الفهرس 
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Abstract
Fortunately, Covid 19 pandemic crisis yield many lessons to be learned by the international community. The golden lesson realized by all countries articulated on the fact that efficient preparedness to disasters can help to achieve resilience when disaster hit any community. Disaster resilience is a novel approach that helps communities and agencies to respond to disasters in timely manner and maintaining essential functions and operations. Moreover, achieving resilience during disaster can mitigate its impacts and shorten the aftermath of disasters. It is noted that all contemporary disasters management literatures and scholars emphasized that creating disaster resilient organization require robust preparedness.
The present study aimed to assess level of disasters preparedness and resilience of Alexandria university hospitals (AUH) then using the results of assessment to build a strategy to enhance the current level of disasters preparedness and resilience of these settings. It was conducted in three hospitals namely; the Alexandria Main University Hospital, Al-Hadara University Hospital, and Al-Moassat University Hospital. These three hospitals represent more than 25% of the total number of Alexandria university hospitals. Also, these hospitals were selected from university heath sector because they had the largest capacity in terms of licensed beds number, surge capacity, and number of population served.
Two categories of subjects were included in this study as follows:
- All key persons of these hospitals (n=170) such as hospitals directors, head of clinical and non-clinical departments, nursing directors, and head nurses.
- A convenience sample of hospitals staff (n= 410) were included in the study. They were selected from the three hospitals as follows; Alexandria Main University Hospital (n=290), Al-Hadara University Hospital (n=66), and Al-Moassat University Hospital (n=54). They were distributed through proportional allocation using power analysis technique.
Three tools were used to conduct the study as follows;
1. Hospital Disaster Preparedness Self-Assessment Tool: It was developed by the American College of Emergency Physicians (2017). It was adopted to assess and estimate the level of hospitals disaster preparedness. This tool consists of 520 items categorized under two parts. Part (I) ”hospital profile” was used for general description of the studied hospitals status (n=67) in relations to hospital staffing, current patient care capacity, and other hospitals capacities.
Part (II) ”analysis of critical preparedness factors” was used to estimate the level of disaster preparedness of the studied hospitals. It is subdivided into nine factors namely: leadership and governance; emergency management planning; clinical operations; safety, fire and security; logistics and facilities; communication, warning and notification; public information, media relations and risk communications; training, drills and exercises; and performance improvement and quality. Also, It contains binary criteria (n=453) that were verified by “yes” or “no”. The options of “yes” or “no” was assigned the score of “1” or “0”, respectively.
2. Hospital Disaster Resilience Capability Assessment Survey: It was developed by Zhong (2014) to assess disaster resilience capability of the hospitals and estimate the level of disaster resilience index. It was adopted to conduct the study. It consists of 161 items categorized under four dimensions namely; emergency medical response capability; disaster management mechanisms; disaster resources; hospital infrastructural safety and vulnerability.
This tool consisted of two types of questions; numeric and dichotomous binary questions. The numeric questions (n= 80) were used to describe the current capacities of the studied hospitals in relation to the current situation of resilience. On the other hand, the dichotomous binary questions (n=81) were used to calculate the hospital resilience index which is a proxy to conclude the overall status of resilience. These binary questions were assessed by “yes” or “no” and the options of “yes” or “no” were assigned the score of “1” or “0”, respectively.
3. Demographic and Professional characteristics of the Study Subjects Questionnaire: It was developed by the researcher to assess the socio-demographic characteristics of study subjects. It included 17 items such as age, current position, etc. In addition, three open ended questions were added to ask subjects about their points of view about their personal preparedness to respond to any disastrous situation in the current time, hospital preparedness to any crises, and subjects’ perspectives and recommendations to improve the current situation of disaster preparedness and resilience of the studied hospitals.
An official letter from the Faculty of Nursing was sent to the directors of the three studied hospitals to collect the necessary data of the study. The current study proceeds through the steps of strategy formulation proposed by porter (2010) using a methodological descriptive exploratory research design as follows:
I. Situation Analysis
- It was conducted by the researcher through auditing of the selected hospitals’ departments and units to assess the current situation of disaster preparedness and resilience using the three tools of study. Auditing conducted through the following three mechanisms:
Inspection of the related documents to verify the hospitals’ plans, policies, procedures, instructions, etc.
Observation to assess accessibility, availability, validity of resources, instructions, etc.
Interview with hospitals key persons and hospital staff to collect all relevant data related to human resources knowledge, training, roles awareness, etc.
- Tool (III) regarding demographics and professional properties of study subjects and their points of view about the current situation of preparedness and resilience was hand delivered to the key persons and hospitals staff to be completed during interview with them.
- Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was done.
II. Gap Analysis Phase:
- All data collected were coded and open ended questions were categorized into different categories then data were entered into the computer using the Statistical Package for Social Sciences (SPSS) version 25. Data were reviewed and checked for accuracy. Frequency tables and cross tabulations with percentages were used to illustrate the results of categorical data. Quantitative data were summarized by the minimum, maximum, median, arithmetic mean and standard deviation. One Way a Nova test for analysis of variance was used to find the statistical difference between levels of disasters preparedness and resilience of the studied hospitals.
- The findings of the analyzed data were utilized to assess the level of study hospitals’ preparedness and resilience, and identify the gap in the current situation of preparedness and resilience.
III. Strategy Development Phase:
- Strategy for improvement was developed based on the results of gap analysis in which critical actions were proposed to buffer the weak points.
- Points of view of study subjects about the possible ways for improvement of preparedness and resilience were considered in the current strategy.
