|Year : 2016 | Volume
| Issue : 3 | Page : 82-87
Risk assessment in social security hospitals of Isfahan Province in case of disasters based on the hospital safety index
Seyyed Akbar Nilipour Tabatabaei1, Shirin Abbasi2
1 Department of Management, Shakhes Pajouh Research Institute, University of Isfahan, Isfahan, Iran
2 Shakhes Pajouh Research Institute, Iranian Social Security Organization, Isfahan, Iran
|Date of Web Publication||26-Sep-2016|
Department of Management, Shakhes Pajouh Research Institute, University of Isfahan, Isfahan
Source of Support: None, Conflict of Interest: None
Introduction: Hospitals are the most important treatment centers in case of occurrence of disasters. Therefore, ensuring the maintenance the structural and functional security of hospitals in critical conditions is a necessary issue. Creating safe hospitals cause the creation of assessment instruments such as risk assessment. Risk identification as the first step in enhancing preparedness of hospitals for disasters and trying in creating vital factors such as trained personnel, safe and accessible equipment. Doing assessments continuously can provide information necessary for enhancing the system. Methodology: The present study is a descriptive-analytical one conducted using a cross-sectional design in 2015 in Social Security Hospitals in Isfahan Province. To investigate the risk assessment, the Hospital Safety Index Standard Questionnaire was used. It was developed into two sections of general information of hospitals and in the second section; it includes 145 indices in structural, functional, and nonstructural fields. To complete the questionnaire, in each hospital, questionnaires were completed via observation and interviewing the owners of the process. The weighting method was based on the hospital safety index from 0 to 2. Data were analyzed using Excel software. Results: Investigating the results of safety in the three hospitals indicated that hospital 1 with about 64% has the highest level of preparedness and hospital 3 with about 62% has the lowest level of preparedness. In general, the three hospitals were at level B in terms of safety. Conclusion: The results obtained from the safety hospital index in the studied hospitals indicated that the safety level in the tree hospitals is at the moderate level. Although the state of them is not critical, they need planning and conducting measures necessary for improving safety levels, and these hospitals require necessary short-term measures for reducing damages.
Keywords: Hospital, hospital safety index, Isfahan Province, risk assessment, Social Security Organization
|How to cite this article:|
Tabatabaei SA, Abbasi S. Risk assessment in social security hospitals of Isfahan Province in case of disasters based on the hospital safety index. Int J Health Syst Disaster Manage 2016;4:82-7
|How to cite this URL:|
Tabatabaei SA, Abbasi S. Risk assessment in social security hospitals of Isfahan Province in case of disasters based on the hospital safety index. Int J Health Syst Disaster Manage [serial online] 2016 [cited 2021 Feb 24];4:82-7. Available from: https://www.ijhsdm.org/text.asp?2016/4/3/82/191108
| Introduction|| |
Unexpected disasters have been considered as threats for human societies and have been increasing in the recent decades. Disasters occurring in developed countries in the past decade have indicated the necessity of preparedness for handling them and in emergency cases, as one of the important cases in public opinion. The World Health Organization (WHO) presented the slogan of “Health in Disasters” and made all its member countries committed to take step in line with this slogan and conduct planning, management, coordination, training, and other necessary measures with high emphasis on the support, capacity building, and local management.
