Best Practices of Hospitals in Management of
Epidemic Conditions: A Scoping Review
Ali Tahmasebi1, Iravan Masoudi Asl1, Aidin Aryankhesal1 , Soudabeh Vatankhah1 , Gholamreza Masoumi2
1 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical
Sciences, Tehran, Iran.
2 Department of Health in Disaster and Emergencies, School of Health Management and Information Sciences, Iran University of
Medical Sciences, Tehran, Iran.
GMJ.2023;12:e2824
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Correspondence to:
Iravan Masoudi Asl, School of Health Management and
Information Sciences, Shahid Yasami Street, Tehran,
Iran.
Telephone Number: 09125993822
Email Address: masoudiaslirvan@gmail.com
Received 2022-11-20
Revised 2023-01-01
Accepted 2023-03-18
Abstract
Background: Many hospitals globally have valuable experiences in preparing for man-
agement and responding to infectious epidemics. Identifying and analyzing these expe-
riences can provide comprehensive and practical data for decision-making and eec-
tive performance. This study aimed to conduct a scoping review and content analysis
of the best practices of hospital (private or public) management in epidemic conditions.
Materials and Methods: This research is a scoping review and content analy-
sis, conducted in 2021. Data was collected by searching dierent databases, includ-
ing Pubmed, Scopus, Web of Sciences, ProQuest, websites, search engines, and pub-
lic reports without time limits. Content analysis was performed for data analysis.
Results: We retrieved 8842 records from databases and other sources. Finally, 24 studies from
12 countries were selected for analysis. Most studies belonged to the United States (9 cas-
es), and most subjects were on Coronavirus disease 2019 (Covid-19) (19 studies). We clas-
sied the results into two major categories of in-hospital executive readiness and logistic
readiness. Executive readiness included 11 main categories (physical structure, resource man-
agement, exposure reduction, patients and caregivers’ management, corpse management, dis-
infection, sta support, patient admission, instructions and guidelines, tele- communication,
and education) and 26 sub-categories. Logistic readiness consisted of three major categories
(leadership/team making, communication, and using capabilities) and ve sub-categories.
Conclusion: Healthcare managers can use the identied categories and dimen-
sions of managerial readiness and responsiveness as an action plan during an in-
fectious disease epidemic. [GMJ.2023;12:e2824]DOI:10.31661/gmj.v12i0.2824
Keywords: Practice; Hospital; Management; Epidemic Condition
Introduction
Due to climate and environmental
changes and other known and unknown
events in recent decades, a new diseases
called “Emerging Diseases” are threatening
global health. The main reasons behind the
emergence and prevalence of these diseases are
facilitated international traveling, changes in
diet and lifestyle, migration, marginalization,
and others. Thus, environmental changes
can lead to new infectious or communicable
diseases [1]. Regarding the scale and eects
of infectious epidemics, health systems
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Tahmasebi A, et al. Practices of Hospitals in the Management of Epidemic Conditions
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must have plans to deal with these situations
without planning and strong health policies,
countries will face many challenges imposing
a high workload on the healthcare system [2].
These issues include economic turmoil,
social anxiety, unresponsiveness of the
healthcare toward patients, and loss of health
professionals and healthcare providers.
Therefore, the health system needs to address
these diseases in a precise and targeted manner
[2].
An infectious disease outbreak causes many
challenges for health centers, especially
hospitals and healthcare providers. Healthcare
sta compliance with guidelines on
preventing and control of infection, isolating
respiratory patients, sanitizing environment
and equipment, absence of obligatory
training, isolation rooms, waiting rooms and
high-quality equipment, minimizing crowds,
immediate identication of infected people,
minimizing visitors, and easy access to
hand hygiene facilities are among the most
important challenges [3]. A qualitative study
by Kian Lio et al. in Hubei, China, with
the participation of nurses and physicians,
showed that physical problems including
exhaustion due to work pressure, physical
and psychological disorders of the sta,
lack of isolated rooms, lack of medical sta,
dierent and contradictory guidelines, and
sta communication-related problems with
dierent specialties and experiences were
the most common problems in hospitals [4].
Other studies showed that the lack of medical
sta, lack of Personal Protective Equipment
(PPE), sta exhaustion and heavy workload,
sta mental problems, unknown nature of the
disease, hospitals economic challenges, and
communication-related problems were other
challenges in hospitals in Coronavirus disease
2019 (Covid-19) patient management [3-8].
The review of literature on hospital problems
in managing infectious patients and also the
study of healthcare providers’ experiences
showed that hospitals in many countries
and states have many experiences and face
many challenges and problems [4, 5, 9, 10].
In addition, dierent hospitals and people
may propose many strategies to promote the
hospitals’ performance and management of
infected patients [4, 11-14].
Hospital management during outbreaks is
dierent with responsibilities ranging from
preventing disease spread among hospitalized
patients to training the sta and hospitalized
patients. In addition, during epidemics
and outbreaks of communicable diseases,
the capacities of hospitals to respond are
dierent and need dierent management in
hospitals depending on the local situations
and their dierent requirements [15, 16]. In
crises, including the outbreak of the recent
coronavirus, hospitals needed to acquire the
capacity to confront the sudden increase in
the number of referring patients requiring
ecient management [17].
A review of the literature revealed that during
infectious epidemics, dierent hospitals
worldwide, especially in high-income
countries, use diverse strategies to respond
properly to crises [18-23].
Considering many achievements of these
interventions and programs in dierent
hospitals, around the world, in terms of
readiness and responsiveness to the outbreak
of infectious diseases, their evaluation can
provide practical and comprehensive data
for better decision-making and ecient
performance at the time of epidemics.
