JVK
JURNAL VOKASI KESEHATAN
http://ejournal.poltekkes-pontianak.ac.id/index.php/JVK
IDENTIFICATION OF PREPAREDNESS AT GRAHA BUNDA GENERAL
HOSPITAL IN DEALING WITH DISASTERS BASED ON HOSPITAL SAFETY
INDEX
Ghathan Gufraan1 , Ermi Girsang2, Sri Lestari Ramadhani Nasution3
1,2,3

Master of Public Health Study Program, Faculty of Medicine, Dentistry and Health Sciences,
Universitas Prima Indonesia, Indonesia.
Article Info

Abstract

Article History:
Received : 21-04-2025
Approved : 21-07-2025
Published : 31-07-2025

Indonesia as a country with a high level of disaster vulnerability requires
optimal preparedness from all health service facilities, including hospitals. In
this context, hospital preparedness is a crucial aspect to ensure the continuity
of medical services in the event of a disaster. This study aims to evaluate the
level of preparedness of Graha Bunda General Hospital in dealing with
disasters based on the Hospital Safety Index (HSI) developed by WHO. The
method used is a descriptive qualitative approach through in-depth
interviews, field observations, and documentation studies of five key
informants. The assessment was carried out on four main components: hazard
preparedness, structural safety, non-structural safety, and emergency and
disaster management. The results showed that the overall HSI score was at
73%, classified as category A, which reflects good general preparedness. The
non-structural safety and emergency management components each obtained
a score of 86% (category A), indicating high readiness in supporting the
continuity of medical services during disasters. However, hazard
preparedness (64%) and structural safety (57%) are still in category B,
indicating the need to improve physical infrastructure and risk mitigation
systems. This study recommends strengthening the early detection system,
evaluation and strengthening of building structures, and continuous training
for all hospital staff to improve overall preparedness.

Keywords:
Disaster Preparedness,
Hospital, Hospital
Safety Index,
Emergency
Management, Structural
Safety

Correspondence address:
Master of Public Health Study Program, Faculty of Medicine, Medicine
Dentistry and Health Sciences, Universitas Prima Indonesia, Indonesia
Email: ermigirsang@unprimdn.ac.id

Introduction
Hospital preparedness in dealing with
disasters is a crucial aspect in the health system,
especially to ensure optimal services during
emergency situations. Several studies have
emphasized the importance of evaluating hospital
preparedness, such as studies that develop
conceptual frameworks to improve hospital disaster
resilience (Purba et al., 2024). Other research also
underscores the importance of preparedness
evaluation (Moghadam et al., 2016), and the need

ISSN 2442-5478

for hospital preparedness in disaster-prone areas
such as Indonesia (Alruwaili et al., 2019).
Research shows that hospitals become crisis
handling centers during disasters, with the
responsibility of providing optimal healthcare
services under challenging conditions. Indonesia,
as a disaster-prone region, has many hospitals that
are not fully prepared to face emergency situations.
Study (Feizolahzadeh et al., 2019) found that 85%
of hospitals evaluated had low Hospital Safety
Index (HSI) values, signaling significant
vulnerability to natural disasters. Research (M.

