Exploring complexity attributes and their interdependence of emergency hospital projects: a content analysis and DEMATEL-ISM research

Purpose – Although the effectiveness of emergency hospital projects in responding to pandemics and public health crises is well documented, the complexity inherent in these projects—characterized by compressed schedules and stringent infection control protocols—remains insufficiently examined, often resulting in suboptimal project performance. This study aims to advance the understanding and management of such project complexity by systematically investigating its intrinsic attributes and interdependencies. Design/methodology/approach – A two-stage hybrid approach combining qualitative and quantitative methods was used. Initially, an emergency hospital project complexity framework was developed through content analysis. Subsequently, the interrelationships and hierarchical structure among the identified complexity attributes were analyzed using the Decision-Making Trial and Evaluation Laboratory Analysis coupled with Interpretive Structural Modeling (DEMATEL-ISM) methodology. Findings – The results reveal that the complexity framework comprises eight dimensions and 25 corresponding indicators. Both complexity dimensions and indicators are categorized into root, mediator, and outcome groups based on their hierarchical roles. Environmental complexity and goal complexity are identified as root-group dimensions. Within the indicators, constantly evolving pandemic conditions and the laborious nature of installation tasks are classified as root-group attributes. Practical implications – Practitioners are provided with systematic tools to manage complexity during the construction phase, facilitating improved risk and uncertainty mitigation. Emphasis is placed on adopting precautionary measures, enhancement of improvisational capabilities, prioritization of time goals, integration of modular design and digital technologies, and reinforcement of supply chain resilience. These insights hold relevance for a broader range of public emergency response projects. Originality/value – This study makes three theoretical contributions. First, by offering novel insights into the attributes of complexity and highlighting the significance of their interrelationships, this study contributes to a systematic comprehension of complexity within pandemic-driven construction projects. Second, as one of the earliest efforts to comprehensively articulate the complexity of emergency hospital projects, it introduces a framework structured around a “root–mediator–outcome” three-tier hierarchy that elucidates the interdependent nature of complexity attributes. Third, by exploring unique characteristics and complex causal relationships, this research expands the theoretical understanding of project complexity in emergency hospital construction and other public emergency response initiatives.