Planning and Risk Management: A Study of Large Scale Complexes. Erik Wirén, Professor and Consultant to The National Board of Civil Emergency Preparedness, The National Board of Rescue Services and The National Board of Health and Welfare, Sweden
THE CONCEPTUAL FRAMEWORK
There are some interesting similarities between risk management and societal planning One may i.e. think of collective risk as the other side of the planning coin. You cannot plan unless taking risks and you cannot really deal with risks without some sort of planning.
Risk research is a matter for both technicians and behavioural scientists, Both study risk perception, communication and management of risk. Some distortion is however caused by the fact that the two types of agents use completely different definitions of risk in society.
This implies that special notice must be given to the existing gaps between so called factual knowledge about the matter at stake, the degree of common understanding of its importance and the real ability to do something about it. Douglas and Wildavsky have pointed out that society seems to choose various strategies in risk management depending oh the actual level of knowledge and understanding. If both are high then one can expect technical solutions, if they are low there is likely to be ignorance and in the mixed situations the problem will be met by political majority solutions or time consuming compromising.
If we add one more dimension to this cross-table ability in time, then we get a cube, where one comer is distinguished by (H) high knowledge, high level of understanding and high degree of ability in proper time. The opposite comer (L) will be doomed by ignorance. It is like an iceberg where you only see the top which you are able to handle. That is where you put in your efforts.
Rationalistic technicians prefer technical solutions and tend
to disregard from other possible ways to solve problems.
Behavioural scientists are more inclined to look for a variety of
strategies, like i.e. mediation, information och public debate.
When dealing with this from the scientific point of view one will
have to regard how planning problems generally are perceived and
communicated. This is, as far as I know, not a very well examined
area of knowledge.
LARGE SCALE COMPLEXES
The examples that I want to apply the practice of this
conceptual framework on are taken from large scale hospital
complexes. How large these hospitals are is sometimes hard to
believe. I put the map of one not so very large Stockholm
hospital over the map of the old town of Stockholm. The building
area of the hospital covered the whole of the old town and the
Royal Palace showed to be no bigger than an average nursing ward.
These large hospitals are especially interesting to study as
they can compare with small societies or even towns. They are
supposed to function even during wartime stress and they must be
self-supporting to a high degree. They are like big ships at sea
that have to function well under all kinds of circumstances
without assistance from the outside world. This
self-supportedness means all aspects of functionality, including
the skill and the courage of the crew. The crew has to be ready
to deal with all kinds of risks, to improvise and to use
available resources the best way in the present situation.
This notion leads to the question which are the restrictions
for successful improvisations? At a certain level of resource
scarcity there is in fact no chance to handle a certain
situation. Thus a minimum level of resource availability has to
be secured and this limit is really what I want to discuss with
reference to accute hospitals. What functionality and
resourcefulness is vital for a hospital in order to maintain its
functionality during for instance a war situation? War represents
in this case the worst scenario of crises and disaster.
ACCUTE HOSPITALS IN SWEDEN
Sweden has about 100 accute hospitals of varying size and
importance. They have in the study I am referring to all been
thoroughly examined from the point of view of technical risk,
that is building quality and technical provision with first of
all electricity, water and heating. Without competent staff and
availability of premises and these necessities no medical care
can be delivered.. Then of course we have on top of that
communication systems, medical gas delivery, sewage systems and
many other things.
The entire study has been carried out by the same group of
experts during 10 years. It goes without saying that many
assessments cannot be made with full accuracy and objectivity or
expressed in cold figures. The reports are however made as
comparable as possible by the experts. A five grade scale has
been used for certain technical matters for peace and war time
functionality. I shall return to that, but first a few words
about the examination of risks due to building construction.
Weapon risk analysis
The analytical model used for analyzing building properties has been developed from a technical risk assessment of how dangerous it is to stay in a certain premise during a defined air raid attack delivering one ton of bombs randomly over an area of one hectar. The effect of such an attack on people depends on the quality of the building structure, the composition of materials, the shape and height of the buildings and many other things. The model takes into account three kinds of risks for a person in the premise to be killed or severely injured:
All these effects are calculated for every premise of the
hospital and summarized as Risk level, called RT. We do
not assume that hospitals are primary targets for bomb attacks.
The actual risk depends on how the hospital is situated in
relation to possible military targets. This is expressed in a
figure called Target Level, IN. The product of these two
figures RT x IN is called the Resulting Risk RR. What this
resulting risk tells is the probability for a person to be killed
or severely injured in the actual premises during a defined war
action. This assessment is well founded upon internationally
collected empirical facts and computerized into a program useful
for analyses as well as planning.
It is surprisingly enough far more dangerous to stay in a
hospital than to be in the hospital park. The buildings are in
other words dangerous. Some give some protection, A good shelter
has risk figures of 5-15, a normal house 40-70 and a large
hospital over 100.
The report shows the results in cumulative diagrams,
indicating the percentage of the area that has good (RT less than
50) resistance and acceptable usefulness from risk aspects.
| A small hospital | A large hospital |
| 90-100 % of the area | None of the area for accute |
| has acceptable risk level. | medical activities has acceptable risk level. |
Technical supply systems analysis.
The security analyses were made for each support unit and for
each building containing medical activities. The assessment of
support units is based upon studies of its built up, existing
security measures and vulnerability concerning as well
generating-distribution-receiving to the hospital as distribution
within the hospital area of the actual service. The assessment is
made separately for peace time and war time medical needs.
The assessments are given points and average values for given points. They have not been given various weight for different kinds of support, but through the complex interdependencies one kind of maintenance can also affect other assessments and thus automatically be given higher value. The studied systems are
| A small hospital | A large hospital |
Numbers indicate mean values for peace and war time use. 3-2,8 = good, 2.8-2 = acceptable, 2-10 = poor, and 1-0 = bad.
CONCLUSIONS
The studies has made it possible for the expert group to draw
up rules for how to design " the good hospital" from a
risk management point of view. The check-list contains aspects on
the following matters of concern:
The analyses demonstrate the need for forethought in planning
rather then for extra "cosmetic" investment in security
measures. Risk management is in other words economically wise
when it is integrated with creative and imaginative planning. It
is often called awareness.
Risk management aspects have to be considered as early as
possible in the planning process.
