A Case Study in the Identification of Critical Factors Leading to Successful Implementation of the Hospital Incident Command System

Introduction The Hospital Incident Command System (HICS) is a system of incident management that applies the principles of the Incident Command System (ICS) to hospitals. ICS is an organizational and multi-organizational management system developed in the 1970s by California’s FIRESCOPE (Firefighting Resources of California Organized for Potential Emergencies), a working partnership of fire service partners at the local, regional, state and federal level. Both HICS and ICS provide a scalable, flexible organizational structure that allows for common terminology and span of control during incident response and may expand or contract depending on the size of the incident. Many of the 6,000 hospitals in the United States use a version of HICS for emergency management, and international use continues to increase. HICS is also used by all Navy hospitals. The Orange County Emergency Medical Services Agency developed HICS in 1991 in partnership with the California Emergency Medical Services Authority (EMSA), and EMSA released subsequent versions, each with increasing stakeholder input. The Fifth Edition was released in 2014. This thesis is a case study in the identification of critical factors leading to the successful implementation of HICS by Stanford Medicine in response to the Asiana plane crash of July 6, 2013, hereafter referred to as Asiana. Problem Statement HICS is widely used, yet there is a paucity of research on HICS implementation. No model exists for evaluating HICS implementation or using it as a predictor of success. A study of HICS may benefit hospitals, provide input for future revisions, and add to the body of knowledge about HICS. The impact of HICS, positive or negative, has not been comprehensively studied, and implementation of the system seems to be limited to anecdotal examples. Before the hospital response to the 2013 Boston Marathon Bombings provided anecdotal support for the value of HICS, the most compelling documentation available on the value and use of HICS in the United States was a survey conducted at Northridge Hospital after the Northridge Earthquake of 1994. A research endeavor of HICS implementation during an emergency response appears timely, if not overdue. Research Question What are the critical factors that lead to the successful implementation of HICS based upon Stanford Medicine’s response to Asiana? For the purposes of this case study, Stanford Medicine refers to Stanford Hospital, Lucile Packard Children’s Hospital, an