Disasters may impair people of any community throughout the world at any time. Disasters occur at high frequency and exert wide influence, typically causing property damage, injuries, and death. ^{Reference Hou, Lv and Ding1} Sudden disasters have affected more than 1.5 billion people of the world’s population in the past decade ^{Reference McDermott, Hardstaff and Alpen2} and enforced devastating effects on health and medical infrastructure and posed significant challenges to health systems. ^{Reference Giri, Risnes and Uleberg3,Reference Bambarén, Uyen and Rodriguez4}

Hospitals may receive an early warning for some natural disasters, eg, hurricanes and floods, and activate their response plans before the occurrence of an event. However, there is no preventive alert for some other natural disasters, such as earthquakes, at present. Some disasters affect a small number of people: therefore, there is a demand for health systems in a short period of time. Still, some others cause large numbers of casualties, followed by the massive demand for health systems. ^{Reference Mehta5} Hospitals, as the cornerstone of any health system, play a crucial role in response to natural disasters. ^{Reference Pouraghaei, Jannati and Moharamzadeh6,Reference Sauer, McCarthy and Knebel7} Hence, they must be necessarily prepared to respond to disaster and avoid it. ^{Reference Sauer, McCarthy and Knebel7} Following to disasters, necessity increases for health care in the affected areas. In this regard, increasing the capabilities of local hospitals for the management of such unusual situations enjoys the highest priority for disaster mitigation measures. ^{Reference Ochi, Tsubokura and Kato8}

Hospital managers play crucial roles in managing potential capacity effectively in disasters. ^{Reference Shabanikiya, Gorgi and Seyedin9} A disaster management program enables the hospital staff to give effective response to disaster. ^{Reference Abd elazeem, Adam and Mohamed10} Although hospital preparedness has been emphasized in many reliable study sources, the results of multiple studies have demonstrated that lack of preparedness and high vulnerability is a significant challenge for hospitals to deal effectively with disasters. ^{Reference Bambarén, Uyen and Rodriguez4,Reference Pouraghaei, Jannati and Moharamzadeh6,Reference Paganini, Borrelli and Cattani11,Reference Seyedin, Abasi Dolat Abadi and Sorani12} For example, the hospitals involved in providing relief to those injured in western Iran by the earthquake, which occurred in November 2017 in the Azgeleh-Sarpol-e-Zahab area of Kermanshah province, included many challenges for disaster response. ^{Reference Ahmadi and Bazargan-Hejazi13} Asefzadeh et al. in a review study examined 15 hospital preparedness surveys from 2007 to 2015. The results indicated that 80% of the studies estimated the hospitals’ preparedness at a moderate level (40-60%) and 13% at a low level. ^{Reference Asefzadeh, Rajaee and Ghamari14}

While hospitals are exposed to internal disasters, they also play an important role during the disaster response period. ^{Reference Hendrickx, D’Hoker and Michiels15} Frequent evaluation and monitoring to identify weaknesses and proper planning can contribute to improve the hospital safety level and ultimately improve the quality of hospital services. ^{Reference Etchegaray and Thomas16}

Health-care system managers must learn the information required in the field of disaster management and make the necessary planning to have a proper performance in disasters. ^{Reference Amiri, Mohammadi and Khosravi17}

Maintenance of capability and performance of hospitals upon disasters is important so that they can respond to a large number of patients who encountered the disaster, when performing their ongoing tasks. ^{Reference Ardalan, Sabzghabaei and Najafi18}

It is essential for hospitals to address disaster risk management. ^{Reference Sharifi, Arab and Khosravi19} The purpose of disaster risk management is reduction of underlying risk factors and preparedness for an immediate response to the emergency consequences. ^{Reference Baas, Ramamasy and Dey de Pryck20} Disaster risk management is a holistic approach to all hazards for the whole disaster cycle ^{Reference Ciottone, Biddinger and Darling21} including prevention and mitigation, preparedness, response, and recovery. ^{Reference Schipper and Pelling22}

