The People, Process, & Progress Podcast - Why Developing Core All-Hazards Planning Skills are more beneficial than using the Hospital Incident Command System (HICS) | KEV Talks #21

Episode Date: February 14, 2023

My thesis:"Teaching Hospital and Healthcare personnel the skills and principles of All-Hazards Incident Management pay more positive dividends and develops more well-rounded response skills than teaching the same people how to follow the Hospital Incident Command System (HICS) structures."So, I believe using the standard ICS is more holistic and beneficial than using HICS.Episode takeaways:Choose the most qualified for ICS positions, not the highest rankingLet the situation dictate what's needed in Operations, not the preset HICS structureUse ICS for planned events and unplanned incidentsPractice with internal and external partners, oftenCreate a Policy Group that complements the core ICS org structureRemember...Have a planStay informedGet involved

Teaching healthcare personnel the principles of all hazards incident management will pay more dividends and develop better skills than teaching and following the hospital incident command system. This is my, Kevin Pinnell, your host of the KevTalk podcast's thesis for today's episode. It represents my feedback, my thoughts alone, none of the organizations I work with currently or have worked with in the past, but it reflects a sentiment that I have based on my professional experience as an all-hazards incident management team member, having been exposed to and worked with both the hospital incident command system and the standard incident command system. So in today's episode, I am going to support my thesis by talking about the pros and cons of both the hospital incident command system and the all-hazards incident

management principles. But first, welcome to the KevTalks podcast. Now that you're logged in, let's get locked on and hear people's compelling stories, share industry leading best practices, and hope that we can all make progress together. Be sure to visit KevTalksPod.com to read more articles and in-depth information about these great episodes and learn more from leaders in the healthcare, technology, wellness, and public safety spaces. For now, though, let's fly back into this episode in 3, 2, 1. So let's jump back into this. What is the Hospital Incident Command System? It is a system developed in the 80s, really the 90s, in Orange County, California by the EMS system there based on Firescope, which is kind of a standard for wildland fire and the Hospital Council of Northern California. And it's specifically the incident command system

with specific forms and stuff. And we'll get into those for hospitals and healthcare. So what is the all hazards incident command system I mentioned in the intro in my kind of thesis statement? It is a component of the National Incident Management System or NIMS. It has its roots in the military and wild Management System or NIMS. It has its roots in the military and wildland fire, meaning this is how we're going to respond to things. These are structures, it's response focused and involves the all hazards process involves this tool called the planning P that I've talked about here before a literal P with meetings kind of in it. And so I want to talk about why I think it's way more valuable to teach folks how to plan for,

prepare for, respond to all hazards than to just use a system that's made for a specific thing. And to me, it's kind of the, you know, teach him or give a man a fish, feed him for a day, teach a man to fish, feed him for a lifetime. Similar, you know, one thing I thought of was kind of a cook. I can teach you to make eggs and then you can make eggs and have breakfast and that's cool and that's a good meal and it's good for you. But if I taught you how to make a whole breakfast or to be able to choose what kind of breakfast you want to make with eggs and bacon

and toast and juice and whatever else, I give you more tools. That's to me what it feels like to know all hazard skills as opposed to being kind of brought up and trained in and using the hospital incident command system only for healthcare. So I'm going to try and be as fair as I can as impartial as I can. I think I'm going to do a pretty good job here. I'm going to do pros and cons for each. And honestly, though, to me, there's more cons with hospital incident command system. And again, this is my two cents based on being a credentialed planning section chief and medical unit leader for quite a few years, and having either been part of or led local and regional, state, even national level events, things like that. And then also seeing how this is used

or not used both both systems, right, whether it's all hazards or hospital, it's a system, it's forms, it's the people that make the difference. And that's some of my points and key takeaways. But before we jump to the end, let's start with the first pro for me of the hospital incident command system. It can be used and is talked about in their manual. And I can put a link to that in the show notes here that for emergencies and non-emergencies, right? So that is a good thing that they stress is that this should be used, whether it's big or small, and that's a key component. And that's the same thing for the all-hazard incident command system. Some of the mindset from folks that stand up HICS or stand up an incident command system or do planning early on,

