The orchestration of leadership as a core phenomenon of a staff-based hospital incident command system: a qualitative grounded theory study
BackgroundHospitals can experience disruption to their operations due to a variety of crisis events. To maintain operational functionality, hospitals are required to implement a hospital incident command (HIC). This study explores the process from routine operations to a staff-based HIC, analyzing h...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) Chapter/Article |
| Language: | English |
| Published: |
18 May 2026
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| In: |
SSRN eLibrary
Year: 2026, Pages: 1-29 |
| ISSN: | 1556-5068 |
| DOI: | 10.2139/ssrn.6787593 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.2139/ssrn.6787593 Verlag, kostenfrei, Volltext: https://papers.ssrn.com/abstract=6787593 
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| Author Notes: | Maik von der Forst, Erik Popp, Hanne Schaefer, Kirsten Bikowski, Klaas Franzen, Markus Ries, Janna Küllenberg |
| Summary: | BackgroundHospitals can experience disruption to their operations due to a variety of crisis events. To maintain operational functionality, hospitals are required to implement a hospital incident command (HIC). This study explores the process from routine operations to a staff-based HIC, analyzing how leadership communication and dynamics emerge, evolve, and are negotiated during crisis transitions. The focus lies on interactions between roles, practices, training, and structures under high operational pressure.MethodsThis qualitative, single-site study applied a Grounded Theory methodology and was based on a HIC tabletop exercise conducted following targeted training. Data comprised semi-structured post-exercise interviews with 19 HIC members from diverse professional backgrounds and observational materials (notes and protocols).ResultsThe analysis indicates that the enactment of staff-oriented HIC structures varies along a spectrum of coordination: Explicit orchestration of leadership communication was associated with a shift toward more structured coordination, reflected in clearer role articulation, defined process boundaries, and separation of briefing and operational tasks. Where orchestration was less pronounced, coordination tended to rely on routine practices, accompanied by blurred responsibilities and more fragmented coordination patterns.DiscussionDespite the importance of HIC systems, research in this area remains limited. Analytical propositions frame staff-based incident command in hospitals as an interactionally accomplished practice. Moderation is proposed as a potential enabler of coordination under time pressure and uncertainty, alongside accountability closure, material scaffolding, and boundary management. These mechanisms may be particularly salient in largely untrained hospital collectives and shift attention from formal compliance toward interactional enactment conditions. |
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| Item Description: | Gesehen am 01.06.2026 |
| Physical Description: | Online Resource |
| ISSN: | 1556-5068 |
| DOI: | 10.2139/ssrn.6787593 |