Background Hospital incident command groups’ (HICG) performance may have a profound impact on hospital response to major incidents. Previous research has assessed hospital incident command group capacity as opposed to performance and factors associated to performance. The objective was to assess associations between decision-making and staff procedure skills of the hospital incident command group. Methods This was a prospective observational study using performance indicators to assess hospital incident command groups’ decision-making and performance. A total of six hospitals in Stockholm, Sweden, with their respective HICGs participated. Associations between decision-making skills and structural procedure skills during major incident simulations were assessed using measurable performance indicators as per the protocol of the Disaster Management Indicator tool. Results Decision-making skills are correlated to structural procedure skills and overall HICG performance. Proactive decision-making skills had significantly lower means than reactive decision-making skills and are significantly correlated to structural procedure skills. Conclusion There is a significant correlation between decision-making skills and structural procedural skills. Hospital incident command groups’ proactive decision-making abilities tended to be less developed than reactive decision-making abilities and may be a predictive factor for overall hospital incident command performance. A lack of proactive decision-making ability may hamper efforts to mitigate the effects of a major incident.

Background Hospital incident command groups’ (HICG) performance may have a profound impact on hospital response to major incidents. Previous research has assessed hospital incident command group capacity as opposed to performance and factors associated to performance. The objective was to assess associations between decision-making and staff procedure skills of the hospital incident command group.Methods This was a prospective observational study using performance indicators to assess hospital incident command groups’ decision-making and performance. A total of six hospitals in Stockholm, Sweden, with their respective HICGs participated. Associations between decision-making skills and staff procedure skills during major incident simulations were assessed using measurable performance indicators Results Decision-making skills are correlated to staff procedure skills and overall HICG performance. Proactive decision-making skills had significantly lower means than reactive decision-making skills and are significantly correlated to staff procedure skills.Conclusion There is a significant correlation between decision-making skills and staff procedural skills. Hospital incident command groups’ proactive decision-making abilities tended to be less developed than reactive decision-making abilities. These proactive decision-making skills may be a predictive factor for overall hospital incident command group performance. A lack of proactive decision-making ability may hamper efforts to mitigate the effects of a major incident.