When hospitals are confronted with a health emergency episode, the capacity, availability and resilience of physical infrastructure systems are often assumed as ready and with unlimited capacity. However, in real-life situations, inadequate planning and a misinterpretation of infrastructure capabilities and capacities leads to essential component failures, and to breakdowns in overall robustness. Without sound and operational technical systems in place, both patients and hospital staff are at risk. This is one of many lessons I’ve learned as Director of Engineering & Building Services for SA Health, a South Australian government healthcare organization.
Under normal conditions, the physical infrastructure systems that provide hospitals with power, heating, cooling, ventilation and environmental controls run quietly in the background, forgotten by the vast majority of hospital facility occupants. We design and build hospitals for peace of mind, resilience, availability and business continuity. But when emergencies and pandemics hit Australia, such as SARS and H1N1, rapid hospital facility expansion was required (more beds, more medical equipment, more essential services). These can quickly overwhelm the existing capacity of core and critical infrastructure systems.
Planning for these events is part of the due diligence and duty of care of every healthcare organization. Risk mitigation strategies and emergency readiness action plans are most likely in place. However, the nature of one episode will not match another, so emergency planning should incorporate additional resources, knowledge and rapid decision-making. Having a “plan B” for the hospital’s physical infrastructure, and being able to act upon this, can be the only way to minimize the impact of a subsequent surge in patients.
Following global guidelines and regulations but with local implementation and readiness
Preparing for emergencies, such as pandemics, requires consistent long-term planning and should also incorporate compliance to both global and regional regulatory resources. As far back as 2002, the World Health Organization (WHO) has been providing hospitals and clinics across the globe with guidance for planning hospital preparedness when dealing with a pandemic emergency.
A significant portion of the WHO planning recommendations relate to supplies, technical infrastructure, engineering and maintenance, laboratory services and all the logistics supporting the delivery of well-working health care services. Some hospitals very effectively link these recommendations to their efforts to comply with local hospital accreditation criteria. It is the local emergency preparedness action plan that defines the efficiency and effectiveness of outcomes, as it applies to the specific context and potential impact relevant for each healthcare organization.
At SA Health in Australia, we’ve looked at incorporating the legislative and standard-based requirements in the emergency hospital preparedness planning. This has enabled us to include the means for stress testing our processes, our people’s skills and ability to cope under pressure, as well as our technologies and physical infrastructure. The aim was to anticipate potential risks and failures. Resilience testing on a regular and consistent basis is an important phase of the planning as both the situation on the ground and hospital operational procedures are always dynamically changing. Being able to visualize and analyze the response to infrastructure stress for a specific scenario enabled us to work at both the process and technical levels, to pre-empt critical failures or breakpoint incidents. Desktop exercises and simulated scenario planning often go the distance; however, these testing techniques cannot account for the smallest of details. Planned and well-executed physical testing not only highlights potential technical issues in a systems’ response, but also defines the manual processes and logistics which may need to be adopted for the continuity of safe patient care. The advancement in operational technologies and digital services, which are now part of most modern hospitals’ intelligent infrastructure, allow us to visualize, prevent and predict potential failure regimes, breakpoint thresholds, reliability and uptime.
In emergencies, healthcare organizations work and coordinate their activities differently
An emergency influx of patients also requires hospitals to have a specialized Incident Command System (ICS) in place. This is a working body of experts that take control and run the operations throughout the emergency. In my experience, in addition to both professional medical and nursing experts, emergency response teams consist of representatives handling intra-agency coordination and communication, bed and surge capacity planning, human resources, supply chain and logistics support. However, despite comprehensive organizational alignment, planning, and testing to strengthen preparedness, the unexpected can happen. This can especially be the case when the duration of an emergency is unpredictable. Experience has shown that even the best plan can have flaws. Some of the overwhelmed systems will fail and impact patient care. When they fail, the backup plan must be as detailed and as ready-to-action as the original plan. For example, during events surrounding previous pandemic incidents in Australia, it paid off to line up and train a panel of vendors and suppliers, specialized in the technology and infrastructure systems – power, water, gas. These groups were prepared to rapidly mobilize specialist resources for critical needs and restore physical infrastructure functionality and operation.
No such thing as being over-prepared
Hospital preparedness programs and planning for natural disasters, mass casualties or other types of emergency events which can impact capacity planning provide good insights. In the case of a pandemic, when estimated timelines and capacity surges can often change, critical infrastructure availability, reliability and resilience will be challenged. Simple tasks such as testing the reliability of uninterruptible power supplies, network resilience, heating and cooling capacity, power quality and environmental controls are often overlooked. These tasks highlight typical errors and faults which should become part of daily maintenance operations. Looking at the potentially insignificant and often deferred issues in technical systems through the lens of emergency readiness, puts a completely new perspective and risk profile to the management of spaces, environmental suitability for safe and secure care, availability and flexibility to extend, re-purpose and retrofit, such that you can accommodate the surge in clinical activities. In my experience, a hospital preparedness program should holistically consider maintenance backlog, ongoing building redevelopment and retrofitting activities, as well as the impact of new construction. This allowed us to have a reasonable understanding and confidence in the actions to take, safely and securely.
In emergency situations, more than heroes, you need a solid emergency preparedness plan. This plan should include the resources and technology to predict faults and visualize infrastructure performance, with clear roles and responsibilities, and laser-sharp execution. Anything less could jeopardize safety and continuity of care.
To learn more about how modern physical infrastructure systems can help better support hospital resilience and business continuity efforts, click here.