or maybe if they haven't had a lot of exposure, is that we can only use this for big things, right? Only something bad has to happen, something big, but it's not true. It's just like any other planning process. You use it when you need to, you should use it as often as possible. And it shouldn't be looked at as a pain in the butt, it should be looked at as efficient, but that all comes down to how we use it. The second pro for me is it is tailored to healthcare. That's good, right? Not every nurse or doctor or tech or environmental health, you know, whoever that works at a hospital, all those skills has time to take separate incident command system training. And it's

good to tailor that to the needs of a healthcare organization. And I like that. It does follow the core incident command system principles. So you can see that throughout the org structures and the forms, and that's really good. It has good planning guides on the website that is run by and who developed it in Orange County, pardon me, the California Emergency Medical Services Authority. And again, I'll link to that. So really good job aid. So if you're someone that says, hey, tap, you're it, you're this position, which is something you shouldn't do in an emergency and everyone's out sick or something, that might happen. But anyway, on the HICS website, they have great job aids, great planning guides.

And kudos to them. That's really good. It's very helpful for folks that don't live this kind of stuff every day. And you don't want somebody showing up not knowing what to do, scared to make a decision, because think of if you have to evacuate a hospital or assist with a mass casualty like the Boston bombing. And I remember clearly, and maybe you all do too, one of the doctors from the hospital right there mentioned, hey, we stood up our incident command system and we did this and that. So you could tell they had done it before. You could tell

they had practiced it and they had practiced it with the EMS agencies, which is a critical thing, right? And I'll touch on that at key takeaway. So those are my pros to HICS. What are the cons to HICS? To me, the thing that was my number two pro is also my number one con. It's tailored to healthcare, right? So it's very specialized. It has specialized units in the operations section and some of the other suggestions I'll get into in a second. But I think when you tailor a skill that should be more dynamic and more broad looking, you can put blinders on folks and think, oh, I can only do this because their exposure to it, you know, whether you're a VP of something or a director of this or that is not going to be that often, right? Because you're focused on hospital and healthcare operations, not how often am I

going to do incident command system stuff. I think too, that my second con for it is when you look at the suggested structure, and again, they're suggestions. So kudos to HICS, it's a suggestion, not you have to do this. It's very, very top heavy. So you have C-suite, vice presidents, those kind of folks in section chief levels. And a quick review, the standard incident command system, whether it's HICS or the standard, so to speak, core incident command system is command staff, which is your incident commander, public information officer, safety officer, and liaison officer. And then your section chiefs is there's an operations section, planning section, a logistics section, and finance and admin section. And I've actually even had like an IT and technology section when you have huge events, like big sporting events, where there's a lot

of technology involved. And again, making structures work for you is part of what you learn in the all hazards process. And so when you see the suggested positions in the Hicks manual, it's like VPs and C-suite this, and that's very top heavy, where to me, you need those folks in a policy group and a decision making group and really who I want to run the sections, the doers of things that kind of mid to higher level leadership, but not the top are probably directors and managers. So that's a fallback to me. It does not include a policy group in there. And so I think that's to me a huge, a huge benefit of any structure, team structure. And you don't have to be a public

safety person. Think of a project or a program. You have an org chart, right? Who's in the org chart? Who's doing what? Your steering committee is your policy folks. And then the actual core org chart is who's doing the work with some a bit higher decision maker to try and escalate or help make decisions when needed. And then if they're stuck, then they'll go to the steering committee. That's what a policy group is. And so to me, there's also tons of branches in the operations section. And they are very functional focus. And that's fine, because a branch, you can make it functional or geographic, whatever, kind of per the rules, so to speak. But there's a lot of them where I think there could be less. And again, if you learn to be dynamic, folks could realize, oh, I could just make a group,

which is functional because I have less people. I don't have to have this huge branch because I'm going to get out of that mindset that this HICS only works for big things. And that comes down to the emergency manager of the organization or whoever's in charge of this is getting the mindset in the folks at the hospital, the doctors, the nurses, leadership buy-in number one, kind of going backwards there, that we should use HICS for just about any time we have to organize big events or moves or openings or whatever, because it's great practice and just see how it goes.

