Inter-agency governance risk in managing hospital responses to extreme weather events in New South Wales,Australia: a facilities management perspective of shared situational awareness

Extreme weather is predicted to become more frequent and severe into the future. While our understanding of hospital infrastructure vulnerability to such events has advanced considerably in recent years, current approaches to healthcare facilities management treat hospitals in isolation from their surrounding governance infrastructure. However, recent research indicates that if hospital resilience is to be properly understood, health infrastructure must be managed holistically, as part of a much larger governance system of interdependent organizations. The inter-agency governance risks associated with this system are currently ignored in the facilities management literature. To explore these risks, an in-depth case study of 24 agencies in the state of New South Wales, Australia is presented. The results show that facilities managers are embedded in a highly complex and dynamic array of governance boundaries which are largely unresolved and misunderstood. A number of practical strategies are presented which could be adopted to significantly improve facilities manager’s integration into this system. These include: mapping hospital dependency on other agencies to build surge capacity; resolving overlapping operational boundaries with other agencies; proactive risk reduction for critical external support infrastructure; understanding potential conflicts with the objectives external agencies in responding to an extreme weather event.     

A socio-ecological analysis of hospital resilience to extreme weather events

Hospitals play a critical role in helping communities respond effectively to extreme weather events (EWEs). Despite predictions of more EWEs, little is known about the process by which hospital infrastructure resilience to such events can be built. Using Gunderson and Holling’s Adaptive Cycle, a new theoretical perspective based on socio-ecological resilience theory is provided to understand this process. Data were collected using semi-structured interviews, observations of disaster drills and disaster planning meetings, as well as additional documentary analysis of past incident reports. The research findings were then refined and validated in a focus group meeting with respondents. The findings indicate that there are significant organizational barriers which prevent facilities managers improving the resilience of hospital facilities to future EWEs. It was found that the disaster planning process is ad hoc and non-inclusive, focused on man-made disasters and compliance driven, top-down approach, under-resourced and is driven by a general ignorance of the importance of resilient-built facilities to health care delivery during an EWE. It is concluded that to produce more resilient hospital infrastructure, there needs to be a more well-resourced, integrated and collaborative approach to disaster management planning which enables health facilities managers to play a more central role in disaster planning decisions. There also need to be better systems, technologies and training implemented to manage information about health infrastructure performance before, during and after EWEs.     

A Bayesian network model to assess the public health risk associated with wet weather sewer overflows discharging into waterways

Overflows from sanitary sewers during wet weather, which occur when the hydraulic capacity of the sewer system is exceeded, are considered a potential threat to the ecological and public health of the waterways which receive these overflows. As a result, water retailers in Australia and internationally commit significant resources to manage and abate sewer overflows. However, whilst some studies have contributed to an increased understanding of the impacts and risks associated with these events, they are relatively few in number and there still is a general lack of knowledge in this area. A Bayesian network model to assess the public health risk associated with wet weather sewer overflows is presented in this paper. The Bayesian network approach is shown to provide significant benefits in the assessment of public health risks associated with wet weather sewer overflows. In particular, the ability for the model to account for the uncertainty inherent in sewer overflow events and subsequent impacts through the use of probabilities is a valuable function. In addition, the paper highlights the benefits of the probabilistic inference function of the Bayesian network in prioritising management options to minimise public health risks associated with sewer overflows.     

Reducing risks to electric power infrastructure due to extreme weather events by means of spatial planning: Case studies from Slovenia

The paper concerns the potential for spatial planning to improve the reliability of electric power infrastructure. The aim is to reduce risks of electric power outages due to extreme weather events (EWE) by proper siting of installations. A method of evaluating risks due to EWE is applied in two case studies. The first considers ice storms and the damage they cause to power grids; the second considers the damage of heavy rainstorms to hydroelectric power plants (HPPs). The results are presented in the form of a risk assessment method that can be incorporated into spatial planning.     

Risk and resilience: strategies for security

Traditional approaches to security and safety are being challenged by ever-increasing complexity in today's socio-economic systems. New vulnerabilities are arising for many reasons: demographic shifts, trans-boundary networks, modern business practices, new systemic risks, and reliance on closely coupled infrastructure systems, among others. In such circumstances there needs to be greater allowance for uncertainty, and a different balance of proactive and reactive risk management. Decision-makers in both governments and the private sector require more comprehensive strategies that combine active management of specific risks with enhancement of generic resilience in society. Security will depend increasingly on community attributes such as social capital, informal communication networks, and organisational culture. As a general strategy for managing complex risks, this paper recommends a multilayered approach involving systems planning, risk management, resilience building, and adaptive responses.     

