H. Shevchuk, S. Huryev, S. Satsyk
State Institute “Ukrainian Scientific and Practical Center of the Ministry of Ministry of Ukraine”
Introduction. The paper demonstrates the results of the analysis of using the concept of hospital security as the assessment risk factor and the component of modern approach to crisis management. The topicality of the items study is related to the fact, that modern society is facing increasing challenges due to the increase in the frequency and intensity of natural disasters and large accidents, in this case the world experience of elimination such disasters, indicates, that medical institutions firstly are hospitals, whose effective functioning is extremely necessary for reducing medical and sanitary outcomes, especially those that are vulnerable to the impact of emergency factors. The World Health Organization (WHO) has been working and supporting this area for over 25 years, and the intervention of the Hospital Safety Index methodology was the way of ensuring the safety of hospitals in emergencies and disasters. At the same time, our analysis of sources the scientific and specific information on assessing the state of the problem: determining the safety of hospitals revealed, that this methodology has certain shortcomings and needs to be improved.
The aim of the study. According to the abstact above, we have set the goal: improving the safety of hospitals (health care facilities) for the possibility of their effective functioning in emergency situations by identifying, assessing risk factors and organizational, structural, functional readiness of institutions with extrapolation to the theory of risk management theory (Risk Management).
Materials and methods. Our research is based on the analysis of information from scientific and specialized sources, namely: International Disaster Database, EM-DAT, Center for Disaster Epidemiology Research (CRED) of Leuven Catholic University (Belgium), official WHO expert reports concerning the safety of hospitals. The research methods were: synthetic, bibliographic, risk management method and methods of formal logic. The logical analysis of the data and identification of main causal factors of deficiencies and risk factors was carried out. In our study, the methodology for identifying risks as an element of crisis management in assessing hospital safety was first used. For qualitative risk assessment, we have applied the coefficient of mathematical expectation of reducing the effectiveness of clinical interventions, as well as a calculated matrix for assessing hospital safety risks.
Results. Conforming to analyzing the WHO’s general recommendations for interpreting hospital safety index with the use of risk management theory, it was detected that there are discrepancy in the classification of hospital safety index when the risk management theory is used, which is particularly more evident when considering general recommendations due to the index of the risk and recommendations, which is needed to reduce the risks, using Hospital Safety Index. In this regard, we have proposed an adaptation of the existing classification of the Hospital Safety Index, taking into account clinical risk values. The general recommendations are made accordingly to the necessary security measures and are adjusted, depending on the values of the Hospital Safety Index (HI) and the risk characteristics. The value of clinical risk at the level of minimum (0.00), with an IBD equal to 1.00 or theoretically impossible (0.01-0.09), IBL (0.91-0.99), allows to neglect the risk and continue work according to plan. Clinical risk values at the level of insignificant (0.10-0.24), IBD (0.81-0.90), or significant (0.25-0.49), IBD (0.67-0.80) – there is a need to take steps to increase the hospital’s ability to respond to emergencies. The values of clinical risk at the level of critical (0,50-0,79), IBL (0,56-0,66) and more critical (0,80-1,90), IBL (0,34-, 0,55) – there is a need to take immediate steps to increase the hospital ability to respond to emergencies. And in case of poor security (0.33-0.00 IBD) and catastrophic clinical risk level (more than 2), urgent measures are needed to increase the hospital ability for respond to emergencies, that is, the hospital will not be able to work during emergencies.
Conclusions. The provision of hospital security should be considered as an element of implementation of risk-oriented principles of reduction the obstacles and volume of health consequences of emergencies, therefore we decided to consider the concept and principles of determination methodology of the Hospital Safety Index as the component of crisis management and mechanism of the risks government.
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