As U.S. hospitals moved quickly to make plans and respond to the COVID-19 pandemic, many struggled with significant challenges in managing the crisis simultaneously with maintaining the health and safety of patients and hospital staff. This event has demonstrated the need for hospitals to develop effective emergency management (EM) programs to deal with the current crisis and future disaster events. Federal agencies and others have published guidelines on hospital EM, but these guidelines frequently change, are sometimes inconsistent, and do not describe the process for effectively managing emergencies and expected outcomes. Consequently, hospitals have invoked a variety of EM practices in dealing with COVID-19, with varying impact. The variation in EM is especially salient when comparing rural and urban hospitals, which not only differ in terms of resources and the surge in COVID-19 cases, but rural hospitals are typically located in areas with a larger high-risk population of patients with underlying conditions who can have greater complications if COVID- 19 is contracted. Therefore, it is critical to understand hospital EM in response to COVID-19 across both urban and rural settings. Building on prior research, we hypothesize that successful EM programs have distinguishing attributes. First, effective EM practices demonstrate elements of resilience, or capabilities to respond to disruptive events with minimal negative impact to performance. Second, effective EM includes a mixture of formal mechanisms such as standardized protocols and reporting structures, as well as informal mechanisms, such as adaptive routines and flexible roles. Our research examines the EM practices of 12 urban and rural hospitals to identify effective techniques and processes that enabled these organizations to provide quality care and move toward resilience during and after COVID-19. We will use qualitative and quantitative approaches to examine how the combination of EM practices employed by hospitals contributed to resilience, improved health outcomes, and stronger hospital performance overall. We first plan to conduct interviews with hospital executives and clinical leaders directly involved in EM during COVID-19 so we can identify and compare EM practices across each of the study hospitals using thematic analysis (Aim 1). Next, we will use the interview data in Aim 1 to design surveys which we will administer to key personnel at each hospital. Using factor analysis, we will develop a validated scale to assess the saliency of different EM practices, formal and informal mechanisms, and resilience (Aim 2). Last, we will conduct complementary quantitative analyses to examine patient outcomes and hospital performance in relation to the EM scales we developed in Aim 2, so that we can determine which practices and mechanisms of implementing EM were most effective. From these findings we will identify core elements and benchmarks of successful EM programs for broad dissemination (Aim 3). Through our research, we aim to provide hospitals with evidence-based EM practices that will better equip them for the current crisis and future disasters.

Public Health Relevance

During the COVID-19 pandemic, U.S. hospitals responded with a variety of emergency management (EM) practices to deal with the disaster while simultaneously providing quality care to patients and a safe environment for hospital staff. Through a mixed-method approach, this research analyzes how rural and urban hospitals effectively employed EM practices to manage a disaster event, while providing quality care for all hospitalized patients. Our findings will provide an evidence base for effective EM programs which can be used during the current pandemic and in future disaster events.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Special Emphasis Panel (ZHS1)
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Nix, Mary
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Harvard University
Public Health & Prev Medicine
Schools of Public Health
United States
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