Vivien W. Chow

Managing the health risks of extreme weather events by managing hospital infrastructure

Purpose – A predicted increase in climate change-related extreme weather events will present hospitals with new health-related and physical risks which were not originally anticipated in building and infrastructure designs. Markus et al.s building systems model is used to analyse a range of adaptive strategies to cope with such events. The paper aims to discuss these issues. Design/methodology/approach – Focus group interviews were conducted with a wide range of hospital stakeholders across three case study hospitals in Australia and New Zealand which have experienced extreme weather events. Findings – It is concluded that effective adaptive strategies must balance responses across different organisational sub-systems. Contrary to previous research, the findings indicate that hospital managers do see hospital infrastructure as an important component of disaster response. However, it is the least adaptable of all response subsystems, making other options more attractive in the heat of a crisis. Research l...

Modelling the risks of extreme weather events for Australasian hospital infrastructure using rich picture diagrams

Anticipated increases in the frequency of extreme weather events in the future are likely to expose hospital infrastructure to new risks which are poorly understood. Traditional approaches to risk identification and analysis produce linear, narrow and static risk profiles which fail to consider complex sub-system interdependencies that may assist or hinder healthcare delivery during an extreme weather event. The ability to create resilient hospitals depends on new risk management methodologies which provide an understanding of these complex relationships. Focus groups with key stakeholders in three hospitals in Australia are used to construct rich picture diagrams (RPDs) of hospital infrastructure interdependencies under different extreme weather event scenarios. They show that the risks posed to hospitals by extreme weather events cannot be considered in isolation from the surrounding infrastructure, emergency management systems, health systems and communities in which they are imbedded. The new insights provided have major governance and policy implications for agencies responsible for ensuring that hospital infrastructure can continue to support the delivery of effective health services during extreme weather events.

Flexibility: Beyond the Buzzword—Practical Findings from a Systematic Literature Beview

Objective: The goal was to identify practical, cost-effective, design-related strategies for “future-proofing” the buildings of a major Australian health department. Background: Many health buildings become obsolete before the end of their effective physical lives, requiring extensive reconfiguration or replacement. This study sought to move beyond the oft-used buzzword flexibility to seek effective strategies to accommodate future change (future-proofing) that could be further explored in Australia and other developed countries. Methods: A systematic literature review compiled definitions of flexibility and adaptability from a range of sources. Nineteen case studies were identified that illustrated various future-proofing strategies. A matrix was developed to classify different approaches to flexibility and then used to assess the case studies. Results: Analysis was hampered by inconsistent use of terminology and limited availability of quantifiable methods for assessing the long-term success of approaches to future-proofing. Several key strategies were identified, classified, and discussed in terms of their relevance and application. Conclusions: More rigorous definitions of flexibility, adaptability, and related terms are needed to enable more useful comparisons of the strategies implemented to future-proof health projects. Local conditions often affect both the strategies adopted and the degree to which they can be considered successful. Many of the case studies analyzed in this research were not operational long enough to enable assessment of their claims of being future-proofed. Therefore, review of lifetime facility costs, including the service life periods of major facility components, should be considered, and some older projects should be evaluated in terms of these criteria.

Inter-agency governance risk in managing hospital responses to extreme weather events in New South Wales, Australia: a facilities management perspective of shared situational awareness

Extreme weather is predicted to become more frequent and severe into the future. While our understanding of hospital infrastructure vulnerability to such events has advanced considerably in recent years, current approaches to healthcare facilities management treat hospitals in isolation from their surrounding governance infrastructure. However, recent research indicates that if hospital resilience is to be properly understood, health infrastructure must be managed holistically, as part of a much larger governance system of interdependent organizations. The inter-agency governance risks associated with this system are currently ignored in the facilities management literature. To explore these risks, an in-depth case study of 24 agencies in the state of New South Wales, Australia is presented. The results show that facilities managers are embedded in a highly complex and dynamic array of governance boundaries which are largely unresolved and misunderstood. A number of practical strategies are presented which could be adopted to significantly improve facilities manager’s integration into this system. These include: mapping hospital dependency on other agencies to build surge capacity; resolving overlapping operational boundaries with other agencies; proactive risk reduction for critical external support infrastructure; understanding potential conflicts with the objectives external agencies in responding to an extreme weather event.