Designing a Decision-Making Model for Emergency Evacuation of Hospitals in Crisis Conditions

This study aimed to design a comprehensive and empirically validated decision-making model for the emergency evacuation of hospitals in crisis conditions, integrating environmental, institutional, and threat-related variables. This applied research employed a mixed-methods design. In the qualitative phase, data were gathered through semi-structured interviews with seven crisis and hospital management experts, combined with thematic analysis using Braun and Clarke’s six-step method and supported by MAXQDA software. These interviews, along with an extensive literature review, were used to identify themes and build the initial conceptual model. The quantitative phase involved the development and distribution of a validated researcher-made questionnaire, which was administered to 440 healthcare managers, decision-makers, and crisis specialists. Factor analysis, Cronbach’s alpha, and structural equation modeling (SEM) using LISREL were employed to assess the model’s validity, reliability, and predictive power. The findings confirmed the significance of three primary dimensions—external environment, hospital-related factors, and threats/crises—in shaping emergency evacuation decisions. The coefficient of determination (R²) for the external environment and hospital factors was 0.90 each, indicating very high explanatory power, while threats and crises showed a moderate R² of 0.45. All 59 questionnaire items had strong factor loadings, and Cronbach’s alpha values for each construct exceeded 0.94, confirming the tool’s reliability. Path analysis demonstrated statistically significant direct effects: external environment (β = 0.59, t = 26.47), hospital factors (β = 0.55, t = 31.03), and threat/crisis conditions (β = 0.45, t = 15.90). The study presents a validated, multidimensional model for hospital evacuation decision-making that reflects both theoretical soundness and practical applicability. The model offers a structured approach for healthcare systems to improve emergency preparedness and response capacity by aligning institutional readiness with external and situational demands.