Therefore, the present scoping review aimed
to evaluate hospital experiences in dierent
countries and assess the best practices of
hospitals in managing epidemic conditions.
Considering mentioned conditions and due
to covid 19 epidemic eects on hospital
performances and high rate of mortality and
the importance of gathering related practices
to managing epidemic conditions, the scoping
review was used as reviewing method.
Materials and Methods
The present scoping review and content anal-
ysis was conducted in ve phases in 2021.
The phases included: 1: identication of the
research question, 2: identication of relevant
studies, 3: study selection, 4: data charting, and
5: data analysis and reporting the results. We
adopted the scoping review approach from the
book entitled "systematic review to support
evidence-based medicine" [24]. Main key-
words and sample search strategy in PubMed
are shown in appendix. Also, this study’s eth-
Practices of Hospitals in the Management of Epidemic Conditions Tahmasebi A, et al.
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3
ics code is IR.IUMS.REC.1399.1100 of the
Iran University of Medical Sciences.
Phase 1: Identication of Research Question
The primary research question was: what hos-
pitals around the world have taken measures
in managerial readiness and responsiveness
to infectious epidemics, and what experiences
do they have?
1.1. Inclusion and Exclusion Criteria
The papers indicating the hospitals’ measures
and experiences in dierent countries in man-
agerial readiness and responding to infectious
epidemics in both Persian and English lan-
guages were included. The search time was
unlimited.
1.2. Exclusion Criteria
Articles and reports that were not just about
hospital readiness and responsiveness (stud-
ied health system or a country).
Articles quantitatively assessing a hospital’s
performance or achievements.
Articles reporting a special act or the hospi-
tal’s measure as a case.
Articles only elaborated on the concepts and
models of hospitals readiness or responsive-
ness in infectious epidemics.
Studies reporting hospitals’ readiness or re-
sponsiveness against other crises including
earthquakes, oods, res, and others.
Phase 2: Identication of Relevant Studies
We used experts’ comments, literature re-
view, assistant librarian, EMTREE terms, and
Medical Subject Headings (MeSH) to extract
keywords. We collected the required data us-
ing keywords from PubMed, Scopus, Web of
Sciences, and ProQuest (Appendix 1: search
strategy). The search time was unlimited. We
manually searched several valid journals after
databases to identify and cover more papers.
We conducted citation checks and reference
checks for selected papers in Google Scholar.
We also searched the European Association
for Grey Literature Exploitation (EAGLE),
Healthcare Management Information in Con-
sortium (HMIC), and the System for Informa-
tion on Grey Literature in Europe (SIGLE)
for grey literature. In addition, we scrutinized
the ocial websites of courtiers’ ministries of
health and international organizations such as
the World Health Organization (WHO) and
the World Bank. The search strategy details
are included in supplementary le 1.
Phase 3: Study Selection
Two members of the research team inde-
pendently carried out the study selection. They
solved the rst stage of controversy through
discussion. In two cases, they referred to a
more experienced third party. First, they stud-
ied the titles and excluded irrelevant studies.
Next, they evaluated the abstract and full texts
to identify and exclude the irrelevant studies
endnote (version 5) was used to organize and
analyze the titles and abstracts and to detect
duplication. PRISMA owchart [25-27] was
applied to report the results of the study se-
lection (Figure-1). For preventing personal
bias, two authors screened the papers and if
in some cases did not reach an agreement, a
thirdparty expert made the nal decision.
Phase 4: Data Gathering
We designed two manual data charting forms
using Microsoft Word (version 2016 manu-
factured by Microsoft company in the USA)
software for data collection and consultation
with research team members, according to the
objectives. The rst (main) form showed the
general information about the article and its
major results. The charted data included au-
thors, publication year, country, article type,
objectives, epidemic, major elds, subordi-
nate elds, and conclusion. The second (com-
plementary) form dealt with more detailed
information. It avoided the perplexity of the
primary form and provided more complete
data about the article. This form also includ-
ed the author, publication year, and main and
subordinate elds. Initially, the data from
three articles were extracted as a pilot study,
and then, the defects in the forms were solved.
Two research team members extracted data
from the selected studies and solved the am-
biguities.
Phase 5: Data Analysis
After collecting the data, we analyzed them
through content analysis and then summarized
and reported them. The content analysis iden-
ties, analyzes, and reports patterns (themes)
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Tahmasebi A, et al. Practices of Hospitals in the Management of Epidemic Conditions
inside a text. It has many uses in qualitative
data analysis [28-31]. Two research members
independently encoded the data. The sequence
of data analysis and coding was familiariza-
tion with the texts (immersion in the results),
identication and extraction of primary eld
(identication and extraction of more relevant
articles to primary elds), articles placement
in their elds, revision and completion of the
results of each eld using the results of the
articles in that eld, and getting ensured about
the reliability of the elds and extracted re-
sults in each eld (gaining agreement between
two coders through conversation and solving
the problems). We reported some descriptive
data using descriptive statistics, including
percentage, frequency, and others. Microsoft
Excel (version 2016) was used to draw charts.
Results
Article Selection
We found 8842 articles from databases and
other resources and excluded 2457 cases for
duplication. Also, 6214 articles were exclud-
ed by title check, and 147 studies by checking
their full texts. Finally, we included 24 stud-
ies (Figure-1). After a complete evaluation,
we entered data charted tables (Appendix
1, provided in supplementary le 1). In this
study, we identied and analyzed 24 cases of
hospital experiences from 12 countries. Most
were in the US (9 cases), China (3 cases), and
Italy and Singapore (2 cases for each). Most
of the studies (17 cases) were conducted in
high-income countries and two of them were
from lower middle income (Iran) and middle
Figure 1. Selection of studies on the hospital’s managerial readiness and responsiveness to infectious
epidemic
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Practices of Hospitals in the Management of Epidemic Conditions Tahmasebi A, et al.
