EAPSI: Quantifying the effect of centralization on the resilience of the regional healthcare system in the 2010-11 Canterbury earthquake sequence

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Healthcare systems have been identified worldwide as critical infrastructure that must remain functional for communities to effectively respond to disasters such as earthquakes. Much disaster resilience research has assumed that system-wide functionality can be predicted from the performance of independent hospitals. Healthcare, however, functions as a networked system of providers and facilities, rather than a set of independent entities. Therefore, to better understand healthcare delivery after a disaster, it is important to capture the contributions and interactions of all parts of the system. This study will apply engineering techniques for analyzing complex systems to a resilience-based framework in order to characterize healthcare at a system level. This framework will be used to determine the effect of centralization on overall healthcare system performance following seismic events. The Canterbury region, which sustained severe damage in the 2010-2011 Canterbury Earthquake Sequence, provides a unique opportunity to study a highly centralized healthcare system recovering from a series of devastating earthquakes. This work will be performed in collaboration with Dr. Sonia Giovinazzi and the University of Canterbury in New Zealand.The healthcare system will be characterized through interviews with administrators, engineers, and healthcare providers. Emphasis will be placed on how organizations within the system allocate resources needed to create surge capacity, such as space (including infrastructure), staff, and supplies. This study will also examine how resource allocation changed after the earthquakes. Fault-tree analysis will be applied to connect the high-level functionality of the healthcare system (e.g., ability to provide surgery) with base-level performance of resources (e.g. loss of sewage) under four conditions: decentralized pre-earthquake, centralized pre-earthquake, decentralized post-earthquake, and centralized post-earthquake. Resilience under each condition will be calculated for scenario events using functions-based resilience metrics developed for this study. This NSF EAPSI award is funded in collaboration with the Royal Society of New Zealand.