This report discusses the low-cost, easy-to-use tool called the "Hospital Safety Index" that allows countries to quickly measure and rank a health facility’s level of safety, prioritize actions that would improve safety and monitor progress. This good practice example the case of Mexico to show how the "Hospital Safety Index" can be applied to a country.
The event that prompted action
How can you determine if a hospital or health facility is safe when faced with the threat of disasters? And what exactly does “safe” mean? What can be done when health facilities are deemed not safe? For many years, the issue of hospitals safe from disasters has raised more questions than it has answered.
The job of developing indicators, providing baseline data and measuring progress has also proven difficult, given the diversity in size, location, staff, operating budget and vulnerability to natural hazards and crises. As not all hospitals face the same risks, nor are they built using the same methods, a wide range of elements needs to be taken into consideration to help give a snapshot of where the facility stands.
The above-mentioned issues are being tackled by the Disaster Mitigation Advisory Group (DiMAG), a group of expert engineers, architects, health services administrators and disaster specialists. The DiMAG is developing a low-cost, easy-to-use tool called “Hospital Safety Index”. This tool will allow countries to quickly measure and rank a health facility’s level of safety, prioritize actions that would improve safety and monitor progress.
How does the Hospital Safety Index work? First, general information is gathered on each facility’s level of complexity, the population it serves, the number of health staff it has, natural hazards prevalent in the area, and disaster history. Evaluators then use a checklist to measure aspects that contribute to the facility’s safety: structural components (load-bearing walls, foundations, columns, etc.), non-structural components (architectural elements such as laboratory equipment, furnishings, ventilation or electrical systems) and organizational/functional elements such as the emergency operations centre, contingency plans, backup systems for water and electricity. Each component’s safety is ranked as high, medium or low, following a series of pre-determined standards. These scores are weighted according to the importance of the aspect being evaluated. A programme automates and standardizes the assessment and evaluation phase, reducing bias and lessening the chance of mathematical error.
Applying the Hospital Safety Index takes very little time (several hours) and gives an accurate although general idea of which safety level the facility falls into and what improvement measures are recommended. However, this tool does not replace an in-depth vulnerability assessment conducted by experienced engineers.
Mexico, a large country with more than 3,000 public and private hospitals, offers an interesting example of how this process works. In 2006, Mexico created a “National Committee on Safe Hospitals,” made up of representatives from a variety of institutions such as the Mexican Hospital Association, the Social Security Institute and the Secretary of Health.
More than 400 people have been trained to use the Hospital Safety Index, which classifies the hospital’s safety level into categories A, B or C according to a numerical ranking. What does this score mean?
Hospital Safety Index Score and Measures Required
C = 0 – 0.35: Urgent measures must be taken immediately, as the health facility’s current level of safety is insufficient to protect patients and staff during and after a disaster or emergency.
B = 0.36 – 0.65: Short-term measures are required, as the health facility’s current level of safety could potentially put patients, staff and the facility’s ability to function at risk during or after a disaster or emergency.
A = 0.66 – 1: Although it is likely that the hospital will continue to function in emergency situations, it is recommended that measures continue to be taken in the medium and long term to reduce risk and incorporate mitigation measures particularly for structural safety.
The Index was then applied in more than 100 health facilities, which were determined to be at risk, either because of their geographic location or due to their critical importance in the health network. The results showed that more than 60 per cent of these hospitals were classified as “safe” in terms of structural and non-structural components. However, almost the same percentage was deemed to require improvements in the functional/organizational aspects (disaster planning, organization, training, critical resources, etc.) After reviewing the results, the coordinator of the Mexico’s Civil Protection System committed to include “Safe Hospitals” as a national disaster reduction priority, for which he received the backing of the country’s president. Mexico is committed to applying the Hospital Safety Index to all high-risk facilities (slightly over 1,000) in 2007 and to begin the process of certifying those facilities with an “A” rating.
In the Caribbean — where a single hospital can be of vital importance, as it may be the only one in a country, additional considerations have been added to the required survey form to measure the degree of disruption to a health facility if the recommendations are implemented, and the cost associated with doing so. Authorities can appreciate at a glance that, with limited funds and minor disruption, their safety score can be improved.
Although the Hospital Safety Index is just getting off the ground, it has proved to be a powerful instrument for rallying country support around the issue of safe hospitals.
Rating the safety of a health facility (as opposed to focusing on vulnerability) requires striking an appropriate balance between providing a secure environment for the patients, making health care accessible and factoring in economic considerations. This is a complex process and the Hospital Safety Index is only one of a variety of tools that managers can use to gather the information they need for sound decision making.
More information is available from:
Dr. Felipe Cruz
Division Chief, Disasters and Contingencies
Mexican Social Security Institute