The Dynamics of Hospital Surve Capability: An Empirically Grounded Conceptual Framework

While high-impact events such as natural disasters and infectious disease pandemics have increased significantly in recent decades, we know little about how hospitals effectively organize and respond to surges, or sudden, unanticipated escalations in treatment needs. To address this gap, we conducted a longitudinal study of five multi-hospital health care systems in the U.S., as they experienced and worked through surges in demand associated with the COVID-19 pandemic. We discover a variety of organizational-level tactics that hospitals engage to effectively manage surge capacity, defined as a hospital’s ability to manage surges that challenge or exceed present capacity to treat patients. We organize these tactics into an emerging, conceptual framework explaining three dimensions of hospital surge capability: overseeing capacity management efforts, managing capacity supply and managing capacity demand. We conclude that effective surge capability involves the dynamic adaptation of capacity at the hospital level, which is accomplished through the organizing of various surge response tactics. These tactics fit together to provide hospitals a strategic approach to surge management. We contribute to the surge management literature by developing a framework to explain effective surge response that extends beyond the accumulation of adequate space, staff, stuff, and structures and that addresses surges in demand at the hospital, as opposed to response unit (e.g., an Emergency Department) or community-wide levels.