Sustainable Healthcare Resilience: Disaster Preparedness in Saudi Arabia’s Eastern Province Hospitals

Abstract

In a world increasingly vulnerable to environmental and health crises, sustainable healthcare systems are crucial. This study focuses on the resilience and sustainability of healthcare services in Saudi Arabia’s Eastern Province, assessing their readiness to endure and adapt amidst disaster scenarios. Conducted through a cross-sectional survey involving 522 hospital employees, the research provides an in-depth analysis of various sustainability-related aspects of healthcare preparedness. This includes examining both structural and non-structural safety elements, standard operating procedures, staff training in disaster response, data security, and sustainable management of resources during emergencies. The results reveal a noteworthy commitment to sustainable disaster preparedness: 53.7% of hospitals, predominantly governed by the Ministry of Health, have implemented comprehensive disaster recovery plans. Furthermore, the study found a strong representation of female participants (54.2%) in these hospitals. A significant 64.1% of respondents confirmed the existence of disaster recovery plans in their workplaces, and an even higher percentage, 70.6%, reported receiving specific training in disaster response. These findings underscore the proactive efforts of Eastern Province hospitals in fostering a sustainable and resilient healthcare framework, demonstrating an approach that prioritizes preparedness beyond immediate crisis response. This proactive stance is pivotal in ensuring the continuity of healthcare services amidst the ever-evolving nature of global disasters.

1. Introduction

In the context of today’s rapidly evolving global landscape, the imperative for robust business continuity planning has become more pronounced than ever. At its core, business continuity focuses on preempting disruptions and resolving them efficiently, ensuring that organizations can reduce potential losses and sustain their operations [1]. As Venclova et al. opined, the crux of business continuity lies in guaranteeing that critical business functions remain available to all stakeholders, from customers to suppliers, especially during crises [2].

Every society, regardless of its economic standing or geographical positioning, is bound by a shared understanding: The essentiality of healthcare. In the wake of global challenges, ranging from pandemics to geopolitical tensions, the interconnectedness of our world has become increasingly evident. This realization underscores a critical point: Disruptions in one part of the globe can have unforeseen and far-reaching impacts elsewhere. This ripple effect amplifies the need for hospitals and healthcare systems everywhere to be not only fortified against immediate local challenges but also adaptable to global shocks.

Understanding the specific challenges and needs of different regions is vital in shaping effective business continuity plans. This study is particularly motivated by the unique position of Saudi Arabia’s Eastern Province. Situated in a geopolitically significant and climatically diverse region, the hospitals here are not only responsible for addressing routine healthcare needs but also for being on the frontline in times of regional and global crises.

This dual responsibility has led to an urgent need to assess how equipped these hospitals are in terms of resources, training, and overall preparedness for unexpected disruptions. The concept of business continuity, therefore, transcends borders, cultures, and economies. It speaks to a universal aspiration: the preservation of life and well-being, even in the face of adversity.

In recent years, the concept of sustainability has gained significant prominence in healthcare, encompassing not only environmental stewardship but also the resilience and long-term viability of healthcare systems. Sustainable healthcare is characterized by its ability to withstand and adapt to changing circumstances, especially in the face of crises and disasters. This resilience is crucial not only for immediate patient care but also for the sustained well-being of communities and the stability of healthcare systems over time.

In this light, business continuity planning in hospitals becomes a critical component of sustainable healthcare. It ensures that healthcare services are not only maintained during crises but also adapted and evolved in response to changing environmental and societal needs. This study, set in the context of Saudi Arabia’s Eastern Province, explores business continuity planning as a key factor in the sustainability of healthcare services. By assessing hospitals’ readiness to face and adapt to disasters, we contribute to the broader dialogue on sustainable healthcare, emphasizing the importance of preparedness, resilience, and adaptability in the face of environmental and health challenges.

This focus on sustainable healthcare is particularly pertinent given the increasing frequency and intensity of global crises, such as pandemics and natural disasters, which pose significant risks to the continuity and effectiveness of healthcare services. The need for a sustainable approach to healthcare delivery—one that encompasses robust disaster preparedness and recovery plans—has never been more critical. Therefore, this study not only addresses the gap in current knowledge regarding hospital preparedness in Saudi Arabia’s Eastern Province but also contributes to the understanding of sustainable healthcare practices in a rapidly changing world.

