Enhancing Crisis Preparedness in Healthcare Facilities: A Risk-Based Assessment Tool for Preventing Targeted Violent Attacks

Introduction: Terrorist and other deliberate attacks on outpatient healthcare facilities pose a serious threat to the health and safety of the population. Strengthening the resilience of outpatient healthcare facilities to violent incidents requires a comprehensive approach that includes physical security, technological measures, staff preparedness, and effective emergency management. According to World Health Organization estimates, between 8% and 38% of healthcare workers experience physical violence during their professional career, highlighting the substantial magnitude and seriousness of this problem across healthcare systems. Objective: The study focuses on establishing a hierarchy of key dimensions of crisis preparedness. A second objective is to propose a methodological procedure that healthcare facilities can use to determine their own hierarchy of preparedness aspects and that is sufficiently flexible to be applied across different types of facilities and healthcare systems. Methods: The research was conducted as a mixed-methods study combining qualitative and quantitative approaches. The quantitative part used the Analytic Hierarchy Process with 30 experts from 30 different outpatient healthcare facilities. Expert inputs were obtained through pairwise comparisons provided by these thirty crisis preparedness specialists and healthcare professionals. Results: The research revealed key shortcomings in the crisis preparedness of the analysed outpatient healthcare facilities. Six main preparedness dimensions were identified, three of which were rated as having the highest priority in the expert assessment. Based on these, the authors proposed a tool for assessing the current level of crisis preparedness, which can be applied within the internal audit of similar types of facilities. Conclusion: The proposed tool contributes to the protection of soft targets in the healthcare sector and supports systematic planning of security measures. The study also provides a methodological framework usable by junior professionals and healthcare policy makers. Plain Language Summary: The research focused on the physical and technical security measures of buildings and on the security documentation of outpatient healthcare facilities. The study did not involve human or animal subjects and therefore did not require formal ethics committee approval. All respondents (members of the expert panel) were solely involved in pairwise comparisons of criteria necessary for the application of the AHP method. Prior to providing their assessments, all members of the expert panel were duly informed about the purpose of the study, the procedures used, and the processing and storage of the input data for the AHP method. They explicitly provided their informed consent to participate in the study before its commencement. For these reasons, the AMBIS University Ethics Committee granted an ethics waiver, recorded under reference number EC 04/2025. Keywords: crisis preparedness, outpatient healthcare facilities, risk management, violent attacks, active attacker, preventive measures, public health, patient safety, health policy