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Comparing Internal Self-Assessment and External Evaluation of Hospital Safety Index (HSI) for Disaster Response: A
Vahid Ghanbari1, Afshin Goodarzi1, Ali Mohammadi2
1Prehospital Emergency Care Department, Paramedical Faculty, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran.
Background:
Hospitals must ensure preparedness and safety to maintain services during disasters. Results from the Hospital Safety Index (HSI) often indicate that hospitals are safe and capable; however, it is important to verify whether these assessments are consistent across different evaluators. This study compared hospital safety scores between internal evaluators (hospital staff) and external evaluators.
Methods:
This cross-sectional study was conducted in 2022 using documented hospital safety assessment data from hospitals supervised by Kermanshah University of Medical Sciences (KUMS) in western Iran. Independent-samples t-tests, the intraclass correlation coefficient (ICC), and Bland-Altman plots were used to compare mean scores and assess agreement between evaluators.
Results:
For structural safety, the difference between internal and external evaluators was not significant (95% CI, -9.19 to 9.67). In contrast, the differences were pronounced for non-structural safety (95% CI, 7.00 to 20.63) and functional safety (95% CI, 10.56 to 28.84), with both confidence intervals excluding zero. Agreement between evaluators was poor across most hospital safety domains (ICC < 0.05).
Conclusion:
Internal evaluators rated their hospitals significantly safer than external evaluators did. Given the pronounced differences in non-structural and functional safety, and the poor inter-rater agreement across most domains, relying solely on internal assessments may mislead hospital managers about disaster preparedness. Hospital managers should therefore regard external evaluation as an opportunity to reveal their hospital's vulnerabilities in disaster safety.