Introduction
Crisis management is important especially in the field of health. The main goal of hospitals during a crisis is to reduce the number of deaths, increase the number of survivors, reduce the negative effects of disabilities, and alleviating the physical and mental pains of victims. The organization of hospital operations during disasters should be done by the employees who are active in the hospital during normal times. Therefore, the organization of human resources and holding maneuvers for the preparation of them are very important in hospitals. The disaster management includes four components of preparation, response, recovery, prevention/mitigation. Having the knowledge of these mechanisms can play an essential role in improving the performance of hospitals and healthcare centers. This study aims to investigate the factors affecting the development of disaster management mechanisms of hospitals in Arak, Iran

Materials and Methods
The study population includes all managers, nursing managers, supervisors and other members of the crisis team in the hospitals of Arak city (n=480). In this study, since the structural equation modeling (SEM) was used, and the number of items in the questionnaire was 47, the minimum sample size should be between 235 and 705. After distributing 300 questionnaire, 240 questionnaires were returned complete. To collect the required data, the questionnaire developed by Moghimi and Ramadan (2013) was used. The questionnaire has two parts. The first part surveys demographic factors (gender, age, educational level, and work experience). The second part has 47 items rated on a five-point Likert scale. It has acceptable validity. To check its reliability,  30 questionnaires were distributed among the participants. By calculating Cronbach’s alpha, the reliability was obtained 0.897. After collecting the data, they were analyzed in LASERL software using SEM.

Results
The most of participants had age 30-39 years, a work experience of 10-15 years, and a bachelor’s degree. The results showed that lack of stability in business environment, risk taking, and organizational culture had a significant effect on the development of disaster management mechanisms in hospitals of Arak city.

Discussion
According to Mitroff & Pearson (1993) the crisis cannot be attributed only to technical and systematic defects; organizational structure and interaction between organizational members can also prevent a crisis. Levinson (1997) stated that the increase in patients’ awareness of their rights and the expansion of a black hole (financial budget deficit) in the financial health insurance system directly affects the hospital performance and results in an increase in uncertainty about the hospital business environment which can affect the development of disaster management mechanisms. According to Perrow (1984), the health care system is an human-based integrated service system that includes interconnected elements including employees and equipment. Therefore, system reliability is an essential requirement for medical systems. It requires medical institutions to choose at least one high-risk process and conduct risk analysis. Consistent with these studies, we concluded that lack of stability in business environment, risk taking, and organizational culture are effective factors of the development of disaster management mechanisms of hospitals in Arak city.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the ethics committee of Arak University of Medical Sciences (Code: 1274.1401.REC.ARAKMU.IR). 

Funding
The current research has not received any financial support from financial organizations in the government, commercial or non-profit sectors.

Authors' contributions
Design, writing, editing, and data collection: Nahal Moharekpour; writing, review, and data analysis, Vahab Habibpour, Davood Shamsi.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgements
The authors would like to thank all participants in the research.

 

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