Amidst this broad spectrum of organizations, hospitals stand out as pivotal entities. Their unparalleled role in delivering emergency care to disaster victims underscores the dire need for their uninterrupted functioning [3]. When calamities such as earthquakes, floods, or other unforeseen disasters strike, the world looks to its healthcare facilities to remain not just operational but efficient. And with disasters amplifying in frequency and intensity globally [4], the pressure on healthcare systems has been mounting. While these disasters inherently challenge the healthcare paradigm, the expectation is clear: Healthcare facilities must be resilient [5]. This resilience is tested across myriad dimensions, from managing site impacts and technology failures to handling drug shortages and manpower deficits [6].

In the grand tapestry of global healthcare, there is a constant interplay between preparedness and adaptability. It is imperative to understand that the foundation of an effective business continuity plan is not just the documentation or the tangible assets. It is about fostering a culture of readiness. A culture where every individual, from top-tier management to the frontline staff, embraces their role in ensuring that the hospital does not just survive but thrives amidst adversities. It is this collective mindset, paired with robust strategies and infrastructures, that truly determines a hospital’s resilience.

The global stage reveals a tapestry of varied preparedness levels in hospitals. Switzerland, for instance, reports an encouraging 82% of its hospitals are equipped with comprehensive disaster response plans [7]. Yet, when we pivot to Singapore, only 75.3% of healthcare professionals expressed confidence in their organization’s disaster response acumen [8]. This disparity becomes even more glaring in places such as Los Angeles County, where the readiness of hospitals to handle surges during disasters is reportedly limited [9]. This uneven terrain of preparedness even extends to the very front lines. In Texas, a concerning 90% of nurses voiced their lack of confidence in addressing disaster scenarios effectively [10].

Now, casting our lens on the Eastern Region of Saudi Arabia, we find a robust infrastructure with 21 hospitals and 131 primary health care centers [11,12]. These facilities, equipped with a substantial 8200 beds, serve as the region’s healthcare backbone [13]. However, it is not just about numbers. The inherent vulnerabilities tied to Saudi Arabia’s geographical and climatic intricacies expose it to a plethora of risks [14,15]. Recognizing this, there have been concerted efforts to bolster the nation’s disaster risk reduction (DRR) strategies over the years [16]. International bodies such as the WHO have even tailored tools such as the hospital emergency response checklist to aid in this endeavor [17,18].

Despite these strides, a knowledge gap persists. While prior studies have delved into the Eastern Region’s hospital preparedness—revealing, for instance, that an impressive majority have disaster management plans and regularly educate their staff about them [19,20]—a more nuanced understanding remains elusive. There is an evident dearth of insights into how the emergency department’s frontline—the nurses and doctors—perceive their readiness and the role of business continuity planning (BCP) during these challenging times [21].

This narrative, therefore, seeks to bridge this gap. It prompts us to ponder on a fundamental yet unexplored question: Are the hospitals in Saudi Arabia’s Eastern Region truly fortified for the future? Are their alternative plans, resources, and proactive measures robust enough?

The aim of this study is to critically examine and evaluate the robustness of business continuity planning within hospitals in Saudi Arabia’s Eastern Province. This assessment is particularly focused on understanding the alternative resources and contingency plans in place, evaluating the proactive steps taken for crisis management, and, importantly, measuring the perceived preparedness levels among healthcare professionals. Through this analysis, our study endeavors to paint a comprehensive picture of hospital readiness, which crucially involves both robust infrastructure and the invaluable human element in ensuring the continuity of essential healthcare services during emergencies.

2. Materials and Methods

2.1. Participants

The target population for this study included all employees actively engaged in various capacities within hospitals in the Eastern Province of Saudi Arabia. This encompassed a wide spectrum of hospital staff, ranging from frontline clinical personnel to administrative and support staff. To be eligible for inclusion in the study, participants had to be currently employed in any operational role within these hospitals. This inclusive approach was designed to capture a diverse array of perspectives and experiences, ensuring a comprehensive understanding of hospital preparedness and response capabilities across different levels of hospital operations.

2.2. Sample Size

The sample size for this study was meticulously calculated using a simple random sampling technique. The calculation was based on a confidence level of 95% and an assumed outcome probability of 0.5, commonly used in preliminary studies where the outcome proportions are unknown. This approach determined that a sample size of 522 participants would be necessary to ensure statistically significant results. Such a sample size is deemed robust enough to provide representative insights into the preparedness of hospitals across the Eastern Province, while also maintaining a high standard of statistical rigor. Additionally, this sample size accounts for potential non-responses or incomplete submissions, thereby ensuring the reliability and validity of the study findings.

