The severe acute respiratory syndrome coronavirus 2 global COVID-19 pandemic, has resulted in millions of infected patients and deaths worldwide (Radi et al. 2020). Around 80% of COVID-19 patients show no symptoms or only mild to moderate symptoms (Cascella et al. 2020, Lucchini et al. 2020, Velavan and Meyer 2020). No experts can predict the specific date when the COVID-19 crisis will end and the number of cases, critically ill patients and deaths have increased dramatically along with the growing demand for ward and intensive care unit (ICU) beds. More importantly, people with mild or no symptoms could unknowingly transmit the disease among their family members and the community. The spread of the virus could worsen the situation by increasing the demand for hospital-based medical care needed to provide therapeutic interventions and prevent the spread of the illness among family and community members (Lai et al. 2020, Yuan et al. 2020).
Many healthcare systems worldwide have thus experienced increased burdens due to the limited availability of hospital beds, and healthcare systems cannot manage the surge in the number of coronavirus patients (Yuan et al. 2020). These impacts on hospitals – whether immediate issues or long-term effects – can be expected in all types of disasters including pandemics, particularly when healthcare facilities lack plans to strengthen their surge capacity and staff resilience (Harley et al. 2010, Powers and Daily 2010). One of the available effective strategies for responding to pandemics is constructing temporary field hospitals to provide extra beds and other health care services, which may prevent healthcare systems from collapsing.
The concept and purpose of field hospital systems are complex, and their definition depends on the type of disaster. However, all field hospitals are constructed in specific geographical areas to manage high numbers of survivors of disasters caused by natural forces, wars and epidemics (Bar-Dayan et al. 2000, Zaboli et al. 2018). In the COVID-19 pandemic, temporary field hospitals have focused on admitting, isolating and managing patients with mild to moderate symptoms with positive COVID-19 tests or awaiting test outcomes.
The Chinese city of Wuhan in Hubei Province took the lead in establishing the first field hospitals to manage the surge in patient numbers (Yuan et al. 2020). The construction of temporary field hospitals is an extremely costly process, however, their success is undeniable, and this system has been adopted by many countries worldwide (Mateen et al. 2020). Tracking the key performance indicators (KPIs) of input, activities and output during field hospital establishment can help assess the success of each project in meeting its financial and other objectives. In addition, tracking KPIs could draw attention more quickly to areas that require modifications and rapid responses.
However, no practical example exists of using KPIs to evaluate the efficacy of field hospital construction projects. The present study thus sought to demonstrate the value of using KPIs and a logic model (i.e. input, activities and output) during the building of a field hospital to manage the coronavirus pandemic in Jeddah, Saudi Arabia. This goal was addressed by the following research questions:
RQ1: What are input, activity and output KPIs?
RQ2: How can the logic model approach be best applied to developing KPIs for field hospital construction?
RQ3: How can indicators be designed to reflect the level of work performance in field hospital projects?
RQ4: What information can the indicators draw on to assess field hospital construction accurately?
The following sections provide evidence of the importance of using sets of performance indicators and the selected logic model to identify field hospitals’ principal elements and provide a solid foundation for developing appropriate KPIs.
Key Performance Indicators (kpis)
The primary reason for building the field hospital under study was to manage large numbers of infected patients with mild and moderate symptoms (Yuan et al. 2020). Although empirical data can be a potent tool in terms of increasing the efficacy of establishing and operating field hospitals, the need to respond quickly to unpredictable evolving issues during and after construction can take priority over performance evaluations (Savaya and Waysman 2005). In addition, because field hospitals are commonly built under pressure, a limited amount of time is available to collect information. Without a set of predefined performance indicators, administrators may have difficulty determining whether their field hospital was constructed as planned.
KPIs are defined as measurable values that determine whether a specific project is achieving its key objectives (Marr 2012). Indicators measuring a specific project’s performance are of great importance to project managers. In the context of temporary hospitals, KPIs highlight different performance aspects of the project that are fundamental to providing insights into how to achieve field hospital goals by both controlling the epidemic and managing the surge in patients. According to Rozner (2013, p. 5), well-designed KPIs help field hospital decision makers as follows: “they can establish baseline information; set performance standards and targets to motivate continuous improvement; measure and report improvements over time; compare performance across geographic locations; benchmark performance against regional and international peers or norms; and allow stakeholders to independently judge health sector performance. KPIs can, therefore, help make project objectives explicit and enable managers to gather, process and report data to track the progress made towards achieving these objectives” (Ioan et al. 2012, p. 12).
KPIs need to be the product of logical and critical analyses and problem and solution arbitration. A practical tool that can help to conceptualise the production process in question is logic models (Rozner 2013).
Logic models are used to explain the links between problems and their solutions (Savaya and Waysman 2005, Zaboli et al. 2018). These models can support projects’ formation and define their success. Logic models help managers analyse problems, develop measures and articulate goals. These models can also be used to clarify project objectives and the steps necessary to achieve them. When a logic model is applied to a specific project, the model encompasses the following elements:
Input, which may include all resources that ensure the delivery of services
Activities, which can comprise actions that need to be undertaken to achieve the project’s objective(s)
Output, which may include the project’s results
Outcomes, which can involve the intended benefits for society at large
When project managers clearly describe the way that investments of time, effort and resources are expected to achieve the intended objectives, a strong basis is created for designing indicators that capture projects’ key components, which are vital to the assessment process. For example, in a field hospital construction project, a simple application of a logic model would be done as follows. If sufficient funding, planning and governmental support (i.e. input) are available to build and equip a field hospital to treat patients with COVID-19 (i.e. activities) and to operate at its maximum capacity (i.e. output), then the surge in patients will be accommodated (i.e. outcomes).
Outcome indicators are mainly used to assess the long-term benefits of operating field hospitals for the community. For instance, controlling the number of patients with COVID-19 reduces the number of critically ill patients and deaths and increases the community satisfaction with the hospital services. Because the present study focused on the field hospital construction rather than its subsequent operations, the outcome indicator was not considered.
The next step in the process is to identify the hospital components that are essential at each stage of the logic model. By developing indicators that track the different elements of the model, the hypothesised associations between input, activities and output can be tested to identify whether a significant relationship is present. Testing the connections between the project’s main components at each stage of the logic model facilitates making adjustments to the project design as needed (Savaya and Waysman 2005). For example, if information is gathered on the activity of setting up the field hospital in existing infrastructure and on the outcomes delivered in project schedule reports, a relationship between the type of infrastructure and project completion time can be identified. Similarly, input indicators that assess the project schedule may reveal services limitations caused by infrastructure that act as barriers to additional adjustments to cope with increased capacity demands.
These insights can be used to improve the field hospital construction by increasing the infrastructure service capacity or adding external services to increase capacity upon demand. Thus, the assumption can be made that well-designed indicators enable the identification of emergent problems and adjustments to the project as needed (Savaya and Waysman 2005).