My fifth con for the hospital incident command system is that there are a lot of units in the operations section, which if you start to get into where hospital incident command system is that there are a lot of units in the operations section, which if you start to get into where hospital incident command system folks that are familiar with that are going to work with people in the field like public safety or other folks that use the standard coral hazards or incident command system, those don't go together, right? There's units in other sections, but not in operations. And maybe that's a, you know, a bit of a nitpicky thing, but it makes a difference if we want to talk the same language across the entire response. Think of big active shooter things, think of earthquakes, right? It should all be connected. And that doesn't mean there's going to be one big plan and one big incident action plan for the whole thing. But if we're not quite speaking the

same language, and you say unit, and I think it belongs in the planning section, because I've never used units in the operations section, that can be confusing. And the sixth thing to me is that there's a lot of specialized forms. Now, this is a con to me because maybe you're not using the core forms as much, but I think it's also a pro, right? So there's like patient movement, those kinds of things. And that's specific to healthcare. That's great. And I'll be the first one to tell you, I use and like the standard incident command system forms, but I change those forms to fit what I need. So this one's kind of on the fence about. So I like that they're customized, that they fit healthcare, but I don't like it because maybe folks won't be as familiar with other incident command system forms if they're exposed

to that. So what about all hazards? This magic formula that I seem to be talking about. Well, let's talk about some of those pros. So the same thing, use it for emergency, non-emergency, planned, unplanned events should be used for that. It fits all hazards, which means I can use the same principles that I know how to do. And with my teammates, whether it's an earthquake, a flood, a mass casualty, a fire, a missing person, it doesn't matter. We're going to make it work for us. And I already have those skills. I think it makes you more dynamic because I'm not stuck into these units in operations. We're going to make the org chart and operations fit whatever we need it. It's going to be as bigger or small as we need it to be. I'm going to call these things, these groups, these branches, if I need them, whatever I want to that makes sense to me and everybody else on my team.

And I don't have to use quite a prescripted set of names. The fourth thing is it works across all venues, meaning events or incidents, right? And so, and same thing for Hicks. But to me, all hazards, whether we're going to plan a 10K or a big company barbecue, or we have to evacuate the hospital because there was an earthquake, right? It works for all of those. I'll say the cons to me for all hazards is for some folks, and given the amount of time that many people,

particularly in healthcare and hospital work, they may not have time to put in and get the grasp of it widely. But that comes down to who's teaching the concept. Do you get a teacher that tells war stories the whole time? Do they really bring it down to, let's simplify this. You're already using this in your job, right? If you're triaging a patient, if you're setting up a structure in the ER or the operating room or in a nursing unit, think of your org chart, that's an operation section, right? It's the exact same thing. So I think that really depends on how you teach. And the thing about the other con for all hazards is it's less scripted. So some think that that really depends on how you teach. And the thing about the other con for

all hazards is it's less scripted. So some folks that maybe aren't keen to make decisions in the heat of battle, or you know, when it's really hard to do, which in healthcare is tough, because, you know, they're making tough decisions all the time, that is less scripted. So it's harder for someone to just follow along a job aid, or a form or-setup org chart. And if you don't have the experience to be able to quickly think, okay, I need these kinds of skill sets, lines and boxes in an org chart before you start asking for folks, then that's important. So I don't have really a lot of other cons, honestly, because I've seen all hazardous incident management work and bring people together. One for big, huge events, big,

huge sporting events, international events, political events, presidential debates, those kinds of things. And it didn't just help those events be planned better and make them safer. It helped the relationships that happened outside of it. Now you can do the same thing if you're using HIX, if you're working with other people, if it's building relationships within your organization, if you're working with people outside. But when you have all hazards and you travel around and you're part of these teams, it makes a huge difference and it builds relationships. So really knowing that you can use these on planned events more and more often to loop people in is a big thing. So in my pretty quick evaluation of the hospital

incident command systems, pros and cons here, and the all hazards, to me, there are way more cons to the hospital incident command system and mostly have to do with the rigidity and the very high level, top heavy structure that involves. I don't want the folks that need to make decisions for a whole system and the money the system has and the people the system has mired in determining operational level things. I want the operational level people that do that every day making those decisions because I know if you've been in meetings or worked with folks, the high level folks are super busy. They're super important. They have a lot on their mind. But when it comes to the details,

they may not have that because they have so much in their scope of work that they're going to have to ask their folks that work for them anyway. So that's, to me, a key principle of when you learn all hazards, it's we're going to put the most qualified, not the highest ranking. And so that starts my takeaway list. So whether you use the hospital incident command system and you think, Kevin, I'm not listening to you. We use HICS. I've been in healthcare forever. Love it. Not changing. Awesome. Or you go, you know what? How can we partner with our local emergency management or incident management team in your area and get some of this more all hazards training and practice, which is a great opportunity. The first thing is to choose the most qualified people, not the highest ranking.

