Hospital resilience-informed decision making: uncertainties and interdependencies

Hospitals are at the heart of the healthcare service and emergency planning. Disruptions in hospitals may inflict large consequences to health and safety of a community, especially in emergencies. Since hospitals’ services are essential for effective emergency and disaster response, breakdowns (or outages/interruption) may cause direct and/or indirect impact in the form of delayed or hampered response. Therefore, hospital resilience is negatively affected by uncertainties and interdependencies-induced threats and/or failures. The dependency/interdependency and complexity of the infrastructures, which provide services to hospitals, are numerous. This increases the risk of interdependency-induced failures to hospital services and the impacts can get propagated to people and society that use the hospital services. In addition to that, hospital operational uncertainties are inevitable and might also cause failure/interruption to hospital services. Hence, there is a need to identify and map these uncertainties and interdependencies for more resilience-informed decisions on hospitals’ operation in case of emergencies. In response to this need, this paper aims to introduce an integrated resilience-based framework in which hospital decision-making process is improved through a collaborative environment to cope with uncertainties and interdependencies-induced failures. Methodologically, a comprehensive literature review has been adopted to identify the external and internal interdependencies of a typical hospital and map them through system dynamic approach. In addition to this, the authors have theoretically assessed whether different digital construction technologies, such as Building Information Modelling technologies, could be used in order to identify, visualise and map the operational uncertainties. The study concludes that the idea behind this integrated operational framework could provide resilience-based strategies which actively contributes improving current practices in hospital organizations and also to introduce protocols (Business Continuity Plans) that help stakeholders to produce effective strategies in the case of disasters.