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

Abstract

Objective: Disasters exacerbate inequities in healthcare. Health systems use the Hospital Incident Command System (HICS) to plan and coordinate their disaster response. This study examines how two health systems prioritized equity in implementing the Hospital Incident Command System (HICS) during the 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 two 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 employed various strategies to incorporate health equity throughout implementation, addressing all five 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 towards a more equitable disaster response.