2.3. Data Collection Tool

The primary instrument for data collection in this study was a carefully structured questionnaire, designed to capture a comprehensive range of information relevant to hospital preparedness. The initial section of the questionnaire gathered demographic data, including respondents’ age, gender, professional role, years of experience in the healthcare sector, and educational background.

Following the demographic section, the questionnaire delved into more specific aspects of hospital preparedness. This included evaluating the safety of both structural and non-structural elements within hospital facilities, assessing adherence to established standard operating procedures and emergency protocols, and exploring the extent of staff awareness and preparedness for handling mass casualty incidents. Additionally, the questionnaire investigated the robustness of data security measures in place and the strategies employed to manage utilities during emergency outages. This comprehensive approach was intended to provide a holistic view of the preparedness levels, encompassing both physical infrastructure and human resource capabilities in the face of potential disasters.

2.4. Pilot Study and Reliability

Prior to the full-scale deployment of the survey, a pilot study was conducted to test the reliability of the questionnaire and to fine-tune its design based on initial feedback. This pilot phase involved a smaller subset of the target population, from which we collected 15 responses. These responses were instrumental in assessing the clarity, relevance, and overall effectiveness of the questionnaire items.

The reliability of the questionnaire was quantitatively evaluated using Cronbach’s alpha, a standard measure for assessing the internal consistency of survey instruments. The calculated Cronbach’s alpha for the entire questionnaire was an impressive 0.867, indicating a high level of reliability. Additionally, the reliability coefficients for individual items ranged from 0.701 to 0.824, further validating the consistency of the questionnaire’s components.

These results from the pilot study provided the confidence to proceed with the main survey, ensuring that the questionnaire was both reliable and appropriately tailored to effectively capture the necessary data for this research.

2.5. Data Collection Procedure

To maintain the integrity of our data, vigilant measures were taken; any incomplete responses were promptly identified and excluded from the final dataset.

To ensure a broad and diverse range of responses, we developed an electronic version of the questionnaire, designed for ease of access and completion by the hospital staff. The digital survey was distributed using a systematic approach to reach a wide cross-section of employees in hospitals across the Eastern Region of Saudi Arabia. This dissemination was carried out primarily through official hospital communication channels, including emails and electronic bulletins, to ensure it reached a large number of staff members in various roles and departments.

We employed a rigorous follow-up process to ensure a robust response rate, aiming to reach and, if possible, exceed our targeted sample size. As part of our commitment to data quality, we implemented strict protocols to review the responses. Any submissions found to be incomplete or inconsistent were carefully identified and excluded from the final dataset. This approach was taken to preserve the validity and reliability of our findings, ensuring that our analysis was based on comprehensive and accurate information provided by the respondents.

2.6. Data Analysis

The data analysis was conducted using SPSS software (version 29), a widely recognized tool for statistical evaluation. Initially, descriptive statistical methods were applied to provide a foundational understanding of the data. This involved calculating frequencies, percentages, and standard deviations to summarize the key characteristics of the dataset.

Given the nature of the data, both inferential and descriptive statistics were deemed necessary for a comprehensive analysis. To examine the relationships between categorical variables, such as the presence or absence of disaster preparedness measures, chi-square tests were employed. These tests are particularly effective for analyzing binary and nominal data, offering insights into the associations between different aspects of hospital preparedness.

For continuous variables, Spearman’s rho correlation was used to assess the strength and direction of relationships, particularly between the readiness for continuity of essential services and the information technology domain. This non-parametric measure was chosen due to its suitability for ordinal data and its robustness against non-normal distributions.

Additionally, multiple linear regression analysis was undertaken to explore the predictive relationships between various independent variables and a continuous dependent variable, allowing us to understand the factors influencing hospital readiness. Throughout the analysis, a p-value of less than 0.05 was maintained as the criterion for statistical significance, ensuring the reliability of our findings.

2.7. Ethical Considerations

Institutional review board (IRB) approval was obtained from the King Saud University Research and Ethics Committee (Ref No: KSU-HE-23-696).

3. Results

3.1. Demographic Characteristics

Table 1. Profile of sampled participants.

