Opportunities and Challenges for Resilient Hospital Incident Management: Case Study of a Hospital’s Response to Hurricane Harvey

Communities face unforeseen threats from natural and human-made disasters. As disasters grow more intense and critical infrastructure increases in complexity, resilience has emerged as an essential attribute of incident management systems. Despite concerted efforts to examine government organizations and their associated policies, understanding resilience traits exhibited by hospitals and healthcare systems during disasters is limited. We employ two fundamental viewpoints of safety to assess what went wrong (Safety I) and right (Safety II) during Hurricane Harvey in a large regional hospital. Through qualitative analysis of semi-structured interviews with hospital emergency management and operators, we examine both opportunities and challenges in six aspects of hospital incident management: organizational structure and functions; situational awareness; operating plans; human and physical resources; lessons learned from previous incidents; and leadership and high-level decision making. The benefits of incorporating both the Safety I and Safety II frameworks in evaluating hospital incident response and the implications of this approach for disaster management policies are discussed.