Stress testing hospitals using service measures and resilience indicators

Abstract

Within healthcare systems, hospitals provide essential acute and emergency care to save lives and mitigate the impacts of potentially disruptive events on communities. To ensure that hospitals are ready to deal with such events, their resilience must be estimated. Although frameworks to do this exist, they mostly consist of checklists for assessing hospital preparedness which leave it to the decision-makers to determine the effects of resilience-enhancing interventions on service provision and to prioritise interventions accordingly. To help bridge this gap, this paper presents a framework to assess overall hospital resilience using service measures and resilience indicators. As intended to be used to assess resilience to hypothetical scenarios of interest, it is referred to as a stress testing framework. The framework uses five service measures and twenty indicators to estimate and quantify resilience. The values of the resilience indicators and the values of the service measures are explicitly connected, and the resilience assessment is done by comparing the values of service measures at the current operational condition against the values at the baseline condition, i.e., the reference condition at which the hospital is supposed to work. The framework is explained using a fictive example based on a tertiary hospital in Beirut, Lebanon. The framework provides a clear structured high-level overview of the resilience of hospitals and facilitates decision-making as to which actions should be taken to improve resilience.