Hospital Disaster Resilience Research Articles

Dimensions of hospital resilience emphasized during the COVID-19 pandemic response: A systematic review.

Hospitals must maintain their effective operations during and after disasters. Due to the current increase in disasters, hospital resilience has drawn scholarly attention. This study aimed to review studies on the changes in the definition of hospital resilience after COVID-19, build a conceptual framework for careful measurement, and identify the main dimensions of hospital resilience emphasized during the COVID-19 pandemic. The initial phase of this study was a systematic review of articles published before the COVID-19 pandemic to extract the hospital resilience-related dimensions for the second phase. The second phase involved text-mining articles published both before and after the emergence of COVID-19. In the systematic review phase, 12 databases were searched from 2006 to January 2020, including Scopus, Web of Science, MEDLINE through PubMed, Embase, ERIC, ProQuest, the Cochrane Library, Emerald, Springer, Science Direct/ELSEVIER, Google Scholar, and SID (for Persian language papers). Then, after COVID-19, articles published in these databases between January 2020 and May 2022 were evaluated using text mining. During the systematic phase, 17 out of 1530 papers published before COVID-19 were synthesized to collect components of hospital disaster resilience. These identified components were the inputs for the text-mining phase. The text mining on pre-COVID papers resulted in six clusters, with the highest weight (0.65) belonging to general resilience and disaster preparedness, while in the post-COVID text mining phase, including 70 papers, 8 clusters have been identified, with the highest weight cluster (0.78) focusing on the mental and psychological aspects of resilience among healthcare workers. Following the COVID pandemic, scholarly attention has shifted to the more personal dimensions of hospital resilience, including psychological resiliency. It seems necessary for policymakers to focus more on the individual and psychological resilience of hospital staff.

Does hospital medical staff maintain hospital disaster resilience?

Background/Aim. In the event of a disaster, it is necessary for medical personnel to demonstrate the operational component of disaster resilience, which requires certain knowledge and skills regarding disaster medical response algorithms. The aim of this study was to analyze the preparedness of hospital?s healthcare staff for maintaining hospital disaster resilience. Methods. An anonymous survey was conducted from July to September 2019 among 295 medical staff employed in hospitals in the territory of the city of Plovdiv, Bulgaria. Pearson?s Chisquare test, Student?s t-test, and graphical analysis were used in the statistical analysis. Results. Most of the medical staff, i.e., 85.8%, believed that disaster drills are not held regularly in hospitals, 30.8% thought that the training period was shorter than two years, and the majority, i.e., 86.1%, did not participate in exercises. Conclusion. Due to the irregular implementation of exercises and the small number of participants in them, the level of preparedness for responding to disasters is not maintained at a high level in hospitals in the Plovdiv region. Therefore, it is necessary to introduce a specific training program and exercise once a year, which should have a beneficial effect on increasing the preparedness of the medical staff for disasters and improving the operational resilience of the hospital.

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

BackgroundThe 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.MethodsThis 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.ResultsThe 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.ConclusionsThe 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.

Factors influencing hospital preparedness and resilience for emerging infectious diseases: a systematic review

Hospitals have crucial roles during an outbreak of emerging infectious diseases. They are expected to manage the surge of patients while continuing essential health services. This study aims to investigate the factors that influence hospital disaster preparedness and resilience in facing emerging infectious disease threats. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method. International electronic databases, including PubMed, Science Direct, ProQuest, and SAGE, were investigated for the research studies that were published between 2001 and 2022 in English-language. The inclusion and exclusion criteria were determined to extract factors or indicators influencing hospital disaster preparedness and resilience encounter emerging infectious diseases. For the initial 672 articles, we identified 16 articles that specifically addressed the aims of this review and formed the basis of the intended analysis. Seven factors influence hospital preparedness, with human resources and crisis management being the most important. The hospital’s resilience has 18 factors that are classified according to the disaster phase. Hospital resilience is concerned with all phases of a disaster (mitigation, preparedness, response, and recovery), not just operational management during a disaster (as is preparedness).

Enabling Transformational Leadership to Foster Disaster-Resilient Hospitals.

