Pooling hospital resources to enhance resilience and sustainability under concurrent supply and demand shocks

Introduction Recent health crises have highlighted the structural vulnerability of hospital operations, pushing operational resilience and social sustainability to the forefront as organizational imperatives. While healthcare supply chain literature extensively addresses safety stock management, demand forecasting, and supplier diversification as resilient strategies, less attention has been given to internal hospital resource reorganization as a resilience strategy during crises. Managers lack evidence-based tools to adapt internal operations when facing distinct or simultaneous supply and demand shocks. Consequently, crisis management still relies on rigid trade-offs, often resulting in substantial delays or postponement of elective surgical care. To address this gap, this study evaluates internal cross-departmental resource pooling as an operational resilience strategy to mitigate surgical delay and preserve service continuity across mixed patient pathways. Methods A discrete-event simulation model was developed to compare two organizational configurations within a mixed-flow (emergency and elective) surgical environment: a siloed versus a pooled organization. The model incrementally tests three distinct crisis scenarios: a demand shock, a supply shock, and a simultaneous dual shock. These scenarios were applied to a real-world case study at the Fez-Meknes Regional Hospital in Morocco, encompassing 10 surgical specialties across three departments currently operating in silos. Results Simulation results demonstrate the consistent superiority of the pooling strategy across both isolated and combined shocks. Transitioning to a shared-resource system significantly improves operational resilience by optimizing emergency waiting times. Concurrently, it significantly reduces waiting times for elective patients, thereby mitigating long-term backlog accumulation and maintaining service continuity across all surgical pathways during severe disruptions. Discussion This study contributes to the literature by demonstrating how internal resource pooling functions as an operational shock absorber, linking structural flexibility directly to care equity and service continuity under multi-shock crisis conditions. Managerially, these findings provide evidence-based decision support to guide hospital administrators in breaking down departmental silos to ensure operational resilience and equitable patient care during crises.