A QUALITATIVE study suggests hospital crisis decision-making can sideline routine care, while strengthening preparedness for later emergencies.
Hospital Crisis Decision-Making Narrowed Priorities
Hospital crisis decision-making became increasingly concentrated on COVID-19 in this qualitative study of 18 key decision-makers working in a peripheral hospital. Comparing routine operations with crisis periods, the researchers found that leadership attention, oversight, and coordination were drawn heavily toward COVID-19 wards and pandemic-related demands. Interactions with external bodies also intensified during the crisis, shaping how decisions were made across the hospital.
The study used a modified version of the World Health Organization’s six building blocks framework to examine how decisions shifted under pressure. During routine operations, mechanisms were in place to reduce unintended consequences across services. During the pandemic, however, those safeguards were less consistently maintained outside the immediate crisis response. As a result, non-COVID areas were more likely to be deprioritized, increasing the risk that important services unrelated to the acute emergency could be affected.
Recurrent Crises Revealed Unintended Consequences
The findings suggest that unintended consequences were not simply isolated byproducts of emergency response, but a meaningful vulnerability within hospital crisis decision-making. When attention narrowed around the most urgent threat, services outside the crisis focus became more exposed. This has implications for healthcare systems seeking to preserve quality and continuity of care during prolonged or overlapping emergencies.
At the same time, the study found evidence of organizational learning. Experience gained during COVID-19 appeared to improve staff preparedness, operational capabilities, and logistical performance during the subsequent war. Relationships and patterns of collaboration developed during the pandemic also helped streamline wartime decision-making, suggesting that crisis-era structures can carry long term value when they are retained and adapted.
The authors concluded that hospital leaders should preserve internal and external collaborations built during crises rather than allowing them to fade during routine periods. They also emphasized the need for regular, systematic real-time evaluation checkpoints to identify risks to non-crisis-related services before those unintended consequences escalate. Further multi-center research is needed to determine how transferable these findings are across different hospitals and crisis settings.
Reference
Bernstine T et al. Operating in recurrent crises: a qualitative study of decision-making and unintended consequences in a peripheral hospital. Front Public Health. 2026;14:1728146.
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