Resilient Hospital Structures, Systems and Services

Interest in healthcare resilience started in the mid-1940s and it took approximately two decades for researchers to pick up the topic and realise its importance. By the early 2000s the body of knowledge reached a level of maturity with details of international case studies about the performance of health facilities and systems to multi-hazards, guidance, and regulations able to lead to secure the minimum level of resilience of health systems. However, the failure of health systems to respond effectively to COVID-19 indicates that preparedness was not adequate and that there is a gap between this body of knowledge and practice. This gap is driven by many factors but mostly by the ‘Lost in Translation’ (LiT) Effect. Lost in Translation Effect happens when the application of guidelines is done in a mechanical, ‘paper filing’ method without understanding their goal and the knowledge behind them. There are countless contributors to LiT Effect such as appropriate knowledge of disaster resilience, an individual’s workload, motivation and capability to acquire new knowledge let alone the difference between agendas and organisational priorities. Some of these have been investigated and concluded that more work is needed to generate knowledge to translate strategic evidence at operational levels. This will enhance the further learning of professionals and enable them to develop adequate plans.

The way disaster resilience is approached is one of the key issues of healthcare vulnerability. Health systems are struggling with the large number of day-to-day challenges. Disaster resilience falls low on decision makers’ lists of priorities, specifically when risks are moderate or low, due to being viewed as a burden instead of an obligation, a moral and a legal requirement. The analogy of the human body can help understand how healthcare facilities internal systems, specifically the immune system, operate. Immunity is integrated throughout the body; it detects and manages most external hazards such as bacteria and viruses without affecting daily activities. The immunity of the human body is comparable to the resilience of healthcare facilities and health systems and perhaps should be operating in a similar way. Resilience needs to be embedded in the daily routine of health systems and facilities operations.. The Jigsaw Concept is a simplification approach to enhance understanding the complexity of healthcare facilities and systems without overlooking details. It applies structured thinking to reduce the LiT Effect by identifying the components of healthcare facilities and systems, their interconnectivity and interdependency and predicting and mitigating the impact of the failure of each of these on the overall functionality in a continuous and integrated way. This functionality depends on six internal interconnected components, namely building integrity, lifeline systems, equipment, supplies, workforce and management and governance to regulate the way all these operate. Externally, it depends on interdependent components such as suppliers and infrastructure (e.g. transportation, power, water, internet and gas networks). Failure of one of these could cause direct or indirect failure of the continuity of healthcare service. Each of these components plays a unique role in the system similarly to pieces of a jigsaw needing to be assembled in a specific way to provide a clear picture and clarity is affected when one piece is missing. Advanced and smart technologies might play a role in dealing with this compounded complexity; however, there are many questions to be answered before this technology is applied such as ethics and ownership of used and generated data.