Iran is among disaster-prone countries, and once in a while, some part of the country experiences natural disasters and is overcome by them. In addition, according to the latest statistics reported by the Centre for Research on the Epidemiology of Disasters in 2015, from 2005 to 2015, about 1,040,074 individuals were affected by natural disasters. Hospitals as the most treatment institutes should enjoy necessary and sufficient preparedness before the occurrence of disasters to guarantee rapid responses to disasters. Since in case of the occurrence of unexpected disasters, hospitals are the most important centers for admission of victims of disasters, the first organizations involved in side effects resulting from the occurrence of these events; therefore, they need the development of a coherent plan to deal with these events. Infrastructures of hospitals should have preparedness for providing vital and emergency services in case of the occurrence of disasters. In spite of the issue that hospitals and institutes providing health-care services for handling damaging disasters. Therefore, ensuring the maintenance the structural and functional security of hospitals in critical conditions is a necessary issue. Among the cases required for hospitals to do in case of the disasters are measures and policies before the occurrence of unexpected events, which should be conducted for reducing damages and casualties as well as being ready for handling disasters and planning for measures after the occurrence of disasters. Regarding the unexpected nature of most natural disasters and lack of preparedness of treatment centers and hospitals, the necessity of making rapid and correct decisions as well as performing operations, the theoretical framework of the field has introduced knowledge called the safe hospital index. These indices cause the improvement of hospitals' performances in emergency condition. The tendency to setup safe hospitals causes the creation of evaluation instruments such as risk assessment in hospitals. Safe hospitals try to create vital factors such as trained personnel, safe and accessible equipment, appropriate structure, and high-level performance. Risk assessment, includes identification of risks, vulnerability, and potentiality, is the first step in enhancing the preparedness of hospitals for handling disasters. Doing assessments continuously can provide information necessary for enhancing the system.
Similar studies have been conducted on the investigation of the safety and preparedness of hospitals in Iran. The first study was the development of the Persian version of the disaster risk index prepared in 2010.
A research conducted by Mirzaei et al. indicated that in general, in spite of differences in the functional, structural, and nonstructural domains, the level of safety in all hospitals is at moderate level. Sabzghabaie et al. also investigated the safety of selected hospitals affiliated to Shahid Beheshti University using the WHO/Pan American Health Organization Checklist and concluded that the standard of hospital safety levels in most studied hospitals was at moderate levels. Fazli conducted a similar study in the Iranian Red Crescent Hospital in Mecca. Studied hospitals were at the moderate level in three structural, nonstructural, and functional dimensions. Samsuddin's studies in 2015 indicated that structural, nonstructural, and functional components are three main parts in reinforcing hospitals. This issue requires the development of a guideline in Malaysian hospitals for reducing vulnerability in hospitals. In spite of the existence of the Disaster Management Organization in the province and developed instructions about crisis management as well as a lot of efforts exerted so far, no research has been conducted on the degree of preparedness of hospitals in this province regarding crises. The present study is to identify weaknesses of these hospitals by evaluating factors affecting the degree of preparedness of social security hospitals from the viewpoint of handling internal and external disasters. Findings of the present study can contribute to enhancing knowledge of decision makers of the health sector for informing and eliminating potential deficits of planning and more preparedness of hospitals for dealing with unexpected events. Therefore, the present study was conducted with the aim of investigating the degree of preparedness for handling unexpected disasters in Social Security Hospitals in Isfahan Province based on the hospital safety index in 2015.
Therefore, regarding the priority of the Social Security Organization in the path of improving preparedness and reduction of the degree of vulnerability in medical centers, the present study has significance results for the mentioned hospitals.
| Methodology|| |
The present study is a descriptive-analytical one conducted using a cross-sectional design in 2015 in Social Security Hospitals in Isfahan Province including three hospitals; hospital 1 outside the city of Isfahan, hospital 2 in the northeast part of the city, and hospital 3 at the center of the city. Inclusion criteria for Social Security Hospitals include high volume of patients, enjoyment of different public and specialist wards and units, structural oldness, and the necessity of immunization in them, and the possibility of easier access of the researcher to documents. In Isfahan Province, there are three Social Security Hospitals providing services to 22% of the population covered by this insurance. These hospitals need appropriate management in disasters.