Hospitals' operational performance during disasters varies from failing, to being responsive and resilient, to dealing with disruption and surprise. Transformational leaders enable continuously learning hospitals that are resilient in the face of disasters by adapting regeneratively and evolving beyond undertaking conventional lesson-learning after each disaster. However, learning from successful transformational leaders in healthcare is still ad hoc with a lack of guidance on how to develop such leaders. Hence, this study sought to identify key competencies of transformational leaders by exploring hospital leaders' actions in dealing with disasters, considering the disaster cycle of prevention, preparedness, response, and recovery (PPRR). A qualitative case-study design was adopted comprising in-depth semi-structured interviews with twelve senior hospital staff with operational leadership experience with disasters. Three significant categories (themes) and seven key component competencies (sub-themes, in brackets) of transformational leaders were revealed through the analysis of transcripts: (1) 'Governance and leadership' ('transformative agency' and 'decisive accountability'); (2) 'Planning and risk assessment' ('risk navigation', 'disaster attunement', and 'planning agility'); and (3) 'Communication and network engagement' ('communication accelerator' and 'collaboration innovator'). The authors propose a transformational leadership model for hospital disaster resilience and an assessment checklist for leaders' self-reflection to support hospitals in their transition to resilient operations.

IMMEDIATE BED AVAILABILITY IN CASE OF A DISASTER

Introduction: During a disaster, an increase in the number of casualties requiring hospital admission is recorded. This challenge the hospitals' management - there is a need for beds, rooms, consumables, drugs, and medical teams to support the increased number of patients arriving. Purpose: This study aims to analyze the awareness of hospital medical professionals about the required procedures described in the hospital contingency plan for increased bed availability in case of disaster. Materials and methods: 295 hospital medical professionals in the Plovdiv region, Bulgaria, participated in an anonymous survey that contained 55 questions. Results: Most of the respondents are not familiar with the approved procedures to optimize the availability of emergency beds after the disaster that impacts the hospital disaster resilience. Conclusions: Optimization of activities related to operational hospital disaster resilience must include training of medical specialists in immediate bed availability procedures.

Hospital Disaster Resilience: a Conceptual Framework

This article analyses the concept of hospital resilience to natural disasters (earthquakes, global warming, pandemics, and man-made disasters such as war, conflict and cyber-attacks) in the context of theoretical insights in scholarly articles on the concept of resilience, and elements of its perception and other aspects. The research conducted identified that the concept of a resilient hospital encompasses its ability to maintain functionality at minimal resource costs, and reduce the likelihood of shock in the event of various disasters. This capacity to withstand hazard can be of various types, for example, constructive, infrastructural or administrative. The following four elements are most commonly identified levels of resilience: context, disturbance, capacity to deal with disturbance, and reaction to disturbance. A resilient hospital maintains the following characteristics: rapidity, robustness, redundancy, resourcefulness, awareness, diversity, self-regulation, unity and adaptiveness. A variety of means are used to amplify resilience to distinct disasters and it is relevant to manage different types of resilience, but the human factor is indisputably essential in this framework.

Disaster medical support plan as an element of the hospital disaster resilience.

Abstract.

The Policy Gap and Inefficiency in Public Volunteers' Response to Assist the Hospitals After Natural Disasters in Iran: A Grounded Theory Methodology.

This study aims to explore a public volunteer's hospital response model in natural disasters in Iran. This study employed grounded theory using the Strauss and Corbin 2008 method and data analysis was carried out in three steps, namely open, axial, and selective coding. The present qualitative study was done using semi-structured interviews with 36 participants who were on two levels and with different experiences in responding to emergencies and disasters as "public volunteers" and "experts". National and local experts were comprised of professors in the field of disaster management, hospital managers, Red Crescent experts, staff and managers of Iran Ministry of Health and Medical Education. The main concept of the paradigm model was "policy gap and inefficiency" in the management of public volunteers, which was rooted in political factions, ethnicity, regulations, and elites. The policy gap and inefficiency led to chaos and "crises over crises." Overcoming the policy gap will result in hospital disaster resilience. Meanwhile, the model covered the causal, contextual, and intervening conditions, strategies, and consequences in relation to the public volunteers' hospital response phase. The current public volunteers' hospital in Iran suffered from the lack of a coherent, comprehensive, and forward-looking plan for their response. The most important beneficiaries of this paradigm model will be for health policy-makers, to clarify the main culprits of creating policy gap and inefficiency in Iran and other countries with a similar context. It can guide the decision-makings in upstream documents on the public volunteers. Further research should carried out to improve the understanding of the supportive legal framework, building the culture of volunteering, and enhancing volunteers' retention rate.

