Hospital Resilience Research Articles

Measuring hospital resilience before and during the COVID-19 pandemic

Organizational resilience scales have been adapted to the hospital context. To prepare for high consequence infectious diseases (HCID), the Long Hospital Resilience Scale (L-HRS; N=48) was tested in two German hospitals in 2019 and the Short Hospital Resilience Scale (S-HRS; N=317) after the first wave of COVID-19. Results show reliability of both the long and the short version. The L-HRS is associated with satisfaction with hospital preparation for HCID. S-HRS shows a perceived better adaptation of hospitals during COVID-19 and is related to higher self-efficacy of hospital staff. Both scales identify opportunities to promote resilience at various levels in 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.

Work Stress on Burnout: The Mediating Role of Resilience

This study analyzes (1) the effect of work stress on burnout in nurses at Madina Bukittinggi Hospital (2) the effect of work stress on resilience in nurses at Madina Bukittinggi Hospital (3) the effect of resilience on burnout in nurses at Madina Bukittinggi Hospital (4) the effect of work stress on burnout through resilience in nurses at Madina Bukittinggi Hospital. This research is a causal research. The population of this study were all nurses at Madina Bukittinggi Hospital. The number of samples used was the total population of 64 people taken using total sampling. Data collection using a questionnaire with a Likert Scale. The analysis technique used through SmartPLS 4 software. The results of data processing in this study indicate that: (1) work stress has a positive and significant effect on burnout in nurses at Madina Bukittinggi Hospital (2) work stress has a negative and significant effect on resilience in nurses at Madina Bukittinggi Hospital (3) resilience has a negative and significant effect on burnout in nurses at Madina Bukittinggi Hospital (4) resilience mediates the effect of work stress on burnout in nurses at Madina Bukittinggi Hospital.

Resilience of hospital and allied infrastructure during pandemic and post pandemic periods for maternal health care of pregnant women and infants in Tamil Nadu, India - A counterfactual analysis.

COVID-19 has impacted the healthcare system across the globe. The study will span three pandemic waves in 2020, 2021, and 2022. The goal is to learn how the pandemic affects antenatal care (ANC) and emergency delivery care for pregnant women in Tamil Nadu, India, and how medical services respond. The study employs counterfactual analysis to evaluate the causal impact of the pandemic. A feedforward in combination with a simple auto-regressive neural network (AR-Net) is used to predict the daily number of calls for ambulance services (CAS). Three categories of the daily CAS count between January 2016 and December 2022 are utilised. The total CAS includes all types of medical emergencies; the second group pertains to planned ANC for high-risk pregnant women and the third group comprises CAS from pregnant women for medical emergencies. The second wave's infection and mortality rates were up to six times higher than the first. The phases in wave-II, post-wave-II, wave-III, and post-wave-III experienced a significant increase in both total IFT (inter-facility transfer) and total non-IFT calls covering all emergencies relative to the counterfactual, as evidenced by reported effect sizes of 1 and a range of 0.65 to 0.85, respectively. This highlights overwhelmed health services. In Tamil Nadu, neither emergency prenatal care nor planned prenatal care was affected by the pandemic. In contrast, the increase in actual emergency-related IFT calls during wave-II, post-wave-II, wave-III, and post-wave-III was 62%, 160%, 141%, and 165%, respectively, relative to the counterfactual. During the same time periods, the mean daily CAS related to prenatal care increased by 47%, 51%, 38%, and 38%, respectively, compared to pre-pandemic levels. The expansion of ambulance services and increased awareness of these services during wave II and the ensuing phases of Covid-19 pandemic have enhanced emergency care delivery for all, including obstetric and neonatal cohorts.

Resilience against IT attacks in hospitals : Results from an exercise in aGerman university hospital