Figure 2. The schematic pattern of results from the content analysis of studies on hospitals' readiness and
responsiveness during infectious epidemics
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Tahmasebi A, et al. Practices of Hospitals in the Management of Epidemic Conditions
Table 1.Main and Sub-categories Extracted from Studies On the Executive Readiness of Hospitals during Infectious Epidemics, Explanations, Examples
Main category Sub-category Explanation Example (reference)
Physical structure
Segmentation of units Changes in the physical space of medical units according to patients and hospital’s needs,
dividing them into two infectious and non-infectious units Baggiani et al. (32) - Italy-in Covid-19
Specifying pathways, accesses/
movements Specied commuting routes in hospital for specic people who could move under specic
conditions Macron et al. (33)- Italy-in Covid-19
Arranging the unit according to
the infection control principles Special focus on the ventilation in all clinical and non-clinical units and the rooms Buising et al. (34) –Australia-in Covid-19
Resource management
Providing resources (human,
medications, beds, etc.) Provide necessary resources in dierent ways in the time of infectious epidemics
Ogoina et al(2016) (35)- Nigeria- in Covid-19
Ma J et al. (2020) (36)-China-in Covid-19
Distribution of resources (human,
medications, beds, etc.). Eective and ecient distribution of resources in hospitals during epidemics Schiller et al. (2020) (37)-USA- in Covid-19
Exposure reduction
policies
Avoiding students and interns’
entrance Reducing exposure to disease agents and minimize the exposure to unnecessary entrance for
medical students
Jebelli B, et al:2020 (38)- Iran-in Covid-19
Minimizing non-medical sta
(logistic)
Included remote working, homecare services, and utilizing modern technologies for visits
and holding online meetings Buising et al. (34) –Australia-in Covid-19
Lowering down commuting Changes in commuting routes, decreased caregivers visits Jebelli B, et al:2020 (38)- Iran-in Covid-19
Buising et al. (34) –Australia-in Covid-19
Patients and caregivers’
management
Triage and screening Patients screening, diagnosis of infectious, separating them, and their protection Baggiani et al. (2020) (32) - Italy-in Covid-19
Lab examinations Nasopharyngeal swab examination and in case of positive result the case was transferred to
Covid-19 unit in emergency through specied routes
Baggiani et al. (2020) (32) - Italy-in Covid-19
Change in plans and minimizing
visits
Patients were kept and visited in isolated units in both pediatric and adult emergencies but the
same was done in the pediatric clinic in the afternoons.
Cannava et al. (2010) (39)-China- H1N1
inuenza outbreak
Corpse management
Preparing corpse
Corpse transfer from the unit to the hospital morgue must use proper Personal Protection
Equipment (PPE). The corpses should be covered properly in a bag. After they enter the
morgue they must be kept in a cool area preferably in the lower row of the shelf. Also it
must be written on a black board that this body is the body of covid-19 patient. Before the
con is closed, a member of the family must be allowed to see the body at least from a
distance of 2 meters.
Baggiani et al. (2020) (32) Italy-in Covid-19
Death report and medical
documentation
Deaths from the disease in hospitals were assessed by a group of specialists from dierent
elds, infection control ocer, and a trained nurse and they have prepared report and sent it
to the hospital and local authorities
Arya SC, et al:2004 (40)-India- dengue
outbreak
continue on next page
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Practices of Hospitals in the Management of Epidemic Conditions Tahmasebi A, et al.
countinue of table 1. Main and Sub-categories Extracted from Studies On the Executive Readiness of Hospitals during Infectious Epidemics, Explanations, Examples
Disinfection plans
Disinfectants Using Ethyl alcohol biocides (70%), Hydrogen peroxide (0.5%), Sodium hypochlorite (0.1-0.5
chlorine free) and other sanitizers to disinfect medical equipment according to the European
standard (476,EN 14).
Baggiani et al (2020) (32) Italy-in Covid-19
Working plans and procedures Sanitizing sta were properly trained and they were cleaning Covid-19 patients’ rooms
Jebbeli et al. (2020) (38)
Iran-in Covid-19
Baggiani et al (2020) (32) Italy-in Covid-19
Sta support
Safety tools and PPE Providing safety personal protection equipment’s including mask, shield, and etc.
Walsh A,2021 (41), Canada-in Covid-19
Wong et al (2020) (42), Singapore-in Covid-19
Reorganizing plans and working
units Supportive interventions, team working, and self-care, exibility, and tolerance techniques were
provided by hospitals managers to health sta
Gupta S and Federman DG.2020 (43) - USA-in
Covid-19
Remote working and decreasing the
exposure of high-risk personnel Sending high-risk sta for remote work and In some cases, these people were isolated in their
homes for 12 weeks
Britton CR,2020 (44) – UK-in Covid-19
Changing patient
admission policies
Minimizing electives medical cases
Minimizing elective and non-emergency patients’ admission. Usually, it happens for minimizing the
probability of patients and their caregivers’ infection, decreasing medical equipment consumption
and allocating them to infectious patients, and concentrating health sta on infectious patients
Jebelli B, et al:2020(38)- Iran-in Covid-19
Minimizing surgeries lowering the number of elective surgeries and the allocation of almost 80% of Whole Time
Equivalents (WTE) to Covid-19 patients by changing working schedules and concentration of
health sta on Covid19 patients.
