Healthcare Resilience Research Articles

Emergency preparedness in healthcare systems: the “policy-effect” of COVID-19

Abstract The COVID-19 pandemic has highlighted that health services preparedness is crucial. Indeed, effective planning enables streamline operations, optimized resource allocation, and transparent communication during crises. Within this context, our analysis aims to assess EU countries’ healthcare systems preparedness, by policies analysis and capacity factor analysis, and relationship with COVID-19. We reviewed policies regarding influenza, antimicrobial resistance (AMR), and climate change in EU countries, using a web-screening of national and international authorities and institutions. Furthermore, we performed a factor analysis on WHO’s States Party Self-Assessment Reporting (SPAR) and evaluated the results using an iterated principal factor analysis with promax rotation. Few countries updated their policies after the pandemic, particularly regarding influenza plans. Italy stands out as an exception, having updated its national plan in 2021, while other countries maintain pre-COVID plans. Regarding AMR, only few countries, including Sweden, Netherlands, Malta, Germany, Spain, Belgium, and France, updated their plans post-pandemic, while Estonia and Romania lack plans entirely. Addressing the climate crisis and its impacts on health and healthcare resilience, all EU countries aligned with the EC regulation on climate action through National Energy and Climate Plans in 2023. Moreover, EU countries had average preparedness level of 75.77 (SD: 8.23), calculated on SPAR 2022, with significant disparities. Three major factors contribute to preparedness levels: planning, service delivery, and specific subtopics (e.g. food safety, radiation, infectious diseases). Our findings reveal the complexity of preparedness, showing diverse approaches across countries, despite EU regulations and WHO guidelines. International collaboration is crucial to standardize policies and enable countries to leverage successful examples, improving public health outcomes. Key messages • Health services preparedness, underscored by the COVID-19 pandemic, is crucial for effective planning and crisis management. • The analysis demonstrates varying levels of preparedness across EU countries, with differences in policy updates and adherence to international guidelines.

Healthcare Resilience in Saudi Arabia: The Interplay of Occupational Safety, Staff Engagement, and Resilience

This research investigates the relationships between occupational health and safety (OHS), staff resilience (SR), staff engagement (SE), and organizational resilience (HOR) within Saudi Arabian hospitals. Employing a quantitative, cross-sectional design, data were collected from 127 administrative staff members working in both public and private hospitals in Saudi Arabia. Using SmartPLS to test the hypothesized relationships and mediation effects, the findings reveal that OHS significantly impacts both SR and SE, and SR significantly influences HOR. Additionally, SE significantly affects HOR. This study also confirms a partial mediation effect of SE and SR in the relationship between OHS and HOR. The model demonstrates substantial explanatory power for HOR, SE, and SR. These results underscore the critical role of OHS in fostering a resilient healthcare environment by enhancing staff engagement and resilience. This study’s implications highlight the importance of targeted interventions to improve OHS practices, promoting overall hospital resilience in alignment with Saudi Arabia’s Vision 2030.

Artificial intelligence for enhancing resilience

In an increasingly complex and unpredictable world, resilience-the ability to withstand and recover from adverse conditions is essential across various sectors. This research paper investigates the transformative potential of artificial intelligence (AI) in enhancing resilience across multiple domains. We explore how AI technology can be utilized to develop resilient infrastructure, providing advanced predictive maintenance and real-time monitoring capabilities that ensure robustness and longevity. The study examines the role of AI in improving disaster response, offering rapid data analysis and decision-making support to enhance emergency management outcomes. In climate change, AI-driven strategies are assessed for their effectiveness in fostering climate resilience, including predictive modeling of extreme weather events and optimizing resource allocation. The paper also discusses AI applications in healthcare resilience, such as enhancing diagnostics, patient care, and operational efficiency during crises. Business continuity and crisis management are examined, highlighting AI's capability to anticipate disruptions and maintain operational stability. The paper emphasizes the importance of strengthening cybersecurity resilience using AI to detect and mitigate threats proactively. AI's role in enhancing community and social resilience is analysed, particularly in supporting vulnerable populations and fostering social cohesion. Additionally, we explored AI-powered solutions for urban resilience, focusing on smart cities and sustainable development. The study also covers AI's contributions to environmental and ecological resilience, resilient supply chain management, and resilience in the hospitality and tourism industry. Finally, we investigated AI's potential in fostering psychological resilience, providing personalized mental health support and stress management tools. Through these diverse applications, the paper underscores AI's critical role in building a resilient future.

