Report from a workshop on hospital safety index assessment in Croatia
A workshop organized by WHO/Europe and the WHO Country Office, Croatia took place in Zagreb on 4 May 2011 on hospital safety index assessment in Croatia. Thirty-six participants from hospitals from around Croatia participated. The workshop was opened by Dr Antoinette Kaić-Rak, Head, WHO Office in Croatia, and State Secretary for Health and Social Welfare, Dr Ante Zvonimir Golem.
Pilot project results
The first presentation on managing hospital safety systems in crisis situations was given by Dr Golem, who presented the results of a pilot project with six Croatian hospitals on hospital safety index assessment. The assessment was conducted using the WHO assessment tool, giving a safety index indicator for each of the six hospitals taking part in the pilot project. Out of the six hospitals there were two in each of the three safety categories, meaning that out of those hospitals, two would be able to function in a crisis situation and could use minor investments, two need measures in order to improve their structural and functional safety, while the remaining two would not be able to function in a crisis situation and need urgent measures in order to be able to continue functioning within the health system. The results of this pilot project are valuable as they point to areas in which investments are needed in these particular hospitals for their safety to be improved and for the hospitals to be able to function in a crisis situation.
WHO evaluation tool
The second presentation on assessing the health system’s crisis preparedness was given by Dr Corinna Reinecke, WHO consultant. The presentation focused on the methodology of how assessments of health systems’ preparedness for crisis situations are conducted. The use of a WHO evaluation tool that was used in eight was explained in detail, with examples from missions conducted in Armenia, Italy, Kyrgyzstan, Moldova, Turkey, Azerbaijan, Kazakhstan, Malta, Poland and the Ukraine. Dr Reinecke explained the key elements and layout of the tool, as well as how the assessments were conducted. The tool is a helpful resource to assess the functioning of health systems with the goal of giving support to the Ministry of Health in identification of strengths, weaknesses and gaps in the health systems’ crisis preparedness.
Disaster risk reduction a WHO priority
Dr Gerald Rockenschaub, WHO/Europe gave a presentation on emergency preparedness, a priority for WHO/Europe. Dr Rockenschaub noted that Croatia has extensive experience on how to react and organize the health system in crisis situations. WHO has identified disaster risk reduction as one of its priorities, with the main objectives in crisis situations being the reduction of health consequences, reduction of infrastructural damages to health facilities and prevention of a situation in which health services are unable to save lives. Dr Rockenshaub stated that in order for health facilities to be able to adequately react in crisis situations, WHO promotes an all-hazard approach, meaning that 80% of measures necessary in order to enable a good response are generic – that is, they present a multisectorial challenge such as water supply, waste disposal, etc. Whereas the underlying challenges are weak building safety policies, insufficiently trained staff, underinvestment, no hospital emergency response plans or plans that are not tested. Dr Rockenschaub mentioned crisis situations from the past where the response was not good, from which there are lessons to be learned. Israel was presented as a country with good practices in hospital crisis preparedness ,with good plans and regular exercises. Dr Rockenschaub reminded that we need better all-hazard programs in all countries, drills and exercises, better cross-border collaboration, a multisectorial approach and trained staff in order to be successful in overcoming crisis situations.
Croatian plan for crisis response
The fourth presentation of the day by prof Ivan Medved, the Minister of Health’s Adviser on Crisis Situations focused on crisis preparedness and prevention of health crisis situations, explaining the results from the HSIA pilot study in Croatia. Prof. Medved reminded the participants of the workshop that in today’s world there are certain risks on which regular organization in health cannot respond to well and for this reason, crisis preparedness is necessary. He presented the Croatian plan for response to crisis situations, at the heart of which is the Crisis Headquarters of the Ministry of Health. The cornerstone of county crisis preparedness is hospitals, the first line of response in crisis situations. Prof. Medved stated that the pilot project on hospital safety index assessment that was conducted in Croatia in which six hospitals took part will be extended to further hospitals – a total of 18. He also stressed that Croatia now has five educated evaluators for hospital safety assessment, one of them being the next presenter, Mr Hrvoje Hrabak.
Case study: Dubrovnik hospital
Mr Hrvoje Hrabak, one of the five trained evaluators for hospital safety index assessment presented a hospital safety case study featuring the Dubrovnik hospital. After giving a detailed account of the hospital’s location and structural situation Mr Hrabak described the both the structural and nonstructural elements relevant for calculating the safety index and the non-safety index. Out of the six hospitals that took part in the pilot study, this hospital was given a high safety index making it a hospital very likely to continue functioning in case of a crisis. Mr Hrabak’s presentation gave the participants a concrete example on how the WHO tool for hospital index assessment was used in case of one hospital.
Protecting people and property
The sixth presentation of the day, given by the hospital’s safety engineer, Mr Mile Žarak was on protection of people and property. Mr Žarak gave a detailed account of a new, modern hospital to be built in Zagreb. The hospital will employ 1845 people and it will be a teaching hospital where future medical staff will be educated. The geographical location and architectural layout of the hospital, as well as its fire safety system and other systems in place to enable the protection of people and property were explained. The hospital will be one of the six hospitals to be included in the hospital safety index assessment pilot study. Mr Žarak concluded his presentation stating that in spite of all this, there also is room for improvement of the security system in this hospital.
The final presentation of the day on health protection during mass events was held by prof Ivan Medved. One mass event to be held in Croatia is the Pope’s visit scheduled for the beginning of June 2011. With that in mind, prof. Medved reminded the participants of the workshop of the on the Croatian legal framework regulating the preparedness for crisis situations in general (the Constitution, the National Generic Plan for Response in Crisis Situations, the Crisis Headquarters of the Ministry of Health). Prof. Medved noted that the world today is more connected across borders, which is also interesting for health. In the case of mass gatherings one must keep in mind the potential risks related to such events, one of which is terrorism. Prof. Medved described the function of the Croatian crisis headquarters, the information flow and the organization of response in such situations. He finished the presentation stating that the next step would be to conduct a focused study to identify strengths and weaknesses and to share experiences with other countries, health professionals and WHO.
The workshop was closed by Dr Gerald Rockenschaub, who stated that the upcoming mass event is an opportunity to improve the crisis response system. He noted that it is important to consider all the potential hazards and that in the case of such an event, WHO will provide support if necessary, and also reminded participants about the International Health Regulations. Dr Rockenschaub stated that the continuation of the hospital safety index assessment pilot project in Croatia presents a good opportunity to test the tool and tailor it to the local, or perhaps regional context. Dr Rockenschaub thanked everyone for taking the time to attend the workshop, hoping that collaboration will continue and bring about improvements for both Croatia and its neighboring countries.