title: Disaster resilience in tertiary hospitals: a cross-sectional survey in Shandong Province, China.
abstract: BACKGROUND
  Hospital disaster resilience can be defined as a hospital's ability to resist, absorb, and respond to the shock of disasters while maintaining critical functions, and then to recover to its original state or adapt to a new one. This study aims to explore the status of resilience among tertiary hospitals in Shandong Province, China.
  
  
  METHODS
  A stratified random sample (n = 50) was derived from tertiary A, tertiary B, and tertiary C hospitals in Shandong Province, and was surveyed by questionnaire. Data on hospital characteristics and 8 key domains of hospital resilience were collected and analysed. Variables were binary, and analysed using descriptive statistics such as frequencies.
  
  
  RESULTS
  A response rate of 82% (n = 41) was attained. Factor analysis identified four key factors from eight domains which appear to reflect the overall level of disaster resilience. These were hospital safety, disaster management mechanisms, disaster resources and disaster medical care capability. The survey demonstrated that in regard to hospital safety, 93% had syndromic surveillance systems for infectious diseases and 68% had evaluated their safety standards. In regard to disaster management mechanisms, all had general plans, while only 20% had specific plans for individual hazards. 49% had a public communication protocol and 43.9% attended the local coordination meetings. In regard to disaster resources, 75.6% and 87.5% stockpiled emergency drugs and materials respectively, while less than a third (30%) had a signed Memorandum of Understanding with other hospitals to share these resources. Finally in regard to medical care, 66% could dispatch an on-site medical rescue team, but only 5% had a 'portable hospital' function and 36.6% and 12% of the hospitals could surge their beds and staff capacity respectively. The average beds surge capacity within 1 day was 13%.
  
  
  CONCLUSIONS
  This study validated the broad utility of a framework for understanding and measuring the level of hospital resilience. The survey demonstrated considerable variability in disaster resilience arrangements of tertiary hospitals in Shandong province, and the difference between tertiary A hospitals and tertiary B hospitals was also identified in essential areas.
authors.affiliation: Center for Emergency & Disaster Management, School of Public Health and Social Work & Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4059, Australia. amigo-008@163.com.
authors.forename: Shuang
authors.initials: S
authors.lastname: Zhong
authors.forename: Xiang-Yu
authors.initials: XY
authors.lastname: Hou
authors.forename: Michele
authors.initials: M
authors.lastname: Clark
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Zang
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.forename: Ling-Zhong
authors.initials: LZ
authors.lastname: Xu
authors.forename: Gerard
authors.initials: G
authors.lastname: FitzGerald
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D003697:Delphi Technique; D004189:Disaster Planning; D004190:Disasters; D006302:Health Services Research; D006801:Humans; D015233:Models, Statistical; D017751:Safety Management; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000458:organization & administration*