Environmental stresses

Rapid population growth

Climate change

Ageing demographic





Fire and accident










Structural stresses


Poor air quality

Health inequality


Skills/education inequality

Wealth inequality

Corruption/ bribery



Structures and infrastructures

Systems and technology


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


People – physical






Financial/ economic



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


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80