Lack of planning and organization to deal with disasters, hospital unpreparedness, and lack of staff training may damage irrecoverably the health-care system. ^{Reference Ojaghi, Nourizadeh and Mahboubi23} Hospitals may be functionally disrupted by disasters due to the high volume of referrals, over-hospitalization, inadequate training, nonstandard and insufficient education, communication system disorders, etc. ^{Reference Ardalan, Najafi and Sabzghabaie24}

Disaster risk management reduces the adverse effects of internal and external events that detrimentally influence the organization’s activity. ^{Reference Zarezade, Abolhasani and Eslami25} Paying attention to risk management-based approaches will be very influential in improving hospital safety. ^{Reference Pretagostini, Gabbrielli and Fiaschetti26} Despite numerous studies carried out to assess hospital disaster risk management, the researcher did not achieve an integrated and comprehensive answer concerning the challenges of hospital disaster risk management. Hence, this study aimed to investigate the challenges of hospital disaster risk management so that it can take a step to provide strategies and interventions to remove these barriers and improve the hospital disaster risk management.

Methods

This study is a systematic literature review and thematic analysis to explore the challenges of hospital disaster risk management. In this study, a systematic review was performed on articles, documents, and reports related to objective of the research. The search time period ranged from January 2010 to January 2020. Persian and international databases included PubMed, Scopus, Web of Science, ProQuest, Google scholar, Sid, Magiran, and Irandoc.

Search components were “Hospital”, “Risk Management”, and “Disaster”. Equivalent words or phrases were obtained in MeSH and Emtree search engines to find the maximum number of articles. In addition, some keywords were completed or revised through related articles or after consultation with experts. The final keywords were divided into 3 groups, as described in Table 1. Then, according to the search engine, the desired syntax was adjusted, and the search was performed (Table 2).

Table 1.

Keywords of the study

Table 2.

Search syntax in PubMed

Inclusion criteria comprised of the types of quantitative, qualitative, and review articles published related to the subject and question of the research, publication in English and Persian, publication date from January 2010 to January 2020, and access to the full text of the articles. Exclusion criteria also included abstracts of congress articles and articles dealing with outside hospital area.

At the end of the search and after deleting duplicate copies, the 2 members of the research team screened articles, books, and documents independently according to their titles and abstracts, taking into account inclusion and exclusion criteria.

The full text of the remaining articles was reviewed by 2 researcher colleagues using a researcher-made form. Low-quality studies or invalid research methods were excluded. The extraction of data from the remaining articles was performed using researcher-made forms. In the event of any dispute, the paper was checked by a third peer, and the research team made the final decision. The forms (critical appraisal checklist and data extraction) were developed and processed during the study.

In addition to a descriptive evaluation in terms of study type and methodology, findings were analyzed relating to the research question and their results, and appropriately selected articles. Thematic analysis of articles was also performed at this stage.

Results

In total, 762 articles and documents were recovered. To avoid repetition, 145 articles were deleted, 414 articles and documents did not meet the objectives of the research, and 191 articles did not follow the eligibility criteria and were excluded. Finally, 12 articles were included in the study. The PRISMA diagram is displayed in Figure 1. The researchers strived to propose honest presentation of results by observance of correct procedure of source writing and intellectual property rights in excerpting the data from the studies.

Figure 1.

PRISMA diagram of studies included in the systematic review.

Most documents investigated were qualitative studies. Among them, 7 articles (58.3%) were concerned with Asia, 2 articles (16.6%) on Europe, 2 articles (16.6%) from the United States, and 1 article (8.3%) of Africa were studied. Over 75% of the documents were original articles, and 25% of them included review articles. The results derived from the systematic review are summarized in Table 3.

Table 3.

Summary of systematic review results

Thematic Analysis

Based on the given findings, the sources were subjected to the thematic analysis at this phase of study, and the extracted themes were classified, focusing on the thematic variables of the research and summarized in a data table, which included the hospital disaster risk management challenges. The accuracy and perfection of extracted themes were reviewed and confirmed by other members of the research team and some disaster experts. Their results are provided in Table 4.

Table 4.

Extracted themes and subthemes as hospital disaster risk management challenges