Doctor inside a hospital with stethoscope in hand and patients in the background; Doctor inside a hospital with stethoscope in hand and patients in the background;

Resilience in health is more than the facilities alone

‘The world's 15 hottest sites on Tuesday were all in Australia’ was the news headline last summer, with most of the country sweltering in 45+C degree heat. The preceding winter saw the earliest ever start to the fire season, and the entire state of NSW declared in drought.  

Extreme weather events with far reaching impacts - including damaged or disrupted health care services - are challenging us more frequently.

It’s crucial that health facilities, systems and people can absorb these disturbances and function in crisis scenarios, providing continuity of service. This is holistic resilience at a broad scale. 

While the health industry in recent years has made great gains in designing buildings to mitigate impacts of flooding, earthquakes, ensure water supply and back-up power and so on, even greater gains can be made now by widening our understanding of resilience and factoring it into health projects. 

Physical place – design for the future

Disasters can disable facilities exactly when they are needed the most – during blackouts and heatwaves.

Ensuring facilities are resilient and services can be maintained during extreme events involves understanding and anticipating the changes in climate that may lead to additional exposure of individuals (patients, staff and general public), systems and the infrastructure. 

Sydney’s new Westmead Hospital is a case in point. Integral to achieving its status as a post disaster facility was analysing all potential disasters and their impact. Getting the right people together to determine what post disaster meant to them, what needed to operate and function and how each facility would respond post disaster was integral to informing the built design. It enabled Arup’s electrical engineers to align the design with clinical goals. 

The remarkable new Spaulding Rehabilitation Hospital on the waterfront in Boston is another great example of designing for future climate. It’s one of the  most resilient hospitals in the world, incorporating dozens of features – redundant power and heating systems, superb daylighting, operable windows, protection from rising seas – that not only make it resilient to flooding, but well prepared to cope with many other predicted impacts of climate change. The building can maintain critical life-support conditions in the event of extended loss of power, heating fuel or water (passive survivability).

Building organisational leadership and resilient people

However, resilience in health is more than the physical spaces and facilities. It is also critical to build resilient organisational leaders to ensure the people working in them are prepared for the impacts on their physical place and operations, including the increased demand for services during extreme events.

If leaders, staff and organisational structures aren’t resilient, the system will break down – no matter how resilient the building. If the lone facilities manager doesn’t come to work because their house has been flooded, who will sort things out when they go wrong? If the system fails - what happens, who do you go to, what backups are in place? Is there a culture that can respond when the system goes down? 

Enhancing the adaptive capacity of individuals, organisational structures and leadership can help minimise or mitigate negative impacts when systems fail in crisis events. By creating resilient organisational structures, a culture of understanding and appreciating risk, and being proactive about anticipating and responding to different shocks and stressor events, the organisation can continue providing its core services and supporting its communities. 

The Royal Adelaide Hospital (RAH), Canberra Hospital, and the Community services climate resilience program for the Victorian Department of Health and Human Services are evidence that the industry is embracing this holistic approach. They show upfront design for resilience and assessment of scenarios at a broader level, an understanding of levels of organisational resilience, how staff get to work, what challenges might they experience during a crisis event and how to build individual and organisational capacity to respond.

Exterior view of Royal Adelaide Hospital building Exterior view of Royal Adelaide Hospital building
Royal Adelaide Hospital, South Australia

For the RAH, a number of trials and scenario simulations were mapped well in advance of the commissioning and transition phase so people, processes, systems and the facility were ready on day one to respond to a disaster or extreme event. 

The team practised detailed scenarios – how patients might arrive, how staff would respond to a surge of patients, involvement of Emergency Services, and the role of the Emergency Response Team as well as decision-making protocols. The patients’ journey and interfaces with clinical workflows and support services, systems and the facility were simulated by staff and volunteers as ‘actors’. 


We are on the right path

The road to resilience in health is complex with many challenges for the industry: staffing rural locations, funding for front line services, short term planning, unknown future technologies, procurement and operational structures (although recent changes will see great benefits in facilities’ quality, making them easier to maintain). The list goes on.

Despite these challenges, great strides have already been made and we can achieve even greater outcomes by adopting a broad holistic view. 

We are already on the right path, with sustainable and resilient design receiving more attention in early healthcare project discussions. We need to continue to make buildings flexible with the ability to re-purpose with minimal expense. But we can achieve even more by creating resilience in the rest of the health network – systems, organisational structure, the culture and people. 

Extreme events will catalyse change in health and there are significant opportunities for the sector to lead a transformational agenda of holistic resilience planning in the face of these climate challenges.