Developing a Hospital Disaster Risk Management Evaluation Model

Toward hospital resilience: a qualitative study on the identification of hospital shocks during disruption era in Indonesia

BACKGROUND

Hospital resilience has been well recognized among healthcare managers and providers as disruption of hospital services that threatens their business environment. However, the shocks identified in the recent hospital resilience concept are mainly related to disaster situations. This study aims to identify potential shocks that hospitals face during disruptions in Indonesia.

METHOD

This qualitative study was conducted in Makassar, Indonesia in August-November 2022. Data was collected through semi-structured interviews with hospital managers and resilience experts using a semi-structured interview guide. 20 key informants were interviewed and data were analyzed by thematic analysis.

RESULTS

The study identified seven shocks to hospitals during the disruption era: policy, politics, economics, hospital management shifting paradigms, market and consumer behavior changes, disasters, and conflicts. It also identified barriers to making hospitals resilient, such as inappropriate organizational culture, weak cooperation across sectors, the traditional approach of hospital management, inadequate managerial and leadership skills, human resources inadequacies, a lack of business mindset and resistance to change.

CONCLUSION

This study provides a comprehensive understanding of hospital shocks during disruptions. This may serve as a guide to redesigning the instruments and capabilities needed for a resilient hospital.

Strategic analysis of Iran's climate resilient health system

INTRODUCTION

Climate change is a long-term systematic climate variability caused by human activities that alters the composition of the global atmosphere. Health systems should be adaptive and resilient to climate change. Hence, this research aimed to strategically analyze the resilience of Iran's health system to climate change.

METHOD

This study utilized a multiple methods approach. First, in-depth semi-structured interviews were conducted with 32 key climate change and health experts to identify the strengths, weaknesses, opportunities and threats of the Iranian health system's resilience to climate change. Purposeful and snowball sampling techniques were used to ensure maximum diversity among the participants. Then, a questionnaire was developed based on the findings of the first stage and was completed by 33 climate change and health experts. Finally, the strategic position of Iran's health system's resilience to climate change was determined using the internal - external factors matrix.

FINDINGS

A total of 84 internal factors and 101 external factors were identified that affect the resilience of Iran's health system against climate change. The internal factors were categorized into seven dimensions (i.e., governance and leadership; health financing; health workforce; facilities, equipment and medicines; health information system; health services delivery, and key results). The external factors were categorized into six dimensions (i.e., political, economic, social, technological, environmental, and legal factors). The average score of internal and external factors were 2.47 and 2.12, out of 4 respectively. Iran's health system was found to be in the strategic position of V in terms of resilience to climate change. Therefore, precautionary strategies such as strengthening the climate resilience of healthcare facilities, promoting healthcare facilities' adaptation to climate change, public-private partnership, strengthening the health service delivery system, quality management and cost management, should be implemented to strengthen the resilience of Iran's health system to climate change.

DISCUSSION

Iran's health system is facing significant weaknesses and challenges that have hindered its resilience to climate change. Iran's health system can better prepare and respond to the health impacts of climate change, and safeguarding the health and well-being of its population by addressing these challenges and implementing adaptive and resilience strategies.

Developing hospital resilience domains in facing disruption era in Indonesia: a qualitative study

BACKGROUND

The studies of hospital resilience have been of increasing importance during the last decade due to disasters and pandemics. However, studies in developing the domain and indicators of hospital resilience were limited mainly on disaster response. A few studies of hospital resilience focused on how to deal with disruptions such as environmental turbulence, rapid technological changes, and changes in patient preferences. This study aims to develop domains and indicators of hospital resilience in facing the disruption era.

METHODS

This qualitative study focused on exploring the domains and indicators to face disruptions that have been identified in the first exploratory phase of the studies. Key informants included hospital experts from the government, medical practitioners, and academics. A total of 20 key informants were involved in semi-structured interviews which were conducted face-to-face, via telephone and Zoom. Data was analyzed using a grounded theory approach to discover domains for a resilient hospital.

