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Centering Health Equity in the Implementation of the Hospital Incident Command System: A Qualitative Case Comparison Study

Published online by Cambridge University Press:  14 February 2024

Rachel Moyal-Smith ,
Jill A Marsteller ,
Daniel J Barnett ,
Paula Kent ,
Tanjala Purnell  and
Christina T Yuan
Rachel Moyal-Smith*
Affiliation:
Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
Jill A Marsteller
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
Daniel J Barnett
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Baltimore, MD, USA
Paula Kent
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
Tanjala Purnell
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
Christina T Yuan
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
*
Corresponding author: Rachel Moyal-Smith; Email: rsmith@ariadnelabs.org
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Abstract

Objective:

Disasters exacerbate inequities in health care. Health systems use the Hospital Incident Command System (HICS) to plan and coordinate their disaster response. This study examines how 2 health systems prioritized equity in implementing the Hospital Incident Command System (HICS) during the coronavirus disease 2019 (COVID-19) pandemic and identifies factors that influenced implementation.

Methods:

This is a qualitative case comparison study, involving semi-structured interviews with 29 individuals from 2 US academic health systems. Strategies for promoting health equity were categorized by social determinants of health. The Consolidated Framework for Implementation Research (CFIR) guided analysis using a hybrid inductive-deductive approach.

Results:

The health systems used various strategies to incorporate health equity throughout implementation, addressing all 5 social determinants of health domains. Facilitators included HICS principles, external partnerships, community relationships, senior leadership, health equity experts and networks, champions, equity-stratified data, teaming, and a culture of health equity. Barriers encompassed clarity of the equity representative role, role ambiguity for equity representatives, tokenism, competing priorities, insufficient resource allocation, and lack of preparedness.

Conclusions:

These findings elucidate how health systems centered equity during HICS implementation. Health systems and regulatory bodies can use these findings as a foundation to revise the HICS and move toward a more equitable disaster response.

Keywords

Hospital Incident Command Systemimplementationhealth equityCOVID-19
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 18 , 2024 , e44
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

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