Britton CR,2020 (44) – UK-in Covid-19
Iannuzzi NP, et al:2020(45) - USA-in Covid-19
Instructions and
guidelines
Developing guidelines and
instructions Designing and developing guidelines and protocols to treat infected patients
Filice et al (2013) (46)-USA-
H1N1 inuenza outbreak
Lombardi et al. (2020) (47) - USA-in Covid-19
Utilizing guidelines and instructions Using national guidelines and protocols and developing protocols based on their needs Buising et al (2021) (34) Australia-in Covid-19
Using telecommunications
Holding meetings, conferences,
classes, etc. online Using remote communications and cyberspace for organizational goals during epidemics
Shao et al. (2020) (48)-China- in Covid-19
Jebbeli et al. (2020) (38)
Iran-in Covid-19
Online services and counselling to
people
and patients Providing patients and community online services on medical and mental health Shao et al. (2020) (48)-China- in Covid-19
Schwaezkopf et al (2020) (49) USA-in Covid-19
Training
Training personnel Training personnel about self-protection, using PPE, ways of transmission, etc during epidemics Chopra V, et al:2020 (50)- USA-in Covid-19
Xiang et al (2020) (51) -China- in Covid-19
Training people general training of patients about self-protection Xiang et al (2020) (51) -China- in Covid-19
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Tahmasebi A, et al. Practices of Hospitals in the Management of Epidemic Conditions
income (Nigeria). Covid-19 was the most re-
ported epidemic (19 studies). Other epidem-
ics were Flu (2 studies), Ebola (2 studies), and
dengue fever (1 study). Mortality rates of in-
fectious diseases for each country are shown
in the appendix data extraction. The content
analysis of measures and experiences of 24
hospitals from dierent countries helped clas-
sify the results under two major categories of
executive readiness and logistic readiness.
Executive readiness included 11 major cate-
gories and 26 sub-categories. Logistic readi-
ness covered three major categories and ve
sub-categories (Figure-2, Table-1 and -2).
Executive Readiness: Dimensions
The hospital executive readiness included 11
main categories (Physical structure/Resource
management/Exposure reduction policies /
Patient and caregivers’ management/Corpse
Table 2. Main and Sub-categories Extracted from Studies on the Logistic Readiness of Hospitals during
Infectious Epidemics, Explanations, Examples
Main category Sub-category Explanation Example
(reference)
Leadership/team
making
Forming
leadership
team with the
participation
of managers
and dierent
stakeholders
Some hospitals at the onset of epidemic
formed a leadership team with the presence
of dierent specialists and dierent people
from dierent units
Gupta S and
Federman DG.2020
(44) - USA-in
Covid-19
Walsh A,2021
(41), Canada-in
Covid-19
Utilizing
capabilities
Utilizing the
capabilities of
other wards
and specialties
During an outbreak some wards such as
emergency and ICUs are more engaged
than others. Due to the decreased number
of patients there must be a plan to utilize
the sta and facilities of other wards.
Iannuzzi NP, et
al:2020(45) - USA-
in Covid-19
Britton CR,2020
(43) – UK-in
Covid-19
Using the
capabilities
of other
governmental
organizations,
military forces,
voluntary
people and
NGOs etc.
Many hospitals have plans to use the
capabilities of organizations, military
forces, voluntary people and NGOs along
with their capabilities in other wards. They
were successful in utilizing them especially
in terms of resources.
Jebelli B, et
al:2020(38)- Iran-
in Covid-19
Lateef O, et
al:2015 (52)-USA-
Ebola virus disease
(EVD)
Communications
Intra-
organizational
Eective communication with other
wards and units inside hospitals and other
hospitals and other parts of health system
to fulll needs and defects was the routine
plan and priority of hospitals during
outbreak
Britton CR,2020
(43) – UK-in
Covid-19
Marcon E, et
al;2020 (33) –
Italy-in Covid-19
Buising KL,
et al:2021
(34)-Australia-in
Covid-19
Inter-
organizational
Many hospitals, along with their own
intra-organizational communications,
plan to establish extra-organizational
communications with other organizations
and layers of community to advance their
plans and control the outbreak eciently
Chopra V, et
al:2020 (50)- USA-
in Covid-19
Arya SC, et
al:2004 (40)-India-
dengue outbreak
management/Disinfection plans/Sta sup-
port/Changing Patient Admission Policies/
Instructions and Guidelines/Instructions and
Guidelines/Using telecommunications/Train-
ing) and 26 subcategories during infectious
outbreaks. Table-1 shows their description
and examples.
Logistic Readiness: Dimensions
The results of the major categories (leader-
ship/team making, communication, and using
capabilities) and ve subcategories in logistic
readiness of hospitals during infectious out-
breaks and their explanation and examples are
presented in Table-2.
Discussion
By reviewing and content analyzing the expe-
rience and behavior of 24 hospitals in dier-
ent countries during infectious epidemics (es-
pecially Covid-19), we divided their readiness
and responsiveness into two main dimensions
of executive readiness (11 categories and 26
subcategories) and logistic readiness (3 cat-
egories and 5 subcategories). This study in-
cluded 14 categories and 31 subcategories.
Evaluation of studies on hospitals’ readiness
and responsiveness during infectious epi-
demics showed their comprehensiveness and
maximum conceptual coverage. For example,
Ippolito et al. (2006), preliminarily review-
ing the literature on hospitals readiness and
responsiveness during infectious epidemics
and bioterrorism, pointed out ve categories,
including clinical awareness and education,
initial investigation and management, surge
capacity, communication, and caring for sta
and others [53].
In a comprehensive report by WHO (2014)
on the readiness of hospitals during infectious
epidemics, the authors mentioned ecient
management, an infection control plan, com-
munications, human resource management,
logistics, hospital pharmacy, hospital emer-
gency, hospital laboratory, providing basic
services, stability of services, mental-psycho-
logical services, supports, and capacity of sur-
gery rooms as the most crucial factors [54].
