Responsiveness and Adaptability of Healthcare Facilities in Emergency Scenarios: COVID-19 Experience

The COVID-19 pandemic revealed many vulnerabilities of the contemporary built environment along with limited preparedness and low efficiency in mitigating unexpected and unprecedented challenges. This article discusses the efficiency and responsiveness of basic hospital spatial layouts in three different scenarios: normal operation; the segregation of a large number of patients and still providing them with access to emergency healthcare, typical for a pandemic; and a sudden, extremely high number of admissions typical for compound disasters and terrorist attacks. A set of parameters and a method for general adaptability assessment (GAAT) that can be used as a tool in decision-making processes as well as evaluation of both existing facilities and the new models for resilient hospitals resulting from the experience of the pandemic are proposed. The paper emphasizes why factors among which adaptability, convertibility, and scalability should be at the very core of hospital development and management strategies. It also discusses new models of adaptable healthcare facilities that enable day-to-day operations to continue alongside a pandemic, and other emergency scenarios.

Ireland

This chapter provides an extended look at health politics and the largely tax-financed health system in Ireland. It traces the historical development of the Irish healthcare system, characterized by the institutionalization of a health service that obliged and incentivized the middle classes to pay for their healthcare, out-of-pocket or through voluntary private health insurance. Since the late 1980s, the hospital sector has become more privatized, while universal coverage has been partially introduced to the primary sector. While center-right government legislation which institutionalized the treatment of private patients in public hospitals elicited strong parliamentary opposition from across the political spectrum, the fiscal incentivization of private hospital development, introduced by a center-right coalition, was subject to little debate. The most significant turning point in healthcare policy since 1989 has been the removal of means-testing and provision of free general practitioner care to the under-6s and the over-70s. Cross-party consensus on a plan to move towards a universal tax-based healthcare system was reached in 2017.

Rating Hospital Performance in China: Review of Publicly Available Measures and Development of a Ranking System

Background In China, significant emphasis and investment in health care reform since 2009 has brought with it increasing scrutiny of its public hospitals. Calls for greater accountability in the quality of hospital care have led to increasing attention toward performance measurement and the development of hospital ratings. Despite such interest, there has yet to be a comprehensive analysis of what performance information is publicly available to understand the performance of hospitals in China. Objective This study aims to review the publicly available performance information about hospitals in China to assess options for ranking hospital performance. Methods A review was undertaken to identify performance measures based on publicly available data. Following several rounds of expert consultation regarding the utility of these measures, we clustered the available options into three key areas: research and development, academic reputation, and quality and safety. Following the identification and clustering of the available performance measures, we set out to translate these into a practical performance ranking system to assess variation in hospital performance. Results A new hospital ranking system termed the China Hospital Development Index (CHDI) is thus presented. Furthermore, we used CHDI for ranking well-known tertiary hospitals in China. Conclusions Despite notable limitations, our assessment of available measures and the development of a new ranking system break new ground in understanding hospital performance in China. In doing so, CHDI has the potential to contribute to wider discussions and debates about assessing hospital performance across global health care systems.

Urban Growth and urban need to fair distribution of healthcare service: a case study on Shiraz Metropolitan area

Objective (1) To analyze urbanization development pattern in Shiraz after the year 1977; (2) To analyze hospital development model in Shiraz after the year 1977; (3) To review and prioritize location-allocation criteria for hospitals; and (4) To specify appropriate locations for the establishment of potential future general hospitals in Shiraz based on selected criteria. Results Although a significant expansion is seen from different geographical directions (particularly northwest and southeast of the city) in the urbanization model after the year 1977, the construction of hospitals has been limited to the central parts of the city and the areas around the city lack any hospitals. The “open access path to the hospital during incidents and disasters and a light traffic” criterion has enjoyed the highest priority amongst the 24 selected hospital location-allocation criteria. Appropriate locations for establishment of new hospitals in the future have been marked as colored maps. The present study has been able to determine and prioritize a comprehensive list of hospital location-allocation criteria. Moreover, the achieved maps from this study can be used by policy makers to develop new hospitals.

TIME ACCELERATION ANALYSIS AND OPTIMAL COST OF HOSPITAL HOSPITAL DEVELOPMENT PROJECT ON SHIP BUILDING USING CRITICAL PATH METHOD (CASE STUDY: PT. PAL INDONESIA (PERSERO))

Hospital Auxiliary Ship is an Indonesian Navy ship produced by PT. PAL Indonesia (Persero). The construction of this BRS ship was very time consuming and one of the main parts of the ship building project was the construction of the hull structure. In relation to time and production costs, the shipyard must be as efficient as possible in the use of time in each activity or activity, so that costs can be minimized from the original plan. Acceleration of the total duration in a project is done by accelerating critical activities in the project. To find out which are the critical activities of a project, the Critical Path Method (CPM) technique is used; namely by drawing a Network Diagram of the project. By using the CPM method in scheduling a ship hull construction project, it can be seen which activities should take precedence so as not to experience delays and waste. After that, the crashing method is carried out by increasing work hours (overtime) which aims to speed up the time of the project. The results of research for activities that are in the initial critical path with the CPM method can be seen as activities A, C, H, M, R, W, AB, AC, AD, AI, AP, AT, BA, BJ, BN. After accelerating, the critical path activities include activities A, C, H, M, R, W, X, AC, AD, AI, AP, AT, BA, BH, BO. Calculation of the project during initial conditions with Early working days without using overtime hours PT PAL Indonesia (Persero) costs Rp. 5,299,631,000, - while the Crashing Method is through the addition of 1 hour / day overtime so that the project implementation can be accelerated from the initial implementation of 450 days to 412 days and PT. PAL Indonesia (Persero) issued a project cost of Rp. 5,323,752,480, -. Keywords: Hospital Support Ship, Scheduling, CPM, Crashing.

Evaluation of an Emergency Treatment Unit – in a District General Hospital – Sri Lanka – A case Study

Emergency Treatment Unit of a hospital is the place where, acutely unwell patients admitted to the hospital, are given the immediate treatment in the critical stage. DGH – Gampaha – Sri Lanka is a tertiary care hospital with a bed strength of 795 with a well - recognized Emergency Treatment Unit. Objective of this study was to evaluate the Emergency Treatment Unit of District General Hospital, Gampaha, Sri Lanka. Data was collected through oobservations, key informant interviews and reviewing registers and records. Findings were subjected to SWOT analysis. 1) Identified strengths included accessibility, Infrastructure, ETU concept, 24 hour service, competent staff, availability of equipment and investigation facilities and Information management. 2) Some weaknesses identified were; shortage of staff, absenteeism, gaps in competency, shortage of equipment and inadequate quality management system. 3) Receiving priority attention by the provincial, regional and the hospital management, Administration Support Team, Hospital Management Committee, Hospital Clinical Society, Hospital Development Committee, Hospital Development Foundation and regular donations were recognized as opportunities. 4) Finally, Unnecessary transfers from peripheral hospitals, by pass of peripheral hospitals by patients, frequently changing of the management and delay in procurement, repairing and condemning processes were noted as threats. TOWS analysis using a TOWS matrix was performed and strategies were developed for further improvement.