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 42-49

Thomasian et al., 2021) in Latin America and the
Caribbean and (Djalali et al., 2019) in Southeast
Asia also revealed low preparedness scores at many
health facilities.
In Indonesia, many hospitals have low HSI
scores, indicating the need for increased
preparedness in dealing with disasters. Research by
(Sundoro et al., 2023) (Prayitno & Widiastuti, 2024)
in Yogyakarta shows factors such as lack of staff
training, inadequate infrastructure, and limited
emergency medical equipment contribute to the
low HSI score. Study (Indriani et al., 2023) in West
Sumatra found that many hospitals do not have
comprehensive emergency plans and have not
conducted disaster simulations on a regular basis.
(Yenni et al., 2021) revealed that despite the
increased awareness, implementation on the ground
is still far from adequate in terms of structural and
non-structural safety, as well as risk management.
Hospital preparedness based on HSI is an
important step to ensure readiness to face
emergency situations. The HSI developed by WHO
is a standard tool to assess hospital preparedness for
disasters (Safarpour et al., 2022). Hospitals with
low HSI scores tend to have difficulty handling
mass casualty incidents, ensuring the availability of
resources, and maintaining critical services (OrtizBarrios et al., 2020). The impact of inadequate
preparedness includes operational disruptions,
delays in critical medical care, infrastructure
damage, patient and staff safety risks, inability to
handle patient surges, stress on medical personnel,
and damage to hospital reputations (Bajow &
Alkhalil, 2014; Goniewicz & Goniewicz, 2020)
Research has highlighted the importance of
structural and non-structural elements in hospital
preparedness, including infrastructure security,
emergency services, and trained personnel
(Heidaranlu et al., 2016). Inadequate preparedness,
as seen during the COVID-19 pandemic, can lead
to the transmission of nosocomial diseases and
hamper emergency response efforts (Tagashira et
al., 2021). Disaster preparedness evaluations point
to training, logistics, management, safety measures,
communication, and resource availability as key
factors that affect overall preparedness levels (E.
Marcozzi et al., 2020).
The strategy to improve HSI involves a
holistic approach, including infrastructure
improvements, ongoing training for staff, and
strengthening risk management. Some strategies
include the implementation of a clinical pathway
(Sativa Julianti et al., 2022), digital marketing (Sari
Sembiluh & Sulistiadi, 2022), marketing mix
strategy, architectural design Hospital Management
Information System (Vieryna et al., 2023), analysis
of nursing services and implementation of
remuneration system (Santoso, 2019; Soetisna et al.,
2015), as well as strategic planning optimization
(Pakarbudi, 2022; Sumadi & As-Syafi'iyah, 2021).

Research on hospital preparedness for
disasters has seen significant developments in
recent years (Pomegranate & Putra, 2021). Recent
studies emphasize a multidimensional approach
that includes structural, non-structural, and
managerial aspects in evaluating preparedness.
Hospital
capacity-building
programs
are
increasingly leading to technology integration,
scenario-based disaster simulation training, and the
development of adaptive early warning systems.
Research has also shown that collaboration
between stakeholders—including government,
civil society, and the private sector—is a crucial
factor in building sustainable hospital resilience in
the face of emergencies (Rajabi et al., 2017).
A literature review shows that the evaluation
of hospital preparedness using the Hospital Safety
Index (HSI) has substantial theoretical and practical
implications (Giovanni et al., 2024). From a
theoretical perspective, the use of HSI has
contributed to the development of conceptual
models to measure the resilience of hospitals in the
face of different types of disasters, especially in
developing countries. The results of this evaluation
also provide empirical data that strengthen the
health policy framework in disaster risk
management in the health service sector. From a
practical standpoint, HSI helps identify system
weaknesses that may not be detected in
conventional assessments and provides a basis for
more targeted resource allocation.
This study raises the topic "Identification of
Preparedness at Graha Bunda General Hospital in
Dealing with Disasters Based on Hospital Safety
Index" with the aim of evaluating and increasing
hospital preparedness capacity in dealing with
disaster situations. The selection of this location is
based on the geographical position of Graha Bunda
Hospital which is located in a disaster-prone area
and its active involvement in disaster risk
mitigation programs. Although studies have
examined the application of HSI in various contexts,
there are still gaps in the mapping of the
preparedness of private hospitals in areas with high
potential risks, particularly in the operational
aspects and internal coordination in responding
effectively to disasters. Therefore, this study is
important to provide an empirical picture of
hospital readiness in a local context that has not
been widely revealed in the previous literature.
Through this approach, the researcher aims to gain
a contextual and comprehensive understanding of
the perceptions and experiences of key informants
related to hospital preparedness in the face of
disasters.
Method
This study uses a qualitative approach with a
descriptive design to describe in depth the
phenomenon of hospital preparedness for disasters
based on the Hospital Safety Index (HSI). The