Ghotbi et al. (2020) evaluated WHO reports
and scientic papers and suggested hospi-
tal management strategies during Covid-19.
They discussed triage management, acute
respiratory disease clinics, patients’ quaran-
tine in healthcare-providing centers, proce-
dures and experiments, sta, call tracking,
the healthcare system, and general education
(non-pharmacological interventions) [55].
Considering infectious diseases-related crisis
involving a large number of people in a com-
munity and high hospital occupancy, and a
high potential for exposure of hospital man-
agers and sta to infectious agents, hospitals
should be highly prepared and increase their
capabilities to respond to patients in the short
term. Therefore, adequate resources, instruc-
tions, and evidence can help hospital manag-
ers. The model presented in this study and the
dimensions derived from a review of dier-
ent hospital experiences during the epidemic
can be used as a practical and comprehensive
guide by hospital and health system adminis-
trators. The key points are dierences in hos-
pital needs, regional characteristics, hospital
readiness and responsiveness, depending on
the country or region. Therefore, each hospi-
tal should plan to use models and instructions
according to the local setting and its circum-
stances.
A key issue highlighted by the current study
and research reviewed in other resources
is adequate sta support and management.
A comprehensive plan is needed to support
health workers in many areas before, during
and after a crisis to meet needs at work, at
home, and in the community. A major chal-
lenge for the healthcare system is the lack of
human resources, which must be adequately
addressed before a crisis occurs [56)] because
manpower is a very critical factor in manag-
ing crisis epidemics, supporting them should
be considered.
The US has increased inter-sectorial collab-
oration among the responsible organization
to employ a new working force, facilitated
foreign human working forces, and avoided
the migration of health sta during Covid-19
[57]. Healthcare providers are exposed to in-
fection. Therefore, they should have access to
PPE and their respective user guides [58]. In
line with the former studies, the present study
highlighted the application of PPE, including
gowns, gloves, masks, and face shields [59,
60]. During pandemics, training and using
Practices of Hospitals in the Management of Epidemic Conditions Tahmasebi A, et al.
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9
scientic evidence is necessary to promote
the eciency of the health system and health
sta durability [61]. Another challenge is
health sta psychological problems caused
by the pandemic crucial conditions, increased
number of patients, patient’s clinical con-
dition, specialty services, heavy workload,
exhaustion from long working shifts, fear of
transmitting the infection to self or family,
patients and coworkers’ death, insucient
PPE, following health protocols at work and
at home, lack of trust and support, social dis-
tancing policies, and long-term separation
from family and children [5, 6, 11, 62-64].
Fear of transmitting the infection to the family
is a big problem for medical sta, caused by
close contact with patients.
Due to the long-term commune of the infec-
tious diseases and delayed symptoms, they
fear they might transmit the disease to their
family members. This challenge can be solved
by proper management of personnel working
schedules and regular shifts and resting in-
tervals, employing active and new working
force, regular medical examinations to be en-
sured their health, especially before their os,
and supporting and caring for medical sta,
psychological, and self-care facilities and ser-
vices [4, 6, 65, 66].
The literature review of hospital experiences
shows that hospitals face many administrative
challenges during the rst days of an infec-
tious disease outbreak (especially Covid-19).
Challenges facing hospitals include rapid tri-
age of patients, segregation of suspected pa-
tients and assignment of levels of care, lack of
support from medical sta, and challenges in
communication and collaboration in multidis-
ciplinary teams.
Managers can control the crises by a set of
measures, including long-term planning be-
fore crises, forming crisis teams during the
crises and assigning precise roles to the mem-
bers, holding regular meetings, media confer-
ences, using communication tools to train and
avoid rumors, precise supervision on infec-
tion prevention and control, following health
protocols and punishing those who violate the
protocols, supporting medical sta and having
the humane attitude, sending high-risk sta to
remote work, providing insurance coverage to
working damages, providing sta with safety,
accommodation, welfare, and psychological
facilities, and forming a professional team to
train new sta.
Pandemics and epidemics pose a variety of
challenges and problems to health-providing
systems and disrupt routine situations and
their control [4, 11, 13, 67). Therefore, man-
agers can eectively respond to similar future
situations by using their experience and con-
sulting with colleagues in other countries and
international organizations.
The present study showed that most of the
reported experiences came from high-in-
come countries. Because of the dierences in
the social, economic political situations, and
health systems of these countries with low and
middle-income countries (LMICs), we should
consider the situations of each country and
even province in modeling the policies and
experiences and make necessary changes to
adopt the policies with indigenous situations.
The present review comprehensively and ex-
tensively collects and analyzes the evidence
and experiences of hospitals on their readiness
and responsiveness against infectious epidem-
ics and provides practical and comprehensive
data about the readers and policymakers. It
faces several limitations, including limited ac-
cess to the evidence and experiences of other
countries.
The probable reason can be the lack of pub-
lished experiences in other countries and/or
their publication in local (non-English) lan-
guages. Also, because the authors can read
only English and Persian articles, only these
article results are mentioned in this study.
Conclusion
The crises caused by infectious outbreaks
have aected an extensive part of the popu-
lation and community, cause many patients to
refer to the hospitals, and threaten the medical
personnel and managers.
These ensure that hospitals are prepared to
the highest level and improve their ability to
eectively respond to patient needs and re-
ferrals in the short term. Therefore, the pres-
ence of resources, instructions, and enough
evidence can greatly assist hospital managers
and authorities.