Demographics	Groups	n	%
Type of hospital	Ministry of Health Hospital	223	53.7
	Military Hospital	70	16.9
	University Hospital	60	14.5
	Private Hospitals	62	14.9
Gender	Male	190	45.8
	Female	225	54.2
Nationality	Saudi	316	76.1
	Non-Saudi	99	23.9
Age Group	Below 20	13	3.1
	21–30	141	34.0
	31–40	172	41.4
	41–50	68	16.4
	above 50	21	5.1
Profession	Physician	83	20.0
	Dentist	38	9.2
	Pharmacist	36	8.7
	Nurse	42	10.1
	Paramedic	39	9.4
	Therapist (respiratory, speech, occupational, psychology)	25	6.0
	Technician/technologist (e.g., lab, radiology, MR)	68	16.4
	Information technology	15	3.6
	Administrative staff	67	16.1
	Allied health professional	2	0.5
Years of experience	Less than a year	30	7.2
	1–5	133	32.0
	6–10	123	29.6
	More than 10	129	31.1
Highest educational level	High school	7	1.7
	Bachelor’s degree	209	50.4
	Diploma	36	8.7
	Master’s degree	89	21.4
	PhD	74	17.8
Experience in disasters/pandemics	Yes	304	73.3
	No	111	26.7
Presence of business continuity plan	Yes	272	65.5
	No	36	8.7
	Not aware	107	25.8
Reasons for absence of continuity Plan (for those who answered “No”, n = 36)	Lack of budget	9	25.0
	Lack of knowledge	7	19.4
	Lack of resources	7	19.4
	Lack of expertise	7	19.4
	Not aware	6	16.7

presents the demographic characteristics of 415 healthcare professionals in Saudi Arabia’s Eastern Province. A majority (54.2%) of the participants were female, and most were Saudi nationals (76.1%). The age group most represented was 21 to 30 years (34.0%). The primary professions included physicians (20.0%), nurses (10.1%), and paramedics (9.4%). Over half of the participants had 1 to 5 years of experience (32.0%) and held a bachelor’s degree (50.4%). Notably, a large proportion (73.3%) had experience working during disasters or pandemics. Regarding business continuity plans, 65.5% of hospitals had such plans, with budget constraints (25.0%) and limited knowledge (19.4%) being the main reasons for their absence.

3.2. Hospital Readiness for Continuity of Essential Health Care Services

It is evident that while a majority are aware of certain key plans such as the earthquake safety plan (58.6%) and the fire evacuation plan (85.8%), there is less awareness of the incident command system (ICS) at 49.9%. Similarly, knowledge about the mass casualty plan and plans for uninterrupted supplies and utilities during disasters stands at 56.1% and 56.6%, respectively. Additionally, 71.1% reported the existence of a disaster management unit or similar in their hospitals.

A critical observation from

Table 2. Hospital readiness for continuity of essential health care services.

Questions	Yes	No	Do Not Know
Are you aware of the Earthquake Safety Plan in your hospital?	243 (58.6)	118 (28.4)	54 (13.0)
Are you aware of the Fire Evacuation Plan in your hospital?	356 (85.8)	42 (10.1)	17 (4.1)
Are you aware of any disaster recovery plans in your hospital?	305 (73.5)	77 (18.6)	33 (7.9)
Did your hospital provide you with any training or awareness campaign on how to respond to a disaster?	293 (70.6)	98 (23.6)	24 (5.8)
Are you aware of your hospital’s disaster recovery or emergency referral plans for medical equipment continuity?	264 (63.6)	106 (25.5)	45 (10.8)
Did your hospital provide you with any training or awareness campaign on cybersecurity risks?	203 (48.9)	154 (37.1)	58 (14.0)
Does your hospital have an Incident Command System (ICS)?	207 (49.9)	61 (14.7)	147 (35.4)
Does your hospital have a disaster management unit or similar?	295 (71.1)	51 (12.3)	69 (16.6)
Does your hospital have a mass casualty plan?	233 (56.1)	61 (14.7)	121 (29.2)
Does your hospital have a plan for the continuity of supplies and utilities in case of any disaster?	235 (56.6)	53 (12.8)	127 (30.6)
Does your hospital offer post-disaster emotional recovery assistance, like counselling and support services?	222 (53.5)	52 (12.5)	141 (34.0)

is the prevalence of “Do not know” responses, highlighting gaps in internal communication and knowledge dissemination within hospitals. These responses reflect a level of uncertainty or lack of awareness among staff about various disaster preparedness measures. This is particularly evident in responses related to the incident command system (ICS), mass casualty plans, and plans for the continuity of supplies and utilities, where a significant number of participants indicated a lack of knowledge. These findings underscore the need for more comprehensive training and communication strategies within hospitals to ensure all staff are adequately informed and prepared for potential disasters.

Moreover, while 70.6% of participants were informed about disaster response training, only 48.9% were aware of training regarding cybersecurity risks, indicating an area needing bolstered efforts, especially considering the increasing reliance on digital systems in healthcare.

