NFPA Journal - January/February 2020 - 51

Addressing the problem
One way fire and life safety at international hospitals seems to be improving
is through the globalization of health
care-specifically, the involvement
of US-based organizations in these
facilities, whether it's a US hospital
opening or advising a facility overseas
or an international hospital contracting
with a US fire protection engineering
consulting firm. While there are no
statistics to prove this is the case, anecdotal evidence supports it and nearly
everyone interviewed for this article
said they had noticed increased efforts
like these over the past five to 10 years.
"The US health care system gets
criticized a lot, but we are by far the
people others ask for help," Brett Spencer, partner and managing director
of Boston Consulting Group's health
care business, told Hospitals & Health
Networks magazine in September 2016.
The magazine said the demand of US
health care expertise was "strong and
growing in many regions of the world,
particularly the Middle East" at the
time. "The Middle East has always
been interested [in US health care]. In
Southeast Asia and China, I think it has
to do with the significant rise in the
upper middle class. They aren't wealthy
enough to fly to the US for care, but
they want more than they can get from
the public health service," Spencer said.
D'Antona said not much has
changed in the past three years. He,
too, identified the Middle East as well
as China as the markets most ripe
for US health care intervention heading into the future. "They look very
aspirationally toward our health care
systems," he said.
About six years ago, Hamad Medical
Corporation, the largest hospital chain
in the tiny Middle Eastern country of
Qatar, reached out to two US-based fire
protection engineering firms asking for
help improving fire and life safety at
their facilities, Koffel said. Koffel's firm
was one of those companies, and it sent
employees on the nearly 7,000-mile trek
to study Hamad's facilities.
"We surveyed all of their hospitals
the same way we would survey hospitals in the US," he said. "Then we told
them they had to do the same thing

that's done in US hospitals-identify
all their problems and create a plan for
improvement."
Another trend that's helping fight the
fire problem in international hospitals
is US-based health care organizations
opening their own hospitals or partnering with existing hospitals overseas.
In 2017, the Baltimore Sun reported
on this trend, noting that Massachusetts General Hospital in Boston had
announced it was helping Jiahui Health
in Shanghai open a hospital. The Cleveland Clinic opened a 364-bed hospital

Hospitals in low"and
middle-income

countries often lack
strict building codes,
certification processes,
and regulatory oversight.
Everything from poor
construction to a lack of
emergency preparedness
within the hospitals can
lead to adverse outcomes
in staff, visitors, and
the most vulnerable
population-patients-
during fires or other
emergencies.

"

in Abu Dhabi in 2015, the Sun said;
the clinic also managed Sheikh Khalifa
Medical City, a 586-bed acute-care hospital in Abu Dhabi, and had recently
bought a health care facility in London.
Additionally, the Mayo Clinic and Partners Harvard Medical International
had also expanded to other countries,
the Sun reported, and Baltimore's own
Johns Hopkins Hospital had 19 projects
occurring overseas at the time the article was published.
As for why hospitals are doing this,
the Sun pointed to the altruistic motive
of wanting to save lives and improve
patient care in other countries, as
well as the financial benefits such
projects can have for US health care
organizations. Many US hospitals have

found themselves bleeding money in
recent years as insurance companies
increasingly deny reimbursement for
nonemergency care at hospitals, driving patients to nonhospital facilities
like urgent care centers. But in non-US
markets, US-based hospitals can profit
from their name alone. It's similar to
how large hotel chains like Marriott,
based in Maryland, have long profited
off the appeal of their brand in other
countries. "Most people would rather
go to a hospital with a name they know,
like Johns Hopkins or Cleveland Clinic,"
Koffel said.
But the trend can also have the
indirect effect of improving safety at
international hospitals.
These facilities are often approved by
international health care accreditation
organizations such as the Illinois-based
Joint Commission International
(JCI). According to a 2017 copy of its
accreditation standards, JCI requires
a hospital to establish and implement
"a program for the prevention, early
detection, suppression, abatement, and
safe exit from the facility in response to
fires and nonfire emergencies."
JCI accreditation is "an important
indicator of the high quality of care
that is being provided, including the
environment of care," said Gershon, the
NYU researcher. Right now, there are
about 1,000 JCI-accredited hospitals in
more than 65 countries outside of the
US. "As more hospitals become accredited, we will see improvements in
hospital emergency management-similar to what we've seen in the US over
the years," she said.
But Gershon was quick to point
out that cost and government action
will serve as barriers to this foreseen
advancement. It all comes back to the
Ecosystem, and the fact that safety
in international hospitals won't be
achieved through just one avenue. It
can only be achieved through "sizeable
investments in personnel, training,
accreditation, equipment, infrastructure, and, most importantly, policies
and procedures," Gershon said. "Political will and financing is needed for all
of these elements to come together."
ANGELO VERZONI is staff writer for NFPA Journal.

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