RESULTS

The study identified a number of domains that are fundamental for a hospital to become a resilient in the face of disruption. These include readiness to face digital transformation, effective leadership, and flexibility in managing resources among others. Situation awareness and resilience ethos, implementation of marketing management, networking, and disaster anticipation are found to be equally important. These domains focused on the hospital's ability to deal with specific shocks from different perspectives as the result of changes from disruptions which are inevitable within the organizational business environment.

CONCLUSIONS

The domains identified in the study are able to respond to the limitations of the concept of hospital resilience, which is currently more focused on hospital disaster resilience. They can be used to measure hospital resilience in the context of the volatility, uncertainty, complexity, and ambiguity (VUCA), which are relevant to the context of the Indonesia hospital industry.

Assessing hospital disaster preparedness: A scoping review of available tools

One of the problems faced after a disaster is health service for victims and hospitals play a critical role in handling disaster victims. Therefore, hospitals must enhance their preparedness and establish a disaster-safe environment to effectively fulfill their role as a provider of health services during a crisis. The aim of this scoping review was to identify hospital disaster preparedness tools used around the globe and to identify the critical aspects that need to be included in hospital disaster preparedness. This study used the five stages of Arksey and O'Malley's scoping review framework to determine what disaster preparedness tools can be used in a hospital setting. The electronic literature searches of English articles published between 2018 and 2023 were conducted using PubMed, Elsevier, ProQuest, ISI Web Science, and Google Scholar databases. The searched keywords were combined into several search terms such as sub-discipline, subtitle, year, language, and content type. The keywords of sub-title searching were "preparedness", "hospital" and "disaster". After applying some inclusion criteria, ten articles out of 1,221 identified records were included in the final analysis. The World Health Organization (WHO) Hospital Safety Index, WHO Hospital Emergency Checklist or their modified versions, and modified Public Health Emergency Preparedness were tools used in assessing hospital disaster preparedness. These tools evaluate some aspects such as structural safety, non-structural safety, and functional capacity. The studies indicated that each tool used to measure hospital disaster preparedness has strengths and weaknesses in each assessed aspect. Although some tools have been recommended to assess hospital disaster preparedness, assessing each tool validity and reliability are critical and needs to be conducted.

Hospital disaster preparedness in sub-Saharan Africa: a systematic review of English literature

BACKGROUND

Disasters are increasing worldwide, with Sub-Saharan Africa (SSA) being one of the most prone regions. Hospitals play a key role in disasters. This study provides a systematic review of the evidence on disaster preparedness by hospitals in SSA countries based on English literature.

METHODS

A systematic literature review was conducted of articles published between January 2012 and July 2022. We searched PubMed, Elsevier, Science Direct, Google Scholar, the WHO depository library and CDC sites for English language publications. The key inclusion criteria were: publications should have been published in the above period, deal with hospital disaster preparedness in SSA, the full paper should have been available, and studies should have presented a comparison between hospitals and/or a single hospital.

RESULTS

Results indicate improvements in disaster preparedness over time. However, health systems in SSA are generally considered vulnerable, and they find it difficult to adapt to changing health conditions. Inadequately skilled healthcare professionals, underfunding, poor knowledge, the absence of governance and leadership, lack of transparency and bureaucracy are the main preparedness barriers. Some countries are in an infancy stage of their health system development, while others are among the least developed health system in the world. Finally, a major barrier to disaster preparedness in SSA countries is the inability to collaborate in disaster response.

CONCLUSIONS

Hospital disaster preparedness is vulnerable in SSA countries. Thus, improvement of hospital disaster preparedness is highly needed.

Resiliency of the Iranian healthcare facilities against the Covid-19 pandemic: challenges and solutions

BACKGROUND

Health care facilities are responsible for preventing and controlling diseases and must be resilient enough to deal with crises. The Iranian health care facilities have faced challenges in managing COVID-19 pandemic. The purpose of this study was to identify the challenges faced by the Iranian health care facilities during the Covid-19 epidemic and to provide solutions.

METHODS

This qualitative study was conducted with a phenomenological approach and using semi-structured interviews with 59 healthcare policy makers, managers, and employees, and medical university faculty members. The participants were selected through purposive and snowball sampling. Thematic analysis was used to analyze the data.

