Prioritization of hospital resilience indicators for disaster preparedness: a fuzzy Delphi-AHP approach in Iranian public hospitals.

BACKGROUND: Hospitals play a pivotal role in response to disasters. It must possess high resilience to maintain functionality during geophysical and environmental hazards. Identification and prioritization of key resilience indicators is essential for enhancing hospital preparedness, especially in disaster-prone regions like Iran. OBJECTIVE: This study aimed to systematically identify and prioritize hospital resilience indicators in Iranian governmental hospitals using experts' opinion and multi-criteria decision-making techniques. METHODS: A descriptive-analytical cross-sectional study was conducted in 2024, involving 50 experts, including hospital supervisors, HSE officers, technical/facilities managers, and administrators with diverse educational backgrounds (Bachelor's to PhD), from five hospitals in Isfahan Province. Resilience indicators were identified through literature review and expert interview. The fuzzy Delphi method was applied to compute weights of relevant indicators, and the Analytic Hierarchy Process (AHP) was used to prioritize these indicators. RESULTS: Out of 60 initial indicators, 48 achieved consensuses higher than 70%. Structural resilience was identified as the most critical domain (weight = 0.2304), followed by Functional/Organizational (0.1602) and Non-Structural Resilience (0.1301). Key high-weighted indicators also included seismic resistance (0.0840), comprehensive disaster management plans (0.0504), and safety of medical equipment (0.0510). CONCLUSION: The integrated fuzzy Delphi and AHP approach prioritized hospital resilience indicators tailored to Iran's disaster context. These findings provide a framework to guide resource allocation and policy development to strengthen hospital disaster preparedness and response capacity, particularly in Isfahan's context, with potential applicability to similar settings.