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Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 42-49

research location is at Graha Bunda General
Hospital, East Aceh Regency, with implementation
time starting from June to August 2024.
The population in this study includes all staff
and management involved in hospital emergency
preparedness and response procedures (Hayati &
Husna, 2018). The research sample was determined
using a purposive sampling technique with a total
of five people selected based on their strategic roles.
The informants consist of hospital directors,
medical officers, security officers, and facility
managers. The inclusion criteria in this study
include staff who have worked at least one year in
the hospital and have direct involvement in disaster
preparedness activities. The exclusion criteria
include staff who are not actively working, such as
long leave, or who are not willing to provide
information.
The research instrument was developed based
on indicators from the Hospital Safety Index, which
consists of four main modules: hazard preparedness,
structural safety, non-structural safety, and
emergency and disaster management. The HSI
form has 151 indicators that are assessed on a low,
medium, and high scale, with a scoring scheme that
results in a percentage classification of the level of
preparedness (HSI Guide, 2017).
Data collection was carried out through indepth interviews, field observations, and
documentation studies. The data collected includes
primary, secondary, and tertiary data to support the
validity and richness of the information. In addition,
the narrative analysis approach is used to
understand the structure of the story, the meaning
of the experience, and the narrative pattern of the
informant (Amrullah et al., 2024).
The stages of narrative analysis include
interview transcription, theme identification, and
structured narrative preparation based on the
informant's real experience in the field (Almuida et
al., 2023; Dahlia et al., 2023). This process is
strengthened with direct quotes and reflections on
relevant theories, resulting in conclusions that fully
describe the preparedness of Graha Bunda Hospital
in dealing with disasters.

Table 1. Research Informant
Infor
mant
Position
Background and Roles
Code
Managing hospital
K1
RSU Leader
strategy, >10 years
experience
Civil engineering
Facilities
K2
background, >8 years
Manager
experience
Responsible for safety
U1
Head of K3
training
Head of
Coordination of medical
U2
Medical
services in emergency
Section
situations
Emergency
Playing a direct role in
U3
room doctor
disaster management
Information from in-depth interviews was
used to assess hospital preparedness based on
Hospital Safety Index (HSI) indicators.
Preparedness Analysis Based on HIS
Components
Hazard
Assessments of potential hazards show that
most types of hazards that may affect hospitals are
classified in categories A and B. Hospitals
demonstrate good preparedness in dealing with
geological and technological hazards, but need to
improve in dealing with social and biological
hazards.
1.

Table 2. Recapitulation of Hazard at Graha Bunda
Hospital
Dominant
Types of
Range
Percen
Categorie
Hazards
Score
tage
s
73–
Geological
11–12
A
80%
Hydro67–
Meteorologic
10–11
A
73%
al
Climatologic
53–
al and
8–9
B
60%
Biological
67–
Technologist
10–13
A
87%
47–
Social
7–8
B
53%
Total Hazard
10
64%
B
Index

Result
Graha Bunda General Hospital is a health
facility located in East Aceh and has become a
reference for the surrounding community. The
hospital provides general and specialist medical
services, such as outpatient, inpatient, surgical, and
emergency services. Graha Bunda Hospital has a
vision to become an excellent and independent
hospital in health services, as well as a mission to
provide services with Islamic nuances and support
local government health programs.
This study involved key informants and key
informants who have an important role in hospital
preparedness. All identities of the informants are
disguised to maintain confidentiality.

Source: Primary Data, 2024
The interview showed that Graha Bunda
Hospital has implemented an earthquake-resistant
building design and a good drainage system.
Evacuation routes are available complete with
directions, and exercises are carried out
periodically.
2.

44

Structural Safety

Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 42-49

Assessments of structural aspects show that
most indicators are still in the medium category (B).
Some elements such as structural detailing and
resistance to non-earthquake hazards show good
results.

The disaster management of Graha Bunda
Hospital received category A with an index of 86%.
All
aspects
from
planning,
logistics,
communication, to evacuation and recovery show
high readiness.