Workspace Layout for Resilient Performance using Social Network Analysis: A Case Study.

Purpose: To present the social network analysis-based approach used to create a new workspace layout for three hospital services as part of a campus expansion at a large tertiary care public hospital. Objective: To analyze the relationships among service members across four healthcare resilience abilities (monitor, anticipate, respond, and learn) and utilize network metrics to indicate the suitability of a shared workspace layout for the services. Background: The hospital expanded by 70%, providing space for relocating key services-the rapid response team, medical on-call team, and nursing supervision. Initial observations suggested a shared workspace layout based on anecdotal evidence. Method: Stakeholders have reached a consensus on a three-stage process to assess the suitability of a shared workspace layout for these services: first, collecting data on social interactions with a focus on resilience abilities; second, presenting layout alternatives based on sociograms; and third, evaluating these alternatives and devising a strategy for allocating personnel to shifts based on a resilience score derived from social network metrics. Case Study: The examination of social network metrics allowed identifying key individuals contributing to the overall resilience of the three services. Sociograms provided visual representations of how these individuals were spatially distributed within the shared layout. Discussion: The process was designed to shape a resilient layout and incorporated initial data, preferences, and constraints into layout proposals. Additionally, it utilized a resilience score from existing literature to formulate a strategy for staff allocation to shifts, ensuring consistent collective resilience ability across all shifts.

Healthcare Resilience in Trinidad and Tobago: A short report on the Healthy Hospital Initiative at the Sangre Grande Hospital

Objective: To describe the establishment of the Healthy Hospital Initiative (HHI), its activities and accomplishments, challenges and future steps. Methods: The initiative was implemented at the Sangre Grande Hospital in the Eastern Regional Health Authority (ERHA), one of five Regional Health Authorities in Trinidad and Tobago. A review of personal records maintained by members of the Healthy Hospital Initiative was undertaken. These records included descriptions of the activities, accomplishments and obstacles that the team experienced. Results: The Healthy Hospital Initiative was launched in November 2019 with the aim of creating an environmentally sustainable health system and improving the physical and mental health of staff and patients. A senior doctor led the initiative and team members included a range of staff, including both clinical and non-clinical professionals who were all volunteers. This allowed for a multi-directional, inclusive approach and created a sense of ownership amongst the staff. In 2022, several activities were implemented: green spaces, recycling bins, a kitchen garden and staff exercise sessions. In addition, team members participated in training on Pan-American Health Organization (PAHO) Smart hospitals and collaborated with a local non-governmental organisation as well as the University of the West Indies, St. Augustine campus engineering department to develop further projects. Conclusion: Next steps include promoting similar projects in community health facilities, developing a hydroponics system and, assessing the disaster resilience and carbon footprint of the hospital.

Healthcare as a driver, reservoir and amplifier of antimicrobial resistance: opportunities for interventions.

Antimicrobial resistance (AMR) is a global health challenge that threatens humans, animals and the environment. Evidence is emerging for a role of healthcare infrastructure, environments and patient pathways in promoting and maintaining AMR via direct and indirect mechanisms. Advances in vaccination and monoclonal antibody therapies together with integrated surveillance, rapid diagnostics, targeted antimicrobial therapy and infection control measures offer opportunities to address healthcare-associated AMR risks more effectively. Additionally, innovations in artificial intelligence, data linkage and intelligent systems can be used to better predict and reduce AMR and improve healthcare resilience. In this Review, we examine the mechanisms by which healthcare functions as a driver, reservoir and amplifier of AMR, contextualized within a One Health framework. We also explore the opportunities and innovative solutions that can be used to combat AMR throughout the patient journey. We provide a perspective on the current evidence for the effectiveness of interventions designed to mitigate healthcare-associated AMR and promote healthcare resilience within high-income and resource-limited settings, as well as the challenges associated with their implementation.