- Thirteen strategic goals were developed in which each goal represent a strategic improvement action that need to be fulfilled in each factor of preparedness and resilience. Moreover, a number of specific objectives were added under each strategic goal which also represents the core elements that need to be accomplished to meet the improvement strategic goals.
- Critical actions to achieve the developed objectives were proposed based on the results of auditing and subjects’ opinions.
- The responsible bodies to implement the critical actions were also defined and indicators for achievement of each objective were stated.
- The developed strategy was presented to the hospitals directors and a jury composed of five experts in disasters management from Alexandria University to review the proposed measures and activities included in the strategy, and assure its validity, applicability, and feasibility for implementation in the university hospitals.
- The final form of disaster preparedness and resilience improvement strategy was developed based on the recommended modifications of the jury.
- The final developed strategy composed from two parts;
Part (I): Disaster preparedness improvement strategy that articulated around the nine key pillars of hospitals preparedness proposed by the American College of Emergency Physicians
Part (II): Disaster resilience improvement strategy that articulated around the four criteria of efficient hospital resilience proposed by Zhong. et al, Torrens Resilience Institute, and Multidisciplinary Center of Earthquake Engineering Research.
IV. Communication and Dissemination Phase:
After development of disaster preparedness and resilience improvement strategy, the researcher met with hospitals’ key persons including hospitals directors, and heads of all clinical and non-clinical departments to communicate the developed strategy.
Ethical considerations:
- An official approval was obtained from the Ethical Committee of the Faculty of Nursing, Alexandria University to conduct this study.
- The aim of the study was explained to subjects and written informed consent was obtained from them for their participation in the study. Confidentiality, privacy and anonymity of subjects were maintained; as well as their right to withdraw at any time, from the research, were assured without any consequences.
The followings are the main results yielded by this study:
1- Demographic and professional properties of the study subjects
Subjects’ age ranged from 23 to 59 years old (mean= 39.64±9.957).
The highest percent of study subjects (27.6%) were master degree holders, while the minority (5.1%) of them attained only the preparatory certificate.
The study subjects’ years of experience since graduation ranged from 1 to 30 years (Mean ± SD =12.83±8.832).
Near two thirds of the study subjects (60.3%) did not participated previously in responding to any types of crises or disasters, which is contrary to 39.7% of them who participated in responding to different types of disasters.
The majority of study subjects (89.5%) did not participated in any type of committees concerned with disasters management.
Near three quarters of study subjects (71.9%) did not received previous training about disasters management which is contrary to 28.1% of them who received.
The highest percentage of the study subjects (73.8%) did not attend any workshop about disasters management in their workplace.
2. Levels of crises and disasters preparedness of the studied hospitals
Around two thirds of the study subjects (69.8%) have unacceptable level of disaster preparedness and readiness at the current time. On the other hand, 19.5% of them have insufficient but acceptable level of preparedness and a small percentage of them (10.7%) have effective level of disaster preparedness.
The three studied hospitals have unacceptable level in the overall disasters preparedness. In particular, the three studied hospitals have acceptable but insufficient preparedness level in two disasters preparedness factors namely: disasters logistics and facilities; and safety, fire, and security. On the other hand, the three studied hospitals recorded unacceptable level in the remaining seven factors of disasters preparedness.
The highest mean score for the overall preparedness found in the Main University Hospital (377±0.00) followed by the Al Hadara University Hospital (306.00±0.00) then El Moassat University Hospital (296.00±0.00).
Also, the highest level of preparedness was recorded in disasters logistics and facilities factor (55.3%) among the three studied hospitals while the lowest level was found in disasters training, drills, and exercises factor (17%).
3. Levels of disasters resilience of the studied hospitals
Around three quarters of the study subjects (74.7%) are located in the moderate zone of disasters resilience. On the other hand, 20.3% of them are located in the low zone of resilience and a small percentage of them (5%) are located in the high zone of resilience.
The overall level of disasters resilience of the three studied hospitals is located in the moderate zone of resilience.
Concerning disasters resilience factors, the three studied hospitals are located in the moderate zone of resilience in these factors. Also, the highest resilience level was recorded in disasters stockpiles and logistics management factor (40%) among the three studied hospitals while the lowest resilience level was found in emergency medical response capability factor (35%).
The highest mean score of overall hospitals disasters resilience was found in the main university hospital (63.00 ± 0.000) followed by Al-Hadara University Hospital (58.00 ± 0.000) then Al-Moassat University Hospital (53.00 ± 0.000).
Conclusion and Recommendation
This study concluded that Alexandria university hospitals have poor insufficient level of disasters preparedness and moderate level of resilience. They suffer from many serious weaknesses in their preparedness especially in disaster training and drills, disaster leadership and governance, crisis communication, disaster planning. These weaknesses will deter Alexandria university hospitals from achieving resilience when disasters strike. It is implied that here is a need for continued and intensified efforts to upgrade disasters preparedness and resilience of Alexandria university hospitals preparedness.
This study has reached to the following main recommendations:
1. Conduct continuous training programs at least twice annually regarding basic life support; disasters management plans and procedures to acquaint all staff with knowledge and skills required for rapid rescue and response.
2. Establish a hand book that include all disasters management policies and plans and make it accessible for all staff in all units within Alexandria university hospitals.
3. Establish a department composed of multi-disciplinary team concerned with crises and disasters management in each hospital accountable to develop, update, test, and monitor disasters management plans and procedures.
4. Develop incident command system and hospital command center within each hospital that enable monitoring and control of operations during disastrous incidents
5. Adopting surge plans and procedures to increase the patient care capacity during disasters to at least 25% comparable to capacities in normal operations.