Operational enablers and barriers in hospital incident command: insights from a single-center table-top exercise at a tertiary care university hospital - a qualitative phenomenological Study
Background In crises, hospitals must rapidly shift from routine operations to structured crisis management, requiring the activation of an incident command system. However, empirical insight into their operational functioning during activation remains limited. Goal: to identify operational enablers...
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| Main Authors: | , , , , , , , , |
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| Format: | Article (Journal) Chapter/Article |
| Language: | English |
| Published: |
May 17, 2026
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| In: |
medRxiv
Year: 2026, Pages: 1-31 |
| DOI: | 10.64898/2026.05.13.26353139 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.64898/2026.05.13.26353139 Verlag, kostenfrei, Volltext: https://www.medrxiv.org/content/10.64898/2026.05.13.26353139v1 
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| Author Notes: | Markus Ries, Maik von der Forst, Hanne Schäfer, Kirsten Bikowski, Klaas Franzen, Paul Geoerg, Fabian Weykamp, Erik Popp, Janna Küllenberg |
| Summary: | Background In crises, hospitals must rapidly shift from routine operations to structured crisis management, requiring the activation of an incident command system. However, empirical insight into their operational functioning during activation remains limited. Goal: to identify operational enablers and barriers influencing effective crisis response. - Methods Prospective cross-sectional, qualitative, single-center study conducted after a table-top exercise within a hospital incident command system at a tertiary care university hospital (NCT06913010). Data was collected through semi-structured interviews, participant observation, and document analysis, and analyzed using a narrative-phenomenological approach. - Results Nineteen participants were included. Analysis identified nine thematic clusters shaping operational performance: (1) structure and roles; (2) communication; (3) decision-making and prioritization; (4) information management; (5) infrastructure and technology; (6) personnel and organization; (7) training, exercises, and team dynamics; (8) documentation; and (9) external communication and media. Enablers included clear role definition, structured communication, phased decision-making, and regular training. Barriers included role ambiguity, fragmented communication, insufficient prioritization, infrastructure limitations, and staffing constraints. - Conclusion Preparedness frameworks are necessary but insufficient as stand-alone approaches, as operational execution determines real-world performance. Recurring deficits included unclear roles, inconsistent communication, weak prioritization, and gaps in infrastructure and personnel. A limited set of standardized practices - including a clear separation od roles, leadership intent, closed-loop communication, explicit decision cycles from information gathering to structuring to decision-making, checklists, visualization, central information management, and rapid “80% decisions”-substantially enhanced performance. Mission command (Auftragstaktik) further enabled adaptive, coordinated action. Strengthening hospital incident command is a key lever for achieving system-level resilience in crises. |
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| Item Description: | Gesehen am 01.06.2026 |
| Physical Description: | Online Resource |
| DOI: | 10.64898/2026.05.13.26353139 |