And that is the biggest hit to me where you see the suggested positions in the Hicks manual of who should be in section chief positions and who should be, you know, public information officers and all this kind of thing that some are pretty straightforward. You know, if you're doing public information for a healthcare system, you're the PIO, you're the public information officer for whatever structure. But if you're the president or the CEO of a hospital, you shouldn't be the operations section chief. You have so much more to worry about and you need somebody that's doing operational decisions every day and is familiar with what folks can do now, not maybe what they could do when I was in that position five years ago or 10 years ago, if that makes sense. The second takeaway for me is that let the structure or the organization in the operations section what you need it to be in the other sections. But operations is where you build out really the org chart of the people that are doing things, but you make it fit you instead of making it fit the Hicks system.

Use these for planned and unplanned events. This is my third takeaway. And I mentioned it a few times because that is a critical way to build confidence for your team, to build competency for ourselves. And then also to just remind folks, like we can use this whenever we want. It's not the alarms going off. We can only use it when there's something bad happening. I don't know if this warrants that because it's not so big. You know what, if it's a company wide thing, use it, right? It's easy. It's great practice. And then when something bad does happen, something for real does happen. It's not new. It's not an uncomfortable thing. It's hey, we put the most qualified people that we knew had

the experience in these positions, not necessarily in the healthcare system. And then we also have this policy group that's going to back them and it's going to make a big difference. And we use it all the time. So it's not new. we lose power and we got to, you know, evacuate or something like that. My fourth thing is, and I mentioned this too, I think is even if you use and Hicks, you stick with it, you're all in, you got to practice with external partners, right? Certainly internally got to work it with all your people, run people through there, give them experience in the different, they call them units in the ops section. They really would be groups or divisions, which is like geographical

or functional. So basically, rotate your folks through who are in nurse managers or who are chief residents or who are key positions that are doing operational stuff but have supervisory experience. Run them through some drills. Set up some structures, some incidents, some events, some mock things and get them that experience. Now, my fifth takeaway and a big suggestion that I think should be a part of Hicks and is a part of essentially the incident command system and emergency operation center interface when you get into the all hazards world is the policy group

plus incident command system structure setup, which means I 100% want the C-suite, want the VPs, want all the leaders that can make decisions about money and time and people and facilities and have connections. They have to be there. They support us. They guide us. They break the tie in decisions. There are escalation points, but they should be in a policy group, even in a separate room, because it gets loud. It just gets loud when you're working in an incident command post or incident command center. And it's hard to hear each other. And so that they're also not maybe biased by what's going on in the room. But they there, there's tons of policy and super high level stuff going on in each of the major areas of a

healthcare system. And then in the main room, operation section is going to be humming, it's going to be loud, planning sessions going to be facilitating the process and the meetings and the timing. And of course, logistics is going to get us all the stuff and the facilities and the communications and all that. And finance is telling us how much money we can spend. And so that connection, those two structures, a policy group paired up with the standard incident command system structure and our public information officers and all those folks is, I think, the way to go.

And what I would really like to see have HICS as a standard. So again, takeaways, choose the most qualified, not the highest ranking. Let the structure dictate what's needed, not, you know, some prescriptive thing like you see in the HICS instant command system. Use plan, use it for planned and unplanned events right so practice this all the time don't think it can only be something big practice with partners internal and external all throughout right think of a training cycle throughout the year all the time and use the policy group and incident command system structure so that again back to the first point there's there's real qualified close to the ground folks or mid-level managers are doing the organization or the

coordination and operations and your your top level leaders are doing the organization or the coordination and operations. And your top level leaders are doing what they do best, right? Clearing the way, making decisions, that policy group and ICS structure is just, it's very effective. It's helpful. And it makes a huge difference. You all have made a huge difference in this podcast. I appreciate your time. I appreciate you being here, sharing this. Please subscribe. Leave me a review on Apple Podcasts. That'd be great. Helps rise us to the top. Got more interviews coming up. Really, I'd find learning about product management and comedy and standing at project management offices in the past few episodes. Remember, have a plan so you can keep your teams together and head in the right direction. Stay informed with facts, not just fear or rumors, and get involved so you,

your team, your organization can make an impact and make a difference. Godspeed, everybody.