Background <p>Major emerging infectious diseases often trigger the “medical run”, presenting significant challenges to health systems. Developing hospital resilience is crucial for enhancing the capacity to manage such crises. Therefore, this research aimed to construct an element system of hospital resilience to medical run in major emerging infectious diseases.</p> Methods <p>Utilizing the 4R conceptual model and literature content analysis, a preliminary draft for hospital resilience was developed. Subsequently, a two-round Delphi survey involving 18 Chinese experts across various fields refined this system. The Standard for Conducting And Reporting Delphi Studies (CREDES) guided this process. The weights of each element were determined using the analytic hierarchy process.</p> Results <p>The effective recovery rate for both Delphi rounds were 100% (18/18), with an authority coefficient of 0.9159. The first round revealed a Kendall’s concordance coefficient for total elements of 0.136 (<i>P</i> &lt; 0.05); the second round showed a coefficient of 0.214 (<i>P</i> &lt; 0.05). The final element system included four primary elements (Resourcefulness, Redundancy, Robustness, Recovery), 21 secondary elements, and 65 tertiary elements, with weights of 0.2908, 0.2056, 0.4348, and 0.0688, respectively.</p> Conclusions <p>This study constructed the element system of hospital resilience to medical run in major emerging infectious diseases. The results are designed to elucidate the components of hospital resilience in the context of major emerging infectious disease, which can help mitigate the impact of medical run. The study will provide hospitals with a checklist and assessment program for enhancing resilience, offering significant implications for the development of hospital training and management strategies.</p>