“Recovering, not recovered” Hospital disaster resilience: a case-study from the 2015 earthquake in Nepal

ABSTRACT Background Disasters are an increasing threat to human health, but we know little about their impact on health services, particularly in low and middle-income settings. ‘Resilient hospitals’ have been increasingly recognized as a cornerstone of disaster management. While various frameworks of hospital resilience exist, they emerged from pre-disaster considerations, and do not incorporate evidence from post-disaster settings. Objective This dissertation investigated the impact of a large-scale sudden onset disaster in a tertiary hospital in Nepal, and explored its resilience mechanisms. Methodology This consists of an in-depth case-study combining quantitative data from routinely generated hospital records and qualitative data from semi-structured interviews with hospital staff. We used both advanced statistical methods and mixed inductive and deductive coding to analyze the data. Results Most of the admitted earthquake victims required surgical interventions and long hospitalizations, considerably straining the hospital. For six weeks, the average number of daily admissions decreased. During this period, the share of injury-related admissions was particularly high, and such admissions were particularly long compared to the baseline. Admissions due to other conditions relatively decreased and were shorter. We found that the hospital’s resilience was highly dependent on emerging adaptations, in addition to the pre-existing disaster plan. Individual resilience of staff also played a major role, and was influenced by senses of safety, meaningfulness, and belonging. Conclusion Hospitals should prepare resources and plan for their known disaster risks, but should also allow for a certain flexibility to innovative adaptions to emerging, unforeseen challenges. Challenges faced by hospital workers should not be undermined, and addressing them will increase hospital resilience.

Hospital disaster resilience: development of an assessment tool using expert panel and fuzzy analytical network process

PurposeResilient hospitals have the vital role in reducing mortality, severity of injuries by providing required emergency services during accidents and disasters. This study aims to identify and prioritize key indicators on hospital resilience.Design/methodology/approachThis cross-sectional study was conducted in 2019. The draft of the indicators obtained from the systematic review of the previous study was finalized, with three expert panel sessions and 14 experts in resilience fields. The outputs of these sessions were divided into three domains including constructive resilience, infrastructural resilience and administrative resilience, 17 sub-domains and 71 indicators. Then fuzzy analytic network process method was used to weight and prioritize the final indicators of hospital disaster resilience.FindingsAdministrative resilience, logistic and financial management and strategic outsourcing agreement allocated the highest weight as domain, sub-domains and indicators, respectively. The weight of each sub-domain and indicator was also determined.Originality/valueInvestigating the weight of domains, sub-domains and indicators shows the importance of managerial and operational issues in hospital resilience. By using the indicators and relative weights, a tool for measuring hospital disaster resilience can be created in further studies. The output of these assessments is effective in promoting safety and increasing awareness of hospital managers and health policymakers.

Safer Hospital Infrastructure Assessments for Socio-Natural Disaster - A Scoping Review.

The aim of this review was to explore hospital socio-natural disaster resilience by identifying: studies assessing structural and non-structural aspects of building resilience; components required to maintain a safe and functional health facility; and if the checklists used were comprehensive and easily performed. A review systemic approach using PRISMA was taken to search the literature. The search focused on articles that discuss hospital disaster resilience. This includes assessments and checklists for facility structural and non-structural components. This review identified 22 articles describing hospital assessments using checklists containing structural and non-structural elements of resilience. These studies identified assessments undertaken in ten countries, with eight occurring across Iran. A total of seven differing checklists were identified as containing aspects of structural or non-structural aspects of building resilience. The World Health Organization (WHO) has authored three checklists and four others were developed independently.The structural resilience domain includes building integrity, building materials, design standards, and previous event damages as important elements to determine resilience. Within the internal safety and resilience domains, 11 differing elements were identified as important to non-structural or internal infrastructure resilience. These included the safety of power, water, telecommunication, medical gas supply, and medical equipment resupply systems.Independent evaluation methods were reported in the majority of articles, with a small number highlighting the benefits of both self-evaluation and independent review processes. Implementation of training programs to evaluators was mentioned in three papers with the assessor's knowledge and understanding of all checklist elements being highlighted as important to the validity of the evaluation. The review identified the assessment of hospital resilience as important for management to determine areas of vulnerability within the hospital's infrastructure and to inform improvement strategies. Assessment criteria must be comprehensive, highlighting structural and non-structural aspects of facility infrastructure. These assessments are best done as a multi-disciplinary collective of experts, involving hospital employees in the journey. This collaborative approach provides a key educational tool for developing disaster capacity, engaging ownership of the process, and the resulting improvements.The on-going development of health facility and wider health system resilience must remain a key strategic focus of national governments and health authorities. The development of standardized procedures and guidelines must be embedded into daily practice.

