Abstract
Objective: The objective of this study was to explore perceptions of senior leadership in hospitals on the motivations, cost, benefits, barriers, and facilitators of investment in emergency preparedness. Study design: This is a qualitative study which used a grounded theory approach to develop a theory of hospital emergency preparedness. Setting and study participants: A purposive sample of hospital leaders (n = 11) in the US state of Nebraska were interviewed. Results: Results showed that the environmental risk associated with the hospital location, the hospital's position in the community, and the preparedness requirements of the Centers for Medicare and Medicaid Services contribute to investment decisions. Rural hospitals face unique challenges in preparing for disasters, for example, lack of trained personnel. Facilitators of disaster preparedness include the availability of federal funds, the commitment of leadership, and an organizational mission aligned toward emergency preparedness. Hospitals invest in hazard vulnerability assessments; partnerships with other organizations in the community; staff trainings and infrastructure. Conclusions: The authors concluded that hospitals in Nebraska are committed toward investing in preparedness activities. The theory of hospital emergency preparedness developed will be used in a subsequent study to develop a decision-support framework for hospital investment in preparedness.