According to the legal definition healthcare systems and their components (e.g., hospitals) are part of the critical infrastructure of modern industrial nations. During the last few years hospitals increasingly became targets of cyber attacks causing severe impairment of their operability for weeks or even months. According to the German federal strategy for protection of critical infrastructures (KRITIS strategy), hospitals are obligated to take precautions against potential cyber attacks or other IT incidents. This article describes the process of planning, execution and results of an advanced table-top exercise which took place in a university hospital in Germany and simulated the first 3 days after acyber attack causing atotal failure of highly critical IT systems. During afirst stage lasting about 8 months IT-dependent processes within the clinical routine were identified and analyzed. Then paper-based and off-line back-up processes and workarounds were developed and department-specific emergency plans were defined. Finally, selected central facilities such as pharmacy, laboratory, radiology, IT and the hospitals crisis management team took part in the actual disaster exercise. Afterwards the participants were asked to evaluate the exercise and the hospitals cyber security using aquestionnaire. On this basis the authors visualized the hospital's resilience against cyber incidents and defined short-term, medium-term and long-term needs for action. Of the participants 85% assessed the exercise as beneficial, 97% indicated that they received adequate support during the preparations and 75% had received sufficient information; however, only 34% had the opinion that the hospital's and their own preparedness against critical IT failures were sufficient. Before the exercise took place, IT-specific emergency plans were present only in 1.7% of the hospital facilities but after the exercise in 86.7% of the clinical and technical departments. The highest resilience against cyber attacks was not surprisingly reported by facilities that still work routinely with paper-based or off-line processes, the IT department showed the lowest resilience as it would come to acomplete shutdown in cases of atotal IT failure. The authors concluded that the planning phase is the most important stage of developing the whole exercise, giving the best opportunity for working out fallback levels and workarounds and through this strengthen the hospitals resilience against cyber attacks and comparable incidents. Ameticulous preparedness can minimize the severe effects atotal IT failure can cause on patient care, staff and the hospital as awhole.

COVID-19 Pandemic Did not Influence Number of Oncologic and Emergency Surgeries: A Retrospective Cohort Study from a Tertiary Hospital in Austria.

Many articles described a massive decline in surgical procedures during the COVID-19 pandemic waves. Especially the reduction in oncologic and emergency procedures led to the concern that delays and cancelling surgical activity might lead to a substantial increase in preventable deaths. Overall numbers and types of surgery were analysed in a tertiary hospital in Austria during the winter period (October-April) from 2015/16 to 2021/22. The half-years 2019/20, 2020/21 and 2021/22 were defined as pandemic half-years and were compared with the mean results of the previous, four, pre-pandemic half-years. A reduction was found for overall numbers and elective surgeries during 2019/20 (4.62%; p < 0.0001 and 12.14; p < 0.0001 respectively) and 2021/22 (14.94%; p < 0.0001 and 34.27; p < 0.0001 respectively). Oncologic surgery increased during 2021/22 (- 12.59%; p < 0.0001) and remained unchanged during the other periods. Emergency surgeries increased during 2019/20 (- 6.97%; p < 0.0001) and during 2021/22 (- 9.44%; p < 0.0001) and remained unchanged during 2020/21. The concern that the pandemic led to a decrease in oncologic and emergency surgeries cannot be supported with the data from our hospital. A flexible, day-by-day, resource allocation programme with central coordination adhering to hospital resilience recommendations may have helped to adapt to the impact of the COVID-19 pandemic during the first three pandemic half-years.

ROLE OF AGILE EMPLOYEES IN BUILDING HOSPITAL RESILIENCE: AN INVESTIGATIVE STUDY

The Covid-19 pandemic has huge impact on business environment throughout the globe, particularly it posed many challenges for healthcare sector. There are about 219 known viruses which can cause diseases to the human beings and researchers estimate that this number is like one drop of ocean. In the past twenty years, there are many virus outbreaks like SARS, Swine Flu, MERS, Ebola and Zika. These pandemics registered billions of cases and lakhs of deaths, fortunately the mortality is less due to less spread. But the recent outbreak of Corona virus registered around 61.8Cr cases and 65.5L deaths worldwide and the mortality rate is above one percent. Till now these seven viruses caused around 1Cr deaths and there are 200 plus known and thousands of unknown viruses in the world which may affect mankind in the future. Therefore, the health system in each country should prepare them to face the pandemic situations. WHO also provided policy recommendations to build resilience in the health system. Health system can be resilient when every healthcare organisation becomes resilient. There are four stages in pandemic shocks and each stage requires different resilient characteristics like adaptative, responsive, collaborative, informative, accountable etc. In this context the current research is conducted to study the role of agile employees in building hospital resilience. KEYWORDS: Resilience, Agility, Health System, Pandemics, Adaptative, Responsive, Collaborative, Informative, Accountable

