Risk Criteria in Hospital Site Selection: A Systematic Review

May Risk Criteria in Hospital Site Selection: A Systematic Review Funding Statement Introduction: Hospitals should be safe and remain functional in emergencies and disasters as it is mentioned in the Sendai Framework. Proper selection of a hospital location has a direct effect on survival of affected population in disasters as well as cost and benefit of the hospital in non-emergency situation. Different studies applied different criteria for Hospital Site Selection (HSS). The present study through a systematic review aimed to find out a categorized criteria list that have been used for (HSS) in the literature. Methods: In accordance with the PRISMA statement, ?PubMed?, ?ScienceDirect?, ?Google Scholar?, and ?Scopus? were searched up to end of 2015. All English Articles that were published in peer-reviewed journals and had discussed site selection criteria for hospitals were included. Out of 41 articles, 15 met the inclusion criteria in which 39 general criteria for HSS were applied. These criteria were categorized in six main groups including cost, demand, environmental, administrative, disaster risk, and ?other? concerns through a focus group discussion. Discussion: Few researchers applied risk related criteria for HSS. Further consideration of ?risk of hazards? and ?burden of diseases? in comprehensive studies, is recommended for HSS to guide the decision makers for building more resilient hospitals. The authors received no specific funding for this work. Introduction Hospitals are one of the main elements of social services, and a cornerstone of response to disasters in an acute phase, especially in countless mass casualty incidents. Social service delivery has its roots in the time when humans began living together as a community to meet their needs. Accordingly, health-related services were developed particularly in more centralized populations, when diseases and injuries became one of the most challenges besides food and water1. The percentage of people living in cities is rapidly increasing due to having an easy access to social services. To provide a chance for having equitable access to hospitals a convenient location of establishing the service centers is of great importance1. In the decision-making process to establish a new hospital or renovate an old one proper location plays an important role specifically with regard to guaranteeing the profit return on investment. In other words, determining the location of a hospital is an important factor that can affect the cost and benefits2. In 2006, Younis et al showed that the geographic location influences the profitability of a hospital i.e. financial performance3. Considering the projections related to the increase in urban population to greater than 5 billion by 2025 and its effects on increasing the vulnerability in addition to climate-change related risks, assigning a proper location for medical centers becomes a crucial factor for planners4,5,6, given its long time impacts7. For instance, in a study by Bell (2007) it was indicated that the location of a hospital would have a direct effect on survival in situations such as nuclear attacks8. Also Ochi (2014) stated that inappropriate location may cause damages to a hospital due to external hazards such as earthquakes9. On the other hand, Sendai framework emphasizes structural disaster risk prevention and reduction measures as well as the promotion of resilience of new and existing critical infrastructures such as hospitals10. In this regard, there are two main theories used to optimize hospital location. The first is based on the Weberian model, which focuses on a single objective namely the minimum cost or maximum profit. (WU 2007) The second theory has its roots in ?behavioral approach? which simultaneously considers several factors to determine the most appropriate location. For instance, Analytic Hierarchy Process (AHP), a Multi-Criteria Decision-Making (MCDM) method, is based on ?behavioral approach?11. The present study through a systematic review aims to retrieve a list of disaster risk related criteria applied in hospital site selection (HSS). Methods Study design This study is a descriptive systematic review investigating risk criteria in HSS. The 27-item Preferred Reporting Items for Systematic Review and Meta-analysis statement (PRISMA) 2009 checklist is used as a reference12. The study protocol was approved by the Higher Education Council of School of Public Health at Tehran University of Medical Sciences. Search methods for identification of studies In the present study, ?hospital ?refers to the legal institution that provides 24-h medical services, including accepting, visiting, admission, and treatment of injured and/or sick individuals13,14. ?Site selection? refers to an operational problem solving research in which the researchers will find out the best location that meets the assigned preferences15. ?Risk? refers to both the probability of an event (hazard) and its (...truncated)