RESC_EU

While fail-free systems are illusory, it is in everyone’s interest that health services be resilient, i.e., that they are able to withstand, respond to, and recover from disruptions. The concept of resilience has been explored in a number of disciplines: ecology, psychology; global health and health policy; reliability and risk engineering; safety science (as ‘resilience engineering’, often focused on patient safety). In this project, we are particularly interested in the intersection between ‘infrastructure resilience’ and ‘health systems resilience’. We consider health services as a fundamental infrastructure in modern societies, providing preventive, emergency and elective care in normal and crisis times. Various types of disruptions can affect healthcare systems. Pandemics like Covid19 create sudden surges in demand in certain areas. Natural disasters reduce capacity if health services are hit and can also generate specific demand. Building damage or cyberattacks have affected hospitals, reducing secondary care capacity. Large migratory movements, e.g. fueled by conflicts, generate increased demand. Climate-driven events, like heatwaves, also generate surges in demand that will become more intense and more frequent. Research on health services resilience remains essentially descriptive and qualitative in health policy, focused on crisis response or high-level characteristics of health systems that can help mitigate the impact of disruptions (e.g., funding mechanisms). In reliability engineering, studies often focus on specific events that can affect hospitals, such as earthquakes or pandemics, or specific combinations. Some categories of events have been left aside, or treated in isolation, like cyberattacks. Multi-disciplinary solutions are needed to enhance preparedness and resilience of healthcare systems to disasters. We need more generalisable approaches that could be adapted across locations and disaster types, that would focus on multiple facilities (networks), that would account for the spatiotemporal nature of the different hazards, and that would ultimately enable a comprehensive assessment of healthcare systems under multiple potential disruptions. Our work builds on both the ‘health system resilience’ perspective, and ‘infrastructure resilience’ work in reliability engineering, with additional contributions from epidemiology, health services research, operations research, design, and industrial engineering. Our project will focus on solid cancers, in adults. Cancer care outcomes are a key indicator of overall healthcare system quality across EU and OECD countries facing emblematic challenges in terms of care disruptions. Cancer is a highly prevalent category of diseases, and its management involves a diverse range of providers and techniques: primary care, imaging, biology for diagnosis, and surgery, chemotherapy, and radiotherapy for treatment. Reaching a better operational understanding of care resilience in cancer care will be insightful for multiple other classes of diseases. We will: 1) Propose methods to assess vulnerability and resilience of cancer care at the regional/national level 2) Analyze how health services responded to past disruptions, including with focus on events others than pandemics and natural hazards, e.g. cyberattacks, fire, drug shortages. 3) Propose models to simulate, compare, and optimize responses to disruptions from a diverse set of metrics and perspectives (including medical, economic, societal, and ethical considerations) 4) Involve relevant societal stakeholders through collaborative methods (e.g. serious gaming) 5) Assess how emerging digital technologies fit into this picture, both as a mitigating factor and as an additional risk factor In all these streams, we will combine qualitative and quantitative methods.