Table 2 Details of interviews coding and extraction of factors influencing hospitals’ functional preparedness for disasters
Categories | Subcategories | Examples (codes) |
|---|---|---|
Leadership, command, and coordination | Identifying functions and stakeholders and defining expectations from them | Identifying and documenting the general and specialized functions/tasks and associated processes (Intra-Sectoral and Inter-Sectoral) |
Identifying stakeholders concerning general, specific, and specialized functions/tasks | ||
Determining the roles of stakeholders concerning the functions | ||
Establishing and monitoring stakeholder coordination | Organizing coordination meetings with internal and external stakeholders | |
Cooperation contract agreements and developing joint programs with stakeholders | ||
Constant monitoring of the execution of agreements and programs, as well as comparison with what is anticipated | ||
Reviewing memoranda and plans and modifying tasks and functions over time | ||
Forming specialized committees and teams | Coordination with high- and low-ranking (vertical) officials and units, as well as those of the same rank (horizontal) | |
The senior administrator of the hospital’s membership in the city’s disaster management headquarters | ||
Establishing a hospital disaster management committee, convening committee meetings timely, and follow-up approvals | ||
Forming rapid response teams and DMAT | ||
Establishing HICS | Launching the hospital incident command system and defining its activation conditions | |
Determining the disaster command system members and educating, training, and empowering them. | ||
Establishing an incident command center in the hospital (Hospital Incident Command Center) | ||
Anticipating coordination mechanisms in the command hierarchy | ||
Risk assessment | Risk identification and analysis | Identifying the hazards to the hospital and the community served |
Analyzing and rating hazards to the hospital and the community served | ||
Identifying at-risk areas | ||
Identifying and assessing weaknesses and strengths | Identifying structural and non-structural vulnerabilities of the hospital | |
Analyzing and prioritizing vulnerabilities | ||
identifying hospital facilities and capacities, hospital stakeholders, and hospital partners | ||
Estimating and ranking risks and anticipating risk mitigation measures | Calculating departmental risks and determining the hospital’s safety index | |
Anticipating and implementing risk mitigation measures | ||
Periodically updating risk assessments and analyzing hazards. | ||
Documenting and reporting hazards, vulnerabilities, and capacities of the hospital | ||
Legislation and developing protocols, guidelines, instructions, and programs | Adopting mandatory legislation to promote preparedness | Requiring all stakeholders to collaborate and coordinate with hospitals to enhance preparedness and response |
Requiring hospitals to improve preparedness through legislation mandating | ||
Requiring hospitals to use the experiences, guidelines, and recommendations of the World Health Organization and prosperous countries | ||
The importance of establishing, maintaining, and enhancing hospital preparedness in accreditation metrics | ||
Increasing the impact of preparedness-related measures in hospital accreditation | ||
Requiring hospitals to provide preparedness programs to disaster management headquarters of a city / provincial and university (strengthening the demand for hospital upgrade programs) | ||
Developing and revising preparedness protocols | Developing protocols and guidelines for enhancing hospital preparedness | |
Developing and revising protocols and guidelines for developing hospital preparedness programs | ||
Developing and revising protocols and guidelines for designing response and recovery plans for hospitals | ||
Developing and revising preparedness and response programs | Developing and revising hospital preparedness and response programs | |
Developing and revising SOPs | ||
Developing, revising, and issuing department and individual job descriptions | ||
Anticipating and storing required supplies and equipment | Storing pharmaceutical, medical, and consumable supplies | Preparing a list of pharmaceuticals, medical supplies, and consumables |
Anticipating pharmaceutical needs and storing medical supplies | ||
Providing the spaces and tools necessary for the proper maintenance of supplies and medications | ||
Reviewing the expiration dates of stored drugs and supplies and replacing them with new supplies | ||
Identifying vendors and suppliers of pharmaceuticals and supplies and concluding a memorandum of understanding with them | ||
Identifying possible centers with similar supplies and drugs and signing a cooperation agreement with them | ||
Storing required equipment | Anticipating and providing the technical equipment necessary to provide medical services and support | |
Anticipating and supplying the emergency equipment required to enhance the capacity | ||
Periodic equipment inspection, repair, maintenance, and operation assurance | ||
Preparing medical equipment booklet | ||
Constant training of personnel operating the equipment | ||
Identifying suppliers, industries, equipment maintainers, and cooperation contract agreements. | ||
Identifying possible centers with similar equipment and facilities and signing cooperation agreements with them | ||
Storing essential foods | Preparing a list of food items needed for emergencies | |
Anticipating and providing the food needed in emergencies | ||
Proper storage and evaluation of their shelf-life | ||
Replacing consumed and spoiled foods | ||
Providing proper food storage facilities and equipment | ||
Identifying food vendors and suppliers and agreeing with them | ||
Identifying possible centers with food preparation facilities and signing an agreement with them | ||
Human resources management | Providing, training, and empowering staff | Assessing the necessary human resources and anticipating how to acquire them |
Anticipating and making arrangements for human resource development. | ||
Training current personnel and volunteers | ||
Anticipating the recruitment and management of human resources | Preparing a list of current and potential personnel with their capabilities | |
Updating the list of current and potential personnel | ||
Updating personnel contact information and anticipating replacements | ||
