A socio-ecological resilience perspective to enhance hospital service delivery resilience to extreme weather events

Hospital facilities are critical infrastructure for disaster response that need to remain operational 24 hours and seven days week. However, the capacity of many hospitals to sustain their critical service delivery during disasters has been compromised during past extreme weather events (EWEs) due to structural damage to the built infrastructure and interference to the operational capacity of the hospital itself. The unpredictability and the heightened incidences of EWEs makes hospital disaster and facility adaptation more challenging, especially because of the ageing stock of the built infrastructure, which was not designed with these risks in mind. This study adopts a socio-ecological resilience perspective to investigate how hospital infrastructure can be made more resilient to deal with growing EWE risks. The research adopts a qualitative approach which focuses on the human capacity to learn and adapt. Its aim is to investigate how hospital stakeholders value their built environment as an asset or a liability in responding to EWEs, how they learn about their built environment in such events and how they transfer these lessons into adaptive strategies to make the built environment more resilient to future EWEs. To achieve this aim, three research propositions were investigated within a constructionist ontology and interpretivist epistemology, underpinned by qualitative methods and an in-depth single case study framework. A triangulation of methods consistent with the methodological framework allowed the capturing of multiple realities embedded in hospital stakeholders' experiences. The results demonstrate that the hospital stakeholders have a limited understanding of their built infrastructure in terms of the role it plays in responding to an EWE. Further, not all the lessons learnt from an EWE experience are externalised into the hospital adaptation process. This is due to the lack of both mechanisms and structure to facilitate learning and the feedback processes at multiple scales and levels. Silo cultures, time limitations and economic constraints isolate and discourage a participatory approach towards building resilience in facility planning. These findings highlight the need for a holistic and systemic approach to health-related disaster and facility management planning in supporting hospital service delivery during EWEs.