From Compliance to Competence: Accelerating Readiness to Change in Hospital CBRNE Preparedness

Hospital preparedness for CBRNE events remains an Achilles' heel-not because plans do not exist, but because the gap between documented protocols and executable competence is vast. This editorial describes a transformative workshop for a hospital disaster team, operationalizing their Emergency Operations Plan through high-fidelity simulation, iterative practice, and structured hot wash after-action reviews. Anchored in the Transtheoretical Model, our assessment captured not merely knowledge retention but the team's readiness to change-their shift from passive compliance to active ownership. Post-test assessments revealed a greater than 50% improvement in overall preparedness. Yet numbers tell only part of the story. Hot wash debriefings, conducted immediately after each simulation in a no-blame culture, proved the true catalyst for transformation, exposing micro-failures never surfacing in written reports-communication breakdowns, decontamination bottlenecks, PPE logistics gaps-and enabling real-time corrective action. By the final iteration, the team that hesitated in the first run executed with seamless efficiency, advancing from contemplation to action. This experience carries an urgent message: a binder on a shelf is not readiness. True competence must be forged through stress, feedback, and repetition. The question for hospital leaders is not whether we can afford such training, but whether we can afford to continue without it.