Slack in the infrastructure of intensive care units: resilience management in the post-pandemic era

Abstract

Background Although slack is an asset to resilient hospitals, it is usually explicitly discussed only in terms of the quantity and quality of beds and staff. This paper expands this view by addressing slack in four infrastructures of intensive care units (ICUs) (physical space, electricity supply, oxygen supply, and air treatment) during the COVID pandemic. Methods The study occurred in a leading private hospital in Brazil, aiming at the identification of slack in four units originally designed as ICUs and two units adapted as ICUs. Data collection was based on 12 interviews with healthcare professionals, documents, and comparison between infrastructures and regulatory requirements. Results Twenty-seven instantiations of slack were identified, with several indications that the adapted ICUs did not provide infrastructure conditions as good as the designed ones. Findings gave rise to five propositions addressing: relationships intra and inter infrastructures; the need for adapted ICUs that match as closely as possible the designed ICUs; the consideration of both clinical and engineering perspectives in design; and the need for the revision of some requirements of the Brazilian regulations. Conclusions Results are relevant to both the designers of the infrastructures and to the designers of clinical activities as these must take place in fit-for-purpose workspaces. Top management might also benefit as they are the ultimate responsible for decision-making on whether or not to invest in slack. The pandemic dramatically demonstrated the value of investing in slack resources, creating momentum for this discussion in health services.

RESILIÊNCIA hospitalar na resposta à PANDEMIA De COVID-19: investigando as adaptações de Um hospital no rio de janeiro

“…Foi necessária uma adaptação, até então não considerada, para garantir as medidas de isolamento necessárias e ao mesmo tempo manter a prestação de cuidados. Ao discutir a infraestrutura de UTIs para melhoria do desempenho resiliente a partir de uma análise do contexto da pandemia, Marczyk et al (2023) apontam que os hospitais necessitam de áreas que possam funcionar como UTIs alternativas e que essas áreas precisam dispor de uma estrutura necessária para dar suporte as atividades desenvolvidas nessas unidades. Os autores acrescentam que essas áreas precisam ser projetadas a partir de uma perspectiva clínica e de engenharia a fim de garantir sua funcionalidade.…”

Managing Complexity in Socio-Technical Systems by Mimicking Emergent Simplicities in Nature: A Brief Communication

“…The shift towards acknowledging emergent behaviors has been embraced by resilience engineering, leading to significant insights into the study of socio-technical systems, where such behaviors are crucial for functionality and resilience. This perspective has been effectively applied in analyzing organizations and critical environments like surgical suites, air traffic control, nuclear plants, and construction sites [ 6 , 9 , 10 , 11 , 12 ].…”

MARLIN Method: Enhancing Warehouse Resilience in Response to Disruptions

“…The adaptive capacity (i.e., the potential to modify the changing demands and the responses that the system can implement to those demands about its goals). The adaptive capacity is divided into a base adaptive capacity (corresponding to the homeostatic adaptation that allows for the ordinary dynamic adaptive behavior) and an extensible adaptive capacity (corresponding to the allostatic adaptation that allows for the extraordinary dynamic adaptive behavior); • Capacity for Maneuver (CfM), a quantity along which the risk of saturation (i.e., reaching the limit of maneuvering capacity and thus becoming fragile) can be estimated, and by other authors has been traced to so-called slack resources [101];…”