A socio-ecological analysis of hospital resilience to extreme weather events

Hospitals play a critical role in helping communities respond effectively to extreme weather events (EWEs). Despite predictions of more EWEs, little is known about the process by which hospital infrastructure resilience to such events can be built. Using Gunderson and Holling's Adaptive Cycle, a new theoretical perspective based on socio-ecological resilience theory is provided to understand this process. Data were collected using semi-structured interviews, observations of disaster drills and disaster planning meetings, as well as additional documentary analysis of past incident reports. The research findings were then refined and validated in a focus group meeting with respondents. The findings indicate that there are significant organizational barriers which prevent facilities managers improving the resilience of hospital facilities to future EWEs. It was found that the disaster planning process is ad hoc and non-inclusive, focused on man-made disasters and compliance driven, top-down approach, under-resourced and is driven by a general ignorance of the importance of resilient-built facilities to health care delivery during an EWE. It is concluded that to produce more resilient hospital infrastructure, there needs to be a more well-resourced, integrated and collaborative approach to disaster management planning which enables health facilities managers to play a more central role in disaster planning decisions. There also need to be better systems, technologies and training implemented to manage information about health infrastructure performance before, during and after EWEs.