Three contexts of planning and decision analysis for disaster mitigation in hospitals : Taiwan, Vancouver, and Los Angeles

This thesis investigates the impact of power and water outages caused by both electrical grid failure and natural disasters on the operational capacity of hospitals in three case studies: 1999 Chi-Chi Taiwan Earthquake, Vancouver, and Los Angeles. Using a case study methodology and review of the literature, the study attempts to characterize the types of impacts that are likely to result from power and water outages and how the concurrent impacts of disaster may exacerbate the impacts. Beyond characterizing impacts, the study also investigates the role different regulatory environments play in decision-making. Decision analysis tools are used to illustrate the inter-connected nature of decision-making in disaster mitigation and to identify opportunities to improve outcomes and increase disaster resilience in hospitals. Decision-making outcomes about disaster mitigation are a combination of compliance with legislative standards and financial resources allocated to risk mitigation measures. Dissonance between desired outcomes and actual outcomes frequently arises because of lack of information about the impacts of power outages, budgetary decision-making, and lack of coordination in strategic planning and day-to-day operational choices. The results of the study indicate that while hospitals have made significant strides in disaster preparedness they remain extremely vulnerable to the impacts of power and water outages. Moreover, hospitals lack systemic, detailed information on the probability of a total failure occurring and have in general failed to plan in detail for a scenario where emergency power systems fail. To improve resiliency at hospitals and reduce vulnerability to power and water outages several steps are necessary. First, regulatory and accreditation bodies ought to develop a database to monitor and track the frequencies of outages, the performance of back-up measures, and the outcomes on patient care. Data for metrics such as duration of the outages, patient deaths, patient discharges, cancelled surgeries, financial impacts exist today, but are not reported systematically. Second, reducing hospital vulnerability to power and water outages ought to be a community priority for disaster mitigation planning and provide funding necessary for mitigating the impacts of power and water outages.