In summary, while Table 2 reveals significant progress in certain areas of disaster preparedness, it also highlights crucial areas where further improvement in communication and training is necessary (see Table 2).

In summary, the survey results indicate a promising level of awareness among hospital staff regarding key disaster preparedness plans. Specifically, 85.8% are aware of their hospital’s fire evacuation plan, and 73.5% know of the general disaster recovery plans. However, awareness of more specialized plans, such as the incident command system (49.9%) and mass casualty plans (56.1%), is comparatively lower. These findings point to the need for targeted efforts to enhance awareness and training in specific areas of disaster preparedness.

3.3. Information Technology Preparedness

Table 3. Information technology domain.

Questions	Yes	No	Do Not Know
Is there a disaster recovery plan available for both processes and systems?	266 (64.1)	46 (11.1)	103 (24.8)
Are standards and protocols for operational procedures after disasters available?	234 (56.4)	62 (14.9)	119 (28.7)
Is there an offline and online data backup system in place?	224 (54.0)	43 (10.4)	148 (35.6)
Has the hospital provided training and awareness on cybersecurity risks?	192 (46.3)	139 (33.5)	84 (20.2)

provides insights into the preparedness of hospitals in the Eastern Province of Saudi Arabia in terms of information technology (IT). It appears that there’s a decent level of cognizance regarding cybersecurity and data backup measures, though improvements are warranted.

While 64.1% of respondents are aware of a disaster recovery plan for the technical and informational assets of their hospitals, only 54.0% knew of the presence of both online and offline data backups. Moreover, only 56.4% were aware of the standards and protocols for operating procedures post-disaster. A concerning observation from the data is that only 46.3% of hospitals in the region provided their staff with training or awareness initiatives about cybersecurity risks. This reiterates the need for bolstered communication and training, especially in the realm of IT and cybersecurity (see Table 3).

3.4. Relation Results

The Spearman’s rank coefficient of correlation, denoted by the Greek letter “ρ” (rho), is a nonparametric measure that evaluates the strength and direction of the association between two ranked variables. The strength of the correlation is categorized as follows: 0.00–0.19 represents “very weak”, 0.20–0.39 as “weak”, 0.40–0.59 as “moderate”, 0.60–0.79 as “strong”, and 0.80–1.0 as “very strong”.

Table 4. Correlation matrix between hospital readiness for continuity of essential services and information technology domain.

Information Technology Domain		Hospital Readiness for Continuity of Essential Health Care Services
		Earthquake Safety Plan Awareness	Earthquake Safety Plan Awareness	Earthquake Safety Plan Awareness	Earthquake Safety Plan Awareness	Earthquake Safety Plan Awareness	Earthquake Safety Plan Awareness	Earthquake Safety Plan Awareness	Earthquake Safety Plan Awareness	Earthquake Safety Plan Awareness	Earthquake Safety Plan Awareness	Earthquake Safety Plan Awareness	Overall
Availability of disaster recovery plan incase of a disaster (process and system)	r	0.480 **	0.186 **	0.304 **	0.222 **	0.478 **	0.344 **	0.282 **	0.215 **	0.395 **	0.481 **	0.514 **	0.596 **
	p	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000
Availability of standards and protocols of operation procedures after disasters	r	0.410 **	0.200 **	0.369 **	0.315 **	0.467 **	0.388 **	0.283 **	0.242 **	0.394 **	0.446 **	0.511 **	0.601 **
	p	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000
Offline and online backup data (data)	r	0.140 **	0.204 **	0.160 **	0.216 **	0.178 **	0.279 **	0.210 **	0.213 **	0.201 **	0.189 **	0.216 **	0.317 **
	p	0.004	0.000	0.001	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000
Trainings and awareness on cybersecurity risks	r	0.248 **	0.186 **	0.162 **	0.191 **	0.329 **	0.518 **	0.367 **	0.132 **	0.268 **	0.319 **	0.269 **	0.494 **
	p	0.000	0.000	0.001	0.000	0.000	0.000	0.000	0.007	0.000	0.000	0.000	0.000
Overall	r	0.420 **	0.257 **	0.333 **	0.302 **	0.500 **	0.549 **	0.389 **	0.265 **	0.425 **	0.488 **	0.508 **	0.685 **
	p	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000	0.000

**. Correlation is significant at the 0.01 level (2-tailed).

demonstrates a positive correlation between hospital readiness for continuity of essential services and IT domain factors. The correlation between the availability of standards and protocols for operational procedures post-disasters and hospital readiness for continuity of essential services emerges as the strongest (r = 0.601, p < 0.01). In contrast, the correlation between the availability of process and system and hospital readiness is moderate (r = 0.596, p < 0.01), as is the correlation between trainings and awareness of cybersecurity risks (r = 0.494, p < 0.01). The association between offline and online backup data and hospital readiness is weaker (r = 0.317, p < 0.01), indicating that while backup data is pivotal for hospital preparedness, it does not hold as much significance as a comprehensive disaster recovery plan or lucid procedures. The insights from the table collectively suggest that hospitals with advanced IT capabilities—particularly in disaster recovery, standard procedures, backup data, and cybersecurity—are better poised for maintaining the continuity of essential services amidst disasters.