Impact of the COVID-19 Pandemic on Prostate Cancer Diagnosis, Staging, and Treatment: A Population-Based Study in Northern Italy.

The COVID-19 pandemic has caused delays in cancer diagnoses and reductions in treatments. The aim of this work is to evaluate the impact of the pandemic on prostate cancer by evaluating whether there has been a shift towards more aggressive (Gleason) and more advanced tumors (stage IV) and a decline in treatments. The study was conducted on 1123 cases of prostate cancer incident in the Province of Reggio Emilia, Northern Italy, in the period of 2018-2021. In 2020, there was a decline in new diagnoses of prostate cancer (-31%), followed by a slight recovery in 2021 (+5%). While Gleason 7 and 8-10 values remained constant, a significant decrease was recorded in stage I (38.7%, 41.6%, 35.5%, and 27.7%) and an increase in stage IV (13.1%, 13%, 15.4%, and 20%) cases in the years 2018, 2019, 2020, and 2021, respectively. However, there was no impact on surgical treatment (which remained constant at around 35%) and radiotherapy (around 39%). Our findings underline the profound impact of COVID-19 on prostate cancer management, highlighting the importance of healthcare resilience in the face of unprecedented disruptions.

Retrospective Analysis of the Impact of the COVID-19 Pandemic on Dental Health and Utilization of Dental Services: A Tertiary Care Study between 2017 and 2022

ABSTRACT Background: Worldwide healthcare systems, especially those that provide dental treatment, have been devastated by the COVID-19 epidemic. Future healthcare initiatives must take into account the pandemic’s effects on oral health and service consumption. The purpose of this retrospective study was to examine how the COVID-19 pandemic affected dental health and the use of dental services, with a particular emphasis on a tertiary care facility from 2017 to 2022. Methods: Descriptive analysis was performed on data gathered from patient records, including demographics, diagnoses, treatments, and service consumption. Prepandemic, pandemic, and postpandemic variations in oral health trends and service use were evaluated. Findings: During the pandemic, there was a notable decrease in emergency dental visits, whereas teledentistry consultations increased. Age and socioeconomic level are two demographic variables that have an impact on variations in oral health trends. Conclusion: In summary, the COVID-19 pandemic has had a significant influence on dental health and service consumption, underscoring the necessity of flexible approaches to deal with new issues and inequities in dental care access. This study adds insightful information to the conversation on healthcare resilience and pandemic preparedness.

Seeking systems-based facilitators of safety and healthcare resilience: a thematic review of incident reports.

Patient safety incident reports are a key source of safety intelligence. This study aimed to explore whether information contained in such reports can elicit facilitators of safety, including responding, anticipating, monitoring, learning, and other mechanisms by which safety is maintained. The review further explored whether, if found, this information could be used to inform safety interventions. Anonymized incident reports submitted between August and October 2020 were obtained from two large teaching hospitals. The Systems Engineering Initiative for Patient Safety (SEIPS) tool and the resilience potentials (responding, anticipating, monitoring, and learning) frameworks guided thematic analysis. SEIPS was used to explore the components of people, tools, tasks, and environments, as well as the interactions between them, which contribute to safety. The resilience potentials provided insight into healthcare resilience at individual, team, and organizational levels. Sixty incident reports were analysed. These included descriptions of all the SEIPS framework components. People used tools such as electronic prescribing systems to perform tasks within different healthcare environments that facilitated safety. All four resilient capacities were identified, with mostly individuals and teams responding to events; however, monitoring, anticipation, and learning were described for individuals, teams, and organizations. Incident reports contain information about safety practices, much of which is not identified by traditional approaches such as root cause analysis. This information can be used to enhance safety enablers and encourage greater proactive anticipation and system-level learning.

