Hospitals are central to the clinical response during respiratory pandemics, but readiness varies across health systems. This study aimed to identify and rank the critical indicators that determine hospital readiness for respiratory pandemics in referral hospitals in Kerman Province, Iran. The goal was to provide policymakers and hospital leaders with a prioritized set of indicators to guide strategic planning and resource allocation.
The authors used a mixed-method, multicriteria decision-making (MCDM) design. Initially, a semi-structured Delphi process engaged hospital managers and subject-matter experts to identify essential preparedness indicators. The Delphi work drew on the World Health Organization checklist and was adapted to reflect local conditions in the study setting.
After the Delphi phase produced a finalized list of indicators, two quantitative MCDM techniques—the Analytic Hierarchy Process (AHP) and the Best-Worst Method (BWM)—were applied to prioritize the identified indicators. Experts provided pairwise comparisons and best/worst selections as required by the respective methods, and resulting rankings were derived from these judgments.
Following the Delphi rounds, the study identified eight indicators as crucial for hospital preparedness for respiratory pandemics. The abstract specifies the top-ranked and lower-ranked items by name; the complete set of all eight indicators and their precise numerical weights are not fully reported in the abstract excerpt.
Using AHP and BWM, the indicators were ordered by importance according to expert judgment. The highest-ranked indicator was Appropriate Management Team and Planning, emphasizing leadership and preparedness planning as primary determinants of hospital readiness. The second-ranked indicator was Provision of Human Resources, and the third was Provision of Medicine and Equipment. At the lower end of the ranking, Waste Management and Disinfection of the Environment was identified as the least significant among the eight indicators in this study.
The researchers reported that the consistency ratios for both AHP and BWM were within acceptable limits, indicating reliable and coherent expert judgments in the pairwise comparisons and best–worst evaluations. This supports internal validity of the prioritized ordering derived from the expert panel.
The findings underscore the central role of effective leadership and proactive planning in hospital preparedness for respiratory pandemics. Prioritizing management structures and planning processes can enhance overall system responsiveness. Equally, optimizing human resources—including surge staffing, skill mix, and staff deployment—and ensuring timely access to medicine and equipment are critical actions to increase resilience.
For hospital administrators and health system planners, these results suggest directing limited resources first toward strengthening management capacity and preparedness plans, then to workforce strategies and supply chain resilience. Lower-ranked areas such as waste management and environmental disinfection remain relevant operational items but were judged less influential than leadership, staffing, and essential supplies in determining overall readiness in this setting.
The study was conducted in referral hospitals in Kerman Province, Iran, and indicator selection was informed by WHO guidance and local expert consensus. The abstract provides the main ranked findings and notes acceptable methodological consistency; however, detailed numerical weights for each indicator, the full list of all eight indicators with definitions, and specific expert panel composition or sample size are not reported in the abstract excerpt provided here. Generalizability beyond the study region should be considered cautiously because priorities can vary by health system context.
In this MCDM study, leadership and planning (Appropriate Management Team and Planning), workforce availability (Provision of Human Resources), and supply readiness (Provision of Medicine and Equipment) emerged as the most influential determinants of hospital preparedness for respiratory pandemics. The authors conclude that strengthening management structures, optimizing human resources, and ensuring essential supplies are key steps to enhance healthcare system resilience in the face of respiratory pandemic threats.
(Reference: Amini E et al., Disaster Med Public Health Prep. 2026; study conducted in referral hospitals in Kerman Province, Iran; methods included Delphi, AHP, and BWM. The abstract reports the ranked indicators and acceptable consistency ratios. Additional item-level weights and full methodological detail were not reported in the abstract excerpt.)