ArticleBMJ open quality2026
Failure mode and effects analysis of fuel and LPG shortage impacts on hospital operations: a framework for healthcare resilience in conflict-related supply disruptions.
Article in BMJ open quality, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo conduct a proactive failure mode and effects analysis (FMEA) of patient safety risks arising from acute fuel and liquefied petroleum gas (LPG) shortage at a quaternary-care hospital in a modelled geopolitical conflict scenario and to produce a tiered preparedness framework.
designProactive process FMEA using the Institute for Healthcare Improvement (IHI) Healthcare FMEA framework. Risk priority numbers (RPNs) were computed as severity (S)×occurrence (O)×detection (D), each scored 1-10.
settingA 455-bed quaternary-care hospital in South India.
methodsA multidisciplinary team (infectious diseases, quality, engineering, dietetics, nursing, pharmacy) mapped 10 hospital departments across six structured sessions. The hazard scenario modelled a US-Iran war causing Strait of Hormuz closure and acute national fuel and LPG supply shock. Each failure mode was scored on S, O and D; RPN risk bands were defined as Critical (≥200), High (150-199), Medium (100-149) and Low (<100).
results62 failure modes were identified across 10 departments (RPN range 70-252; mean 143.3). 5 failure modes were Critical, 17 High, 34 Medium and 6 Low. The Generator/Power Backup department recorded the highest mean RPN (171.0), functioning as a systemic root-cause amplifier propagating risk across seven other departments. Laundry Services contained the highest-scoring individual failure mode (operating theatre/intensive care unit linen sterilisation failure, RPN 240); Kitchen Services-entirely LPG-dependent-recorded a mean RPN of 163.4. Critical clinical consequences, including ventilator failure, haemodialysis shutdown and emergency surgical cancellation, were traceable upstream to generator dependency.
conclusionsFuel and LPG shortage in a conflict scenario generates cascading, multisystem patient safety failures. Generator continuity is the paramount mitigation target. Kitchen and laundry services carry infection-control risks comparable in magnitude to clinical departments. A proactively constructed, RPN-stratified response framework is essential for hospital resilience in geopolitical emergencies.
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