Exploring society‐to‐cells resilience among community members: A multidisciplinary study in outpatient clinics with diverse participant demographics

AbstractAimThis study explores and understands community members' resilience in outpatient clinics, considering various dimensions and types of resilience.DesignA cross‐sectional study.MethodsThis study was conducted in Saudi outpatient clinics from September to December 2023 and included 384 individuals chosen through systematic random sampling. Various tools were used, such as Social Cohesion and Trust Scale, Community Resilience Assessment Tool, Community Assessment of Psychic Experiences, Environmental Resilience Assessment, Economic Resilience Index, Connor‐Davidson Resilience Scale, Brief Resilience Scale, Resilience Scale for Adults and Healthcare Resilience Index.ResultsParticipants displayed a robust overall resilience level, as indicated by Total Connor–Davidson Resilience Scale score of 63.0 ± 9.0. Additionally, they demonstrated commendable levels of resilience in Total Brief Resilience Scale (56.04 ± 8.6), Resilience Scale for Adults (82.5 ± 7.2) and Healthcare Resilience Index (45.8 ± 5.5). These findings offer significant insights into psychological and emotional well‐being of the study population, highlighting their adaptive capacities and coping mechanisms across various life domains.ConclusionThis study provides valuable insights into the multidimensional nature of resilience in outpatient settings. The cross‐sectional design sets the groundwork for future longitudinal investigations, highlighting the need for a holistic approach to understanding and promoting resilience.ImpactThis study holds immediate implications for participants and their communities. It underscores the adaptive capacities and coping mechanisms prevalent in the outpatient population by revealing commendable resilience levels. This insight enhances individuals' psychological and emotional well‐being, contributing positively to the overall resilience and communal strength. Additionally, this study sheds light on how resilience among community members in Saudi Arabia relates to international advanced nursing communities, providing insight into their work.Patient or Public ContributionPatients who have received outpatient services in the past 6 months were purposively chosen to ensure a diverse representation across age, gender and socio‐economic backgrounds in this study.

Quantifying holistic capacity response and healthcare resilience in tackling COVID-19: Assessment of country capacity by MCDM.

The resilience of a country during the COVID-19 pandemic was determined based in whether it was holistically prepared and responsive. This resilience can only be identified through systematic data collection and analysis. Historical evidence-based response indicators have been proven to mitigate pandemics like COVID-19. However, most databases are outdated, requiring updating, derivation, and explicit interpretation to gain insight into the impact of COVID-19. Outdated databases do not show a country's true preparedness and response capacity, therefore, it undermines pandemic threat. This study uses up-to-date evidence-based pandemic indictors to run a cross-country comparative analysis of COVID-19 preparedness, response capacity, and healthcare resilience. PROMETHEE-a multicriteria decision making (MCDM) technique-is used to quantify the strengths (positive) and weaknesses (negative) of each country's COVID-19 responses, with full ranking (net) from best to least responsive. From 22 countries, South Korea obtained the highest net outranking value of 0.1945, indicating that it was the most resilient, while Mexico had the lowest (-0.1428). Although countries were underprepared, there was a robust response to the pandemic, especially in developing countries. This study demonstrates the performance and response capacity of 22 key countries to resist COVID-19, from which other countries can compare their statutory capacity ranking in order to learn/adopt the evidence-based responses of better performing countries to improve their resilience.

Elevating Healthcare Resilience: Role of drones in mitigating supply chain challenges in Malaysia

This paper explores the usage of drones in the Malaysian healthcare supply chain (HSC) and proposes strategies by identifying the challenges faced. A detailed literature review found several challenges, such as limited technical capability, strict government regulation, the need for a 5G network, and limited drone capabilities. Hence, some of the identified mitigation strategies are investment in tertiary education, government legislation improvement, expedited 5G network adoption, collaboration with NGOs, and providing drones with multi-functionality. This study contributes to the knowledge relevant to drone technology and the HSC. Future studies should investigate the practicability of drones that can support HSC management.

Managing a Mega Mass Casualty Event by a Civilian Emergency Medical Services Agency: Lessons From the First Day of the 2023 Hamas-Israel War.

On 7 October 2023, Israel faced an unexpected attack by Hamas, causing over 1,200 deaths and injuring more than 9,000 individuals. This report delves into the rapid medical response spearheaded by Israel's civilian Emergency Medical Service, Magen David Adom (MDA), during this crisis. Utilizing data from MDA's electronic database, 4,097 dispatch records from the day were analyzed. Of these, 39.3% were directly related to the attack. EMS teams faced multiple challenges, including handling an overwhelming number of casualties and navigating active combat zones, which impeded safe access to victims, posed significant risks to teams' safety, and constrained patient evacuation strategies. This incident underscores the importance of reinforcing healthcare resilience, particularly emphasizing the need for centralizing various aspects of response efforts. These include streamlined communication, national coordination of pre-hospital resources, and systemic management of patient evacuations. Moreover, providing substantial support for EMS personnel, who operated in highly challenging conditions, is imperative.

