Mapping the socio-technical causes of overheating risk and unequal thermal burden in hospitals in England: a qualitative systems inquiry using AcciMap
This study employs a qualitative systems inquiry using AcciMap to demonstrate that hospital overheating in England is a complex socio-technical challenge driven by fragmented ownership and unequal adaptive capacity, requiring coordinated interventions across governance, infrastructure, and preparedness systems rather than being treated solely as an estates issue.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
When the summer sun beats down, hospitals face a unique and dangerous challenge. Unlike a home where a resident can simply open a window or turn on a fan, a hospital is a place where people are often too sick to move, too dependent on others to change their clothes, or too tied to machines to leave their beds. The building itself, often designed for a cooler climate from decades ago, can trap heat, turning corridors and wards into ovens. This is not just a matter of comfort; it is a matter of safety. When the air gets too hot, staff become exhausted and less able to think clearly, while patients, already vulnerable, face higher risks of illness. For years, the solution to this problem has been viewed through a narrow lens: as a building maintenance issue, a seasonal nuisance, or a personal responsibility to drink more water. But a new study suggests this view is incomplete. It argues that the heat problem in English hospitals is not caused by a single broken air conditioner or a lack of will, but by a complex web of how the hospital system works, how information flows, and how different people experience the same hot room in vastly different ways.
Researchers set out to understand exactly why hospitals in southern England continue to overheat, even when everyone knows it is a problem. They did not simply count how many times the temperature rose; instead, they looked at the whole system. They gathered 129 reports of overheating incidents from two major hospitals, interviewed leaders and staff, and held focus groups with both healthcare workers and patients who have conditions that make them sensitive to heat. They also brought in experts from across the country to refine their ideas. By piecing together these different stories and data points, the team built a detailed map of how the hospital environment functions. This map, known as an AcciMap, is a tool used to trace how small factors at different levels of an organization—from national policy down to a single nurse's desk—connect to create a specific outcome. In this case, the outcome was the persistent risk of overheating and the unequal burden it places on people.
The study found that the heat problem persists not because hospitals are unaware of the danger, but because the ability to fix it is scattered and broken. The researchers identified six main pathways that keep the problem alive. First, there is a gap between knowing the risk and having the power to act. Hospital leaders admit the heat is dangerous, but they often lack the money, the authority, or the clear plan to make permanent changes to the buildings. Second, the problem is often hidden in plain sight. Because staff are trained to be tough and to keep working through discomfort, they rarely report the heat. They use fans, move patients, or just endure the temperature, which makes the system look like it is coping well when, in reality, the burden is just being shifted onto the people inside.
This reliance on temporary fixes creates a third pathway: resilience based on workarounds. Staff and teams constantly invent small, short-term solutions to keep the hospital running. While these actions prevent immediate disaster, they also allow the underlying structural problems to remain unaddressed. The heat returns every summer, the staff find new ways to cope, and the need for a permanent solution is delayed. Fourth, the study highlighted that the heat is not felt equally by everyone. A mobile doctor can walk to a cooler room or find a drink of water, but a patient with a spinal injury or a nurse tied to a specific bed cannot. The ability to adapt to the heat depends entirely on a person's mobility, their role, and their physical condition, meaning the most vulnerable people absorb the worst of the heat.
The fifth pathway involves the failure to use existing safety plans. Hospitals have emergency procedures for bad weather, but these are often not triggered by heat or are not connected to the daily reality of the wards. The final pathway is about how the problem is talked about. If heat is framed merely as a seasonal comfort issue, it is easy to ignore. But if it is framed as a safety risk or a workforce health issue, it gains the attention of decision-makers. The researchers found that the language used to describe the problem shapes whether it gets fixed.
The final map produced by the study shows that no single department can solve this alone. The problem sits at the intersection of national funding, building design, daily management, and the physical limits of the human body. The researchers concluded that fixing hospital overheating requires more than just installing air conditioning. It demands a shift in how the system thinks about heat. It requires connecting temperature data directly to the well-being of staff and patients, ensuring that emergency plans are actually used, and recognizing that the people who can move and change their environment are not the ones suffering the most. The study suggests that true resilience comes from acknowledging that the current way of coping is fragile and that a durable solution must be built on better information, fairer support for the most vulnerable, and a system that acts before the heat becomes a crisis.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.