Table 3. Structural Safety Index of Graha Bunda
Hospital
Dominan
Average
t
Assessment Aspects
Presentati
Categori
on
es
Previous events and
B
47–53%
fixes

Table 5. Emergency & Disaster Management Index
of Graha Bunda Hospital
Assessment
Percentage Category
Components
Coordination and
emergency response
80–93%
A
committees
Emergency response
80–93%
A
and recovery plan

Building and material
integrity

B

Resistance to other
hazards

A

Total Structural Safety
Index

B

53–60%
67%
57%

Source: Primary Data, 2024
Based on observations, the hospital has a
three-story building structure that is integrated,
facilitating the evacuation process. The building
uses earthquake-resistant materials, equipped with
a natural lighting system and lightning repellent.
Nonstructural Safety
Nonstructural components are in category A
with a safety index value of 86%. All vital hospital
systems such as electricity, water, medical gas,
HVAC, and medical devices are in good and safe
condition.

A

Total Nonstructural
Index

86%

A

Human resources
and logistics

80–93%

A

Patient service in
emergency situations

87–100%

A

Total Emergency
Management Index

86%

A

Hospital Safety Index (HSI)
HSI is an overall score that reflects hospital
readiness based on four main components. Based
on the results of the assessment, Graha Bunda
Hospital obtained a score of 73%, which is included
in category A.
Table 6. HSI Recapitulation of Graha Bunda
Hospital
Assessment
Scor
Catego
Percentage
Components
e
ry
Hazard
10
64%
B
Structural Safety
9
57%
B
Nonstructural
13
86%
A
Safety
Emergency &
Disaster
13
86%
A
Management
HSI Overall
11,3
73%
A
Index
Source: Primary Data, 2024
Although he has not used HSI directly, the
informant stated that the hospital has carried out
various safety improvement efforts. The future use
of HSI is considered as a tool for further evaluation
and planning.

Source: Primary Data, 2024
Graha Bunda Hospital has been equipped with
smoke detectors and fire extinguishers spread
throughout the area. Routine fire training is carried
out and special teams are on standby for evacuation
and rescue in case of emergency.
4.

A

5.

Table 4. Summary of Nonstructural Safety of
Graha Bunda Hospital
Component
Percentage Category
Architectural
87%
A
security
Infrastructure and
80–93%
A
access protection
Electrical and
communication
80–93%
A
systems
Water, firefighting,
87–93%
A
sewage, etc
80–93%

87–93%

Source: Primary Data, 2024
The hospital has an emergency reporting
system, alarm, and a trained response team. There
is also a "code red" system to speed up evacuation
and reporting.

3.

Medical equipment
and supplies

Communication and
information

Discussion

Emergency and Disaster Management

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Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 42-49

Graha Bunda General Hospital's Preparedness
Level in Facing Disasters Based on Hospital
Safety Index
Hazard Preparedness Level
The results of the study showed that the
hazard preparedness index at Graha Bunda Hospital
obtained a score of 64%, which was classified in
category B. This indicates that hospitals still face a
number of obstacles in maintaining optimal
function during disasters. Although preparedness
for
geological,
hydro-meteorological
and
technological hazards has been assessed well
(category A), there are significant weaknesses in
dealing with climatological, biological and social
hazards.
Theoretically, these results are in line with the
systemic approach to disaster risk management as
described by (Yuandi, 2021), which emphasizes the
importance of comprehensive multi-hazard
identification and adaptive capacity building as a
key component in the resilience of healthcare
institutions. Unpreparedness for climatological
threats such as extreme temperatures or extreme
weather, as well as infectious disease outbreaks,
indicates a weak integration between risk mapping
and evidence-based emergency response planning.
The interpretation of the 64% score results
also reflects the indirect effect of the limitations of
the early monitoring system and the lack of optimal
synergy between the disaster management
information system and human resource training.
Within the framework of organizational capability
theory, this score shows that despite the basic
resources available, the ability of hospitals to
integrate, build, and reconfigure internal
competencies to respond to changing threats is still
not optimal.
Comparison with the results of previous
research, such as studies by (Maulida et al., 2022)
in Cilegon City, which showed a hazard
preparedness value ranging between 0.67 and 0.85
(category A), underscoring the gap that still exists
in hospitals operating in similar areas but have
differences in structural capacity and contingency
planning. This study underscores the importance of
a not only reactive but also preventive and
anticipatory approach in hospital preparedness
systems, especially in the face of non-physical
threats such as biological and social that are often
overlooked in conventional assessments.

