Willingness to work of Belgian hospital staff in disasters: a mixed method study
Background: Following a disaster, hospitals are at risk for sudden crowding of victims. After the terrorist attacks of 22 March 2016 around Brussels, it is interesting to check hospital staff whether this promotes solidarity, willingness to work and also what makes the difference whether people are prepared to work or not in specific disaster conditions. It is also not known if disaster management is a real concern of hospitals. This study aims to explore the willingness of staff to work and the role of a hospital disaster coordinator in these circumstances.
Methods: This mixed method study is based on an explanatory sequential study design with a quantitative data collection and analysis followed by a second phase with a qualitative research track to explore the willingness to work. A quantitative survey with eleven different, virtual disaster situations was offered at four different hospital staff groups (nurses, doctors, administrative and supporting staff). In the qualitative part we performed focus groups and semi-structured face-to-face interviews with a purposeful sample of staff members. A 'within-case’ analysis was performed to retain the uniqueness of each setting, followed by a 'cross-case' analysis. Study data were collected between March 2014 to July 2016.
Results: Twenty-two Belgian hospitals participated. The willingness to work differs between doctors (33.8%), supporting staff (28.1%), nurses (23.6%) and administrative staff (23.1%). Both, quantitative and qualitative research at three regional hospitals, from February 2016 to July 2016, confirmed a high willingness to work in all groups, but strongly related to the disaster type. The greatest willingness was with a seasonal influenza epidemic, the lowest for Ebola and nuclear incidents. Four facilitators increased the willingness to work: availability of personal protective equipment, insurance that their family is safe, feedback on the incident and previous training. The qualitative study revealed various main themes such as willingness to work, self-efficacy, personal attitude with a positive influence of a good team on willingness to work and completion, hospital disaster management: more than hospital accreditation and legal obligations, the function and role of the hospital disaster coordinator: a real specialisation within the hospital environment.
Conclusion: Although differences in willingness to work depending the context, specific measures, a concerned and dutiful hospital disaster coordinator plays an important role to motivate the four hospital staff groups, which includes a top management commitment to the function. The hospital disaster coordinator is the key figure concerning ‘awareness’ and ‘preparedness’ within the hospital. Hospital disaster preparedness requires a continuous effort throughout the years and hospital disaster planning must reflect continuously on quality and safety policies within the organisation.
