Exploring challenges and opportunities in hospital disaster preparedness: a qualitative study on the perspectives of hospital incident command system members

<p dir="ltr">Purpose: This study aims to explore the perspectives of hospital incident command system (HICS) members to identify key gaps in hospital disaster preparedness and set recommendations to enhance hospital resilience and disaster response capacity in Nepal. </p><p dir="ltr">Methods: A qualitative case study method was employed, involving semi-structured in-depth interviews as a sole method of data collection, with HICS members purposively selected based on their active involvement in hospital disaster preparedness. The interviews were conducted in person in Nepali language, transcribed verbatim, translated into English, and analyzed using an inductive thematic approach. </p><p dir="ltr">Results: Three themes arose from the results. The first theme highlighted the need for policy and systemic reforms, including revising staffing quotas based on updated organization and management survey, developing standardized national guidelines for hospital nonstructural safety, revising tender policies to allow greater flexibility in emergency resource procurement, and updating hospital disaster preparedness and response plans to adopt a more comprehensive, all-hazards approach. The second theme entailed strategic partnerships and community engagement, demanding formal collaboration with external stakeholders, establishing a local coordination hub to streamline disaster response efforts, and pre-disaster coordination meetings with relevant partners. The third theme was concerned with hospital-level operational reforms, suggesting capacity-building efforts like cross-training and mentoring programs, extending training to alternative HICS focal persons, aligning stockpiling strategies with local hazard risks, and assessing triage areas to ensure their functionality during actual emergencies. </p><p dir="ltr">Conclusion: Hospitals in Nepal need a coordinated effort among policymakers, healthcare administrators, frontline hospital personnel, and local stakeholders to bridge existing gaps and build a resilient healthcare system.</p>