Resilience to Disaster: System Design and Future Directions.

Rapid-onset disasters pose a particular challenge to oncology services, especially radiation oncology, which is highly technical and dependent on complex equipment and digital infrastructure. Thoughtful preparation can anticipate vulnerabilities and improve disaster response; however, recommendations are still emerging and individual clinics are largely left to develop and activate their own disaster preparedness plans. A principled conceptual framework for system design is therefore needed. In this article, we discuss such a framework, mapping disaster preparedness considerations onto the widely-used Donabedian model of healthcare quality, which evaluates care across 3 interdependent domains: Structure, Process, and Outcome. We draw on examples from outside oncology-including humanitarian surgical programs and institutional pandemic responses-that have applied this model at the clinical and operational level. We demonstrate that previously reported experience of disaster response in radiation oncology maps coherently onto this framework, and we present specific design principles and practical approaches that organizations can employ. Current guidance from professional societies and accreditation bodies is reviewed, and future directions-including formal risk assessment and commercial disaster-recovery solutions-are discussed. When thoughtfully applied, these principles of system design can help oncology programs build meaningful resilience before the next disaster arrives.