aspects in category B that require attention, such as
the interaction of non-structural elements with the
structure and proximity of buildings that can trigger
negative effects during earthquakes and fires.
Research by Wang et al. (2020) emphasizes
that aspects of structural detailing, such as
reinforcement of columns and beams, as well as the
integrity of foundations, are critical in improving
the structural safety of hospitals. The role of
modern technology in improving the structural
safety of hospitals, such as real-time monitoring of
structures and the use of more durable building
materials. The results of this study show similarities
in the structural safety category, with the hospital
safety index which is also in category B with a
Hospital Safety Index of 0.64.
Nonstructural Safety Level
The results of the analysis showed that
hospitals were in category "A" with a percentage of
nonstructural safety ranging from 80% to 94%.
This shows high readiness in dealing with disasters
and the ability to carry out functions optimally
when a disaster occurs.
Each critical element evaluated scored
excellently,
from
architectural
security,
infrastructure protection, critical systems, to
equipment and inventory. Electrical systems,
telecommunications, water supply, fire protection,
waste management, fuel storage, medical gas
systems, and HVAC systems all scored in the range
of 80% to 94%.
Recent research confirms that nonstructural
preparedness is critical in ensuring sustainable
hospital operations during and after disasters.
According to Dami et al. (2019), this readiness
includes electrical systems, telecommunications,
water supply, and fire protection, all of which must
function properly to maintain the sustainability of
hospital services.
Research by Krishnan et al. (2020) shows that
critical systems such as HVAC, waste management,
and fuel storage play an important role in
maintaining the operational stability of hospitals
during disasters. The safety and operation of
medical and laboratory equipment is also very
important in emergency situations, as shown by the
research of Smith et al. (2021).
Comparisons with other studies show
comparable results. Research conducted by Yenni
et al. (2020) at Dr. Mohammad Hoesin Hospital
found that the hospital's level of non-structural
preparedness was at a high level with a Hospital
Safety Index score of 0.84.

Structural Safety Level
The overall structural safety index was 57%,
categorized as category B, indicating that hospitals
have several obstacles in maintaining their
functions in the event of a disaster. Although not
critical, improvements are needed in some aspects
to ensure optimal operation and full protection.
Several structural elements are ready
(category A), such as system design, building
condition, and roof integrity. However, there are

Emergency
and
Disaster
Management
Preparedness Level
Hospitals have very high preparedness in the
face of emergencies and disasters, with an overall
score of 86% in the Safety Index category, which
includes sub-components with scores between 74%

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Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 42-49

and 99%. This readiness is reflected in the
coordination of emergency and disaster
management activities, such as coordination with
hospital emergency/disaster committees (84%),
preparedness programs to strengthen emergency
response and recovery (94%), and coordination
mechanisms with local emergency/disaster
management agencies (96%).
The emergency response and recovery
planning aspects also showed high readiness, with
the emergency or disaster response plan obtaining
a score of 90% and the hospital recovery plan with
a score of 92%. Internal and external emergency
communication achieved a score of 93%, while the
aspects of human resources, logistics, finance, and
patient care and support were all above 74%.
According to FEMA (2018), effective
emergency
management
involves
strong
coordination between various departments and
external agencies to ensure an integrated response.
WHO (2019) states that a good emergency response
plan should include all possible disaster scenarios
and effective recovery strategies to ensure the
continuity of medical services. In the study of
Amaliah et al. (2021), the functional capacity of
hospital X obtained an index value of 0.55 with the
status of 'B', in contrast to the findings at Graha
Bunda General Hospital which showed very high
readiness with an overall score of 86%.