Risk analysis of combined rainwater detention and pumping systems

Storm sewer systems (SSSs) are complex, with many hydraulic, mechanical and electrical components which may fail during natural extreme events, changing environmental conditions (including urban development), or simply due to poor maintenance. System complexity and management are important and still debated concepts within the framework of SSS risk analysis. A new probabilistic model for a conceptualized urban SSS, including a storage unit (SU) and a pumping station (PS), shows how single-component risk analysis can be extended to complex SSSs and demonstrates the combined effect of key design parameters (SU volume, detention time, prescribed outflow discharge) and management strategy on the overall SSS risk of failure. The risk of failure evaluated in a typical case study, demonstrates that economic restrictions leading to the loss of reliability of PS elements and the lack of redundant mechanical elements represent a major threat to SSSs and suggests a new risk-based definition of ’extended’ SU.     

韧性城市理念下传染病医院弹性建设模式研究

随着新型冠状病毒肺炎疫情的蔓延,国家紧急启动了"重大突发公共卫生事件一级响应"。文章以韧性城市的视角,研究传染病医院在配建标准、用地预留、基础设施预留和装配式技术应用等多方面弹性建设模式,平时可正常运转,重大疫情突袭时可快速扩建,保证城市有足够的专业医疗空间抵抗新型病毒,保障人民群众的生命健康,同时使城市迅速回归正常运转。     

承发包组织模式对建设项目风险分配的影响

工程项目的建设是一个充满风险的过程。在建设领域中 ,长期以来我们一直重“技术” ,轻“管理与组织”。针对这种情况 ,本文从另外一个角度来探讨有关的风险管理问题。笔者从常见的几种承发包组织模式的特点入手 ,着重探讨了不同组织模式对工程风险在参与各方分配的影响。这些对比分析有助于参与各方从组织的高度 ,认清各自所面临的风险 ,从而更好地管理风险 ,以便实现项目的总体目标。     

A simulation-based generalized framework to model vulnerability of interdependent critical infrastructure systems under incomplete information

This paper proposes a novel simulation-based hybrid approach coupled with time-dependent Bayesian network analysis to model multi-infrastructure vulnerability over time under physical, spatial, and informational uncertainties while considering cascading failures within and across infrastructure networks. Unlike existing studies that unrealistically assume that infrastructure managers have full knowledge of all the infrastructure systems, the proposed approach considers a realistic scenario where complete information about the infrastructure network topology or the supply–demand flow characteristics is not available while estimating multi-infrastructure vulnerability. A novel heuristic algorithm is proposed to construct a dynamic fault tree to abstract the network topology of any infrastructure. In addition, to account for the unavailability of exact supply–demand flow characteristics, the proposed approach constructs the interdependence links across infrastructure network systems using different simulated parameters considering the physical, logical, and geographical dependencies. Finally, using parameters for geographical proximity, infrastructure managers' risk perception, and the relative importance of one infrastructure on another, the multi-infrastructure vulnerability over time is estimated. Results from the numerical experiment show that for an opportunistic risk perception, the interdependencies attribute to redundancies, and with an increase in redundancy, the vulnerability decreases. On the other hand, from a conservative risk perspective, the interdependencies attribute to deficiencies/liabilities, and the vulnerability increases with an increase in the number of such interdependencies.     

Implications of climate variability and change on urban and human health: A review

Urban regions have exceptional attributes that leave their dwellers and properties vulnerable to climate variability and change. Global temperatures continue to change, reaching new levels almost every year for the past two decades. This review examines the scientific evidence on the impact of climate change on urban and human health. It identifies research progress and gaps in how human society may respond to, adapt to, and prepare for the related changes. However, the causes are debated; climate variability and change are real. Climate variability and disaster risk are one of the threats to human health that adversely reinforce each other. Better knowledge of the linkage between climate change, variability and extreme weather-related illness is needed and can aid strategies to reduce the vulnerability. However, from this comprehensive review, it can be suggested that increased temperature and radiation are one of the major cause of some heat-related diseases such as skin cancer, heat stroke, heart disease and diarrhea which might strongly influenced by extreme climate events. On the other hand, since the extreme heat-related illnesses occurrence is increasing alarmingly, prevention and control have become a preference in public health programs and other disease control agencies. The study also suggests that public health should be everybody's business. Furthermore, public health education concepts can improve by a broader understanding of the subjective factors that underlie risk-taking and precautionary when exposed to extreme weather events.     

