Assessment of disaster resilience in hospitals: a case study based framework development for Sri Lankan context

Hospitals are essential infrastructures that must maintain continuous operation during and after disasters to ensure the safety of patients and staff while providing medical services, even under surge conditions. Given the critical nature of these facilities, assessing their disaster preparedness is of utmost importance. This study addresses the limitations of the World Health Organization's Hospital Safety Index (HSI) when applied to Sri Lankan hospitals, leading to the development of the Structural Safety of Hospitals Assessment for Sri Lanka (SSH-SL). The study presents a comprehensive framework for evaluating hospital safety, divided into three primary modules: structural safety (utilizing SSH-SL), functional safety, and emergency and disaster management. Enhancements were made to the latter two modules to better align with the specific needs of the Sri Lankan context. The framework introduces a set of equations to calculate the safety index for each module, which then assigns safety levels and provides recommendations for improvement. This framework was applied to assess 15 government hospitals, revealing significant concerns across all three modules, underscoring the need for targeted interventions to enhance hospital resilience in Sri Lanka. The results from the assessment indicate that the structural safety levels of the 15 hospitals are generally at or above average level, suggesting that these facilities can operate during disaster conditions, though steps must be taken to ensure safety of both patients and staff. In terms of functional aspects, the majority of hospitals demonstrated a safety level of average or above, with two hospitals exhibiting below-average safety levels. Regarding Emergency and Disaster Management, 11 out of the 15 hospitals displayed high safety levels, whereas two hospitals had low safety levels. Immediate actions are necessary for hospitals with below-average safety levels, with a focus on implementing both short-term and long-term remedies. Additionally, limitations of the framework were identified during the hospital assessment process. The architectural safety submodule, under functional safety, was recognized as a critical submodule requiring modifications. Several assessment criteria specific to the Sri Lankan context were identified and subsequently incorporated into the existing submodule. Following these adjustments, a Delphi Study was conducted on the enhanced submodule, utilizing a panel of experts to gauge their consensus. Based on the survey results from the Delphi Study, weights were assigned to each assessment criterion within the submodule, leading to the derivation of a comprehensive safety score for the architectural safety of hospital buildings.