3.5. Regression Analysis on IT Factors and Hospital Readiness

The regression analysis conducted identified that the IT domain factors, such as the availability of a disaster recovery plan, standards and protocols for operations after disasters, and training and awareness programs on cybersecurity risks, are significant predictors of a hospital’s readiness for continuity of essential services. The adjusted R-squared value indicates that these IT domain factors account for 50.2% of the variation in hospital readiness, a substantial portion. Furthermore, the Durbin–Watson statistic stands at 1.911, suggesting that there is no autocorrelation in the residuals, confirming the quality of the data used.

Delving deeper into the impact of these factors, it is seen that standards and protocols established for operations after disasters have the strongest influence on readiness, with a coefficient of B = 0.172 and p < 0.01. The availability of a disaster recovery plan comes in close with a coefficient of B = 0.168 and p < 0.01. Meanwhile, the importance of training and creating awareness about cybersecurity risks is also underscored by its coefficient of B = 0.119 and p < 0.01. On the other hand, while having offline and online data backups is crucial, its effect is somewhat minimal, given its coefficient of B = 0.032 and a significance value greater than 0.05 (

Table 5. Regression analysis—hospital readiness and IT domain.

Model		Unstandardized Coefficients		Standardized Coefficients	t	Sig.	95.0% Confidence Interval for B		Collinearity Statistics
		B	Std. Error	Beta			Lower Bound	Upper Bound	Tolerance	VIF
1	(Constant)	0.800	0.036		21.924	<0.001	0.728	0.871
	Disaster recovery plan	0.168	0.023	0.317	7.256	<0.001	0.123	0.214	0.630	1.587
	Post-disaster standards/protocols	0.172	0.023	0.333	7.587	<0.001	0.128	0.217	0.624	1.602
	Data backup (offline/online)	0.032	0.019	0.066	1.737	0.083	−0.004	0.069	0.825	1.213
	Cybersecurity training/awareness	0.119	0.023	0.202	5.151	<0.001	0.074	0.165	0.779	1.283

Dependent variable: Hospital readiness for continuity of essential health care services. Model summary: F = 105.307, p = 0.000, R = 0.712, R² = 0.507, Durbin–Watson = 1.911.

).

In summation, the regression analysis underscores the pivotal role of having a robust disaster recovery mechanism, operational standards post-disasters, and significant training on cybersecurity in fortifying hospitals for continuous service during calamities.

4. Discussion

In the evolving landscape of healthcare services, the readiness of hospitals to effectively manage unforeseen disasters has become increasingly critical. Consistent with the objective set forth at the outset of this study, our analysis focused on evaluating the robustness of business continuity planning in the hospitals of Saudi Arabia’s Eastern Province. Specifically, we aimed to assess the perceived preparedness of these hospitals to maintain indispensable healthcare services during crises and disasters, reflecting on how well-equipped they are in terms of resources, training, and overall strategic readiness.

Central to our findings is the level of awareness regarding disaster preparedness plans among healthcare professionals in Saudi Arabia’s Eastern Province. Our study reveals that while there is considerable awareness of general disaster response strategies, such as fire evacuation plans, recognized by 85.8% of respondents, knowledge of specific protocols such as the incident command system is less widespread, noted by only 49.9% of participants. This variation in awareness levels underscores the necessity of enhanced communication and targeted training efforts, especially in areas requiring more specialized knowledge. Simplifying and disseminating information about all aspects of disaster preparedness will be crucial in ensuring comprehensive readiness across the healthcare sector.

Saudi Arabia’s strategic endeavors in disaster management have been noteworthy. There is a palpable drive towards achieving excellence in handling any potential disaster, an effort that marries local strategies with global best practices [18]. This is all the more pivotal considering Saudi Arabia’s geographical position along the tectonic boundary between the Arabian and Eurasian plates. The emphasis on earthquake safety within the nation’s business continuity plan (BCP) for hospitals is a testament to this proactive approach. Furthermore, even though Saudi Arabia is not globally identified as a seismic hotspot, the nation does not compromise on seismic safety during infrastructure development [19,20]. This commitment is also reflected in our findings, which indicated a heightened awareness among study participants regarding earthquake safety and fire evacuation plans in their respective hospitals.