Towards developing a model for the evaluation of hospital disaster resilience: a systematic review

BackgroundHospitals play a vital role in disaster stricken regions. The resilient hospitals will be able to provide essential services to affected people and it can mitigate the risk of injuries during and after disasters. This study aimed to obtain the indicators required for the evaluation of hospital resilience.MethodsThis systematic review was conducted in 2018. Through this systematic review, international electronic databases were investigated for the research studies published in English. The exclusion and inclusion criteria were determined to extract the hospital resilience indicators. These indicators will be used in order to develop a model to keep the system performance at an acceptable level during disasters.ResultsOut of 1794 research studies published until September 2018, 89 articles and guidelines with full text were surveyed. Thirty-two articles and guidelines were then selected and analyzed to collect the indicators related to hospital disaster resilience (HDR). The domains and the indicators were extracted from these selected research studies. The authors collected and categorized them into three domains and twenty seven subdomains. The three domains included constructive, infrastructural, and administrative resilience. The relevant indicators were designed for each subdomain to assess HDR.ConclusionSince diverse indicators affect hospital resilience, other studies should be conducted to propose some models or tools to quantify the hospital resilience in different countries and scopes with an all hazards approach.

EXTRA RESOURCES POOL - A PREREQUISITE FOR HOSPITAL DISASTER RESILIENCE

Hospital resilience is function of an array of planning, organizational, physical and psychological features. They are related to the hospital staff readiness and preparedness, resources availability, type and stamina of the buildings and constructions, as well to the established communication and coordination within the region and country. When analyzing the disaster resilience, the main feature to be addressed is the disparity between required and available means and capabilities. The aim of this study is to analyze the hospital staff awareness regarding the need of focused resources planning for assuring the disaster hospital resilience. Material and methods: By the means of descriptive and comparative methods the records form diverse disaster medical support and hospitals involvement into the process are analyzed and the most frequent shortfalls regarding the resources exhaustion and its impact on hospital disaster resilience are presented. Dichotomous survey among 54 medical professionals was performed in order to discover their awareness regarding the existing into hospitals, they are working in, pools of resources dedicated for disaster medical support. Results and discussion: Great majority of the inquired hospital staff is demonstrating complete ignorance regarding the extra resources required in case of disastrous events. This could lead to improper use of the available resources when needed and to the poor disaster medical support results. Conclusion: Resources planning studies have to be more detailed during medical managers’ education.

ASSESSING THE CONTENT VALIDITY OF HOSPITAL DISASTER RESILIENCE ASSESSMENT INSTRUMENT

Hospital disaster resilience assessment is a process of analysing the condition of the site, building, people and operations through a checklist of indicators (i.e., structural, non-structural and functional). As in 2011, Global Platform on Disaster Risk Reduction has been established with twofold objectives: 1) by 2011, assessments on the safety of existing hospital facilities to be undertaken and 2) by 2015, action plans for hospitals should be developed and implemented in disaster prone countries. Howbeit the initiative was established, valid instruments for assessing resilience of existing hospital are lacking particularly in Malaysia. Hence, the objective of the paper is to evaluate the content validity of the disaster resilience hospital assessment instrument. Two methods were employed in the form of document analysis (7 instruments) and CVR & CVI questionnaire (6 experts). Based on the document analysis, 129 elements with three main constructs are suggested to be incorporated in the instrument. The CVR scores revealed that 48 out of 129 items are regarded as the utmost critical (structural - 2; non-structural - 7; and functional - 39). The findings for I-CVI and modified kappa coefficient however revealed that 122 items in the instrument are appropriate and excellent. The remaining seven items values are considered fair and poor and recommended to be eliminated. In addition, based on the S-CVI/Ave it is revealed that the content validity of the proposed instrument is adequate. As for this reason, it is noteworthy that the instrument to be highly regarded for evaluating the existing hospitals’ resilience.

Disaster: Are We Prepared?