Anticipating and practicing recruitment techniques and, if necessary, employing personnel | ||
Preparing job descriptions for individuals, issuing them, and re-issuing them as necessary | ||
Experience-based appointment of hospital administrators and officials | ||
Anticipating personnel support measures and mechanisms | Motivating employees and considering monetary and non-monetary incentives for them | |
Anticipating and providing essential supplies, food, shelter, and security for employees and their families | ||
Providing affected personnel with psychological and social services | ||
Anticipating legal and social protection mechanisms for affected personnel | ||
Considering reporting and debriefing sessions for after-disasters | ||
Anticipating monitoring, control, evaluation, and documentation mechanisms for actions | anticipating the recording of actions and experiences | |
Anticipating checklists, forms, and methods of performance monitoring and evaluation | ||
Developing a program for performance monitoring and evaluation | ||
Performing regular visits | ||
Anticipating the mechanism of preparing and documenting performance reports | ||
Identifying those who have learned lessons and anticipating the mechanism of using them | ||
Providing stakeholders with feedback, evaluations, and recommendations to address deficiencies | ||
Training, education, and development of staff | Anticipating educational requirements (educational needs assessment) | Preparing a required educational needs list (educational needs assessment) for various personnel categories |
Preparing a list of the educational requirements of patients, companions, and the general public | ||
Making a list of external stakeholders’ educational requirements | ||
Developing educational curricula and topics based on educational needs priorities | ||
Developing a timetable for training | ||
Holding training courses | Implementing training programs at the beginning and throughout the service for various personnel categories | |
Educating patients and their families after hospital admission | ||
Holding university courses related to the disaster | ||
Evaluating and revising the efficiency of adopted educational programs. | ||
Improving the perception of risks among managers, employees, and the community | Mandatory courses on disaster management and risk reduction for hospital-related professions. | |
Public and general education | ||
Improve the knowledge and attitudes of managers and stakeholders. | ||
Improving the abilities and skills of personnel and managers | Designing and carrying out round table, functional, and full-fledged exercises | |
Designing and implementing exercises with the participation of all stakeholders | ||
Practical performance of general and specific functions by all personnel categories | ||
Evaluating the effectiveness of the exercises and, if necessary, revising them | ||
Designing, implementing, and employing applied research results | Identifying weaknesses and improvements in preparedness programs | |
Developing and conducting applied research | ||
Constantly reporting research and study results to hospital administrators. | ||
Vital supplying and facilities | Anticipating energy supplies and ventilation systems | The proper power supply system and anticipating and providing support systems |
Proper fuel system planning and backup fuel supply systems | ||
Assessment, supply, and storage of alternative fuels | ||
Reliable heating and cooling system and support systems | ||
Educating relevant personnel on the use of storage systems | ||
Anticipating and supplying hospital gas needs | Anticipating hospital support systems and sustainable gas supply | |
Anticipating hospital gases and ensuring their secure storage | ||
Anticipating, supplying, and storing demanded safe water | Proper water supply and support systems | |
Anticipating and storing emergency water supplies | ||
Communication | Anticipating multi-layered access routes | Anticipating and providing the helicopter landing site |
Anticipating multiple and separate access routes | ||
Planning restrictions on hospital entrances and exits | ||
Preparing maps and geographical information | ||
Anticipating multilayer and backup communication systems | Improving current communication equipment | |
Providing wireless and satellite communication system | ||
Educating relevant personnel on the use of storage systems | ||
Designing warning systems for hospitals (such as an alarm) | ||
Providing and using proper uniforms during times of disaster | ||
Anticipating necessary arrangements for managing the media, influential people, and visitors | Developing a mechanism to manage visitors | |
Managing family and companions of the wounded | ||
Anticipating how to interact with journalists and media personnel | ||
Safety and Security (Locating and anticipating safe areas) | Safety of personnel, patients, and family | Taking safety, security, and disciplinary measures |
Managing and avoiding an overabundance of patients | ||
Anticipating arrangements for the safe zone | Identifying the hospital’s safe zone | |
Avoiding the presence of violators and opportunists | ||
Controlling clients at the hospital’s front entrance | ||
Developing necessary arrangements to employ available safe areas | Identifying and managing hospital’s safe zones | |
Anticipating hospital areas where their function can be altered | ||
Providing infrastructure for possible safe areas | ||
Identifying safe zones within the region | Identifying safe zones at the municipal/district level | |
Concluding cooperation agreements to provide safe zones | ||
Updating locations in the region | ||
Underlying disaster risk factors | Financial and economic status | The financial situation of the government (such as inflation) and the community |
The hospital’s financial status and the timely delivery of required budgets | ||
Status of emergency finance | ||
Sociocultural variables and public and governmental beliefs | General attitudes and beliefs regarding disasters | |
The state of public and official perceptions of disaster risk (attitude and belief of managers and people) | ||
Nationwide public support for program implementation and risk management | ||
How high-rank organizations support preparedness programs | ||
The precedence of law and regulation over discrimination and favoritism | ||
The priority of risk perception programs among the people and the authorities |