Emergencies, including small-scale incidents and large-scale disasters, impact health care systems.1 Managing disasters involves complex responsibilities, including planning, organising, synchronising, implementing, controlling, installing, operating, disseminating information, alerting, and supervising.Reference Papp2 Managing disasters from a health services perspective aims to ensure that health services can operate at a nearly average capacity while absorbing the surge in patient presentations.Reference Johnson, FitzGerald and Burns3, 4 Health facilities and hospitals need comprehensive emergency management plans, including protocols for managing large numbers of victims and coordinating relief efforts with stakeholders.Reference Achbani, Bouchriti and Sine5
Ensuring that organizations are prepared and capable of handling any disaster is essential. Because hospitals are considered safe havens for the sick or injured, the significance of being adequately prepared cannot be overstated.Reference Gao, Wu and Li6 Health care workers (HCWs) often find themselves undertaking unfamiliar tasks in stressful environments during emergencies, necessitating a deeper understanding of disaster response protocols.Reference Ali, Ranse and Roiko7, Reference Ali, Ranse and Roiko8 Hospitals may have established preparedness measures, but HCWs may require additional training and confidence to respond effectively to disasters.Reference Sultan, Sørensen and Carlström9
There is consensus about the need to enhance HCWs’ awareness, education, and training regarding disaster-related plans.Reference Ali, Ranse and Roiko8, Reference Ali, Ranse and Roiko10, Reference Ali, Desha and Ranse11 Several emergency planning and training programs exist to equip HCWs with the necessary skills to distinguish between routine and emergency responsibilities and adhere to hospital emergency response plans.12 A comprehensive and collaborative approach to hospital disaster planning is essential.Reference Currie and Heslop13, 14 Such an approach would require the systematic involvement of HCWs from various disciplines to assess potential risks and establish robust, integrated disaster preparedness plans.Reference Al-Shamsi, Moitinho de Almeida and Nyanchoka15, Reference El Sayed, Chami and Hitti16 Moreover, there is a need to reinforce HCWs’ familiarity with accessing critical resources during disaster situations.Reference AlHarastani, Alawad and Devi17
Understanding HCWs’ perceptions of disaster preparedness is essential for devising effective operational strategies, such as tailored training and exercises, to enhance response capabilities. In addition, the extent of HCWs’ preparedness and engagement during unprecedented disasters needs to be evaluated.Reference Ali, Ranse and Roiko7, Reference Sultan, Sørensen and Carlström9 This study aimed to address these knowledge gaps through the following research questions:
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1) How do HCWs define disaster planning and preparedness within the context of hospital disaster resilience?
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2) What are the levels of engagement among HCWs in the hospital disaster planning process?
Methods
Design
This study employed an exploratory qualitative approach, incorporating in-depth, semi-structured interviews. The interviews were structured to facilitate participants’ reflections on their experiences concerning climate change impacts and disasters.Reference Hegde, Hettinger and Fairbanks18, Reference Hollnagel, Woods and Leveson19 Participants’ perspectives on factors influencing their involvement in disaster planning and preparedness were solicited.
Settings
Two hospitals were chosen for this study, one situated in the City of Gold Coast and the other in Brisbane, both densely populated cities of Southeast Queensland, Australia. This selection aimed to ensure exposure to similar challenges, opportunities, hierarchical structures, political management regimes, and adherence to identical policies. Both hospitals offer public health care services, research, surgical and trauma care, general and specialist medicine, maternity and emergency services, intensive care, outpatient care, and health education, among other things. Each hospital has over 50 000 patients annually and employs over 8000 staff members. For confidentiality purposes throughout this study, the hospitals are referred to as (H1) and (H2).
Population and sample
The research team collaborated with hospital advisors from (H1) and (H2) to discuss participant recruitment and ensure the study’s questions and logistics were appropriate for HCWs. The advisor of (H2) served as the disaster and emergency management coordinator, while the advisor of (H1) was a nursing executive. Their roles included acting as the primary liaison between the research team and their respective hospitals. Participants from H1 and H2 are designated as H1.1 to H1.6 and H2.1 to H2.7, respectively.
The sampling focused on services and departments approved by hospital management that had relevant exposure to answer the research question. Individual participants were selected in consultation with hospital advisors. The inclusion criteria were (i) hospital staff, (ii) over 18 years of age, (iii) with experience in disaster and climate change. Key health care worker profiles included managers, doctors, nurses, and auxiliary staff from relevant departments.
