Hastane Afet Dayanıklılığı Stratejilerinin Uygulanmasında Yönetişim Zorlukları: Bir Delphi- DEMATEL Çalışması

Abstract

Hastanelerin afetlere karşı direnç düzeyi, iklim değişikliği ve insan kaynaklı risklerin artışıyla birlikte kent ölçeğinde giderek daha önemli bir konu haline gelmiştir. Bu çalışma, hastane afet dayanıklılığı stratejilerinin uygulanmasını güçleştiren temel yönetişim sorunlarını tanımlamak ve bu sorunların yapısal ilişkilerini ortaya koymak amacıyla gerçekleştirilmiştir. Çalışmanın ilk aşamasında, 12 uzmandan oluşan bir grup ile Delphi yöntemi uygulanmış; içerik analizi sonucunda 23 yönetişim sorunu belirlenmiş ve bu sorunlar 7 tematik alanda sınıflandırılmıştır. İkinci aşamada, söz konusu temalar arasındaki neden–sonuç bağlantılarını incelemek amacıyla 11 uzmanın katılımıyla DEMATEL yöntemi kullanılmıştır. Bulgular, “Operasyonel Hazırlık ve Uygulama Yetersizlikleri (OHUY)” (1,50), “İletişim, Bilgi Yönetimi ve Dezenformasyon (İBYD)” (1,47) ve “Kurumsal Koordinasyon ve Rol Belirsizliği (KKRB)” (1,42) temalarının en yüksek merkezilik değerine sahip olduğunu göstermektedir. Bu durum, söz konusu faktörlerin sistem içinde en fazla etkilenen ve yüksek önem düzeyine sahip unsurlar olduğunu ortaya koymaktadır. Nedensellik açısından en güçlü temalar ise “Stratejik Yönetişim ve Liderlik (SYL)” (+0,29), “Kurumsal Koordinasyon ve Rol Belirsizliği (KKRB)” (+0,10) ve “Kaynak ve Altyapı Yetersizlikleri (KAY)” (+0,10) olarak belirlenmiştir. Bu temalar, sistemin neden boyutunu temsil etmekte ve stratejik müdahaleler açısından öncelikli alanları oluşturmaktadır. Buna karşılık, “Psikososyal Destek ve Çalışan Dayanıklılığı (PDÇD)” (-0,25), “Operasyonel Hazırlık ve Uygulama Yetersizlikleri (OHUY)” (-0,15) ve “Veri ve Dijital Sistem Dayanıklılığı (VDSD)” (-0,12) ise sonuçsal faktörler olarak tanımlanmıştır. Bu faktörler, ağırlıklı olarak diğer değişkenlerden etkilenmektedir. Hastanelerde afet risk yönetiminin stratejik planlara entegre edilmesi, kriz liderliğinin ve sürdürülebilir koordinasyonun güçlendirilmesi gerekmektedir. Bu doğrultuda dijital altyapının ve iletişimin geliştirilmesi, düzenli tatbikatların yapılması ve olası afetlere karşı dirençlilik planlarının oluşturulması önem arz etmektedir. Sağlık personeline yönelik psikososyal destek programlarının geliştirilmesi ve kritik bilgi akışını güvence altına alacak yedek dijital sistemlerin uygulamaya geçirilmesi önerilmektedir.

Keywords

• Hastane
• Afet
• Dayanıklılık
• Delphi
• DEMATEL

Governance Challenges in Implementing Hospital Disaster Resilience Strategies: A Delphi-DEMATEL Study

Abstract

The level of resilience of hospitals to disasters has become an increasingly important issue at the urban scale with the increase in climate change and human-induced risks. This study was conducted to identify the fundamental governance problems that hinder the implementation of hospital disaster resilience strategies and to reveal the structural relationships of these problems. In the first phase of the study, the Delphi method was applied with a group of 12 experts; as a result of the content analysis, 23 governance problems were identified and these problems were classified into 7 thematic areas. In the second stage, the DEMATEL method was used with the participation of 11 experts to examine the cause-effect connections between the themes in question. The findings show that the themes “Operational Preparedness and Implementation Deficiencies (OPID)” (1.50), “Communication, Information Management and Disinformation (CIMD)” (1.47) and “Institutional Coordination and Role Ambiguity (ICRA)” (1.42) have the highest centrality value. This situation reveals that these factors are the most affected and most important elements in the system. The strongest themes in terms of causality were determined as “Strategic Governance and Leadership (SGL)” (+0.29), “ICRA” (+0.10) and “Resource and Infrastructure Deficiencies (RID)” (+0.10). These themes represent the causal dimension of the system and constitute priority areas for strategic interventions. On the other hand, “Psychosocial Support and Employee Resilience (PSER)” (-0.25), “OPID” (-0.15) and “Data and Digital System Resilience (DDSR)” (-0.12) were identified as consequential factors. These factors are heavily influenced by other variables. Disaster risk management in hospitals needs to be integrated into strategic planning, while crisis leadership and sustainable coordination must be strengthened. To this end, improving digital infrastructure and communication systems, conducting regular drills, and developing resilience plans for potential disasters are crucial. Furthermore, establishing psychosocial support programs for healthcare personnel and implementing backup digital systems to secure the continuity of critical information flow are strongly recommended.

Keywords

• Hospital
• Disaster
• Resilience
• Delphi
• DEMATEL

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