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What is the Hospital Safety Index?

Hospital Safety Index
at a Glance

A rapid, reliable and low-cost diagnostic tool.

Easy to apply by a trained team of engineers, architects and health professionals.

Scores are entered into an Excel spreadsheet (the Index Calculator), and automated formulas tabulate the results.

Results take into account the safety level of structural, nonstructural and functional components.

145 items or areas are assessed.

Health facilities fall into one of three safety categories: High, Average and Low.

More than half of the 16,000 hospitals in Latin America and the Caribbean are in areas at high risk for disasters. The Hospital Safety Index helps health facilities assess their safety and avoid becoming a casualty of disasters.

The Hospital Safety Index provides a snapshot of the probability that a hospital or health facility will continue to function in emergency situations, based on structural, nonstructural and functional factors, including the environment and the health services network to which it belongs. By determining a hospital’s Safety Index or score, countries and decision makers will have an overall idea of its ability to respond to major emergencies and disasters. The Hospital Safety Index does not replace costly and detailed vulnerability studies. However, because it is relatively inexpensive and easy to apply, it is an important first step toward prioritizing a country’s investments in hospital safety.

Determining the Hospital Safety Index is a new way of managing risk in the health sector. It allows a health facility's level of safety to be monitored over time. Safety no longer has to be a 'yes-or-no' or an 'all-or-nothing situation, but can instead be improved gradually.

The Hospital Safety Index was developed through a lengthy process of dialogue, testing and revision, over a period of two years, initially by the Pan American Health Organization’s Disaster Mitigation Advisory Group (DiMAG) and later with input from other specialists in Latin America and the Caribbean.

Calculating the Hospital Safety Index

There are a number of steps to calculating a health facility’s Safety Index. First, an Evaluation Team uses the standardized Safe Hospitals Checklist to assess the level of safety in 145 areas of the hospital. Once the Checklist has been completed, the Evaluation Team collectively validates the scores and enters them into a scoring calculator, which weights each variable according to its relative importance to a hospital's ability to withstand a disaster and continue functioning. The safety score is calculated automatically.

The final Safety Index score places a health facility into one of three categories of safety, helping authorities determine which facilities most urgently need interventions:

Calculating the safety score allows health facilities to establish maintenance and monitoring routines and look at actions to improve safety in the medium term. This quick overview will give countries and decision makers a starting point for establishing priorities and reducing risk and vulnerability in healthcare facilities.

Components of the Hospital Safety Index

Evaluation Forms
Form 1: General information about the health facility. This form should be completed prior to the evaluation by the hospital’s disaster committee. It includes information on a health facility’s level of complexity, the population it serves, specialty care and other available services, and health staff.
Form 2: Safe Hospitals Checklist. A trained team of Evaluators then uses the Safe Hospitals Checklist to assess the level of safety of 145 areas of the health facility, grouped by location, structural, nonstructural and functional components. Click here to view or download the Evaluation Forms.
Guide for Evaluators: The Guide for Evaluators is the principal training tool. It provides guidance and standardized criteria for evaluating the components of a health facility individually and as part of the health services network. The Guide is used by a multidisciplinary team of Evaluators, which can include engineers, architects, health staff, hospital directors and others who have undergone previous training. The Guide explains the methodology and rationale for the Hospital Safety Index as well as how to calculate and interpret the health facility’s safety score. Click here to view or download the Guide for Evaluators.
Safety Index Calculator: The scores or values obtained for each component on the Checklist are recorded onto an Excel spreadsheet that uses formulas to automatically calculate a numerical score for each of the 145 assessed components. The results place the facility into one of three safety categories: high, medium, or low. It is important to note that the values given to each component are weighted according to an agreed-upon formula, which has been endorsed in Latin America and the Caribbean, but may not be applicable worldwide. The Calculator module is made available to evaluation team members as they complete their training. Contact disaster@paho.org.

Applying the Hospital Safety Index in the Americas

Several countries in Latin America and the Caribbean are working to improve their ability to assess the safety of their health facilities and set priorities for making improvements.

Mexico’s Civil Protection System launched a national Safe Hospitals Program. As part of the program, a Committee on Evaluation, Analysis and Certification was created and state-level committees carried out an initial analysis of the safety of complex or tertiary-level hospitals located in high-risk areas. A team of hospital safety evaluators, made up of experts from a variety of disciplines and institutions, went through a rigorous training process: an initial six-hour workshop followed by an online course of 60 hours, which was moderated and facilitated by national and international experts on the topic. Those who successfully passed the distance learning course were then certified as evaluators.

The Hospital Safety Index has also been applied in several hospitals in Bolivia, Ecuador and Peru where pilot ‘safe hospitals’ programs will be created. Preliminary results indicate that the nonstructural elements (architectural elements, basic installations and equipment) are most vulnerable. More importantly, political commitment has proven to be an essential prerequisite for making technical progress in improving the safety of health facilities. Likewise, it is important to have a legal framework in place that guarantees action will be taken. Applying the Hospital Safety Index requires motivation and advocacy to ensure that hospital directors invest resources in improving safety.

In the Caribbean, the Hospital Safety Index was applied in Nevis, St. Kitts, Grenada, Montserrat, Saint Vincent & the Grenadines, Anguilla, Dominica and Barbados. Based on the results and recommendations from the evaluation team, the eight hospitals have begun to make needed improvements. Cuba was one of the first countries to apply the Safe Hospital checklist and the results obtained are consistent with the hospitals capacity to continue functioning immediately after hurricanes Gustav and Ike. As was the case in South America, applying the Hospital Safety Index has generated a great deal of interest, not only within the health sector but with other risk management actors as well. Jamaica and Trinidad and Tobago are now planning to apply the Hospital Safety Index in several hospitals. Central America, for its part, has begun an ambitious work plan to train evaluators and develop ‘safe hospital’ plans in several countries.

Clearly, the enthusiasm generated by the Hospital Safety Index has been contagious! This practical and simple tool is allowing us to achieve visible results in the short, medium and long terms that will help make hospitals safe from disasters.

FAQs about Safe Hospitals

Photo Gallery

Safe Hospitals—A Collective Responsibility, A Global Measure of Disaster Reduction, prepared by PAHO/WHO for the UN World Conference on Disaster Reduction.

More publications on Safe Hospitals.