A pool of 20 potential candidates were identified by the hospital advisors, and this sample size was chosen to ensure meaningful data collection, with interviews conducted until data saturation was reached.Reference Malterud, Siersma and Guassora20
Data collection
Two researchers conducted each of the confidential interviews (June 2021 and April 2022), with the first author leading and a co-author observing. Each interview lasted between 45 and 60 minutes and was audio-recorded with participants’ consent. The first author transcribed the recordings verbatim using Microsoft Word and saved them in a format compatible with NVivo software for analysis. Participant details, transcripts, and recordings were coded with participant numbers to maintain confidentiality and were accessible only to researchers named in the approved ethics application.
Data analysis
Braun and Clarke’s frameworkReference Braun and Clarke21 guided the thematic analysis of interview transcripts, which used NVivo (Version 12) software.Reference Braun and Clarke21 This approach facilitated a thorough and nuanced examination of the data and transparency and consistency in the coding process. The audit trail produced by NVivo, which tracked code creation, renaming, and theme identification, strengthened the validity and trustworthiness of the analysis.Reference Lincoln and Guba22 Discussions within the research team minimised biased reporting and identified information gaps. Recruitment of participants ceased when no new themes emerged, and identified themes were organized into content domains using a matrix to identify patterns and connections. The final analysis was reviewed by researchers who were not involved in the initial coding process to enhance reliability.
Several methodological strategies were employed to ensure the credibility and trustworthiness of data analysis. Team discussions and iterative coding were utilised to refine codes and themes collaboratively, reducing bias and identifying information gaps.Reference Lincoln and Guba22 Transparency was maintained by creating an audit trail that documented code development, enhanced consistency, and mitigated personal bias.Reference Carcary23
Data saturation was reached when no new themes emerged, and themes were organized into content domains to identify patterns.Reference Malterud, Siersma and Guassora20 Multiple coders participated to improve inter-rater reliability, while diverse perspectives within the research team and reflexivity helped minimize information processing errors.Reference Schippers, Edmondson and West24, Reference Yang, Schloemer and Zhu25
Ethical consideration
The study was designed and undertaken following the principles of the Declaration of Helsinki. It was granted Ethics approval to conduct interviews with HCWs from (H1) and (H2) in Southeast Queensland by Griffith University Human Research Ethics Committee (Ref No: 2020/542- 09/09/2020), as well as from the hospital sector’s Human Research Ethics Committee (Ref. No.: HREC/2020/QGC/66944- 10/07/2020, SSA reference number: SSA/2020/QGC/66944- 06/01/2021). Informed consent was obtained from all participants involved in the study.
Results
Thirteen of the 21 invited HCWs were available and consented to be interviewed. All participants were adults aged 18 or older, comprised of 10 females and 3 males.
Disaster Types, Participants’ Roles, and Responsibilities
Participants shared diverse experiences related to various types of disasters with the interviewers. Table 1 shows participants’ diverse experiences related to various types of disasters during the interviews. Some interviewees mentioned multiple disasters, so we asked them to focus on 1 or 2 for the rest of the interview. This helped clarify the focus of each interview, which was usually centered on 1 or 2 specific disasters they had encountered.
Participants’ roles and responsibilities and types of disasters*
* H1 Hospital 1; H2 Hospital 2. Participants from H1 and H2 were designated as H1.1 to H1.6 and H2.1 to H2.7, respectively.
Additionally, the table provides insights into the roles and duties of the participants. A generic role-based identification method was employed to categorize participants into Management, Consultancy/Advisory, and Practitioner roles based on how they described their roles and in line with ethical research standards and ensuring participant confidentiality. This approach acknowledged the possibility of individuals holding multiple roles concurrently, such as both nurse and manager. Emphasis was placed on delineating their responsibilities within Clinical Services (Medical, Nursing, Surgical Perioperative, and Infection Management), Executive and organizational Capability, Human Resources, Incident Management, Operational Support Services, and Work Health and Safety.
Thematic analysis
An inductive thematic analysis was conducted on the interview transcripts to explore health care workers’ (HCWs) perspectives on “Disaster Planning” and “Disaster Preparedness.” A systematic coding process identified themes directly from the data without a pre-existing framework. As patterns emerged, disaster planning was characterised by comprehensive, multi-level planning, emphasising business continuity, risk assessment, and a proactive approach to risk mitigation. Similarly, the theme of disaster preparedness arose, focusing on implementing plans, training, resource management, operational readiness, and risk assessments. Additionally, the theme of HCWs’ Engagement in Disaster Planning emerged, capturing varying degrees of involvement, ranging from high to low, with different focuses on collaboration, compliance, and resource coordination. These themes were derived iteratively, with the continuous refinement of codes to ensure they accurately represented the data analysis.
