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. 2025 May 14;23(1):56.
doi: 10.1186/s12961-025-01338-4.

Keeping healthcare afloat: a protocol for a 5-year multi-sited interdisciplinary research project into preparedness of healthcare for floods in the Netherlands

Robert A J Borst  1 , Yared Abayneh Abebe  2 , Karin van Vuuren  3 , Julien Magana  4 , Bert de Graaff  3 , Saba Hinrichs-Krapels  4 , Bas Kolen  2   5 , Maria Pregnolato  2 , Anja Schreijer  6 , Tina Comes  4 , Sebastiaan N Jonkman  2 , Roland Bal  3
Affiliations

Keeping healthcare afloat: a protocol for a 5-year multi-sited interdisciplinary research project into preparedness of healthcare for floods in the Netherlands

Robert A J Borst et al. Health Res Policy Syst. .

Abstract

Introduction: The 2021 European floods in Germany, Belgium, and the Netherlands significantly impacted healthcare. With climate change increasing flood risks, healthcare preparedness is essential. Floods affect healthcare directly and indirectly by disrupting patient access, damaging infrastructure and impeding care continuity. Our interdisciplinary research in the Netherlands systematically assesses flood impacts on healthcare, optimises disaster preparedness, patient logistics, and continuity and explores crisis governance, incorporating lessons from coronavirus disease-2019 (COVID-19).

Methods: Our multi-sited, interdisciplinary project titled "Pandemic lessons for flood disaster preparedness" includes literature reviews on: (i) the (in) direct impacts of floods on healthcare, (ii) disaster decision-making strategies and (iii) patient logistics during crises. Empirically, ethnographic methods (interviews, focus groups, document analyses, and observations) will: (a) assess hospital flood preparedness, (b) explore decision-making and crisis management strategies and (c) analyse the dynamics of health system governance during floods. Data from these sources and flood scenarios will inform models on healthcare impacts and decision-making, culminating in a simulation game for research and training.

Discussion: This study offers a comprehensive, interdisciplinary approach to understanding and improving healthcare system preparedness for floods. By integrating diverse fields such as healthcare governance, disaster risk management, logistics and hydraulic engineering, we provide a unique lens on resilience. A key strength is the incorporation of lessons from the COVID-19 pandemic, allowing us to draw parallels between pandemic response and flood preparedness. In addition, our simulation game serves as a robust tool for translating knowledge into practice. However, the study's reliance on collaboration with busy healthcare and disaster response professionals may limit engagement. Moreover, the absence of direct public and patient involvement in the research design, though partially mitigated by engaging representative organizations, presents a potential limitation. Lastly, the challenge of obtaining real-time data from flood events could introduce recall bias, but triangulation of various data sources aims to address this issue. Despite these challenges, the study's integration of long-term data from recent floods and focus on healthcare-specific crisis governance provides valuable insights for improving disaster preparedness.

Keywords: Crisis; Disasters; Floods; Governance; Healthcare; Resilience; Uncertainty.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: As researchers of two Dutch universities, all our work abides by the Netherlands Code of Conduct for Research Integrity. This code stipulates that researchers must act in an honest, scrupulous, transparent, independent and responsible manner throughout their scientific work. Considering that our team, and thus our institutional embedding, are spread across three faculties from two different universities, we have opted for a decentralized and stepped ethical design. This approach means that each WP applies for ethical clearance separately at the relevant Research Ethics Review Committee (RERC) of their faculty or university. In accordance with accepted academic practice in the Netherlands, ethical clearance is generally sought for empirical studies only and always prior to the start of the data collection. Within our wider project, ethical clearance has been received from Erasmus School of Health Policy & Management, EUR (RERC reference ETH2223-0381) and the TU Delft Human Research Ethics Committee (ID 122466). Particular care will be taken of how our research might potentially intervene in the risk behaviour or perceptions of the actors with whom we engage throughout the project. Flooding events are known to produce emotions that linger over time, including the likelihood of developing post-traumatic stress disorder [57]. Besides, we may unintentionally confront people with their risk of flooding, thereby, fuelling anxiety among such people. To minimise the risk of such interactions, a team of ethicists will advise us during the entire course of our project. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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