To perform risk assessment in the mentioned hospitals, the Safe Hospital Index Standard Questionnaire was used. In the initial part of the questionnaire, general information of the hospital (physical distribution, hospital capacity, and locations possible to increase hospital capacity) and risks threatening hospitals (geological and climatic risks, risks related to social phenomena, environmental risks, and technology-generated risks) were investigated. The index was localized and developed in Iran as a reference book. In the second section, 145 indices were completed in fields of structural safety (parts of the building supporting it such as pillars, ceilings, walls, and roofs), nonstructural (including facilities, equipment, and architectural elements of hospitals), and functional (functional dimension also covers management aspects and having plans for handling disasters). To complete the questionnaire, researchers referred to hospitals in person according to previous coordination with senior managers and started to collect data by asking the secretary of the crisis committee, authorities of engineering and technical facilities in each hospital to complete the questionnaire via observation and interviewing them. After collecting general information from hospitals and identified risks, functional safety assessment (from item 1–6) with the weight as 0.2, nonstructural safety assessment (from item 62–132) with the weight as 0.3, and structural safety assessment (from item 133–145) with the weight 0.5 were completed and scores 0 (poor), 1 (moderate), and 2 (good) and in cases which considered items were not available in hospitals, the item “not available” were used. This method of weighting is one of the models of the safe hospital index which is based on the risk directly influencing the safety of hospitals. The data were analyzed using Excel software and the safety scores were calculated based on weights assigned to each hospital (the total sore of each level multiplied by the number of items in that level). Then, based on the obtained scores, the safety level of each hospital was identified. Regarding the obtained scores, the safety level was classified in Group A with safety score from 66 to 100% (requiring preventive measures for keeping and improving safety), Group B with the safety score from 36 to 65% (necessary measures in a short time for reducing damages), and Group C with the score from 0 to 35% (emergency measures for supporting souls of patients and the personnel). In addition, the possibility of the occurrence of each risk groups in hospitals was identified.
| Results|| |
Risk assessment includes identification of risks, vulnerability, and capacity as the first step in enhancing the preparedness of hospitals in disasters. Doing continuous assessments can provide necessary information for enhancing the system.
In the present study, general data of each hospital were collected, and the distribution of the physical space of each building in different parts of it such as the main building, treatment ward, administrative units, stores as well as other parts were investigated for gauging potential places for increasing the capacity of the hospitals in critical conditions. Bed occupancy rate for each hospital in the first half of 2015 is 74.6% for hospital 1, 81.6% for hospital 2, and 68.4% for hospital 3. The number of surgery rooms in each hospital included 14 ones for hospital 3, 7 ones for hospital 2, and 4 ones for hospital 1 in which routine and emergency surgeries were performed there. The investigation of the opening year of hospitals indicated that hospital 1 and hospital 2 were about 20 years old and hospital 3 was about 53 years old.
In [Table 1], hazard threatening hospitals are classified in five dimensions and fifty subgroups. The highest number of risks in the three hospitals was related to the environmental dimension (100%). In addition, the lowest number of risks was related to the geological dimension (50%). In [Table 2], items related to functional safety assessment including organizing the hospital crisis committee, operational plan for reactions to internal and external risks, emergency operations contingency plans, accessibility of operational plans, preservation and reconstruction of vital services, accessibility to drugs, equipment, and required resources in the section of nonstructural safety assessment of vital services of the electric system, the water supply communication systems, medical gas fuel storage, heating and air conditioning systems in the important areas of hospitals, fixed and mobile office equipment, medical and laboratory equipment and supplies used for diagnosis and treatment, architectural components, and in structural safety assessment, previous disasters affecting the safety of hospitals, and the safety system of the constructs, and type of materials used in buildings were investigated. Findings indicated that the mean safety level was 63.88% in hospital 1, 62.72% in hospital 2, and 61.94% in hospital 3. Investigation of the safety elements in the structural and nonstructural dimensions indicated that hospital 1 had the highest level of preparedness. Finally, after calculating the safety level in each hospital and comparing it with the standards of the WHO, each three hospitals were at the moderate safety level (B) [Figure 1].
| Discussion|| |
Calculating the safe hospital index is a method for enhancing the safety of hospitals. This index provides the possibility of permanent monitoring of the safety level and causes the ranking of hospitals for periodical monitoring, in based on structural, functional, and nonstructural field conduction of reformist measures, and finally, continuous improvement in them. According to the results obtained from the investigation of places potential for increasing then capacity of hospitals based on safe hospital index, the highest possibility for increasing the related capacity is related to hospital 1 with an unused land around it with an area of 144,302 m 2, and enjoying appropriate compatibility for using it in emergency cases with establishing utilities and communication equipment. In this space, the possibility of setting up a field hospital is also possible. The study of Fazli conducted in Iran's Red Crescent Hospital in Mecca indicated that the seasonality of the hospital requires its own specific conditions for creating decisions. Therefore, regarding the physical capacity available in the hospital, planning for the possibility of setting up a field hospital seems necessary.
