The Hospital Safety Index

The Hospital Safety Index, a tool developed by PAHO and a group of Caribbean and Latin American experts, is being widely used by health authorities to gauge the probability that a hospital or health facility will continue to function in emergency situations. 

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 hospitalís 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 countryís 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 Organizationís 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 facilityís 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:

  • Category A is for facilities deemed able to protect the life of their occupants and likely to continue functioning in disaster situations.
  • Category B is assigned to facilities that can resist a disaster but in which equipment and critical services are at risk.
  • Category C designates a health facility where the lives and safety of occupants are deemed at risk during disasters.

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 hospitalís disaster committee. It includes information on a health facilityís 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 facilityís 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.