Specialist physicians' and management personnel's views on climate change mitigation and adaptation in German healthcare facilities: A nationwide survey on attitudes, implementation, and barriers.

Background: Climate change poses major challenges for health systems, making mitigation and adaptation measures in healthcare facilities urgent Methods: In September 2022, a nationwide survey was conducted among a representative subset of specialist physicians and healthcare facility management personnel in Germany. As decision-makers in healthcare, this group was surveyed to assess personal attitudes toward climate change and climate-related actions, and healthcare facility-based implementation of mitigation and adaptation measures, as well as possible barriers. Results: Most of the 514 respondents expressed confidence in their ability to contribute to climate change mitigation and a sense of responsibility to do so. Participants indicated that several structural barriers prevented them from taking necessary climate change mitigation and adaptation action at their facilities. A lack of specifically allocated staff, funding, and poorly defined implementation strategies were the most frequently mentioned constraints. Additionally, the respondents indicated a number of measures which their respective facilities had thus far failed to introduce, such as facility-based heat action plans, education programs, and the integration of sustainability into quality control. Conclusion: Despite high awareness and willingness among healthcare decision-makers, climate change mitigation and adaptation measures are poorly implemented in German healthcare facilities. Limited strategies, expertise, staff, and funding may be key barriers. The results highlight the need for stronger governance, funding, and performance metrics to support climate action in German healthcare.