Experiences have shown that the highest effects of disasters are on the power of the reaction of a hospital in the functional performance and the deficits in its system of providing services. These deficits can be due to the high volume of patients beyond the power of the hospital, insufficient exercises, nonstandard and insufficient trainings, deficits in the communication system, etc. In contrast, the improving performance of hospitals to deal with disasters is much lower than in other sectors.
In the assessment of the functional level, the investigated hospitals had relatively acceptable performance. Accordingly, hospital 3 with 75.18% had the highest level of preparedness. Among the cases of high preparedness of the hospitals, regular establishment of crisis committees, development of action plans based on internal and external risks and prioritizing measures to create the space of the office of hospital emergency operations, and conducting interventions related to developed hospital emergency action plans.
Research conducted on the preparedness of hospital at the fictional level in the study of Amini Ghazvini indicated that the analysis of management performance vulnerability (in the dimensions of financial resources, planning, and resource management) although it was favorable in resource efficacy, in the studied hospital, there was no planning for management resources in emergency conditions.
In a lot of scenarios of the risk occurrences, in spite of the lack of serious damages to constructs, this is the damages to nonstructural components that result in deficits in the performance of hospitals. The likeliness of the occurrence of these risks is very higher than severe risks.
The safety level of nonstructural elements in hospitals was assessed to be at the moderate level. In the present study, the lowest safety assessment level was related to nonstructural elements with 52.14% in hospital 3 and its highest level was related to hospital 1 with 59.13%. The most important measures conducted in hospitals regarding nonstructural elements were prioritizing operational planning based on consolidation and containment methods of electrical equipment, cables and ducts; and establishing alternative communication systems and related equipment purchased by nonstructural elements according to the schedule. The most measures required by the studied hospitals for reinforcing nonstructural elements are in terms of cooling, heating, and air conditioning systems in the important areas of hospitals, architectural components, and administrative (fixed and mobile) equipment.
In the study of Seyyedin regarding the investigation of the vulnerability of the management system in a hospital in case of facing disasters. The results indicated that the degree of vulnerability of the mentioned hospital was at the moderate level in terms of nonstructural factors. The results are consistent with those of the present study.
In another study titled as “Evaluation of the factors affecting the level of preparedness to deal with the earthquake risks in hospitals affiliated to Tehran University of Medical Sciences,” in general, the degree of preparedness of studied hospitals was assessed to be at the moderate level (51.8%). Regarding the significant relationship of educational domains with other mentioned domains of short-term training plans about crisis management and its consistent implementation, nonstructural reinforcement of hospitals was considered as a priority.
From a methodological viewpoint, the limitation of structural assessment methods in screening tools is among important challenges of this domain. Accurate engineering methods which require drawing maps and sampling materials, in addition to being time-consuming, are very expensive in such a way that the possibility of using them for mass assessment is not available. Investigating the preparedness of the studied hospitals in terms of structural elements indicated that hospital 3 with 53.33% has the lowest level of safety, whereas this index was assessed as favorable in the other two hospitals. Among factors affecting the reduction in the safety level of structural elements in hospital 3, its age about 40 years can be referred to. This factor has caused that the possibility creating underlying changes be minimized in the hospital.
The study of Shojaei in structural dimension in the Iran University of Medical Sciences indicated that averagely in all hospitals, paths of emergency exit have been determined, but signs and stands are not seem as clearly as possible.
In a study in 2012 conducted in two hospitals in Italy titled as the safety index in buildings of hospitals, the results indicated that the structural vulnerability in hospitals with older age and the strategic situation of earthquake were higher than (59%) other hospitals (45%). In addition, nonstructural vulnerability in this hospital had a high percentage. The results of the research are consistent with those of the present study.
According to the calculation of safety scores in hospitals, this possibility can be provided to continuous monitoring can be conducted and caring operations can be conducted for improving safety in a shorter period of time. This index was used in several countries of the Latin America such as 1000 hospitals in Mexico, Bolivia, Cuba, and other Caribbean countries. Accordingly, plans for reducing vulnerability were developed and implemented.