Furthermore, the concept of sustainability in healthcare extends beyond immediate disaster response to encompass long-term resilience and adaptability. Hospitals in the Eastern Province of Saudi Arabia, as revealed by our study, are not only preparing for immediate crises but are also considering the sustainability of their operations in the broader context of environmental and societal changes. This aligns with the global move towards sustainable healthcare systems that are designed to be resilient in the face of ongoing environmental challenges, such as climate change, and evolving public health needs [21,22,23].

Modern hospitals are evolving beyond just brick-and-mortar facilities. The integration of technology, strategic location, design adaptability, and backup systems can play a crucial role in ensuring smooth functioning during disasters. Efficient hospital infrastructure, coupled with rapid response mechanisms, can drastically reduce the latency between a disaster’s onset and the commencement of medical intervention [24,25]. The resilience of a health institution is not just measured by the training of its staff but also by the robustness and flexibility of its infrastructure.

Drawing a global comparison, countries such as Japan and the United States have been pioneers in instituting early warning systems tailored to their specific challenges. For instance, Japan’s Meteorological Agency has been lauded for its Earthquake Early Warning (EEW) system, a vanguard move to prepare its citizens ahead of seismic adversities [26,27]. The U.S., battling frequent hurricanes, has fortified its preparedness through a dedicated hurricane early warning system, ensuring timely evacuations and strategic planning [28]. Saudi Arabia, recognizing the potential threats, has not lagged behind and has implemented a robust early warning system targeting meteorological hazards, further enhancing its disaster preparedness quotient.

Community engagement, collaboration, and trust play an indispensable role in disaster management. Hospitals do not operate in isolation; their efficacy during a crisis is often intertwined with the community’s readiness and response. Regular community drills, awareness programs, and transparent communication between healthcare institutions and the public can foster a collective sense of responsibility. In times of crisis, a well-informed and prepared community can significantly ease the strain on healthcare services.

Moreover, the integration of sustainability practices in hospital operations, such as energy-efficient building designs, waste reduction strategies, and sustainable resource management, is a key aspect of building resilience. Hospitals that incorporate these practices not only contribute to environmental sustainability but also ensure their long-term operational efficiency and readiness for crises. Our findings indicate a growing awareness among healthcare professionals in Saudi Arabia’s Eastern Province of the need for sustainable practices within hospital settings.

One cannot overlook the monumental role of training and awareness campaigns when discussing disaster preparedness. Their influence in shaping the workforce’s ability to effectively respond during disasters is paramount. Our data showed an encouraging trend: Over 70% of study participants have been trained to handle disasters, and 64% vouched for the presence of disaster recovery plans within their hospitals. This finding bears semblance to global data as well. A study from Switzerland revealed that an impressive 92% of its hospitals were equipped with disaster plans [29]. Moreover, a pan-European assessment across 27 nations brought to light that while 68% of hospitals achieved commendable preparedness levels, a concerning 32% were in a transitional state, potentially compromising their disaster response [30].

While tangible preparedness mechanisms are fundamental, the psychological readiness of healthcare workers is equally, if not more, essential. Coping with the dual pressures of a disaster scenario and ensuring medical care can be taxing. Hence, training modules should also emphasize building mental resilience, crisis communication, and team dynamics. Such psychological preparedness can significantly improve decision-making processes and overall patient care during disasters.

In the pursuit of sustainable healthcare, community involvement becomes crucial. Sustainable disaster management is not just about the preparedness of hospitals but also about engaging communities in sustainable health practices. This includes promoting health literacy, encouraging environmental stewardship, and fostering community resilience. Such a holistic approach ensures that the healthcare system is sustainable not only in terms of disaster preparedness but also in its capacity to foster a healthy and resilient community.

The essence of a command and control system in disaster management is irrefutable. Such systems are the backbone of effective, uninterrupted communication during emergency operations [18,31]. It is well documented that communication breakdowns, especially during crises, can severely incapacitate response mechanisms [32,33,34,35]. Given the unpredictable demand on health resources during emergencies [18], having a robust command and control system becomes indispensable. However, our study uncovers a discrepancy here. A mere 50% of participants confirmed the presence of an incident command system in their hospitals. This is reminiscent of Khan et al.’s findings, which painted a bleak picture of the command and control system’s preparedness [25]. Contrastingly, a study by Ingrassia et al. showcased a more favorable scenario, where the readiness level was satisfactory [36].