Hospital learning from extreme weather events: using causal loop diagrams

Extreme weather events (EWEs) represent an important opportunity for hospital facilities managers to learn lessons to improve future hospital resilience. However, little is known about the process by which this occurs and how effectively this happens. These questions are addressed by an exploration of how individual hospital stakeholders learn about the performance of their facilities and share these lessons in the adaptation of future hospital disaster management plans. More specifically, the evidence of behavioural and social/collective learning is investigated amongst hospital stakeholders during EWEs. The data gathered from a case study of a major hospital network of four hospitals were qualitatively analysed within a constructionist ontology and interpretivist epistemology using causal loop diagrams (CLDs). This revealed how lessons were learned in the hospital network from collective stakeholder EWEs’ experiences. The findings highlight the need to develop appropriate processes and structures to capture, share and use facilities-related knowledge and embed new lessons learnt into future hospital disaster planning processes. Using Nonaka and Takeuchi's model of organizational knowledge creation, this paper presents new theoretical and practical insights for hospital facilities managers to build hospital resilience by better capturing the facilities-related lessons learnt in responding to an EWE.     

2004年12月26日地震和海啸对建筑结构和基础设施的影响

对2004年12月26日东南亚地区的地震和泰国、印尼海啸对建筑结构和基础设施的影响进行现场试验。海啸对建筑结构和基础设施的影响导致了几个惨痛的教训。由于基础设施,例如桥、海港、码头、医院和通讯系统的破坏延迟了搜索、营救实施以及救济,增加了生还者的痛苦。因地震致使建筑结构破坏的原因包括：软弱地基、强梁-弱柱设计、短柱、有缺陷的梁-柱节点、无延性的细节设计、无筋砌体结构及不良的施工质量。     

Measuring the health impact of temperatures in dwellings: Investigating excess winter morbidity and cold homes in the London Borough of Newham

Fossil fuel energy use in heating and cooling buildings is considered to be a major contributor to observed climate change effects, so there is an environmental imperative to reduce energy use in buildings. We should also improve buildings’ energy efficiency on health grounds. Climate change is predicted to produce more frequent extreme weather events, while epidemiological evidence indicates relationships between ambient temperature and ill health. This points to the need for addressing both climate change itself and the way buildings mediate outdoor conditions, for the sake of vulnerable occupants. The UK government requires evidence in support of policy-making concerning energy use in buildings and consequences for health. This paper reviews epidemiological research to illustrate problems associated with measuring the direct health impact of indoor temperatures, for which evidence remains limited. Conventionally, temperature-related health effects are discussed in terms of seasonal excess deaths. The paper goes on to describe a population-based study in London that considers morbidity rather than mortality. A new methodology is developed that links the risk of cold homes with excess winter hospital episodes, demonstrating its potential for identifying small areas for priority action on improving domestic energy efficiency in terms of health as well as the environment.     

交通基础设施PPP项目中的关键性风险识别与度量

为确定PPP模式下交通基础设施关键性风险排序结果,介绍了PPP模式在我国发展的优势以及遇到的障碍,通过文献梳理与总结,识别出35个PPP模式下交通基础设施项目风险,组织了针对PPP模式研究领域专家学者的问卷调查,对PPP项目风险进行了风险发生概率、风险损失大小、风险发生后处理效率、类似风险管理经验的数值量化,并基于改进灰色关联分析模型对PPP项目进行关键性风险识别与风险度量,指出参与方在实际管理中应重点关注的风险并提出相应对策。     

Influence of weather conditions and eccentric aerodynamic loading on the large amplitude aeroelastic vibration of highway tubular poles

This paper is motivated by a recent involvement of the author in a forensic investigation on the response of cantilever tubular highway poles during a particular winter storm and, in general, unforeseen and extreme wind events. These can be classified as situations in which the reference wind velocity is clearly below the design value but the characterization of the aerodynamic forces challenged by either the presence of an adverse weather condition (deposit of freezing precipitation) or the eccentric loading transferred to the main system through non-structural elements (e.g., luminaire installed at the top of the unit). In particular, a set of wind-induced failures of aluminum-alloy highway light poles in a central region of the United States during a particular event was the original motivation for this study.

The dynamic performance of these systems was analyzed and extended beyond the original scope of the previous investigations to account for the unexpected nature of the loading. Statistical simulations were employed for the interpretation of the results in terms of failure risk.     