In the last issue of Nursing and Midwifery Studies Journal, there was an interesting article about the experiences of nurses in Bam earthquakes in December 2003 that left 25000 dead and put the whole nation into the shock and grief (1). In summary, nurses reported that there was such a mental stress that many of them could not perform their usual simple tasks efficiently. There was a shortage of essential equipment and weak management that led to chaos. As a whole, the health system and nurses were not prepared for that disaster (1). The question is “are we prepared for the next disaster?” Iran is the tenth disaster-prone country in the world and the fourth in Asia (2) and unfortunately, the next disaster will happen sooner or later. Large-scale disaster events such as earthquake, causes social and psychological distortion of the community, infrastructures, and service levels; in this situation, delivering the best healthcare services is a challenging task (3). Therefore, the health system especially nurses should be completely prepared for such events. Although some national efforts have been made, we cannot see the complete preparedness in our health system, as in the recent earthquake in Azerbaijan, the relief operation was far from satisfactory level. There are some lessons that we can learn from our past as well as from the experiences in other countries: Hospitals can act as a source of support and management during disasters. The hospital disaster resilience, especially the focus of community-wide disaster cooperation, on-site medical rescue, and hospital patient care capacity must be improved. Hospitals need to take a more cohesive approach to be resilient and to cope efficiently in a potential disaster (4). Nurses should be equipped through education and training with the necessary knowledge and abilities to work in a disaster. The International Council of Nurses (ICN) framework of nursing disaster competencies for general nurses can be used as a guideline for nursing preparedness (4). The emergency drills are essential part of nursing preparedness. The especial well-trained and well-equipped nursing teams should be available to move to the scene in the first hours after disaster. There should be written disaster-specific plans for different situations such as pandemic influenza, earthquakes, floods, and landslides (5). Nongovernmental organizations (NGOs) should be developed to organize the volunteers during the disasters. In Bam earthquake, the crowds of volunteers who rushed to offer help caused a lot of chaos and along with weak management, led to the misuse of human resources (1). As a largest healthcare workgroup, nurses will be called upon during disasters to provide aid and care utilizing their unique skills, abilities, and understanding of the community. Fortunately there are a huge scientific and research-based materials concerning disaster, its management, and nursing in disaster that can be used for the preparedness. To be effective, nurses must be prepared; this preparation has different dimensions including education and training, leadership, and having disaster-specific plans. The health organizations should take essential steps to manage future disasters more efficiently.

Validation of a framework for measuring hospital disaster resilience using factor analysis.

Hospital disaster resilience can be defined as “the ability of hospitals to resist, absorb, and respond to the shock of disasters while maintaining and surging essential health services, and then to recover to its original state or adapt to a new one.” This article aims to provide a framework which can be used to comprehensively measure hospital disaster resilience. An evaluation framework for assessing hospital resilience was initially proposed through a systematic literature review and Modified-Delphi consultation. Eight key domains were identified: hospital safety, command, communication and cooperation system, disaster plan, resource stockpile, staff capability, disaster training and drills, emergency services and surge capability, and recovery and adaptation. The data for this study were collected from 41 tertiary hospitals in Shandong Province in China, using a specially designed questionnaire. Factor analysis was conducted to determine the underpinning structure of the framework. It identified a four-factor structure of hospital resilience, namely, emergency medical response capability (F1), disaster management mechanisms (F2), hospital infrastructural safety (F3), and disaster resources (F4). These factors displayed good internal consistency. The overall level of hospital disaster resilience (F) was calculated using the scoring model: F = 0.615F1 + 0.202F2 + 0.103F3 + 0.080F4. This validated framework provides a new way to operationalise the concept of hospital resilience, and it is also a foundation for the further development of the measurement instrument in future studies.

Disaster resilience in tertiary hospitals: a cross-sectional survey in Shandong Province, China

BackgroundHospital disaster resilience can be defined as a hospital’s ability to resist, absorb, and respond to the shock of disasters while maintaining critical functions, and then to recover to its original state or adapt to a new one. This study aims to explore the status of resilience among tertiary hospitals in Shandong Province, China.MethodsA stratified random sample (n = 50) was derived from tertiary A, tertiary B, and tertiary C hospitals in Shandong Province, and was surveyed by questionnaire. Data on hospital characteristics and 8 key domains of hospital resilience were collected and analysed. Variables were binary, and analysed using descriptive statistics such as frequencies.ResultsA response rate of 82% (n = 41) was attained. Factor analysis identified four key factors from eight domains which appear to reflect the overall level of disaster resilience. These were hospital safety, disaster management mechanisms, disaster resources and disaster medical care capability. The survey demonstrated that in regard to hospital safety, 93% had syndromic surveillance systems for infectious diseases and 68% had evaluated their safety standards. In regard to disaster management mechanisms, all had general plans, while only 20% had specific plans for individual hazards. 49% had a public communication protocol and 43.9% attended the local coordination meetings. In regard to disaster resources, 75.6% and 87.5% stockpiled emergency drugs and materials respectively, while less than a third (30%) had a signed Memorandum of Understanding with other hospitals to share these resources. Finally in regard to medical care, 66% could dispatch an on-site medical rescue team, but only 5% had a ‘portable hospital’ function and 36.6% and 12% of the hospitals could surge their beds and staff capacity respectively. The average beds surge capacity within 1 day was 13%.ConclusionsThis study validated the broad utility of a framework for understanding and measuring the level of hospital resilience. The survey demonstrated considerable variability in disaster resilience arrangements of tertiary hospitals in Shandong province, and the difference between tertiary A hospitals and tertiary B hospitals was also identified in essential areas.