A qualitative SWOT analysis of hospital medical service managers’ experiences during the 2023 Kahramanmaraş earthquakes

Abstract Background Disasters caused by large-scale earthquakes significantly disrupt healthcare systems; however, while existing research has largely focused on response processes, limited attention has been given to comprehensively evaluating strengths, weaknesses, and areas for improvement in service delivery. Objective This study aimed to examine the factors affecting hospital service delivery during the earthquake process within the framework of SWOT (strengths, weaknesses, opportunities, and threats) and to provide a comprehensive evaluation of health system resilience. Methods A qualitative phenomenological study was conducted. Data were collected through semi-structured individual interviews with purposively selected hospital medical service managers who actively served during the disaster. The data were analyzed using thematic analysis, and the findings were categorized within the SWOT framework. Results The findings were organized into four main themes based on SWOT analysis: strengths, weaknesses, opportunities, and threats. Strengths included effective leadership and coordination, workforce capacity and resilience, operational capacity, and prior training and drills, whereas weaknesses reflected psychosocial strain, deficiencies in institutional preparedness and management, structural and logistical disruptions, hygiene and infection-control inadequacies, and coordination challenges. External opportunities included developments in communication technologies, inter-institutional collaboration and external support networks, social solidarity and volunteer support, and disaster-driven professional and institutional learning. External threats included disaster severity and infrastructure limitations, ongoing seismic activity, extreme winter conditions, infectious disease risks, communication infrastructure disruption, and social pressure and security concerns. Conclusion The findings suggest that effective leadership, adaptive coordination, and institutional preparedness are important factors in supporting hospital service delivery during large-scale earthquakes. Strengthening disaster preparedness, inter-institutional collaboration, resilient communication systems, and psychosocial support for healthcare workers should be considered priorities for enhancing health system resilience and supporting the continuity of healthcare services during future disasters.