A matter of life and death

Dr Nebil Achour

Hospitals are inundated after any natural disaster, so they need to continue to function when those incidents occur. Dr Nebil Achour’s research helps healthcare managers around the world to think strategically when preparing hospitals for the unexpected.

In the critical hours after a major natural disaster, hundreds of lives may depend on the local health service. Hospitals must remain operational, patients must be able to reach them, and medical equipment must continue to work. Even after an earthquake, the local hospital must, if possible, stay standing.

“The question behind my research, always, is: ‘What can be done to make sure that healthcare is available at all times?’” Dr Nebil Achour says. Nebil, Senior Lecturer in Healthcare Management at our university, specialises in ‘healthcare resilience’, the term used to describe how prepared health services are for unexpected crises. “When a disaster like an earthquake happens, access to a hospital or doctor is often the first thing people need.” he adds.

It was an interest in earthquakes that originally stimulated Nebil’s research. Having trained as a civil engineer in his native Tunisia, he became fascinated by the problem of how to protect hospitals in countries with regular seismic activity. He completed his PhD in Japan, where measurable earth tremors occur every day.

“Originally, I believed that a resilient hospital should function as an island, but it can’t.”

At the time, the mainstream view was that, in order to be resilient, a hospital should be self-sufficient. In other words, even if everything outside is falling apart, inside, a hospital should function normally.

But refreshingly, Nebil admits that he, and others, were wrong to look at the problem this way. “Originally, I believed that a hospital should function as an island, but it can’t,” he says. “Things like the road network, or how people and supplies flow in and out, are critical pieces in the jigsaw.”

Since moving to the UK, he has dedicated his research to mapping that bigger picture. A truly ‘resilient’ hospital, Nebil argues, must address a network of challenges. This includes protecting utility connections, telecommunications, access routes and staff – not just the building itself.

 “The question of what needs to be done to ensure that healthcare is available at all times is one we can never stop asking,”

In 2012, having published widely on this subject, he was approached by the World Health Organization (WHO) to help redesign its ‘Hospital Safety Index’. This is a free assessment tool that hospital managers use to measure resilience by working through a checklist of items to assess. It works almost like a property survey, but provides a measure of how likely it is that a hospital would remain operational in a disaster.

Nebil was part of a global team who launched a new version of the Index, inspired in part by his own big-picture thinking. Once this was done, he also worked with the WHO to take active steps to ensure that it was implemented.

Last year, the WHO asked Nebil to join a trial roll-out of the Index in Libya, where the resilience of local health services was being reassessed following the 2011 revolution. “They wanted someone who had helped design the Index to show healthcare managers how to use it for strategic planning,” he explains.

Managers from 15 different hospitals were invited to an intense, five-day workshop, where Nebil and colleagues introduced the Index and helped them assess their own hospitals. “They were surprised by the number of issues that needed to be addressed, and, unsurprisingly, many of their questions were linked to planning for wars,” Nebil says. “Because there is so much involved in keeping a hospital running, I warned them that they might find the workshop challenging – which they did!”

The exercise was a great success. In March this year, Nebil received a letter from the WHO’s Head of Mission, thanking him for his “pivotal role” in initiating changes that will ensure Libya’s hospitals are better prepared for the future.

He is now researching another overlooked aspect of hospital resilience: how the well-being and motivation of staff can often be critical to it functioning successfully during a crisis. Plans are also being drawn up for more international WHO workshops.

Nebil’s work, then, is far from over. “The question of what needs to be done to ensure that healthcare is available at all times is one we can never stop asking,” he reflects. “I’ve been trying to answer it for 18 years. I can guarantee that we will still need more answers long into the future!”




Health research at ARU

Our Faculty of Health, Education, Medicine and Social Care is home to three research institutes, and a wide range of research centres and groups. From medical device and technology to early childhood and pharmaceutical research, we’re working with a number of organisations to develop answers to some of society’s most pressing questions.

If you’d like to find out more about how you can access our research expertise, please get in touch with Rana Zayadin, Partnerships Development Manager for the Faculty of Health, Education, Medicine and Social Care, on 01245 683505.