Defining “Disaster Planning” and “Disaster Preparedness”
The interview transcripts were analysed to explore responses to the question regarding the terms “Disaster Planning” and “Disaster Preparedness,” as presented in Table 2. This analysis provided nuanced perspectives of HCWs regarding this significant aspect of hospital planning.
Participants’ definitions for hospital disaster planning and preparedness*
* H1 Hospital 1; H2 Hospital 2. Participants from H1 and H2 were designated as H1.1 to H1.6 and H2.1 to H2.7, respectively.
Participants described disaster planning as producing comprehensive, multi-level, detailed plans based on risk assessment. Participants also described it in the context of “business continuity” and as a proactive approach, emphasising anticipation and risk mitigation. Through the steps of thematic analysis, researchers delved into the intricate perspectives of HCWs, revealing comprehensive disaster planning as a pivotal foundation of hospital preparedness. In line with this, participants described disaster preparedness as “executing plans and procedures established beforehand.” Moreover, participants highlighted the importance of “education,” “training,” and “resource management” in disaster preparedness efforts. Participants focused on operational readiness and the ability to enact plans in response to emergencies. Additional recurring points of emphasis included the importance of conducting “risk assessments,” “running mock incidents,” and having oversight committees to prepare for potential disasters. Interestingly, 1 participant felt it was important to distinguish between disaster planning and preparedness. Refer to Table 2 for further details.
HCWs’ Engagement in disaster planning
The interview transcripts were analysed to explore the significance of HCWs’ active involvement in the planning process. A thematic category labelled “HCWs’ Disaster Planning Engagement” emerged through this. Captured within this theme were expressions of participants being highly engaged in disaster planning, characterised by collaborative efforts, a sense of ownership, continuous improvement, and consultation with various stakeholders at different levels. Participants described a moderate level of engagement, which incorporated risk assessment methodologies and national guidelines, with varying degrees of direct staff participation. Furthermore, other participants showed a lower level of engagement, emphasizing regulatory compliance, coordination among teams, and resource allocation, with less emphasis on direct staff involvement in the planning phase. Please refer to Table 3 for further details.
Participants’ engagement in disaster planning*
* H1 Hospital 1; H2 Hospital 2. Participants from H1 and H2 were designated as H1.1 to H1.6 and H2.1 to H2.7, respectively.
Discussion
This discussion addresses the research queries regarding HCWs’ perspectives on disaster planning and preparedness within hospital disaster resilience. Specifically, it delves into how HCWs define these concepts and examines the levels of engagement among them in the hospital disaster planning process.
Appreciation of Terminology
Eleven of 13 participants characterized disaster planning in a way that closely aligns with the literature’s definition of planning. For instance, “comprehensive plans” emphasize multi-level, detailed planning and align with how the literature defines it. Planning involves a series of tasks to achieve specific objectives, including goal setting, determining how to achieve them, designing an optimal future state, and identifying the methods and means to reach it.Reference Shafii and Hosseini26
The comprehensive planning approach advocated by HCW participants aligns with the need for detailed, multi-level strategies to prepare hospitals for diverse disaster scenarios.Reference Currie and Heslop13 HCWs’ proactive stance resonates with Priority 1 of the Sendai Framework for Disaster Risk Reduction (SFDDR), emphasizing the importance of understanding various dimensions of disaster risk, including vulnerability, capacity, exposure, hazard characteristics, and the environment. Utilizing this understanding is crucial for effective pre-disaster risk assessment, prevention, mitigation, and the development of appropriate preparedness measures and response strategies.27
The comprehensive planning aligned with the Queensland Emergency Risk Management Framework Risk Assessment Process Handbook, covering Local, District, and State Disaster Management Plans; Business Continuity Planning; Functional Plans; and Hazard-Specific Plans.28 These plans address hazard actions across all phases of disaster management, while business and operational continuity planning within the health system ensures readiness for potential disruptions.29
Business continuity is a holistic management process that offers a comprehensive framework for effective response. Business continuity plans aim to mitigate events’ impact on a firm’s capacity to fulfil customer requirements.Reference Margherita and Heikkilä30 Both “comprehensive plan” and “business continuity” align with planning in Queensland that occurs at various levels, guided by the Disaster Management Act 2003, the Standard for Disaster Management, and the Queensland Prevention, Preparedness, Response, and Recovery (PPRR) Disaster Management Guideline.31, 32