RESULTS

Overall, 43 challenges to the resilience of health care facilities during the Covid-19 pandemic were identified and grouped into 8 themes (i.e., leadership and management, planning, organizational culture, organizational learning, employee management, customer management, resource management, and process management. The most important resilience challenges were: fragmented management system; poor leadership; incompatible health network structure; lack of a national holistic plan; poor case detection; insufficient resources; inefficient information system; negative attitude of managers and employee; organizational inertia; failure to build on lessons learned from crises; low workforce preparedness; lack of community-based management; and improper monitoring and evaluation. Managers should use community-based, evidence-based, and integrated management to build health system resilience against COVID-19, have sufficient knowledge and experience to organize operations, use appropriate and effective coordination models, develop a creative and participatory culture, reengineer processes, and provide necessary resources.

CONCLUSION

The Iranian health care facilities face challenges that prevent them from becoming resilient, responsive, and efficient in managing COVID-19. Policy makers and managers should increase the resilience of health care facilities to shocks and crises by using the suggested measures.

Role of hospitals in recovery from COVID-19: Reflections from hospital managers and frontliners in the Eastern Mediterranean Region on strengthening hospital resilience

Background

COVID-19 highlighted the critical role that hospitals play throughout the prolonged response and continuous recovery stages of the pandemic. Yet, there is limited evidence related to hospitals in the recovery stage, particularly capturing the perspectives of hospital managers and frontliners in resource-restrained and humanitarian settings.

Objective

This paper aims to capture the perspectives of hospital managers and frontliners across the Eastern Mediterranean Region on (1) the role of hospitals in recovering from COVID-19, (2) Hospitals' expectations from public health institutions to enable recovery from COVID-19, (3) the Evaluation of hospital resilience before and through COVID-19, and (4) lessons to strengthen hospital resilience throughout the COVID-19 recovery.

Methods

A multi-methods approach, triangulating a scoping review with qualitative findings from 64 semi-structured key-informant interviews and survey responses (n = 252), was used to gain a deeper context-specific understanding. Purposeful sampling with maximum diversity supported by snowballing was used and continued until reaching data saturation. Thematic analysis was conducted using MAXQDA and simple descriptive analysis using Microsoft Excel.

Findings

In recovering from COVID-19, hospital managers noted hospitals' role in health education, risk reduction, and services continuity and expected human resource management, financial and material resource mobilization, better leadership and coordination, and technical support through the provision of updated clinical evidence-based information from their public health institutions. Qualitative findings also indicated that hospital managers attributed considerable changes in hospitals' resilience capacities to the pandemic and suggested that strengthening hospitals' resilience required resilient staff, sustainable finance, and adaptive leadership and management.

Conclusion

Hospitals are the backbone of health systems and a main point of contact for communities during emergencies; strengthening their resilience throughout the various stages of recovery is critical. Hospitals cannot be resilient in silos but rather require an integrated-whole-of-society-approach, inclusive of communities and other health systems actors.

What is "hospital resilience"? A scoping review on conceptualization, operationalization, and evaluation

Background

COVID-19 underscored the importance of building resilient health systems and hospitals. Nevertheless, evidence on hospital resilience is limited without consensus on the concept, its application, or measurement, with practical guidance needed for action at the facility-level.

Aim

This study establishes a baseline for understanding hospital resilience, exploring its 1) conceptualization, 2) operationalization, and 3) evaluation in the empirical literature.

Methods

Following Arksey and O'Malley's model, a scoping review was conducted, and a total of 38 articles were included for final extraction.