employee capacity through training programs and
disaster simulations, but Kilisuci Hospital still
faces challenges in developing a documented
preparedness plan that involves the surrounding
community.
Proposed strategies to improve preparedness
To improve the preparedness of Graha Bunda
General Hospital based on the HSI Index
evaluation, especially from the level of
preparedness to face hazards and structural
preparedness, several strategies can be carried out:
1. Strengthen early detection and early warning
systems against various types of hazards, such
as earthquakes, floods, and epidemic threats.
The implementation of advanced technologies
such as sensors and integrated monitoring
systems can speed up the response and allow
for more timely evacuations.
2. Conduct an in-depth evaluation of the
hospital's physical infrastructure, including
strengthening the building structure, selecting
building materials that are resistant to external
pressures, and developing a continuous
maintenance plan to ensure long-term safety.
3. Developing hospital emergency response
capacity through investment in training of
medical and non-medical staff in disaster
management, routine disaster simulations,
and evacuation exercises.
4. Improve communication and coordination
between all parties involved in disaster
management, including better implementation
of
information
and
communication
technologies, as well as the establishment of
cooperative networks with external parties
such as local governments, health institutions,
and volunteers.

Overall Preparedness Level
Based on the analysis of the HSI Index table,
the Hazard Preparedness Level (5.1) and the
Structural Safety Index (5.2) are in category B with
percentages of 57% and 64%. This shows that
despite efforts to prepare hospitals for hazards and
physical structures, there are still obstacles that
hinder the maximum functionality of hospitals in
disaster situations.
However, Non-Structural Preparedness (5.3)
and Emergency Management (5.4) reached
category A with a percentage of 86%,
demonstrating excellent readiness in the nonstructural and emergency management aspects.
Overall, the HSI Index shows that hospitals are able
to function optimally in the face of disasters, but
there is still a need for improvement in terms of
structural safety and preparedness to face hazards.
The HSI Index reflects a hospital's ability to
deal with disasters by considering structural and
non-structural aspects as well as emergency
management. The theory underlying the HSI Index
emphasizes the importance of integration between
a strong physical infrastructure and an effective
emergency management system to achieve optimal
preparedness.
A comparison with the research of Kurniawan
et al. (2023) which examined the Disaster Safe
Hospital (RSAB) program at Kilisuci Hospital,
Kediri City, showed slightly different results. The
study found that there was a significant increase in

Conclusion
These results show that Graha Bunda Hospital
has generally met the disaster preparedness criteria
as measured by the Hospital Safety Index, so that
the purpose of the study to evaluate the hospital's
overall readiness has been achieved. Graha Bunda
General Hospital has an overall preparedness level
of 73.3% (category A), which reflects good
preparedness in general in dealing with disasters.
Non-structural preparedness and emergency
management were in category A with scores of 86%
each, indicating excellent emergency management
and
support
systems.
However,
hazard
preparedness (64%) and structural safety (57%) are
still in category B, so infrastructure improvements
and risk mitigation strategies are needed to achieve
more optimal readiness.
Hospital management is advised to
immediately prepare a gradual structural
improvement plan, strengthen the early warning
system, and conduct periodic audits and
simulations to ensure the effectiveness of the

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Jurnal Vokasi Kesehatan Volume 11 Nomor 2, hlm. 42-49

mitigation strategies implemented. The focus on
improvement also needs to be directed at increasing
the capacity of human resources through structured
and sustainable disaster training.
The study had limitations in the limited
number of informants and the scope of the site
covering only one hospital. Further research is
suggested involving more hospitals and
comparative analysis between disaster-prone areas
to obtain a more comprehensive picture.

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Acknowledgments
I would like to thank the Head of Graha Bunda
Aceh General Hospital for all his support for this
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