| Objective:The frequent occurrence of large-scale emerging infectious diseases have caused great harm to human health and social stability,and hospitals,as basic institutions providing medical services,are responsible for the rescue of infection disease epidemic emergencies and need to respond effectively to them.However,hospitals in China still have many shortcomings in responding to large-scale emerging infectious diseases.To address this issue,this study intends to construct a hospital resilience model for large-scale emerging infectious diseases from a social-ecological system perspective to describe a model for hospitals to actively and effectively respond to large-scale emerging infectious diseases and provide guidance for hospitals to conduct relevant evaluations or construction.Methods:1.Analysis of model protective factors and risk factorsIncluding "command","surveillance","communication","health care response" and "public health interventions",the five major elements of the "Framework for Action" proposed by the World Health Organization for responding to infectious disease emergencies were used as the basic dimension of the model,and the protective or risk factors under the basic dimension of the model were produced by systematic literature review,web data mining and typical case analysis.(1)Systematic literature analysis.Pub Med,Web of Science,CINAHL,Pro Quest Health & Medical Complete(PHMC),CNKI,Sino Med and VIP database were identified for systematic search,The keywords like "epidemic","resilience" and "organization" were used to construct search formulas to collect the organizational resilience studies in large-scale emerging infectious diseases,and empirical studies on resilience in health-related organizations were used as the main inclusion criteria,and the literature was screened according to the PRISMA flow chart,and the literature was evaluated by Mixed Methods Appraisal Tool(MMAT).the model protection factors and risk factors are(2)Web data mining.A focused web crawler was designed to obtain textual data related to six thousand cases of domestic epidemics within the websites of the National Health Commission,China News,Jin Ri Tou Tiao,and Sogou We Chat,The data were screened by describing or discussing the contents of the hospital social-ecological systems in the five dimensions of the model.python programs were written to conduct pre-processing such as data cleaning,word segmentation and vectorization for the filtered data.Finally,the preprocessed data were imported into the Latent Dirichlet Allocation(LDA)subject model for topic visualization analysis,and the model protection factors and risk factors are summarized based on the theme names.(3)Typical case analysis.One-to-one qualitative interviews were conducted with medical personnel involved in the fight against the COVID-19 epidemic through purposive sampling combined with snowball sampling,and the data were analyzed by Colaizzi’s seven-step data analysis method and template analysis method.2.Model integration,revision and mappingThe model protective or risk factors were integrated by combining the same or similar elements and keeping different elements,and the model structure elements were condensed by categorizing the protection or risk factors in the same dimension.Based on the "life cycle of crisis" theory and social-ecological system theory,the structural elements,protection or risk factors,and the protection or risk factors of different stages of the model in different systems were revised and determined through expert meetings.Finally,the model diagrams were drawn for each phases.Results:1.Results of model protective factors and risk factors analysis(1)Systematic literature analysis A total of 28 papers were included to summarize the research results of existing studies on organizational resilience evaluation,influencing factors and enhancement strategies in large-scale emerging infectious diseases,and a total of 31 model protective or risk factors were analyzed.The literature analysis revealed that "health manpower deployment","trust culture building","collaborative interoperability" of hospitals and its social-ecological systems in response to large-scale emerging infectious diseases The importance of organizational coordination,trust and cooperation between systems and personnel in command,"infectious disease pathogen surveillance," and other factors suggest that attention to the chain of infection in surveillance has an impact on resilience;"work rules and regulations","information sharing and transparency" indicate the need to focus on the development of systems and processes and information sharing in communication;"diagnostic,treatment and isolation" and "medical service provision" in the health care response show the impact of infectious disease treatment and isolation capacity;in public health interventions,the factors focus on infectious disease infection control.(2)Web data mining LDA thematic analysis of web data from six thousand cases of domestic epidemics analyzed 40 protective or risk factors,which are different to the literature analysis section.In terms of command,the new "emergency plans and drills" and "legal epidemic prevention and cure" show the importance of structured and standardized control work;in terms of surveillance,new factors such as "medical resource monitoring" and "workload survey" suggest that the collection of information and intelligence provides a scientific basis;In terms of risk communication,new factors such as "medical treatment information publication" and "health education and popularization" point to the importance of public-oriented information communication;in terms of health care response,new factors such as "basic medical security" and "intelligent medical information" take into account the impact of basic medical services on overall rescue and treatment;In terms of public health intervention,the new factors of "Anti-epidemic cleaning and disinfection" and "virus testing safety" focus on the risk of infectious disease transmission in the environment.(3)Typical case analysis A total of 26 health care workers were interviewed,and the results of the qualitative data analysis identified 38 model protective or risk factors.In terms of command,"epidemic analysis and planning" and "fluke" showed the influence of task analysis and psychological of health care workers on the resilience;in terms of surveillance,"epidemic public opinion monitoring" and "over-monitoring" suggest the influence of the content and extent of monitoring;In terms of communication,it is necessary to introduce "information technology communication equipment" to overcome the "isolation environment";"multi-protocol infectious disease treatment" and "infectious disease treatment experience" optimize the medical treatment conditions in terms of health care response;in terms of public health intervention,it is necessary to pay attention to "infection discipline construction".2.Revision of model integration and drawing resultsThe integrated model initially identified 58 protective or risk factors in five latitudes,and refined 16 structural elements.The model was finally determined through expert meeting consultation,which contains 12 structural elements and 42 protective or risk factors under five dimensions,as well as the protective or risk factors in different stages and different systems of the model.Finally,a four-stage model diagram was drawn,with each diagram representing a stage and each stage divided into four parts,i.e.,hospital social-ecological system,and each part included different colored labels indicating the dimensions of the resilience model,under which the protective or risk factors were included.The protective or risk factors of the large-scale emerging infectious diseases hospital social-ecological system resilience model in the latency phase focuses on the prevention,where hospital systems’ early warning and preparedness characteristics have a significant impact;in the outbreak phase focuses on the response of the hospital social-ecological system to large-scale emerging infectious diseases,where hospital systems need to activate their emergency plans and quickly form a contact network to facilitate the flow of information,resources and pressure between them,promoting the establishment of an efficient and stable prevention and treatment model;in the diffusion phase focuses on the self-regulation of the hospital social-ecological system,and it is necessary for each hospital system to refine and improve the response model in the early stage to enhance the resilience in response to large-scale emerging infectious diseases through experience sharing and summarization;in the recovery phase emphasis the learning ability of the hospital social-ecological system,to learn from the experience of large-scale emerging infectious diseases and quickly build on them.Conclusions:In this study,a model of hospital resilience in large-scale emerging infectious diseases from a socio-ecological perspective was constructed,in which structural elements present the main structures,resources,capabilities,or traits of the hospital social-ecological system in response to large-scale emerging infectious diseases,which can better explain the meaning of hospital resilience to it;protection or risk factors identify the action guidelines of the hospital social-ecological system in response to large-scale emerging infectious diseases.The model also takes into account the development of large-scale emerging infectious diseases and the impact of the hospital’s social-ecological system on hospital resilience,reflecting the systematic and dynamic characteristics of the model.In addition,this study combines multiple methods to identify protective or risk factors,making the model more objective and scientific.the model has a scientific structure that can promote the understanding of hospitals in dealing with large-scale emerging infectious diseases and provide guidance for building hospitals with more resilience to large-scale emerging infectious diseases. |
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