In this digital age, integrating cutting-edge technology into disaster management strategies is pivotal. From real-time data analytics predicting patient influx, telemedicine services ensuring uninterrupted care, to advanced communication tools for seamless coordination, technology stands as a cornerstone of modern disaster preparedness. Harnessing these advancements can lead to more efficient resource allocation and better patient outcomes during crises.

In the march towards enhancing disaster preparedness in hospitals, employing predesigned, thoroughly tested tools to gauge preparedness levels and business continuity plans becomes crucial. Such measures will not only present an accurate panorama of preparedness across public and private hospitals but also pave the way for more targeted interventions, ensuring that essential healthcare services remain unfazed even in the face of dire challenges.

Finally, the study’s focus on the robustness of business continuity planning within the context of Saudi Arabia’s Eastern Province sheds light on the importance of sustainability in healthcare systems. It underscores the need for healthcare services that are not only resilient in the face of immediate disasters but also adaptable and sustainable in the long term. This aligns with the global goals of achieving sustainable healthcare systems capable of withstanding and adapting to the diverse challenges of the 21st century.

5. Limitations

While our study offers significant insights into the perceived preparedness of hospitals in the face of disasters, it is essential to address some limitations that could have influenced the outcomes.

Firstly, our findings are predominantly based on the self-reported perceptions and judgments of the study participants. While these insights provide a valuable snapshot of the prevailing sentiment and awareness levels, they may not always reflect the objective reality or concrete preparedness measures on the ground. Personal biases or the inherent human tendency to respond favorably could have played a role in shaping some of these responses.

Secondly, the study did not delve into the nuanced socio-economic conditions of the hospitals involved. The socio-economic status of a healthcare institution could substantially impact its level of preparedness, allocation of resources, and ability to implement or maintain disaster recovery plans and business continuity plans (BCP). By not accounting for these variations, we might overlook certain challenges or advantages faced by specific hospitals.

Furthermore, while the study sheds light on training initiatives and awareness regarding BCP, it does not evaluate the quality, frequency, or depth of these training sessions. Different hospitals might have varied training protocols, some more rigorous than others, which could affect the real-world effectiveness of the personnel during disasters.

Lastly, we have made references and comparisons to global standards and practices, such as those in Switzerland, Japan, the United States, and other European countries. However, the unique cultural, geographical, and infrastructural contexts of each region mean that direct comparisons might sometimes oversimplify complex dynamics.

Despite these limitations, our study sets the stage for more in-depth investigations into the intricate facets of disaster preparedness, urging stakeholders to assess, refine, and fortify the robustness of their healthcare institutions. Future studies could focus on gathering empirical evidence, conducting drills, or objectively assessing the efficacy of training programs to paint a more comprehensive picture.

6. Conclusions

This study has highlighted a crucial aspect of modern healthcare systems: The imperative for robust readiness and resilience in the face of unexpected challenges. The evidence from Saudi Arabia’s Eastern Province demonstrates a significant commitment among hospitals towards developing and implementing comprehensive disaster recovery plans. This proactive approach to disaster preparedness extends beyond mere strategic planning; it permeates through the healthcare workforce, encompassing doctors, nurses, and support staff, all of whom have been trained to ensure patient safety and effective care delivery in crisis situations.

Importantly, our analysis reveals a profound awareness and understanding of business continuity plans (BCP) within these hospitals. This awareness reflects a holistic approach to healthcare delivery, one that prioritizes the uninterrupted provision of essential services, even in scenarios with exponential patient surges. This approach is pivotal for sustaining healthcare services during crises, ensuring not only immediate response capabilities but also long-term operational resilience.

Furthermore, the focus on sustainable healthcare practices, as demonstrated in our findings, aligns with global trends towards creating healthcare systems that are resilient, adaptable, and capable of withstanding environmental and societal changes. The readiness of hospitals in the Eastern Province to adapt to diverse challenges, be they natural disasters or public health emergencies, is indicative of a broader commitment to sustainable healthcare practices. This commitment is vital for safeguarding the well-being of communities and ensuring the sustainability of healthcare services in a rapidly changing world.

While the nature of disasters might be unpredictable, a well-prepared and sustainably focused healthcare infrastructure, reinforced by skilled professionals and comprehensive strategies, can significantly mitigate their impact. The strides made in disaster preparedness and sustainability, as demonstrated in this study, are promising indicators of a resilient and sustainable future for healthcare in the region.