Climate and environmental change threaten patient health and the systems that deliver care. At the same time, modern health systems are themselves a significant contributor to global carbon emissions.

Action is needed, and that need is increasingly recognized at the national and international scale. In November 2021, Canada was one of 51 countries to sign on to the Health Program at the United Nations Climate Change Conference (COP26), making a commitment to climate resilient and low carbon, sustainable health systems.

Already, there is considerable capacity for sustainable healthcare in Canada. Many individuals and organizations possess sustainability-related knowledge, skills, and networks and have tested and implemented a range of sustainable healthcare practices and policies. Launched in 2021, CASCADES is funded for a five-year term by Environment and Climate Change Canada’s Climate Action and Awareness Fund for Community-Based Climate Action Projects to support and enhance this work.

CASCADES pursues improvement in clinical or clinically adjacent practices and policies. Through partnerships with patients, providers and organizations, and an orientation towards systems thinking, the initiative seeks to catalyze action and broad engagement in the national transition to climate resilient and low carbon, sustainable health systems.

CASCADES is led by the Centre for Sustainable Health Systems at the University of Toronto, in partnership with the Healthy Populations Institute at Dalhousie University, the Planetary Healthcare Lab at the University of British Columbia, and the Canadian Coalition for Green Health Care.

CASCADES is committed to collaboratively coordinating a national approach to develop new—and refine existing—tools and strategies that can improve the sustainability of health services and systems. The initiative works with teams across Canada to support innovation through both ‘test’ and ‘spread’ phases. CASCADES targets the healthcare community as a whole—front-line care providers, administrators, leaders, and the associations that support the delivery of care across Canada’s provinces and territories.

In the first phase, innovations are tested at one or more sites to assess whether they lead to care that is high quality, resilient, and has low greenhouse gas (GHG) emissions. Test cases produce a prototype playbook: a step-by-step guide for innovation implementation and assessment.

In the second phase, CASCADES works with teams to spread promising service innovations across multiple sites and regions in the country, using quality improvement methodology. Spread cases use the prototype playbook to implement an innovation with consistent processes and impact measurement across all sites and regions. The result is a validated playbook that can be used both to inform policy and to enable widespread implementation of what will then be considered a best practice in sustainable healthcare.

CASCADES leverages and builds knowledge, skills, and networks across Canada’s healthcare community to promote and deliver sustainable health systems. The initiative offers professional development training to equip health professionals, including front-line care providers, administrators, and leaders, with the skills to understand and support sustainable change. CASCADES also supports knowledge-mobilization and networking activities to help the community to identify opportunities for innovation, to encourage excellence and skill-sharing, and to build and support communities of practice.

For health professionals looking to join this growing movement of motivated change-makers, there are a number of ways to get involved.

CASCADES’ suite of continuing professional development training programs ranges from introductory to advanced. Through these programs, participants develop the fundamental skills required to advance climate action in healthcare in Canada. Individual sustainable quality improvement coaching is also available.

CASCADES’ networking and outreach opportunities include a national online forum; Monthly Exchange Sessions (MES), which offer an informal discussion space for members of the healthcare community interested in sustainable health systems; and ongoing events programming targeted to individuals across diverse fields, career stages, and levels of familiarity with climate action.

For more information about CASCADES, please email CASCADES@utoronto.ca.