Saudi Healthcare Resilience: Concurrent Crises Case Study

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Chapter One: Introduction and Background

1.1 Introduction

The concept of health system resilience is gaining prominence across the global health scenario, referring to the ability of the health system to absorb, adapt, and transfer the face of shocks and stresses while managing essential functions. For students seeking help writing assignments on healthcare resilience, this topic provides rich case study material. According to studies Nandi (2022), the resilience of the healthcare system is critical and important when it comes to managing current and cascading events like natural disasters, mass casualties in recent times, the outbreak and heavy mortality rate due to the COVID-19 pandemic. These complex events often strain the healthcare infrastructure of a country, which afterwards ensures the necessity of maintaining robust preparedness, adaptability, and recovery strategies for the healthcare infrastructure of a state and the country's government. On the other hand, Resilient health systems exhibit key attributes like availability and flexibility of resources, adaptive capacity, transformative capacity, and advocacy. Focusing on the healthcare system of Saudi Arabia, the cornerstone of Vision 2030 has undergone a significant transformation, yet it remains vulnerable to multi-hazard crises due to the country's diverse demographic and geographic challenges. This study investigates the resilience of the Saudi Arabian healthcare system to simultaneous and cascading emergencies like the COVID-19 Pandemic. The Saudi Arabian healthcare system demonstrated resilience during the COVID-19 pandemic through a 'whole-of-government' approach, which is based on previous experiences with MERS. The key strategies included implementing strict protocols, establishing specialised facilities like walk-in respiratory clinics, and leveraging the Vision 2030 framework to guide the response. Hospitals followed the Saudi MoH Protocol for Patients Suspected of/Confirmed with COVID-19, NHCC or National Health Command Center dashboard for early warning system as a resilience strategy to manage cascading events like an outbreak of the COVID-19 pandemic.

Figure 1: Research Outline

1.2 Motivation of the Study

Academic and grey literature have demonstrated that resilience of the healthcare system is important for managing the current and cascading events, which are complex crises where multiple emergencies happen simultaneously or concurrently or one disaster triggers another in a chain reaction (cascading). According to research by Overton et al. (2023), healthcare resilience is important for preventing system collapse, ensuring rapid adaptation and protecting both patients and staff when multiple crises unfold simultaneously. It requires robust infrastructure, agile resource management, intersectoral coordination, and a strong, well-supported workforce. The resilience in the healthcare system has gained significant attention in recent years, specifically from the time of the global outbreak of the COVID-19 pandemic (Borzuchowska et al., 2023). The ability of the healthcare system to withstand and recover from concurrent and cascading disruption is important to ensure the continuous provision of essential services. In the Saudi Arabian healthcare system, which operates within an evolving and dynamic environment, investigating the resilience mechanism of the healthcare system is important for future researchers to determine and address both anticipated and unforeseen challenges.

According to Ellis et al., (2019) and Wiig et al., (2020), resilience in the healthcare system encompasses both organisational and individual capacities to adapt, respond and recover from adverse events. The COVID-19 pandemic has highlighted the vulnerabilities in the healthcare infrastructures globally, exposing the strain placed on chronic care services, emergency response capabilities, and healthcare personnel (Yoon et al., (2022); Gröschke et al., (2022). Saudi Arabia, like many other countries, has faced disruption in the healthcare delivery process, which necessitates the requirement of implementing adaptive strategies to mitigate the detrimental impact of the COVID-19 Pandemic (Mahmoud, 2023, WHO, 2022). In such a scenario, the key motivation for this study is to examine how Saudi Arabia’s healthcare system has responded to concurrent crises kike the outbreak of COVID-19 along with the onset of sudden natural disasters and cyber threats. There are several researches that underscore the importance of resilience in mitigating cascading effects that threaten the stability of healthcare services (Pescaroli et al., (2021); Pickering, (2021). By analysing the past responses and identifying the gaps in collected research and articles, this study aims to contribute to strengthening the resilience of Saudi Arabian's healthcare system.

On the other hand, according to research by (Lallie et al., (2021); Harir et al., (2022), Khabbaz et al., (2011)) concurrent and cascading events necessitate the multi-disciplinary approach, integrating perspectives from disaster risk management, cybersecurity, and health system sustainability. Saudi Arabia’s Vision 2030 emphasises healthcare transformation, making resilience a key priority for ensuring long-term sustainability and improved crisis response capabilities (Suleiman & Ming, 2025).

1.3 Problem Statement

The increasing frequency and complexity of concurrent and cascading events like pandemics, natural disasters, and cyberattacks pose significant challenges to healthcare systems across the world. For example, the COVID-19 pandemic exposed critical vulnerabilities, highlighting the urgent need to enhance healthcare resilience against multi-faceted crises. While research acknowledges the importance of resilience (Ellis, Wiig), significant gaps remain in understanding how the healthcare system can effectively manage concurrent disasters, cascading impacts and infrastructure interdependencies.

