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.


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6.4. The number of monitored beds ? 6.5. The number of paediatric beds ?
Signature of the Responsible Person (from department: )

B. Hospital Safety Standard and Procedures
7. Whether the hospital establishes a syndromic surveillance and early warning system for public health emergencies? (1) Yes (2) No; 7.1. The syndromic that need to be surveillance, report and early warning include: 7.2. Whether develop and require that physicians on duty report any suspicious cases to the hospitals' presidents? (1) Yes (2) No; 8. Whether the hospital has direct online reporting system of surveillance information and suspicious symptoms? (1) Yes (2) No; 8.1. Whether the hospital could analyze surveillance data regularly and share this system with the local health authority? (1) Yes (2) No; 9. Is there any pre-event evaluation of types and impact of the potential risks to hospitals in its location?
(1) Yes (2) No; 9.1. When the disaster occurred, within the hospital is there any hazards identification system for different types of risks? (1) Yes (2) No; 9.2. When there is hospital internal risk, are there any strategies for hospitals to evacuate and protect existing patients? (1) Yes (2) No; 10. Is there any evaluation of the safety standards of hospital's critical infrastructures? (e.g., construction safety standard of resistance to earthquakes, fires, floods and infectious diseases).
(1) Yes (2) No; 10.1. If yes, were the critical infrastructures (e.g., buildings, operation rooms, ICU) built to meet or excess the local criteria of resistance to earthquake? (1) Yes (2) No; 10.2. If yes, were the critical infrastructures built in a higher position in the area to prevent floods?
(1) Yes (2) No; 10.3. If yes, was the critical medical equipment located in a higher level of the building to prevent floods? (1) Yes (e.g., the first floor with a higher location, the second floor) (2) No (e.g., underground, the first floor with a lower location); 10.4. If yes, is there any consideration of the safety standard for the risk of fire? (1) Yes (2) No; 10.5. If yes, is there any consideration of using isolated pathways and designated areas for infectious diseases within the hospital? (1) Yes (2) No; 11. When disaster occurred, are there any alternative emergency energy and facilities for backup (e.g., power, oxygen and water pumping, telecommunication system)? (1) Yes (2) No; Signature of the Responsible Person (from department: )

C. Emergency Command, Communication and Cooperation System
12. Is there any disaster committee or disaster group (includes positions from multidisciplinary departments) within hospital that is responsible for public emergencies? (1) Yes (2) No; 12.1. Is there any official document that has been used to establish hospital disaster committee or disaster group? (1) Yes (2) No; 13. Is there any department (has regular contact with the chiefs in multidisciplinary departments) within the hospital that has been assigned responsibility for the work relevant to emergencies?
(1) Yes (2)  Are there any specific disaster plans based on the specific requirements of a single hazard, such as infectious diseases, internal medical accidents, public health emergencies, natural disasters, bio-terrorism and nuclear terrorism, and others? (1) Yes (2) No; 18.1. Please illustrate the document name of the specific disaster plans? 19. Is there any protocol to initiate the plan, so as to guarantee the hospital be in place to face emergencies immediately, (i.e., guarantee staff, equipment and resources are in place immediately)?
(1) Yes (2) No; 20. From the experience of the hospital dealing with the past public emergencies (i.e., mass casualty incident, disasters, pandemics), whether the hospital could operate in accordance with the disaster plan during emergencies? (1) Yes (2) No; 21. Is there any classification response system to cope with different levels and different phases of events? (1) Yes (2) No; 22. Is there any evaluation and revision of the disaster plans in the last two years? (1) Yes (2) No; 23. Is there any dissemination of the content of disaster plans to the key staff (e.g., through regular meetings or training)? (1) Yes (2) No; Signature of the Responsible Person (from department: )

E. Emergency Stockpiles and Logistics Management
24. Are there any stockpiles of various types of emergency drugs within hospitals (e.g., antimicrobial agents, cardiac medications, insulin, anti-hypertensive agents, IV fluids)? (1) Yes (2) No; 24.1. If yes, please illustrate the type names and quantities of these stockpiled drugs? 25. Dose the facility have a means of real-time inventory and tracking of the following resources: including food, water, hand hygiene, stretcher, wheelchair, ventilators (adult), ventilators (pediatric), IV pumps, IV poles, and tourniquet? (1) Yes (2)  33.4. Whether the hospital has cardiac resuscitation devices in ICU? (1) Yes (2) No; 33.5. Whether the hospital has CRRT devices in ICU? (1) Yes (2) No; 34. Whether the hospital has internal capacity (e.g., space, beds and experts) for treating mass casualty of incidents (i.e., here mass casualty treatment capacity refers to each hospital is to assess itself on its capacity to accept at least 30 patients of the same disease within a short period)? (1) Yes (2) No; 34.1. Whether the hospital has capacity (e.g., space, beds and experts) for treating general mass casualty of trauma? (1) Yes (2) No; 34.2. Whether the hospital has capacity (e.g., space, beds and experts) for treating mass casualty of infectious diseases? (1) Yes (2) No; 34.3. Whether the hospital has capacity (e.g., space, beds and experts) for treating mass casualty of blast injury, gunshot wounds and crush injury? (1) Yes (2) No; 34.4. Whether the hospital has capacity (e.g., space, beds and experts) for treating mass casualty of acute chemical poisoning? (1) Yes (2) No; 34.5. Whether the hospital has capacity (e.g., space, beds and experts) for treating mass casualty of radiation issues? (1) Yes (2) No;

Hospital Surge Capacity (Refer to the Hospital Medical Surge Capability Response to the Disasters)
35. When disaster occurs, is there any internal evaluation mechanism for rapid assessment of the available emergency resources and the disaster losses? (i.e., manpower, equipment, number of emergency beds)? (1) Yes (2) No; 36. Are there any prepared spaces and conditions (e.g., electricity, oxygen, water, heat) in place to temporary surge numbers of emergency beds? (1) Yes (2) (2) No; 44. Whether the hospital could organise an independent rescue team that is equipped with emergency package of supplies (e.g., clean water, food, tent, and lighting) for living 3 days (the teams include those health administrative departments or other departments assigned to construct based on the hospital)? (1) Yes (2) No; 44.1. If yes, please illustrate the number of staff for the rescue teams, and their departments and specialty: 44.2. If yes, are the rescue teams equipped with portable medical equipment equipped (e.g., portable breathing machine, ECG monitoring machine, and the X-ray machine? (1) Yes (2) No; 45. Whether the hospital has 'portable hospital' or the capability to support field surgery, and other critical care in the field, which is similar to the function of ICU (using vehicles which are equipped with beds and portable medical equipment)? (1) Yes (2)