PANDEMIC EPIDEMIOLOGY: A COMPREHENSIVE REVIEW OF COVID-19 LESSONS AND FUTURE HEALTHCARE PREPAREDNESS

This comprehensive review examines the epidemiology of the COVID-19 pandemic, shedding light on pivotal lessons learned and their implications for future healthcare preparedness. Analyzing the global landscape of the virus, the review delves into transmission dynamics, risk factors influencing severe outcomes, and the effectiveness of diverse public health interventions. It provides a nuanced exploration of the challenges encountered by healthcare systems worldwide, elucidating strengths and vulnerabilities brought to the forefront by the pandemic. The study underscores the need for a multifaceted approach to healthcare preparedness, emphasizing the critical importance of integrated surveillance systems, agile response mechanisms, and the implementation of evidence-based strategies. Drawing on experiences from diverse regions, the review identifies key lessons in pandemic management, showcasing successful strategies and innovative interventions that have proven effective in curbing the virus's spread. Moreover, the review examines the role of vaccination campaigns in shaping the trajectory of the pandemic and emphasizes the vital contribution of technology in bolstering healthcare resilience. As the world grapples with the long-term effects of COVID-19, this review aims to distill essential insights that can inform future pandemic preparedness efforts. By synthesizing knowledge gleaned from the challenges posed by COVID-19, this comprehensive analysis offers a foundation for evidence-based strategies, guiding global healthcare systems towards enhanced readiness to confront and mitigate the impact of future infectious threats.
 Keywords: Pandemic, Epidemiology, COVID-19, Healthcare, Review.

The Effects of COVID-19 Pandemic on HIV Service Provision in Ukraine.

Ukraine faced significant fluctuations in COVID-19 morbidity and mortality, alongside an escalating HIV epidemic. This mixed-methods study, conducted between February and August 2022, employed a sequential explanatory design combining a quantitative analysis of national data and qualitative interviews to investigate the pandemic's effects on HIV services in Ukraine. The observed trends confirmed that the pandemic significantly disrupted facility-based HIV testing due to logistical challenges, an increased burden on healthcare workers, and supply shortages. Meanwhile, community-based testing showed resilience, largely attributed to programmatic adjustments rather than the pandemic itself. The initiation of antiretroviral therapy declined, especially during initial lockdowns, reflecting diminished treatment capacities. Despite these challenges, telemedicine and home medication delivery innovations supported antiretroviral therapy adherence. Furthermore, improvements in viral load testing and suppression rates showed healthcare resilience. The study highlights the critical need for adaptable, sustainable healthcare strategies in crises, emphasized during the war with Russia.

Next-Gen Security: Leveraging Advanced Technologies for Social Medical Public Healthcare Resilience

Next-Gen Security: Leveraging Advanced Technologies for Social Medical Public Healthcare Resilience

HEALTHCARE SYSTEM EFFICIENCY AND ITS DRIVERS IN PRE- AND COVID-19 PANDEMIC SETTINGS

Purpose – The aim of the study is to assess healthcare system efficiency in both regular circumstances and during the COVID-19 pandemic, with a focus on key factors influencing efficiency, and offer health authorities insights into healthcare system resilience. Research methodology – The analysis was conducted in two stages. The initial stage involved the application of Data Envelopment Analysis output-oriented model with a constant-returnto-scale framework. The second stage employed Tobit regression method to identify factors that influenced countries’ efficiency. Findings – We identified the healthcare system efficiency of 14 CIS and EU countries in Pre and pandemic settings and provided a methodology for results interpretation accounting for the complexity of healthcare systems and temporal variations in pandemic trends. The Tobit regression highlighted the role of the health workforce, emphasizing the caution for the reduction of physicians in the system. Research limitations – The research focused on efficiency in just two regions of Eurasia and only considered medical factors as the primary drivers of efficiency. Additionally, the examination covered the initial year of the pandemic, reflecting only the earlier stages of countries’ performance during the pandemic. Practical implications – This study contributes to the assessment of healthcare resilience on a global scale and provides information for policymakers, aiding in the selection of optimal practices during the pandemic and enhancing preparedness for future crises. Originality/Value – Countries’ efficiency assessment in four models and two settings provides valuable insight into the healthcare systems’ resilience.