Assessing Hospital Safety Index in the Iranian Hospitals

Background: Hospital preparedness for accidents and disasters is vital in maintaining and promoting community health. However, the country’s hospitals are not well prepared for disasters. The hospital safety index (HSI) was 42% in Iranian hospitals in 2014. This study aims to investigate the HSI in Iranian hospitals in 2020 and to provide solutions to improve it. Materials and Methods: This cross-sectional descriptive study was performed for the country’s hospitals. The results recorded in the Farsi version of the hospital safety index (FHSI) software in 2020 were used. Hospital teams used the FHSI checklist (151 options) in three areas of structural, non-structural, and functional safety to assess the hospital and register in the FHSI system. The registered results of the hospitals were collected based on the medical universities of the country. Descriptive statistics were used to analyze the data. Results: A total of 604 hospitals registered safety index information in the system. The mean score of the HSI of the country’s hospitals was 60.84. A total of 130 hospitals (21.5%) had low safety levels, 418 hospitals (69%) had moderate safety levels, and 56 hospitals (9.2%) had high safety levels against disasters. The mean scores were in structural safety (57.20), non-structural (65.24), and functional safety (63.36). Hamedan (76.81) and Kerman (75.61) Provinces had the highest score, and Yazd (53.74), and Lorestan (57.31) Provinces had the lowest score in the country. Conclusion: The HSI against disasters in 2020 compared to 2014 has reached 6 out of 10 and we have about a 41.5% increase in safety (from 43 to 60.84). However, the HSI is moderate. Strengthening the safety and resilience of hospitals, improving the safety of medical equipment, improving the knowledge and skills of managers in the scientific development of preparedness, response and recovery programs, funding and support of crisis programs, attention to security programs, pollution, and evacuation are among the solutions of development and enhancement of hospital preparedness against disasters.

Performance analysis of hospitals before and during the COVID-19 in Iran: A cross-sectional study.

The COVID-19 pandemic placed considerable pressure on the health care systems and caused many disruptions to the care hospital system around the globe. This study aimed to analyze the performance of hospitals affiliated with the University of Medical Sciences and Health Services of South Khorasan Province before and during COVID-19. This cross-sectional study tracked the financial performance (FP) and service performance (SP) of 12 hospitals affiliated with South Khorasan University of Medical Sciences and Health Services using the Farabar system and Hospital Information System (HIS). Our study covered two time periods: from February 2018 to February 2020 (pre-COVID-19) and from February 2020 to February 2021 (during COVID-19). SP analysis of hospitals was performed by examining the trend of monthly changes before and during the COVID-19 pandemic and analyzed using SPSS software version 22 and Paired Sample T-Test. FP of hospitals was analyzed through relevant ratios and analyzed using Microsoft Office Excel. Most SP indicators decreased considerably in all hospitals during COVID-19. FP ratios (e.g., activity and leverage ratios) increased during either or both pre-COVID or COVID periods. Compared to before COVID-19, the operating margin ratio and operating expenses coverage from operating income increased from -0.50 and 66.55 to -1.42 and 41.32, respectively, during COVID-19. Moreover, the net profit margin ratio and Return On Assets (ROA) ratio were increased during COVID-19. COVID-19 has decreased the FP and SP of hospitals due to limitations in providing services to patients since the beginning of COVID-19. Measures such as providing various financing resources and improving the financial resilience of hospitals are essential. Funds should be disbursed to offset hospitals' losses due to reduced elective and outpatient revenue. Policymakers should come up with holistic policies to tackle the adverse impact of such crises in the future, support hospitals financially, and consider allocating additional funding to them during emergencies.

Systematic Review of Hospital Resilience Instrument: Does it Fit to face the Disruption Era?

Introduction: As critical infrastructure, hospitals have an important role as a provider of health care in the health care system. In the era of disruption, hospitals are faced with many challenges known as Volatility, Uncertainty, Complexity, and Ambiguity (VUCA) World. Resilience capacities are needed to cope with all disruptions to maintain business and service functions. This study aims to review hospital resilience instruments to measure resilience in the context of facing a disruption era. Methods: A systematic review in 2020 was conducted. The search of articles was done from electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic databases such as PubMed, Ovid, Science Direct, and Google Scholar were used.

Hospital Resilience in Three COVID-19 Referral Hospitals in Brazil

ABSTRACT Health crises, such as the COVID-19 pandemic, challenge health systems in demonstrating resilience—the ability to cope with change, manage challenges, and adapt in order to retain their effectiveness. Understanding how such challenges affect and produce reactions in those involved in this response is extremely important. This study evaluated resilience in three referral hospitals in the city of Recife, Pernambuco, Brazil—one public, one private, and one philanthropic hospital—by examining the coping activities adopted by the nursing staff working on the COVID-19 frontline. A multiple case study was carried out, using a qualitative approach, triangulating data from direct observations, document analysis, and interviews with 21 nursing professionals working in management and care provision. Data were collected from April to October 2020. The interviews were transcribed and analyzed based on the resilience categories defined by Blanchet (2017): absorption capacity, adaptive capacity, and transformative capacity. Four themes were considered relevant to the objectives of this study: institutional support, access to personal protective equipment (PPE), work relationships, and fear and mental health. Adaptive capacity was demonstrated concerning the four themes analyzed, absorption capacity was demonstrated in two themes, and no transformative capacity was identified. The study highlighted that the health crisis was challenging for all the hospitals studied, regardless of their legal-administrative status. No differences were observed among them in terms of resilience.