Investigation of the safety results in the three hospitals (at three functional, nonstructural, and structural levels) indicated that hospital 1 with about 64% has the highest level of preparedness and hospital 3 with about 62% has the lowest level of preparedness. In general, each three hospitals were at the level B in terms of safety, and they require necessary short-term measures for reducing damages. Among factors affecting the highness of the safety level in hospital 1, one can refer to issues such as smaller area of the hospital, lower number of patients, less structural changes, purchase of required equipment based on operational plans, training the personnel, desktops, and at regular periodic training exercises.
The results of safety assessment in one of the Social Security Hospitals in Tehran indicated that the safety level in the hospital is at poor level and the rate of 25% which put it in Group C at the mentioned level, supporting patients' and employees' lives in case of disasters and after their occurrences are insufficient, and interventional emergency measures and rapid assessment in investigating the reduction in risk and severity of vulnerability in the hospital were necessary. These results were not consistent with those of the present study.
Studies of Sabzehghabei concluded in hospitals affiliated to Shahid Beheshti University indicated that generally, according to the results obtained from the hospital safety level, most investigated hospitals were at the moderate level. Although the state of these hospitals was not critical, they need planning and conducting measures necessary for improving safety levels, and these hospitals require necessary short-term measures for reducing damages. These results were consistent with those obtained from the present study.
Mirzaii et al. conducted a research in Ilam city and concluded that despite differences in the functional, structural, and nonstructural domains, the level of safety in all hospitals is at moderate level (level B). However, a series of required measures in this issues should be conducted and annually, their safety levels should be regularly assessed. These results were also consistent with those of the present study.
The study of Fazli conducted in Iran's Red Crescent Hospital in Hajj in critical conditions indicated that in general, the hospital was at the moderate safety level in terms of structural dimensions (13%), nonstructural (86%), and management dimensions (54%), the seasonality of the hospital requires its own specific conditions for creating decisions. Regarding the assessment of the safety which is at the moderate level, the obtained results in terms of structural dimension were not consistent with the present study.
| Conclusion|| |
With assessing the hospital safety index and the calculation of the safety rate of hospitals to crises as a screening tool via referring to conducted monitoring, it can be identified that to what extent a hospital can preserve its structure and performance in facing a crisis. In addition, by comparing different hospitals in a multidimensional model (structural, functional, management, and nonstructural), the degree of preparedness in different domains of planning in hospitals can be rated. Using this index, policymakers can determine the priority of doing management and constructional interventions in the domain of health care. The results obtained from the safety index in the studied hospitals indicated that although the safety level in each three hospitals was moderate, and also the state of them is not critical, the need to planning and doing measures for improving the safety level of hospitals seems necessary. The best methods for establishing and reinforcing preparedness in these treatment centers are identifying deficits based on conducted studies, eliminating main and important deficits, and then reassessing their preparedness. However, from among the points in investigating mentioned hospitals, the support of the Social Security Organization from their civilian hospitals via allocating required budget in terms of nonstructural dimensions, revision, and reformation of operational plans based on a certain schedule. Holding regular crisis committees, implementing maneuver and training classes for increasing the staffs' understanding, preparing basics and readiness for creating field hospitals, and contracting agreements with other centers of crisis management in the province are among strengths obtained in the present study.
However, the evidence points mentioned in the review of hospital support your hospital's social security organization.
Two limitations of this study include: -The lack of comparison investigation of risk management in academic hospitals and Social Security Hospitals in Isfahan Province - the lack of investigation of the structural domain due to the limitation in creating structures changes can be referred to.
It is recommended that similar studies should be conducted in other areas of Isfahan Province and academic hospitals of the city. In addition, preparedness assessment of Social Security Hospitals to disasters is also recommended.
Thereby, we are obliged to be grateful of authorities of crisis management in the Headquarter of Tehran, the General Director of the Treatment Department of the Social Security Organization, and Secretaries of Crisis Management in the three Hospitals.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]
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