Analysis of hospital resilience in public health emergencies using structural equation modeling: based on risk perception, resource preparedness, and team collaboration

Background: Public health emergencies place sustained pressure on hospital operations and service continuity. However, existing studies have more often emphasized institutional arrangements or resource stockpiles than the governance processes through which hospital resilience is associated with risk sensing, resource orchestration, and collaborative operation. Objective: This study aimed to test a governance-based framework linking risk sensing, resource orchestration, collaborative governance, and hospital resilience in a public health emergency context. Methods: A retrospective observational design was used based on the COVID-19 response of our hospital from January to June 2020. Management archive data and retrospective questionnaire data were integrated, and 386 valid cases were analyzed using structural equation modeling with subgroup and robustness analyses. Results: The results showed that stronger risk sensing was positively associated with stronger resource orchestration and collaborative governance, and that collaborative governance had the strongest association with resilience. The direct association between risk sensing and resilience became non-significant after the mediating variables were included, supporting an indirect pathway through resource orchestration and collaboration. These patterns remained broadly stable across subgroup and robustness analyses. Conclusion: In this single-hospital COVID-19 context, hospital resilience was associated with a sequential governance pattern linking risk sensing, resource orchestration, and collaborative operation. The findings support a capability-oriented perspective on hospital emergency governance, while their applicability is most direct for large, relatively well-resourced hospitals.