Hospital incident command system

Manageable Span of Control

HICS encourages the use of a manageable span of control, meaning that no one person should have too many direct reports. Usually, the recommendation is to keep teams between three to seven people. In other words, if the task can be done with five people, one leader should do it. If the task takes 14 people, there should be at least two teams, each with its own leader to direct the work.

This is one of the most important tenets of ICS and HICS. During day-to-day operations at almost any business, leaders often oversee teams much larger than seven people. That works because workers and team members are typically experts at the tasks they perform on a routine basis. Oversight in this situation is limited to extraordinary circumstances and most workers are capable of completing tasks without intervention by a team leader.

An emergency incident or special event is different. This is a unique situation in which people are going to be asked to perform tasks they don’t usually do. Some tasks could be similar to what they do every day, but often those come with a slew of questions that need to be answered as an incident progresses. It’s important not to burden leaders with unmanageably large teams.

HICS addresses span of control through a flexible organizational command structure. For example, if a medical gas leak in a single part of the hospital required a department to evacuate until maintenance could turn it off, the hospital might activate HICS with an Incident Commander (see below) and a couple of command staff members to direct the department on how to respond.

If the leak grows to the point where there are multiple departments evacuating, now the number of leaders increases to a point that one Incident Commander can’t effectively keep track of everything that’s happening. So, the Incident Commander can appoint someone as the Operations Chief and someone else as the Logistics Chief. Those two people are then able to direct their own teams and respond to the incident, freeing up the Incident Commander to address other things such as public information messaging and notification of additional hospital leadership.

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