Interprofessional exchanges during COVID-19 at the Bichat Claude-Bernard Hospital: insights for research

The management of the COVID-19 epidemic has disrupted the organization of healthcare in hospitals. As part of a research project on the resilience of hospitals and their staff to the COVID-19 pandemic (HoSPiCOVID), we have documented their adaptation strategies in five countries (France, Mali, Brazil, Canada, Japan). In France, at the end of the first wave (June 2020), a team of researchers and health professionals from the Bichat Claude-Bernard Hospital organized focus groups to acknowledge these achievements and to share their experiences. One year later, further exchanges were held to discuss and validate the research results. The objective of this short contribution is to describe the insights of these interprofessional exchanges conducted at the Bichat Claude-Bernard Hospital. We show that these exchanges allowed: 1) to create spaces for professionals to speak, 2) to enrich and validate the data collected through a collective acknowledgment of salient aspects related to the experiences of the crisis, and 3) to account for the attitudes, interactions, and power dynamics for these professionals in a crisis management context.

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).

Potential Strengths and Weaknesses in Hospital Resilience in the Context of the COVID-19 Pandemic in Brazil: A Case Study

ABSTRACT The analysis of hospital resilience is essential in understanding how health services prepared for and responded to sudden shocks and unexpected challenges in the COVID-19 health crisis. This study aimed to analyze the resilience of a referral hospital in the state of Pernambuco, Brazil, in the context of the COVID-19 pandemic. The main theoretical approach based on resilience is the system’s capacity to maintain essential functions and to absorb, adapt, and transform in the face of unprecedented or unexpected changes. A single case study approach was used to identify the strengths and weaknesses of this response capacity. Data triangulation was employed. Data were collected from April (beginning of case discharges) to October 2020 (decrease in the moving average of cases in 2020). A content analysis was then conducted. Data were analyzed in relation to context, effects, strategies, and impacts in facing the disruptions caused by the pandemic. The results indicated the occurrence of four configurations mostly favorable to hospital resilience during the study period. Among the main strengths were: injection of financial resources; implementation of new hospital protocols; formation of a support network; equipping and continuing education of professionals; and proactive leadership. Weaknesses found in the analysis included: initial insufficiency of personal protective equipment and confirmatory tests; difficulties in restructuring work schedules; increasing illness among professionals; stress generated by constant changes and work overload; sense of discrimination for being a health professional; lack of knowledge about the clinical management of the disease; and the reduction of non-COVID assistance services.

The role of social institutions in community resilience following extreme natural hazard events

Social institutions such as hospitals and schools are among the main pillars of community stability. A drop in the functionality of hospitals and schools is likely to have short-term and long-term effects on a community, including a reduction in medical interventions, an increase in unschooled children, and population outmigration in search of essential social services. However, comprehensive community resilience models that consider the role played by social institutions in community stability following natural disasters are scarce at the present time. This paper provides a literature review and critical appraisal of previous studies on the resilience of hospital and school systems and their impact on community well-being. The review encompasses existing resilience models for single hospitals and schools, their role when connected with other hospitals and schools in a network, their reliance on each other as interdependent systems, and their role in community resilience and stability. Different mitigation strategies and policies to enhance hospital and school systems’ resilience after extreme natural hazards are also summarized. The paper concludes with a series of recommendations to improve current models for social institutions, enhance the connection between existing hospital and school resilience models and community resilience frameworks, and develop social stability indices that policymakers can use in preparing and mitigating future extreme events.

Hospital resilience in responding to the Covid-19 pandemic: investigating the adaptations of a hospital in Rio de Janeiro

Hospital resilience in responding to the Covid-19 pandemic: investigating the adaptations of a hospital in Rio de Janeiro

Experiences and challenges of nursing education in response to the COVID-19 pandemic: A qualitative study in Iran.

