Implementation of the Hospital Emergency Incident Command System
Implementation of the Hospital Emergency Incident Command System
Hospital Emergency Incidence Command System (HEICS) was established to assist medical facilities during times of crisis. Although the original version was developed in 1991, there have revisions, but the content has remained almost the same. Initially, HEICS was developed to assist individual medical facilities to handle issues of crisis. However, evidence has shown that a certain degree of external intervention might be required to integrate HEICS into the culture of a medical facility (AHA, 2016). For example, in order to work, one has to make a tour to a facility using HEICS or that an experienced instructor is required to assist a medical facility to migrate into the HEICS style of management. Although it has gone through several revisions, it has been found out that there is a need for a thorough understanding of flexibility and adaptability of the facilities utilizing the system for various types of emergencies and also for all sizes of facilities.
One feature of the system is the responsibility modeled on the chain of command system. The concept is widely accepted in both public and private facilities because it used typical position titles and accepted organizational chart. A facility which has adopted the approach prioritize the various duties using job action sheets. The system is a flexible program which can accommodate emergencies of various types and magnitude. The use of job action sheets together with other forms promote rigorous documentation process, not only for the personnel but also for the facility. Comprehensive documentation of information has been found to be very useful not only for minimizing liabilities, but also for improvement of the recovery of financial expenses. With a common platform of operation, it is possible to transfer resources smoothly from one facility to another. The implementation of the various branches or sections of HEICS is rather flexible because each unit can be customized to meet needs which are unique to a particular crisis. The design of HEICS structure is in such a way that it caused minimum disruptions to the already existing facility departments due similarity in duties and job qualifications.
Structure of the HEICS
A typical organizational structure of the HEICS is a chain of command system, which comprise four units with the topmost leader being the Emergency Incident Commander (EIC). The four sections include planning, logistics, operations, and finance. The head of each section is appointed by the IC. The sub-functions are under the custody of directors and section leader. The supervisors and officers fulfill other critical roles. The structure has been designed in such a way that each manager’s span of control is limited as one way of distributing the work.
HEICS Outline of Implementation Program.
According to Autrey and Moss (2006), the successful implementation of the HEICS requires a deep understanding of the situational awareness (SA) as well as high-reliability teams. The first part of the implementation of HEICS is the concept briefing. A person who is familiar with the program briefs emergency planners and hospital administrators who are interested in learning about the program. The individual conducting the briefing can be a hospital staff who is well conversant with the program or staff from another hospital or an officer who works in the public health emergency services. The second part involves a commitment to implement the HEICS program. After the briefing, the facility can accept or reject the idea of the program. Acceptance to implement the program is followed by the appointment of the transition team. An attempt will be made to make sure the transition team is dominated by the senior level management. Those who comprise the transition team should actively support the initiative and its mission. The third stage is the establishment of the implementation committee to oversee the program. Unlike the implementation team, the implementation committee is a quite larger. It comprises hospital employees from various departments and management levels. The fourth step is to conduct management briefings. This involves a presentation to various stakeholders, including managers, department heads, and administrators in the implementation of the program in the facility. The fifth step is the revision of the hospital emergency/disaster plan. This involves configuration of the currently existing disaster plan so that HEICS program becomes a standard operating procedure. The sixth step is conducting an introductory lesson targeting all hospital employees. This is to ensure there is a need to conduct that the hospital staff is conversant with the program. Occasionally, there is a need to conduct periodic staff education. The purpose being to help staff to meet accreditation/licensing standards. Furthermore, the idea is to keep all hospital response teams to enhance their commitment to the hospital preparedness and also for them to become more proficient in carrying out emergency operation procedures.
An effective management system has been described as one where emergency incidents are handled at maximum efficiency while using minimum human resources and facilities. HEICS has been reported to be of the most reliable programs which not only helps increase the efficiency of hospitals but also increases the patient’s safety. Despite the benefits associated with HEICS, studies have shown that the program also has some barriers. A number of strategies on how to implement the program have been identified. For example, past studies identified the existence of external and internal barriers to the effective implementation of the program. While the internal barriers have been associated with the organizational requirements, external barriers have been linked with infrastructural issues. Organizational requirements comprise organizational culture, resources, and management (Yarmohammadian, Atighechian, Shams, & Haghshenas, 2011). Infrastructural requirements include senior managers’ commitment to implement the program. In their investigation, the authors also found out that some of the barriers to effective and efficient implementation of HEICS are lack of administrative culture that is critical for crisis management, absence of statutory instructions and requirements related to crisis management, high cost of implantation, too many decision-makers, lack of support from authorities, non-commitment of managers, and poor coordination and communication in the crisis tea. Further, they found out that other barriers include absence common language in the management, constant regulatory changes, lack of qualified personnel at various levels, and lack of unity of command.
In order to ensure a high degree of success of emergency incidences in public hospitals, Freedman et al. (2013) contend there is a need to reduce the gap between incidence response and public health emergency planning. They suggested that effective emergency preparedness demands that sustained efforts are put in place to maintain material resources as well as personnel. In order to narrow the gap, the five elements that need to be addressed were identified. This includes coming up with an effective plan for emergency response, the establishment of a framework for incident command system, and creating the robust infrastructure to support the response. Further, there is a need to train employees on equipment, roles, and responsibilities, and also need to conduct periodic exercises for preparedness.
References
American Hospital Association (AHA). (2016). Introduction to the Hospital Emergency Incident Command System. Retrieved from: http://www.aha.org/advocacy-issues/tools-resources/advisory/96-06/011107-disaster-adv.shtml
Autrey, P. & Moss, J. (2006). High-Reliability Teams and Situation Awareness: Implementing a Hospital Emergency Incident Command System. Journal of Nursing Administration, 36(2), 67-72.
Freedman, A. M., Mindlin, M., Morley, C., Griffin, M., Wooten, W., & Miner, K. (2013). Addressing the gap between public health emergency planning and incident response: Lessons learned from the 2009 H1N1 outbreak in San Diego County. Disaster Health, 1(1), 13-20.
Yarmohammadian, M. H., Atighechian, G., Shams, L., & Haghshenas, A. (2011). Are hospitals ready to response to disasters? Challenges, opportunities and strategies of Hospital Emergency Incident Command System (HEICS). Journal of Research in Medical Sciences, 16(8), 1070-1077.
