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INFRASTRUCTURE


Environmental stresses


Rapid population growth


Climate change


Ageing demographic


Globalisation


Shocks


Structures


Infrastructure


Fire and accident


Weather


Seismology


Health


Movement


Cyber


Finance


Reputation


Terrorism


Unrest


Structural stresses


Urbanisation


Poor air quality


Health inequality


Obesity


Skills/education inequality


Wealth inequality


Corruption/ bribery


Sectarianism


Vulnerabilities


Structures and infrastructures


Systems and technology


Environment


Leadership and governance


Security and safety


Skills and training


Health and wellbeing


Mobility and connectivity


Resources and logistics


Business and trade


Sense of place


Community and inclusion


Impacts


People – physical


Psychological


Lifestyle


Sociocultural


Reputational


Environmental


Financial/ economic


Infrastructural


Legal


Figure 1: Organisational resilience assessment diagram.


model and assess current states and develop hypothetical future scenarios. Risk-based decisions can then be made to identify the strategies that are most likely to improve resilience in the long term.


Understand the systems Situational awareness is key to all decision-making, both in the short and long term. Decisions made now around the location, form, function and capacity of healthcare infrastructure will have to stand the test of time. These are very complex decisions with long-term ramifications and are subject to significant due diligence. While this assures the process, it does not necessarily ensure decisions are made with the best possible information, providing the best possible situational awareness. Situational awareness can be built using ‘systems thinking’, making sure our short, medium and long-term understanding of the operational environment is systematically developed and reducing the risk of gaps. Systems need to be understood in


terms of value. Value is also a core concept when defining and building resilience within an organisation. This means value in terms of how an organisation develops and delivers value for all its interested parties. For health systems in the UK, the mission is: “Health and high-quality care for all, now and for future generations.”1 In the UK, all healthcare systems


should be built with a golden thread that supports this mission.


36 From this understanding, the


healthcare systems can be mapped and defined. All systems have incoming logistics, operations and processes, outgoing logistics, public communications, customer services and waste; and they develop through life- cycles. The component systems, products and services that make up the whole can be mapped and assessed in terms of their relative importance in delivering the mission, and their position in their relevant lifecycle. Those areas of the mapped system that are of high significance for the delivery of the mission are also the areas where the system is most vulnerable. This mapping process can take place at a strategic, tactical and operational level, to provide a layered and detailed understanding of a system and its most critical components. This process is core within Business Continuity practice and is covered within a Business Impact Assessment


Understand the risks Our urban environments are incredibly complex, but the more we understand them, the better our strategic decision making will be. Figure 1 illustrates how the systems understanding developed through tools such as business continuity can be linked to an understanding of those shock and stress factors in the environment that can either be sources of disruption or cause business models and business cases to fail or become obsolete. The sum of these factors can be


developed into a resilience demand for each part of the system, and for the system as a whole. When gathering information, a fitness assessment is also useful to identify areas of vulnerability and interdependencies and will map key social and economic drivers such as age distribution and wealth inequality. Figure 1 also highlights some of the


universally important factors that are likely to drive disruption and change in the future. Using a systems approach, these factors can be broken down to factors related to location; inputs; demands; processes and operations; outputs and waste; outpatients and community care; and communications. These factors include climate change,


which has the potential to change the risk profile for infrastructure, exposing areas to new risk, or increasing the frequency of risks such as flooding beyond tolerable limits. Urbanisation also has the potential to put ever greater pressure on land values and increase the scarcity of land availability, resulting in health care facilities being restricted to current sites, without the scope for development within manageable distances. Smart Cities, smart networks, micro


generation and automated vehicles and systems are going to drive significant societal change in the future, and this will change the way health infrastructure is powered, the way it operates and how it integrates with society. Factors such as ageing populations, mass migration, and structural change in


IFHE DIGEST 2017


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