Findings and discussion

In this review, hospital resilience is conceptualized by its components, capacities, and outcomes. The interdependence of six components (1) space, 2) stuff, 3) staff, 4) systems, 5) strategies, and 6) services) influences hospital resilience. Resilient hospitals must absorb, adapt, transform, and learn, utilizing all these capacities, sometimes simultaneously, through prevention, preparedness, response, and recovery, within a risk-informed and all-hazard approach. These capacities are not static but rather are dynamic and should improve continuously occur over time. Strengthening hospital resilience requires both hard and soft resilience. Hard resilience encompasses the structural (or constructive) and non-structural (infrastructural) aspects, along with agility to rearrange the space while hospital's soft resilience requires resilient staff, finance, logistics, and supply chains (stuff), strategies and systems (leadership and coordination, community engagement, along with communication, information, and learning systems). This ultimately results in hospitals maintaining their function and providing quality and continuous critical, life-saving, and essential services, amidst crises, while leaving no one behind. Strengthening hospital resilience is interlinked with improving health systems and community resilience, and ultimately contributes to advancing universal health coverage, health equity, and global health security. The nuances and divergences in conceptualization impact how hospital resilience is applied and measured. Operationalization and evaluation strategies and frameworks must factor hospitals' evolving capacities and varying risks during both routine and emergency times, especially in resource-restrained and emergency-prone settings.

Conclusion

Strengthening hospital resilience requires consensus regarding its conceptualization to inform a roadmap for operationalization and evaluation and guide meaningful and effective action at facility and country level. Further qualitative and quantitative research is needed for the operationalization and evaluation of hospital resilience comprehensively and pragmatically, especially in fragile and resource-restrained contexts.

Risk Assessment of COVID-19 in the Iranian Health System

OBJECTIVE

The outbreak of coronavirus disease 2019 (COVID-19) has exerted unprecedented pressure on healthcare systems throughout the world. This study was designed to develop a national health emergency management program based on risk assessment for COVID-19.

METHODS

Mixed-methods research was used. Based on recommendations of the national epidemiology committee, 2 risk scenarios were used as basic scenarios for risk assessment. Two rounds of Focus Group Discussions (FGDs) were conducted between January and May 2020 with 30 representatives of the health system. The data were collected, analyzed, and integrated by the research team.

RESULTS

In the risk matrix, "contamination of environment and individuals" and "burnout of medical staff" occupied the red zone (intolerable risk). "Defects in screening and admissions," "process disruption in medical care and rehabilitation," "increased mental disorders," "social dissatisfaction," "the decline in healthcare services," and "loss of medical staff" were identified as the orange zone (significant risk) of the matrix.

CONCLUSIONS

The avoidance of environmental and individual contamination and healthcare worker burnout are the priorities in Iran. Attention to intersectoral cooperation, the involvement of non-governmental organizations and private center capacities, integration of information health systems, and developing evidence-based protocols are other measures that can improve the health system's capacity in the response COVID-19.

Nursing Students' Competency to Attend Disaster Situations: A Study in Western Iran

OBJECTIVE

The disaster preparedness of nurses is important as nurses are members of a health care team that needs to work systematically and collaboratively in all conditions. Although education and training naturally underpin effective practice, disaster nursing education is rarely provided to nurses in Iran. Because disaster situations, by definition, overwhelm health services, it is likely that nursing students will be required to join their colleagues in the response. The purpose of this study was to evaluate the competency of nursing students to attend disaster situations.

METHODS

This descriptive, analytical study was conducted in western Iran in 2020. A total of 70 nursing students in the fourth (final) year of their undergraduate nursing education entered the study by a census sampling method. Data collection was undertaken using a validated disaster competency assessment questionnaire. The data were analyzed using SPSS version 21 (IBM Corp, Armonk, NY) with descriptive and analytic tests.

RESULTS

The mean age of participants was 21.4 ± 2.14 and 57.1% of them were women; 45 participants (64.3%) had received no disaster-related training, and 88.6% had no history of participating in disaster exercises. The total score for nursing students' competence was 125.58 ± 14.19. There was a significant relationship between the mean score of nursing competence in response to disasters and student history of participating in an exercise and training course (P < 0.001).

CONCLUSION

Students' competence in disaster situations is poor. Awareness of the competence condition of nurses is the first step to improve their preparedness as the most key members of the disaster health team. Conducting disaster-related training may be appropriate. The results of this study can provide evidence for the development of educational policies in disaster nursing education.

Challenges of Hospital Disaster Risk Management: A Systematic Review Study

OBJECTIVE

This study aimed to investigate the challenges of hospital disaster risk management so that it can take a step to provide strategies and interventions to remove these barriers and improve the hospital disaster risk management (HDRM) through identifying and introducing them to disaster experts.

