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.