In this review, we analyzed 24 dierent hos-
Tahmasebi A, et al. Practices of Hospitals in the Management of Epidemic Conditions
10 GMJ.2023;12:e2824
www.gmj.ir
pitals’ experiences and measures from diverse
countries during infectious outbreaks (espe-
cially Covid-19). We highlighted dimensions
of their managerial readiness and responsive-
ness during infectious outbreaks and present-
ed them in two major categories of executive
readiness and logistic readiness. We believe
this study can be a practical and comprehen-
sive guide for hospital and health system man-
agers and authorities.
Practices of Hospitals in the Management of Epidemic Conditions Tahmasebi A, et al.
GMJ.2023;12:e2824
www.gmj.ir
11
Acknowledgements
This study was funded by the Iran University
of Medical Sciences as a part of PhD thesis
in health care management by grant number
99-3-37-19584.
Conict of Interest
There is no competing interest.
References
1. Fauci AS, Touchette NA, Folkers GK.
Emerging infectious diseases: a 10-year
perspective from the National Institute of
Allergy and Infectious Diseases. Int J Risk
Saf Med. 2005;17(3, 4):157-67.
2. Meskarpour-Amiri M, Shams L, Nasiri T.
Identifying and Categorizing the Dimen-
sions of Iran's Health System Response to
the Covid-19 Pandemic. Journal Mil Med.
2020;22(2):108-14.
3. Houghton C, Meskell P, Delaney H, Smalle
M, Glenton C, Booth A, et al. Barriers and
facilitators to healthcare workers' adher-
ence with infection prevention and control
(IPC) guidelines for respiratory infectious
diseases: a rapid qualitative evidence
synthesis. Cochrane Database Syst Rev.
2020;4:CD013582.
4. Liu Q, Luo D, Haase JE, Guo Q, Wang XQ,
Liu S, et al. The experiences of health-care
providers during the COVID-19 crisis in
China: a qualitative study. The Lancet Global
health. 2020;8(6):e790-e8.
5. Sun N, Wei L, Shi S, Jiao D, Song R, Ma L,
et al. A qualitative study on the psychological
experience of caregivers of COVID-19 pa-
tients. Am J Infect Control. 2020;48(6):592-
8.
6. Maben J, Bridges J. Covid-19: Supporting
nurses' psychological and mental health.
Journal of clinical nursing. 2020;29(15-
16):2742-50.
7. Gao X, Jiang L, Hu Y, Li L, Hou L. Nurses’
experiences regarding shift patterns in isola-
tion wards during the COVID-19 pandemic
in China: A qualitative study. Journal of clini-
cal nursing. 2020 Nov;29(21-22):4270-80.
8. Phua J, Weng L, Ling L, Egi M, Lim CM,
Divatia JV, et al. Intensive care management
of coronavirus disease 2019 (COVID-19):
challenges and recommendations. The lancet
respiratory medicine. 2020 May 1;8(5):506-
17.
9. Sorbello M, El-Boghdadly K, Di Giacin-
to I, Cataldo R, Esposito C, Falcetta S, et
al. The Italian coronavirus disease 2019
outbreak: recommendations from clinical
practice. Anaesthesia. 2020 Jun;75(6):724-
32.-Ahmed SB, Dumanski SM. Sex gender
and COVID-19: a call to action. Can J Public
Health .2020;111(6):980-3.
10. Ahmed SB, Dumanski SM. Sex, gender and
COVID-19: a call to action. Can Jo Public
Health. 2020; 111:980-3.
11. Adams JG, Walls RM. Supporting the Health
Care Workforce During the COVID-19 Glob-
al Epidemic. JAMA. 2020;323(15):1439-
1440.
12. Wang X, Zhang X, He J. Challenges to
the system of reserve medical supplies for
public health emergencies: reections on the
outbreak of the severe acute respiratory syn-
drome coronavirus 2 (SARS-CoV-2) epidem-
ic in China. Biosci Trends. 2020;14(1):3-8.
13. Peier-Smadja N, Lucet JC, Bendjelloul
G, Bouadma L, Gerard S, Choquet C, et al.
Challenges and issues about organizing a
hospital to respond to the COVID-19 out-
break: experience from a French reference
centre. Clinical microbiology and infection.
2020;26(6):669-72.
14. Mo Y, Deng L, Zhang L, Lang Q, Liao C,
Wang N, et al. Work stress among Chinese
nurses to support Wuhan in ghting against
COVID-19 epidemic. Journal of nursing
management. 2020;28(5):1002-9..
15. Banach DB, Johnston BL, Al-Zubeidi D,
Bartlett AH, Bleasdale SC, Deloney VM, et
al. Outbreak response and incident man-
agement: SHEA guidance and resources for
healthcare epidemiologists in United States
acute-care hospitals. Infect Control Hosp
Epidemiol. 2017;38(12):1393-419.
16. Badurdeen S, Valladares DB, Farrar J, Gozz-
Tahmasebi A, et al. Practices of Hospitals in the Management of Epidemic Conditions
12 GMJ.2023;12:e2824
www.gmj.ir
er E, Kroeger A, Kuswara N, et al. Sharing
experiences: towards an evidence based
model of dengue surveillance and outbreak
response in Latin America and Asia. BMC
Public Health. 2013;13(1):607.
17. Petrosillo N, Puro V, Di Caro A, Ippoli-
to G. The initial hospital response to an
epidemic. Archives of medical research.
2005;36(6):706-12.
18. Booth CM, Stewart TE. Severe acute respi-
ratory syndrome and critical care medicine:
The Toronto experience. Critical care medi-
cine. 2005;33(1 SUPPL.):S53-S60.
19. Lee FCY, Wee WK, Johan A. Public hospital
preparations for SARS outbreak: Experience
of Alexandra hospital. Prehospital and disas-
ter medicine. 2005;20(1):24-31.