Sustainable Healthcare Resilience: Disaster Preparedness in Saudi Arabia’s Eastern Province Hospitals

In a world increasingly vulnerable to environmental and health crises, sustainable healthcare systems are crucial. This study focuses on the resilience and sustainability of healthcare services in Saudi Arabia’s Eastern Province, assessing their readiness to endure and adapt amidst disaster scenarios. Conducted through a cross-sectional survey involving 522 hospital employees, the research provides an in-depth analysis of various sustainability-related aspects of healthcare preparedness. This includes examining both structural and non-structural safety elements, standard operating procedures, staff training in disaster response, data security, and sustainable management of resources during emergencies. The results reveal a noteworthy commitment to sustainable disaster preparedness: 53.7% of hospitals, predominantly governed by the Ministry of Health, have implemented comprehensive disaster recovery plans. Furthermore, the study found a strong representation of female participants (54.2%) in these hospitals. A significant 64.1% of respondents confirmed the existence of disaster recovery plans in their workplaces, and an even higher percentage, 70.6%, reported receiving specific training in disaster response. These findings underscore the proactive efforts of Eastern Province hospitals in fostering a sustainable and resilient healthcare framework, demonstrating an approach that prioritizes preparedness beyond immediate crisis response. This proactive stance is pivotal in ensuring the continuity of healthcare services amidst the ever-evolving nature of global disasters.

Factors causing emergency medical care overload during heatwaves: A Delphi study.

Heatwaves pose an important risk for population health and are associated with an increased demand for emergency care. To find factors causing such overload, an online Delphi study included 15 experts in emergency medicine, disaster medicine, or public health. One open-ended question was delivered in the first round. After content analysis, the obtained statements were sent to the experts in two rounds to be rated on a 7-point linear scale. Consensus was defined as a standard deviation ≤ 1.0. Thirty-one statements were obtained after content analysis. The experts agreed on 18 statements, mostly focusing on the input section of patient processing and identifying stakeholders, the population, and primary care as targets of potential interventions. Additional dedicated resources and bed capacity were deemed important as per throughput and output sections, respectively. These findings could be used in the future to implement and test solutions to increase emergency healthcare resilience during heatwaves and reduce disaster risk due to climatic change.

Adaptation to heat and concomitant environmental risks in Europe: a GAP Analysis

Abstract Background Climate change is increasing the frequency and intensity of extreme events like heatwaves, wildfires and droughts. Within the ENBEL project, a GAP analysis was carried out to provide evidence on vulnerability factors of concomitant environmental risks during heat waves and promote the implementation of public health response. Aim To assess the level of implementation of heat wave and co-exposures (air pollution, wildfires and drought) response actions and to identify gaps and needs for public health adaptation in Europe. Methods A scoping review was performed to identify clinical and social vulnerabilities to heatwaves and concomitant exposures and prevention measures in place. Interviews with key stakeholders will provide additional information on response measures addressed to vulnerable groups as well as identifying needs and gaps for adaptation. Furthermore, an assessment of how Covid-19 recovery plans and funding in Europe are supporting climate adaptation and health care resilience was carried out. Results From the literature review interventions mainly focused on outdoor workers and athletes, include guidance, plans and actions on hydration, rest in the shade, cooling clothes and food, as well as acclimatization procedures. The elderly are among those consistently targeted in heat prevention plans, with health and social care surveillance, tele-medicine and awareness campaigns carried out during summer in several high-income countries. Regarding multiple environmental exposures, studies on preventive measures are scarce, and stakeholders reported the need for further research, sharing of knowledge and evaluation of measures to enhance action. Conclusions Although Covid-19 recovery funding is providing marginal benefits for health systems resilience, key barriers to climate adaptation still remain in terms of limited resources, personnel capacity; governance constraints and unclear policy remit.