Administrative Challenges and Incident Command:
ICP effectiveness in emergencies
Infection control and prevention is one of many aspects of hospital administration affected by COVID-19. Hospitals are required to have a standing emergency plan. The CMS Emergency Preparedness Rule, Joint Commission and state Healthcare Preparedness Program help inform the general shape of emergency administration in any given location. Ideally exercises and training help leaders prepare for how things might change in an emergency like the COVID-19 pandemic.
Most hospitals adopt an incident command system (ICS - a temporary leadership structure specifically tailored to a particular emergency) to operate more efficiently in emergencies. ICS is based on principles like management by (emergency) objective, unity of command (it is clear who reports to whom and who has decision-making authority), and optimal span of control during emergencies (typically no more than 5-7 reports per leader). ICS often involves temporary reporting relationships, so flexibility and emotional objectivity is important when working in an ICS structure. It is likely an Emergency Operations Plan (EOP) will be issued periodically tailored to the objectives of the organization in the pandemic at a particular time.
To ensure appropriate ICP practices, appropriate ICP expertise must be integrated into the hospital ICS and EOP. Because of the broad nature of the COVID-19 threat, this likely includes advising different leaders responsible for many areas of hospital operations, including inpatient services, outpatient services, human resources, environmental services, security, and medical supply among others. One ICS role that may be appropriate in an infectious disease emergency is Safety Officer. ICP professionals may also be assigned as Technical Specialists to serve as an advisor to leaders. Alternately ICP professionals may be given operational roles among the different branches of hospital operation. There is likely no one best organizational solution but structures that are not working should be brought to leadership attention so they can rapidly be fixed.
ICP knowledge and practice must typically be incorporated into the Emergency Operations Plan and emergency standard operating procedures (SOPs) to be fully disseminated and adopted into practice. Many of the resources on this website are examples of emergency SOPs.
Critical steps to best serving your institution during the COVID-19 emergency are to study your organization emergency plan, and the current administrative structure addressing the pandemic (which may or may not resemble an ICS). Identify where the decision-makers are who can develop and enforce safe SOPs. Discuss with the incident commander or chief executive how the ICP office can best (most efficiently and effectively) contribute. This may (and likely will) change over time since ICS often scales up or down at different points in the incident response. Reporting relationships may differ markedly from normal operations, so flexibility and emotional objectivity are important capabilities to foster.
Hospital Administration and ICS Resources
Surge and Shortage Management
Supporting Staff and Patients During COVID-19 Stress