One of the critical gaps lies in the limited research on managing multiple concurrent disasters. While structured evidence exists on how the healthcare system can manage individual emergencies, there is a lack of research focusing on operational weaknesses, response to the strategies, and interdependencies that could exacerbate the system failure at the time of concurrent disasters (Samei et al., 2023). Current research lacks clear protocols for integrating emergency response efforts across multiple concurrent disasters. There is a need for evidence-based models that synchronise emergency healthcare operations, ensuring efficient coordination and resource allocation. Cedergren and Hassel (2024) highlight the importance of organisational adaptive capacity, but further research is required to identify the specific best practices which can support coordination, resource allocation, and adaptive strategies in concurrent disaster events.

Another gap which can be identified from allocated research articles is limited information on cascading impacts, which centre on the processes and pathways through which risks spread from one sector to another, causing cascading effects (Pescaroli & Alexander, 2016). There is a need to understand the relationship between sectors (e.g. healthcare dependent on energy and transportation) and to design strategies to minimise cascading impacts.

This study seeks to fill the gap in resilience research by offering an in-depth case study of the healthcare system and its preparedness and response capabilities to concurrent crises in Saudi Arabia. By examining the resilience patterns, organisational adaptability, and policy frameworks, this research might provide valuable insights for policymakers, healthcare administrators, and disaster preparedness professionals. The findings will contribute to the broader discourse on healthcare system resilience and inform strategies for enhancing crisis management in Saudi Arabia and beyond (Horney (2024), Cedergren & Hassel, (2024)).

Mechanics for coordinated response is another literature gap identified, where the current research lacks clear protocols to integrate emergency response efforts across concurrent disasters. There is a need for evidence-based models that synchronise emergency healthcare operations to ensure efficient coordination and resource allocation. On the other hand, Percaroli et al., (2021) have identified the gaps in understanding the mechanism of cascading risks, specifically how risks spread from one sector to another, causing determinantal effects. In such cases, the researchers should focus on the process and pathways through which risks can be restricted and mitigated to ensure the overall health and well-being of people.

These gaps underscore the need for a more integrated and holistic approach to healthcare resilience, one that considers the complex interdependencies and cascading effects that can arise during concurrent disasters.

1.4 Research Objectives

My research seeks to understand and explore the importance of resilience and its impact on healthcare strategies during cascading and concurrent events within the Saudi Arabian healthcare system from the perspective of healthcare professionals. According to research Emami et al. (2024), investigating the resilience of the healthcare systems during cascading and concurrent events is important to ensure effective crisis management and maintaining public health. Therefore, the objectives of my research will be to identify the operational factors that are used to impact healthcare resilience in a broader aspect. More specifically, my research will examine the key operational elements which influence the resilience of healthcare services at cascading and concurrent events. This includes analysing the resource availability, staff readiness, communication channels, and infrastructure robustness. Understanding these factors is essential for developing strategies to strengthen the healthcare system's capacity to withstand and adapt to crises. 

Another objective of this research is to critically evaluate the determinants of healthcare strategies in response to simultaneous and cascading crises. This evaluation includes the determination and assessment of different policy frameworks, decision-making procedures, and leadership effectiveness along with stakeholder engagement, which has a significant impact on developing resilience healthcare strategies to combat the crisis related to cascading and concurrent events. This evaluation can offer insights into the effectiveness of current and existing strategies and identify the areas for further improvement in the broader healthcare system.

My research will also attempt to develop a conceptual framework for healthcare resilience which can encapsulate the elements of healthcare resilience specific to Saudi Arabia’s preparedness strategies. This framework will serve as a blueprint for mitigating the cascading effects of health crises, guiding the development of robust preparedness plans and response mechanisms tailored to the Saudi context. Lastly, the objective of this research will be to carry out a thorough assessment of the impact of concurrent and cascading events on the Saudi Arabian Healthcare System.

To meet this objective, the research will be carried out to investigate how concurrent and cascading events might affect the resilience of Saudi Arabian’s healthcare system. This assessment, therefore, will include factors like system overload, resource allocation challenges, and the effectiveness of existing response protocols.

By addressing these objectives, the study will aim to provide a nuanced understanding of the resilience of the Saudi Arabian healthcare system during the complex crisis period. The research carried out based on these objectives might help the instrument in informing policy decisions, optimising the preparedness strategies, and ultimately ensuring the delivery of effective healthcare services amid concurrent and cascading events.