METHODS

This is a systematic qualitative review study. Data sources included Persian and international databases, which were searched using the keywords of hospital, disaster, risk management, risk reduction, disaster and challenge, and the combination of them. The search period ranged from January 2010 to January 2020. Data were extracted by 2 independent examiners for qualitative thematic analysis.

RESULTS

A total of 762 articles and documents were recovered. Finally, 12 articles entered the study, including 7 studies from Asia, 2 articles from Europe, 2 articles from the United States, and 1 article about Africa. After thematic analysis, 17 sub-themes were achieved and were classified into 4 subjects of technical-physical barriers, organizational-managerial barriers, financial barriers, and human barriers. All articles have not discussed on all categories.

CONCLUSIONS

The results of evaluating the challenges of hospital disaster risk management gained from this study can be beneficial in developing a roadmap to improve the status of HDRM.

Factors Affecting the Decontamination Process in Hospitals in Saudi Arabia

Introduction

Hospitals face various types of disasters that require either decontamination or disinfection interventions. These contaminants can be chemical, biological, radioactive, or infectious, such as COVID-19. Further, there are few studies in the literature on factors affecting decontamination in hospitals in Saudi Arabia.

Methods

Approximately 157 healthcare providers (doctors, nurses, and other specialists) participated in this study. Principle component analysis was used to explore three factors in Saudi Arabia that affect the ability of healthcare providers to decontaminate appropriately.

Results

Three factors were extracted: (1) having adequate skills to perform decontamination, (2) being adequately prepared for decontamination before a disaster occurs, and (3) organizational barriers to decontamination. There was a positive correlation between the skills and preparedness and a negative correlation between barriers and both skills and preparedness.

Discussion

It is essential to prepare for decontamination during disasters more effectively and to ensure that all healthcare providers have the requisite skills. Moreover, barriers to decontamination must be investigated thoroughly to improve implementation.

A case study of a collaborative allied health and nursing crisis response

The COVID-19 pandemic was declared by the World Health Organization on 11 March 2020. The rapid spread of SARS-CoV-2 required an equally rapid response from health-care organizations to find innovative ways to utilize the existing workforce to care for people with COVID-19. Using an evaluative case study, a unique insight into the collaborative allied health and nursing professions' response to COVID-19 at a specialist cardiothoracic hospital in the United Kingdom is presented. The aim of the case study was to evaluate how an interprofessional workforce from the wider organization could be supported to work in critical care as part of a crisis response. In identifying the key enablers to setting up an interprofessional Essential Care Team and learning from the lived experiences of those involved, this case study has demonstrated that, in supported, interprofessional teams the wider organizational workforce can be facilitated to effectively and safely provide critical care services. The lessons learned from this study will support future pandemic responses and aid the identification of further opportunities for interprofessional learning and practice. Ultimately, the study highlights that by identifying and investing in the key enablers, health-care organizations can be better prepared to respond to a global crisis.

Disaster Preparedness and Professional Competence Among Healthcare Providers: Pilot Study Results

The preparedness of a hospital for mass-casualty incident and disaster response includes activities, programs and systems developed and implemented before the event. These measures are designed to provide the necessary medical care to victims of disasters, and to minimize the negative impact of individual events on medical services. Up until now, there has been no systematic survey in Poland concerning the readiness of hospitals, as well as medical personnel, to deal with mass-casualty incidents. Consequently, little is known about the knowledge, skills, and professional competences of healthcare workers. The objective of this pilot study was to start an exploration and to collect data on the competences of healthcare workers, in addition to assessing the preparedness of hospitals for mass-casualty incidents. Utilizing an anonymous survey of a random sample, 134 healthcare providers were asked to respond to questions about the competencies they needed, and hospital preparedness during disaster response. It turned out that the test subjects evaluate their own preparedness for mass-casualty incidents and disasters better than the preparedness of their current place of work. The pilot study demonstrated that a properly designed questionnaire can be used to assess the relationship between hospital and staff preparedness and disaster response efficiency. Evaluation of the preparedness and effectiveness of disaster response is a means of finding and removing possible gaps and weaknesses in the functioning and effective management of a hospital during mass-casualty incidents.