The results regarding HCWs’ perspectives on disaster preparedness reveal various facets that align with established literature. HCWs perceive preparedness as implementing pre-established plans and procedures. This resonates with the World Health Organization’s (WHO) definition of preparedness as actions taken in advance to anticipate, respond to, and recover from hazardous events.33 This underscores the importance of comprehensive preparedness plans for effective responses to potentially hazardous events.34 Preparedness is “the knowledge and capacities developed by governments, response and recovery organisations, communities, and individuals to effectively anticipate, respond to, and recover from the impacts of likely, imminent, or current disasters.”34 The proactive approach highlights anticipation and risk mitigation. Mitigation involves reducing or limiting the adverse impacts of hazards and related disasters.35
HCWs’ engagement and participation in disaster planning
The current study emphasises the vital role of active participation and sufficiency in disaster planning engagement, aligning with the authors’ previous research on challenges in disaster preparedness awareness.Reference Ali, Ranse and Roiko7, Reference Ali, Ranse and Roiko8, Reference Ali, Ranse and Roiko10, Reference Ali, Desha and Ranse11 This approach involves assessing the effectiveness of existing and alternative coping capacities in probable risk scenarios, fostering a culture of continuous learning and improvement.34 The moderate and low engagement observed among 6 of 13 participants underscores the critical need for education, training, and resource management in disaster preparedness efforts. This aligns with the World Health Organization’s (WHO) emphasis on knowledge and capacity development for effective disaster response.33 Furthermore, participants’ focus on operational readiness and the ability to enact plans in response to emergencies highlights the paramount importance of planning and capability integration, as articulated in Queensland’s disaster management framework. The emphasis placed by HCWs on risk assessment, conducting mock incidents, and establishing oversight committees mirrors the WHO’s recommendation that hazard monitoring and early warning systems are essential components of preparedness.31, 33 Disaster risk assessment is “a qualitative or quantitative approach to determine the nature and extent of disaster risk by analysing potential hazards and evaluating existing conditions of exposure and vulnerability that could harm people, property, services, livelihoods, and the environment on which they depend,” further underscoring the comprehensive approach necessary for effective disaster preparedness.34
These findings highlight the significance of continuous learning and improvement, as supported by global health organizations advocating for Interprofessional Education (IPE) to enhance health care systems. This echoes earlier calls for innovative training methods, such as visualizations and simulations.Reference van Diggele, Roberts and Burgess36, Reference Singh and Lillrank37 Furthermore, the findings align with Queensland’s proactive regulatory and training initiatives, as evidenced by the QLD Disaster Management Training Framework, which covers various aspects of disaster management. This framework, supported by Queensland’s Disaster Management Act 2003, underscores the necessity for comprehensive training.32, 38
Limitations of the Study
Given the focus on disaster resilience, there was a concern that the researchers might encounter political or institutional sensitivities related to classified information, public awareness campaigns, and past events. To mitigate this risk, the researchers addressed political and institutional sensitivities in discussions with project advisors before each round of interviews. Additionally, limitations included the non-generalizability of in-depth interviews, their time-consuming nature, the need for a prolonged verification process, and challenges in providing contextual information.
Conclusion
The study found that health care workers (HCWs) emphasized their need for pre-established plans, education, training, resource management, operational readiness, and risk assessment for disaster preparedness. Their focus on comprehensive, multi-level planning aligns with global priorities on disaster risk reduction. HCWs also stressed the importance of continuous learning, which supports global health organizations’ calls for Interprofessional Education (IPE) to strengthen health care systems.
The findings highlight the importance of active engagement and training in disaster planning, aligning with proactive initiatives such as those in Queensland. Recommendations include improving training methods and developing detailed preparedness strategies for hospitals.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/dmp.2025.3.
Data availability statement
The data supporting the results are interview transcripts, which can be made available upon written request of the corresponding author.
Acknowledgments
The corresponding author is a recipient of the Griffith University PhD scholarship [Postgraduate Research scholarship, and a Griffith University International Postgraduate Research scholarship]. The authors acknowledge the hospital advisors and the interviewees for contributing to this study.
Author contribution
Conceptualization, H.M.A., and C.D.; methodology, H.M.A., J.R., A.R., and C.D.; software (NVivo), H.M.A. and A.R.; validation, H.M.A., J.R., A.R. and C.D.; formal analysis, H.M.A., J.R., A.R. and C.D.; writing—original draft preparation, H.M.A.; writing—review and editing, H.M.A., J.R., A.R. and C.D.; visualization, H.M.A. and C.D.; supervision, J.R.; A.R. and C.D. All authors have read and agreed to the published version of the manuscript.
Funding statement
This research received no external funding.
Competing interest
The authors declare no conflicts of interest.
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