Hospitals' Resilience: An Evidence-Based Framework for Sustaining the “Coping” Phase in Non-Linear and Continuous Crises

This study investigates the critical domains and factors of resilience that enable hospitals to recover during extraordinary crises, using the COVID-19 pandemic as a case study. Resilience factors are categorized into four performance criteria: robustness, redundancy, resourcefulness, and rapidity, offering an evidence-based framework for evaluating hospital resilience capabilities. The research employs a two-round Delphi method, involving 13 experts from six major hospitals in Lombardy, to identify key factors across eight domains: supply and storage, layout redesign, strategic decision-making, organizational flexibility, HR management, procedures, knowledge management, and information/communication. The study finds that resourcefulness and redundancy were the most significant resilience factors, emphasizing the importance of interdisciplinary collaboration, structured decision-making, and spatial reorganization. The results highlight that adaptability, collaboration, and redundancy are essential for enhancing hospital preparedness and response during health emergencies. This research provides practical insights and a structured framework for hospitals to assess and strengthen their resilience, improving their readiness for future health crises.