PPP模式下城市基础设施融资风险评价

十八届三中全会提出允许社会资本通过特许经营等方式参与城市基础设施投资和运营,但这种PPP模式下城市基础设施项目一般具有投资大、周期长、参与者众多、融资结构复杂等特点,资金管理、分配及后续经营等环节问题层出不穷,导致融资难度大、融资风险增大。从融资方的角度识别出融资风险因素,分析融资风险因素之间的相互关系,构建了融资风险系统动力学的因果关系图和流程图模型。结合具体案例,利用模型通过仿真分析对PPP模式下城市基础设施融资风险进行评价,有利于相关部门提高融资风险管理水平。     

The potential of sustainable urban drainage systems (SuDS) as an adaptive strategy to climate change in the Spanish Mediterranean

Changes in weather pattern caused by climate change generate more frequent extreme rain events as well as droughts. Sustainable urban drainage systems (SuDS) are useful adaptations to this new reality. The paper surveys the use of these systems in other countries in relation to their use in Spain, particularly the Spanish Mediterranean region. There is a future for more detention of floodwaters as well as more use against drought of water which can be treated and reused.     

Putting context to numbers: a geotechnical risk trajectory to cost overrun extremism

The study investigates the cause of the unusually high cost overruns experienced in highway project delivery in the tropical wetland setting of the Niger Delta region of Nigeria. An empirical profiling of cost overrun research reveals the predominance of mono-method studies, all of which are underlain by positivism. The study argues that such positivist philosophies, although methodologically valid, cannot adequately provide in-depth understanding of the contextual cost overrun drivers in highway organisations. Using a mix of methods, the paper examines the contribution of geotechnical risks to the extreme cost overruns experienced on Niger Delta’s highway projects, and demonstrates the relevance of context in cost overrun research. Adopting a geotechnical narrative, data sourced from 61 highway projects along with 16 interviews conducted with highway agencies in the region is analysed. The results of the analysis identified that poor project governance and procurement practices, have inhibited the competent management of geotechnical risk, creating a propensity for extreme cost overruns on highway projects. The study submits the phenomenon of cost overruns in public infrastructure projects is underlain by a complexity of contextual social constructs, which would have been overlooked in positivists studies. Cost overrun research, therefore, needs to be contextually and numerically anchored.     

A method for the toxicity assessment of wet weather events

The variable nature of wet weather flow events has made it difficult to assess the toxicity of these events with conventional toxicity testing methods. This paper proposes a test protocol that includes an event-focused toxicity test method, a corresponding test metric that more accurately represents the toxicity of brief exposures, and an event-based index that describes the acute toxicity of wet weather events. This testing protocol is designed to quantify toxic response produced by brief contaminant exposures (<24 h), as well as time-varying contaminant exposures, which are typical of wet weather events. The protocol describes the use of an event-focused toxicity test to determine a PE-LET50 (post-exposure lethal exposure time for 50% of the population) metric for individual event samples. The PE-LET50 is a new metric that represents the exposure duration to a sample necessary to produce a 50% response during a post-exposure observation period. The protocol then describes the development of an index that integrates the toxicity of event samples (PE-LET50s) into a measure of total event toxicity. This index is the event toxicity unit (ETU). The development and use of the test protocol is described and results are provided from single and multiple sequential exposures to reference toxicants and from two wet weather discharge events.     

Quantitative risk evaluation based on event tree analysis technique: Application to the design of shield TBM

This paper analyses the risk probability of an underwater tunnel excavation using an earth pressure balance (EPB) type tunnel boring machine (TBM). An event tree analysis (ETA) has been applied to quantify the risk at the preliminary design stage of the tunnel. Probable results, which may be sequenced from specific initiating events, are analyzed, and adequate general countermeasures (safety functions) are selected to ensure safety against risks. To identify the initiating events, various data on underwater tunneling such as empirical analyses; design reports; case studies of practical problems; numerical analyses and model test results; and hydrological analysis results were used. Event trees corresponding to three significant initiating events were constructed. Each event tree consists of five countermeasures that construct 32 paths, and the probability of each path is calculated. A quantitative risk assessment was performed and the occurrence probabilities and criticalities of the paths depending on the initiating events were considered. Based on these ETA results, it was found that the selected underwater tunnel site still has a considerable probability of accidents in spite of common countermeasures. Based on the evaluated risks, improved target probabilities are proposed to reduce the probability of disaster during construction. Additional countermeasures, in other words mitigation actions, corresponding to the new target are considered. As a result, technical risks and economical losses of property can be minimized in a systematic way. It was found that the ETA is an effective method for the evaluation and quantitative analysis of probable risks and for the proposition of countermeasures for hazardous environmental conditions such as the underwater tunnel.