The preparedness of nurses in the COVID-19 pandemic, will be of great importance when it comes to the unknown future of the pandemic and other similar ones. Identifying their problems can lead to better planning, preparation, and management. This study aims to explore Iranian nurses' experience of their preparedness challenges to give an effective response to the pandemic. A qualitative content analysis approach using semi-structured interviews was employed to explore nurses' preparedness experiences. 28 nurses were interviewed, after transcription of the interviews, a content analysis using constant comparison was performed for data analysis based on Graneheim and Lundman approach. The results of the study can be summarized in 6 main categories and 14 subcategories, such as the necessity of continuing educational workshops, the necessity of holding exercises in the same environment, the importance of familiarity with the pandemic, the importance of educating all those involved in providing services in the pandemic, the need for providing immersive education for the pandemic and the need for planning and practice concerning the pandemic. When nurses receive more support, they can have their best performance. up-to-date training can prepare nurses more effectively, which will, in turn, make prepared nurses available, maximize their efficiency, and minimize their adverse mental consequences. Nurse managers may support nurses and increase hospital resilience in such emergencies. Nurses indicated some issues including managers' support, workplace culture, education, physical space, access to PPE, and willingness to provide the best care. These findings can be helpful in the management of the pandemic and preparing nurses as a large group of healthcare workers. Necessary training, along with the provision of adequate resources, should be programmed to support this effective group of health providers.

Effect of COVID-19 on the implementation of a multifaceted intervention to improve teamwork and quality for hospitalized patients: a qualitative interview study

BackgroundHealthcare organizations made major adjustments to deliver care during the COVID pandemic, yet little is known about how these adjustments shaped ongoing quality and safety improvement efforts. We aimed to understand how COVID affected four U.S. hospitals’ prospective implementation efforts in an ongoing quality improvement initiative, the REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) project, which implemented complementary interventions to redesign systems of care for medical patients.MethodsWe conducted individual semi-structured interviews with 40 healthcare professionals to determine how COVID influenced RESET implementation. We used conventional qualitative content analysis to inductively code transcripts and identify themes in MAXQDA 2020.ResultsWe identified three overarching themes and nine sub-themes. The three themes were (1) COVID exacerbated existing problems and created new ones. (2) RESET and other quality improvement efforts were not the priority during the pandemic. (3) Fidelity of RESET implementation regressed.ConclusionCOVID had a profound impact on the implementation of a multifaceted intervention to improve quality and teamwork in four hospitals. Notably, COVID led to a diversion of attention and effort away from quality improvement efforts, like RESET, and sites varied in their ability to renew efforts over time. Our findings help explain how COVID adversely affected hospitals’ quality improvement efforts throughout the pandemic and support the need for research to identify elements important for fostering hospital resilience.

Building Toward a Disaster Resilient Health System: A Study of Hospital Resilience.

This research evaluated the resilience of 6 tertiary and rural health facilities within a single Australian Health Service, using the World Health Organization (WHO) Hospital Safety Index (HSI). This adaptation of the HSI was compared with existing national accreditation and facility design Standards to assess disaster preparedness and identify opportunities for improvement. This cross-sectional descriptive study surveyed 6 hospitals that provide 24/7 emergency department and acute inpatient services. HSI assessments, comprising 151 previously validated criteria, were conducted by Health Service engineers and facility managers before being externally reviewed by independent disaster management professionals. All facilities were found to be highly disaster resilient, with each recording high HSI scores. Variances in structure, architectural safety, continuity of critical services supply, and emergency plans were consistently identified. Power and water supply vulnerabilities are common to previously reported vulnerabilities in health facilities of developing countries. Clinical, engineering, and disaster management professionals assessed 6 Australian hospitals using the WHO HSI with each facility scoring highly, genuine vulnerabilities and practical opportunities for improvement were identified. This application of the WHO HSI, intended for use primarily in developing countries and disaster-affected regions, complimented and extended the existing Australian national health service accreditation and facility design Standards. These results support the expansion of existing assessment tools used to assess Australian health facility disaster preparedness and resilience.

How should support for hospital staff during health shocks be improved? A discussion from Japan's experience during the COVID-19 pandemic.

Human resources for health are at the center of healthcare service delivery and play an important role in ensuring the resilience of health systems. Utilizing the results from a case study examining hospital resilience during COVID-19, this article draws on the experience of individual hospital staff during the first and second waves of the pandemic, briefly describes government responses to support human resources for health during the early stages of the pandemic, and argues the importance of constructive discussions about strategies to create an enabling work environment for healthcare providers, both clinical and non-clinical, during future health shocks.