingeri, Davide, Blount, Hannah, Esteves, Nuno Koch, Daniels, Thomas, Aceves-Gonzalez, Carlos, Brooks, Katya, Jenkins, Katie 
ORCID: https://orcid.org/0000-0002-6740-5139, James, Patrick, Sach, Tracey ORCID: https://orcid.org/0000-0002-8098-9220, Nunes, Ana Raquel, Roberts, Tom, Dall’Ora, Chiara, Portillo, Mari Carmen, Gordon, Ralph, Worsley, Peter R and Filingeri, Victoria
(2026)
Mapping the socio-technical causes of overheating risk and unequal thermal burden in hospitals in England: a qualitative systems inquiry using AcciMap.
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Abstract
Background: Hospital overheating arising from more frequent heatwaves threatens healthcare staff wellbeing, patient safety and service continuity, but is often managed as an estates or seasonal problem. We examined how interacting organisational, infrastructural and experiential conditions sustain overheating vulnerability and unequal thermal burden in hospitals in the south of England. Methods: We conducted a six-phase, multi-source qualitative systems inquiry integrating 129 overheating incident reports from two National Health Service (NHS) hospitals in Hampshire, England, six stakeholder interviews, two focus groups with healthcare staff and patients (n=12), and a national stakeholder refinement focus group (n=4). AI-supported thematic analysis was combined with context-mechanism-outcome synthesis and iterative AcciMap construction, to produce an integrated systems explanation. Results: Twenty themes were consolidated into six interacting explanatory pathways: 1) recognition without durable resilience; 2) hidden visibility; 3) workaround-based resilience; 4) unequal adaptive capacity; 5) underuse of emergency preparedness and business-continuity systems; 6) institutional framing. The analysis indicated that, within the hospital settings investigated, overheating persisted despite recognition because ownership, information, resources and delivery capacity were fragmented across system levels. Frontline workarounds sustained care but could conceal thermal burden and defer structural adaptation. Staff and patients had unequal capacity to regulate exposure because of differences in mobility, autonomy, physiology, clinical dependency and occupational role. Existing preparedness systems offered a route from seasonal reaction to anticipatory action, but overheating was not consistently embedded within them. The AcciMap showed how shared factors connected the six pathways and identified coordinated intervention entry points across monitoring, governance, preparedness, service delivery and infrastructure. Conclusions: Overheating in hospitals in England is best understood as a socio-technical patient-safety and adaptation challenge, not a single-domain estates problem. Our analysis indicates that durable resilience requires environmental intelligence linked to accountable decisions, support for staff and patient adaptation, activation of preparedness systems and long-term infrastructure change.
| Item Type: | Article |
|---|---|
| Faculty \ School: | Faculty of Science > Tyndall Centre for Climate Change Research University of East Anglia Research Groups/Centres > Faculty of Science > Research Centres > Tyndall Centre for Climate Change Research Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Health Economics |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 21 Sep 2026 14:02 |
| Last Modified: | 21 Sep 2026 14:02 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/104599 |
| DOI: | 10.64898/2026.09.10.26362630 |
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