20. Miro S, Kaufman SG. Anthrax in New Jer-
sey: A Health Education Experience in Bio-
terrorism Response and Preparedness. Health
Promotion Practice. 2005;6(4):430-6.
21. Rebmann T, Wagner W. Infection prevention-
ists' experience during the rst months of the
2009 novel H1N1 inuenza A pandemic. Am
J Infect Control. 2009;37(10):e5-e16.
22. Sahin HA, Deveci A. Hospital experience
of an avian inuenza A (H5N1) outbreak in
Turkey. J Int Med Res. 2009;37(5):1501-7.
23. Khan K, Kunz R, Kleijnen J, Antes G. Sys-
tematic reviews to support evidence-based
medicine. Crc press. 2011;71(11):2596-603.
24. Moher D, Shamseer L, Clarke M, Ghersi
D, Liberati A, Petticrew M, et al. Preferred
reporting items for systematic review and
meta-analysis protocols (PRISMA-P) 2015
statement. Systematic reviews. 2015;4(1):1-
9.
25. Moher D, Liberati A, Tetzla J, Altman DG.
Preferred reporting items for systematic
reviews and meta-analyses: the PRISMA
statement. BMJ (Clinical research ed).
2009;339:b2535.
26. Moher D, Liberati A, Tetzla J, Altman DG.
Preferred reporting items for systematic
reviews and meta-analyses: the PRISMA
statement. PLoS Med. 2009;6(7):e1000097.
27. Moher D, Liberati A, Tetzla J, Altman DG.
Preferred reporting items for systematic
reviews and meta-analyses: the PRISMA
statement. International journal of surgery .
2010;8(5):336-41.
28. Campos CJ. [Content analysis: a qualitative
data analysis tool in health care]. Rev Bras
Enferm. 2004;57(5):611-4.
29. Liamputtong P. Qualitative data analysis:
conceptual and practical considerations.
Health Promot J Austr. 2009;20(2):133-9.
30. Seers K. Qualitative data analysis. Evid
Based Nurs. 2012;15(1):2-2.
31. Smith J, Firth J. Qualitative data analy-
sis: the framework approach. Nurse Res.
2011;18(2):52-62.
32. Baggiani A, Briani S, Luchini G, Giraldi
M, Milli C, Cristaudo A, et al. Preparedness
and Response to the COVID-19 Emergency:
Experience from the Teaching Hospital of
Pisa, Italy. Int J Environ Res Public Health.
2020;17(20): 7376.
33. Marcon E, Scotton F, Marcante E, Rigo A,
Monticelli J, Buggio ME, et al. Schiavonia
Hospital response to COVID-19 outbreak: a
rst single-center experience. Ann Ist Super
Sanita. 2020;56(3):365-72.
34. Buising KL, Williamson D, Cowie BC,
MacLachlan J, Orr E, MacIsaac C, et al. A
hospital-wide response to multiple outbreaks
of COVID-19 in health care workers: lessons
learned from the eld. The Medical journal
of Australia. 2021;214(3):101-4.
35. Ogoina D, Oyeyemi AS, Ayah O, Onabor
AA, Midia A, Olomo WT, et al. Prepara-
tion and Response to the 2014 Ebola Virus
Disease Epidemic in Nigeria-The Experience
of a Tertiary Hospital in Nigeria. PloS one.
2016;11(10):e0165271.
36. Ma J, Zhong H, Jiang M, Zeng K, Zhong B,
Liu L, et al. Emergency response strategy
for containing COVID-19 within a psychiat-
ric specialty hospital in the epicenter of the
COVID-19 epidemic in China. Translational
psychiatry. 2020;10(1): 1-4.
37. Schiller DS, Fulman M, Champagne J, Awad
N. COVID-19 pandemic planning response
and lessons learned at a community hos-
pital. American j health system pharmacy.
2020;77(17):1371-4.
38. Jebelli B, Varahram M, Soltanifard Razlighi
M, Palizdar M, Ghazanchaei E. Management
Strategies to Control the COVID-19 Crisis
in Masih Daneshvari Hospital. J Mil Med.
2020;22(6):616-22.
39. Cannava P, Cicillini D, Higgins M, McGrath
A, O'Leary J. Response to H1N1 inuenza
outbreak in a pediatric children's hospital:
challenges faced and lessons learned. Journal
of pediatric nursing. 2010;25(5):375-81.
40. Arya SC, Rajagopal S, Agarwal N, Kaushik
M, Maheshwari P, Agarwal S, et al. Private
sector hospital response to the 2003 dengue
outbreak in the Indian capital metropolis of
Delhi. Am J Infect Control. 2004;32(8):489-
92.
41. Walsh A, Warren Z, Robichaud P, Stuart A,
Bodie K, Lew J, Moore K. A rural communi-
ty hospital's response to COVID-19. Cana-
dian Journal of Rural Medicine. 2021 Jan
1;26(1):38.
42. Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng
SY, et al. Preparing for a COVID-19 pandem-
ic: a review of operating room outbreak re-
sponse measures in a large tertiary hospital in
Singapore. Can J Anaesth. 2020;67(6):732-
45.
43. Gupta S, Federman DG. Hospital prepared-
ness for COVID-19 pandemic: experience
from department of medicine at Veterans
Aairs Connecticut Healthcare System. Post-
graduate medicine. 2020;132(6):489-94.
44. Britton CR, Hayman G, Macfarlane C,
Alawattegama H, Ballecer J, Stroud N, et
al. COVID-19 preparedness and response at
a large UK major trauma operating theatres
department. Journal of Perioperative Practice.
2020;30(7-8):210-20.
