Estimating Relative Importance of Resilience Indicators for Large-Scale Hospital Buildings to Withstand Hydrological Disasters

Abstract

Purpose of the study: Uninterrupted hospital services and medical functions are the keys to functional resilience to cope with mass casualties. This paper presents the important level of resilience indicators for hospital functions to withstand natural disasters.
 Methodology: For the survey, 21 indicators are grouped into three domains focusing on i) general concerns of healthcare infrastructure planning ii) design and planning of hospital buildings iii) emergency service and management. The corresponding indicators were ranked on a Likert scale of 1 to 5. The authors collected 389 responses through an online survey of the healthcare professionals including disaster management professionals, medical officers, hospital architects, planners, project managers, and engineers.
 Main Findings: The data were analysed for determining the Relative Importance Index (RII) of each indicator. The top 7 indicators as an outcome of this research are: ‘access to the emergency services (0.861), ‘planning of refugee settlements’ (0.814), ‘uninterrupted supply of MEP services to critical units’ (0.871), ‘signages for internal circulation’ (0.845), ‘adaptive control, command, and communication system’ (0.848), ‘flexible spatial planning in case of a surge of patients’(0.813), ‘ensuring availability of healthcare workers with the provision of support infrastructure’ (0.758).
 Applications of this study: Assessment of the top indicators highlight the importance of ‘flexible design’ and ‘access to medical functions of a hospital building’. Based on these outcomes, it is proposed to develop a numerical framework for a comprehensive design appraisal of resilient hospital buildings.

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

“…With regards to evaluating capacities, the adaptive capacity is most frequently referenced in the literature on hospital resilience (21, 29,34,36,38,43,48,50,77,78). This may be due to the wide encompassing definitions and variation of "adaptivity" [e.g., "flexibility" (8,18,35,47,48,50,62), "agility" (38, 44), and "performance variability" (13)] and its measures. Studying the wider literature on health systems resilience, a systematic review found the highest number of indicators across different levels of data collection was for the "absorption" domain.…”

“…One study utilized a customized five-dimensional City Resilience Profiling Tool (63), while another evaluated the hospital'sbuilt environment and plans (38) to measure hospital resilience within its environment. Other studies related to natural hazards measured environmental characteristics (e.g., seismic, climaterelated exposures) (10, 40), infrastructural planning and design (47,49,50,63), and modeling to measure hospital's loss of function (39,44).…”

“…This WHO checklist puts a significant emphasis on the safety, structural and architectural integrity of the physical building, its critical infrastructural and alternative back-up systems (i.e., power, water and sewage, HVAC, fuel, gas, hazardous waste management, and fire protection), and the quality and functionality of its medical equipment (17). The resilience of these non-structural elements, including medical systems, equipment and supplies, is integral to hospital resilience (15, 21, [40][41][42][43][44][45][46][47]. Across the literature, some studies list these nonstructural elements together with the structural elements under "space".…”

“…In contrast, others link these critical systems together with "stuff " or "systems", highlighting the interdependence and interconnectedness of these components (18,31,48). Further to this, articles discussing hospital safety and infrastructural engineering also mention the importance of the design and planning of hospital buildings, suggesting that physical and infrastructural stability and safety are prerequisites to resilience (38,42,44,47,49). In response to COVID-19, infrastructural agility and space re-organization, such as the ability to expand and covert hospital rooms, parking lots, and residential or teaching quarters into triage, ICU treatment, isolation, and IPC spaces, were highlighted among the chief lessons learned (3,14,24,25).…”