Organizational Responses: Introduction to Hazard Mitigation Investment Decision Making in Hospitals

Abstract

California hospitals have had to contemplate a complex web of interdependent decisions around SB 1953. The decisions have involved substantial capital commitments, extensive and not always well known opportunity costs, ongoing internal and external political maneuvering, consideration and reconsideration of decision fit with business strategy, establishing relationships with and evaluating the trustworthiness of architectural and engineering firms, and creativity in designing and implementing solutions that may not have been immediately apparent or appropriate. The decisions have not only been complex; they have had to be made again and again. As time has gone by, different players have joined the ranks of the decision makers and those charged with ensuring compliance with SB 1953 and the required regulations. Moreover, circumstances have regularly changed as amendments have been made to the law, as more information has become available, and as healthcare economics have continued to change. Traditional rational decision-making approaches have been found wanting, as “the problem” and possible solutions have been defined differently, depending on who was looking at them and when. This chapter introduces hazard mitigation investment decision making from the perspective of hospitals affected by SB 1953. Later chapters address the specific factors influencing hospital decision making.