45. Iannuzzi NP, Lack WD, Gee AO, Chansky
HA. An Orthopaedic Department’s Response
to the COVID-19 Health-Care Crisis. Inc J
Bone Jt Surg. 2020;102(65):1-4.
46. Filice CE, Vaca FE, Curry L, Platis S, Lurie
N, Bogucki S. Pandemic planning and
response in academic pediatric emergency
departments during the 2009 H1N1 inuenza
pandemic. Academic emergency medicine :
Acad Emerg Med. 2013;20(1):54-62.
47. Lombardi JM, Bottiglieri T, Desai N, Riew
KD, Boddapati V, Weller M, et al. Address-
ing a national crisis: the spine hospital and
department's response to the COVID-19 pan-
demic in New York City. The spine journal.
2020;20(9):1367-78.
48. Shao Y. Psychiatry hospital management
facing COVID-19: From medical sta to
patients. Brain Behav Immun. 2020;88: 947.
49. Schwarzkopf R, Maher NA, Slover JD,
Strauss EJ, Bosco JA, Zuckerman JD. The
Response of an Orthopedic Department
and Specialty Hospital at the Epicenter of
a Pandemic: The NYU Langone Health
Experience. The Journal of arthroplasty.
2020;35(7s):S3-s5.
50. Chopra V, Toner E, Waldhorn R, Washer L.
How Should US Hospitals Prepare for Coro-
navirus Disease 2019 (COVID-19)? Annals
of internal medicine. 2020;172(9):621-2.
51. Xiang YT, Zhao YJ, Liu ZH, Li XH, Zhao
N, Cheung T, et al. The COVID-19 outbreak
and psychiatric hospitals in China: managing
challenges through mental health service
reform. Int J Biol Sci. 2020;16(10):1741-4.
52. Lateef O, Hota B, Landon E, Kociolek LK,
Morita J, Black S, et al. Chicago Ebola
Response Network (CERN): A Citywide
Cross-hospital Collaborative for Infectious
Disease Preparedness. Clinical infectious
diseases. 2015;61(10):1554-7.
53. Ippolito G, Puro V, Heptonstall J. Hospital
preparedness to bioterrorism and other infec-
tious disease emergencies. Cell Mol Life Sci.
2006;63(19-20):2213-22.
54. World Health Organization. Hospital pre-
paredness for epidemics. Geneva: World
Health Organization; Available from: https://
apps.who.int/iris/handle/10665/151281.
55. Ghotbi B, Navkhasi S, Ghobadi S, Shah-
savari Z, Kahrizi N. Hospital Management
Strategies during the Covid-19 Pandemic.
Health Research Journal. 2020;5(2):118-25.
56. Akram B, Fatemeh G, Mohsen S, Razieh R.
Healthcare Communicators And Instructors’
Administrative-Recreational Experiences
In Breaking O With The Headquarter:
A Qualitative Study. Payavard Salamat.
2013;6(6):434-444.
57. Shaer FA. CGFNS Policy Brief. Healthcare
Workforce Resilience Act: S.3599; 2020..
58. Atay S, Cura Ş. Problems Encountered by
Nurses Due to the Use of Personal Protective
Equipment During the Coronavirus Pandem-
ic: Results of a Survey. Wound management
& prevention. 2020;66(10):12-6.
59. Adams JG, Walls RM. Supporting the health
care workforce during the COVID-19 global
epidemic. Jama. 2020;323(15):1439-40.
60. Vijayaraghavan BKT, Jha V, Rajbhandari D,
Myatra SN, John O, Ghosh A, et al. Hy-
droxychloroquine plus personal protective
equipment versus standard personal pro-
tective equipment alone for the prevention
of COVID-19 infections among frontline
healthcare workers: the HydrOxychloro-
quine Prophylaxis Evaluation (HOPE) trial:
A structured summary of a study protocol
for a randomized controlled trial. Trials.
2020;21(1):1-3.
61. Tippett V, Watt K, Raven S, Kelly H, Coory
M, Archer F, et al. Anticipated behaviors of
emergency prehospital medical care provid-
ers during an inuenza pandemic. Prehospital
and disaster medicine. 2010;25(1):20-5.
62. The L. COVID-19: protecting health-care
workers. Lancet. 2020;395(10228):922.
63. Smereka J, Szarpak L. The use of person-
al protective equipment in the COVID-19
pandemic era. Am J Emerg Med.
Practices of Hospitals in the Management of Epidemic Conditions Tahmasebi A, et al.
GMJ.2023;12:e2824
www.gmj.ir
13
2020;38(7):1529-30.
64. Cheng LT, Chan LP, Tan BH, Chen RC, Tay
KH, Ling ML, et al. Déjà Vu or Jamais Vu
How the Severe Acute Respiratory Syndrome
Experience Inuenced a Singapore Radiolo-
gy Department's Response to the Coronavirus
Disease (COVID-19) Epidemic. American
journal of roentgenology. 2020;214(6):1206-
10.
65. Li L, Xv Q, Yan J. COVID-19: the need
for continuous medical education and
training. The Lancet Respiratory medicine.
2020;8(4):e23-e.
66. Liu S, Yang L, Zhang C, Xiang YT, Liu Z,
Hu S, et al. Online mental health services in
China during the COVID-19 outbreak. Lan-
cet Psychiatry. 2020;7(4):e17-e8.
67. Soto ME, Guarner Lans V, Soria Castro E,
Manzano Pech L, Pérez Torres I. Is An-
tioxidant Therapy a Useful Complemen-
tary Measure for Covid-19 Treatment an
Algorithm for Its Application. Medicina .
2020;56(8):386.
14 GMJ.2023;12:e2824
www.gmj.ir
Tahmasebi A, et al. Practices of Hospitals in the Management of Epidemic Conditions