Research Questions

My research project is motivated by the central question: How do concurrent and cascading events impact the resilience of the Saudi Arabian healthcare system, and what strategies can be implemented to enhance its preparedness and response capabilities?

To simplify the research work, the central question of this project has been divided into several sub-questions so that the answers to these questions can become more systematic.

The Resilience of Saudi Arabia’s healthcare system is pivotal in effectively managing concurrent and cascading crises. Operational challenges such as resource shortages, infrastructure vulnerabilities, and workforce limitations can lead to system failures during simultaneous emergencies. Historically, Saudi Arabia has faced events like the MERS-CoV outbreak in 2012 and the COVID-19 outbreak in 2020, which tested the preparedness and effectiveness of response strategies used by the healthcare system. According to Pickering. (2021), healthcare professionals play a crucial role in evaluating readiness by assessing operational capabilities and understanding the critical infrastructure interdependencies. Their insight is considered to be vital when it comes to identifying vulnerabilities exposed during crisis periods and formulating effective response plans. Furthermore, addressing infrastructure interdependencies is critical. There is a lack of understanding of the interdependencies among critical infrastructures (e.g. energy, water, transport) and their direct effects on healthcare operations. Resilience frameworks are needed to evaluate and enhance operational readiness, such as staff capabilities, equipment reliability, and infrastructure robustness (Tekinerdogan et al., 2024). The absence of comprehensive frameworks that address these interdependencies hiders the ability of healthcare systems to prepare for and respond to complex crises effectively.

These gaps emphasise the need for research focusing on concurrent and cascading events in healthcare resilience, especially after COVID-19 exposed critical vulnerabilities (Piquer et al., 2023). Understanding healthcare system vulnerability in concurrent events, the relationships between entities, and the interdependency of critical infrastructure is essential. Therefore, this study aims to address these gaps by investigating the resilience of the Saudi Arabian healthcare system in the face of concurrent and cascading events, providing insights and recommendations for strengthening its preparedness and response capabilities. Despite the existing research on disaster preparedness, there is a notable gap in understanding how the Saudi Arabian healthcare system can manage such multifaceted crises effectively. Addressing these gaps can be crucial for developing comprehensive frameworks that enhance healthcare resilience in muti-hazard scenarios. This research aims to investigate the resilience of Saudi Arabia’s healthcare system in the face of concurrent and cascading events, identifying key vulnerabilities and proposing strategies to strengthen preparedness and response capabilities (Barten, 2022). By focusing on the unique challenges within the Saudi context, this study seeks to contribute valuable insights into building a more robust and adaptable healthcare system which is capable of withstanding complex emergencies.

1.5 Potential Impacts of Research

Investigating the resilience of the Saudi Arabian healthcare system in the face of concurrent and cascading events holds significant potential to enhance the nation’s disaster preparedness and response strategies. This research includes several outcomes, including:

1. Identification of systematic vulnerabilities: by analysing or assessing the resilience and responsiveness of the healthcare system to manage cascading and concurrent crises, this study will uncover critical operational weaknesses and interdependencies that may exacerbate system failures during such crisis events (Gröschke et al., 2022). This insight is important for developing targeted interventions to fortify the healthcare infrastructure.
2. Development of coordinated response framework: this research aims to establish evidence-based models for synchronising emergency healthcare operations across various sectors. These frameworks will facilitate efficient resource allocation and communication, ensuring a unified response during overlapping crises (Yoon et al., 2022).

This research and identified gaps will also offer insight into CAS or Complex Adaptive System theory, which can be considered as a framework for enhancing resilience during concurrent and cascading crises. CAS theory emphasises the adaptability and self-organisation within a system composed of interdependent agents, like hospitals, medical personnel, and resource management entities (Glover et al., 2020). Recognising the healthcare system as a CAS allows for a deeper understanding of how these components interact dynamically, specifically under a crisis condition. This perspective highlights the importance of flexibility, decentralised decision-making, and the capacity for rapid adaptation- the key factors to effectively manage overlapping emergencies. By fostering self-organisation and adaptive behaviours, the healthcare system can better respond to unforeseen challenges, ensure continuity of care, and minimise system failures (Ellis et al., 2019). Therefore, this study is important to check the extent to which CAS theory can offer a comprehensive framework to analyse and improve the Saudi Arabian healthcare system's capacity to withstand and adapt to complex and multifaceted crises.

As a whole, this research will provide a nuanced understanding of the Saudi Arabian healthcare system’s resilience, offering practical solutions to enhance its responsiveness and capacity to manage concurrent and cascading events effectively.

1.6 Definition of Key Terms

To reduce the redundancy, all terms included in this section are not defined in the text except for the literature review, which included a definition for the logical flow of the review:

Table 1: Key terms:

References

Saudi Healthcare Resilience: Concurrent Crises Case Study

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