{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:29:45Z","timestamp":1792524585029,"version":"4.5.0"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In crises, hospitals must rapidly shift from routine operations to structured crisis management, requiring the activation of an incident command system. However, empirical insight into their operational functioning during activation remains limited. Goal: to identify operational enablers and barriers influencing effective crisis response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective cross-sectional, qualitative, single-center study conducted after a table-top exercise within a hospital incident command system at a tertiary care university hospital (NCT06913010). Data were collected through semi-structured interviews, participant observation, and document analysis, and analyzed using a narrative-phenomenological approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nineteen participants were included. Analysis identified nine thematic clusters shaping operational performance: (1) structure and roles; (2) communication; (3) decision-making and prioritization; (4) information management; (5) infrastructure and technology; (6) personnel and organization; (7) training, exercises, and team dynamics; (8) documentation; and (9) external communication and media. Enablers included clear role definition, structured communication, phased decision-making, and regular training. Barriers included role ambiguity, fragmented communication, insufficient prioritization, infrastructure limitations, and staffing constraints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Preparedness frameworks are necessary but insufficient as stand-alone approaches, as operational execution determines real-world performance. Recurring deficits included unclear roles, inconsistent communication, weak prioritization, and gaps in infrastructure and personnel. A limited set of standardized practices\u2014including a clear separation of roles, leadership intent, closed-loop communication, explicit decision cycles from information gathering to structuring to decision-making, checklists, visualization, central information management, and rapid \u201c80% decisions\u201d-substantially enhanced performance. Mission command (\n                      <jats:italic>Auftragstaktik)<\/jats:italic>\n                      further enabled adaptive, coordinated action. Strengthening hospital incident command is a key lever for achieving system-level resilience in crises.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1880835","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:04:03Z","timestamp":1785305043000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Operational enablers and barriers in hospital incident command: insights from a single-center table-top exercise at a tertiary care university hospital\u2014a qualitative phenomenological study"],"prefix":"10.3389","volume":"14","author":[{"given":"Markus","family":"Ries","sequence":"first","affiliation":[{"name":"Crisis and Disaster Management Unit, Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]},{"name":"Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]},{"name":"Rhine-Neckar Public Health Service","place":["Heidelberg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maik","family":"von der Forst","sequence":"additional","affiliation":[{"name":"Crisis and Disaster Management Unit, Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]},{"name":"Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanne","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"Crisis and Disaster Management Unit, Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Bikowski","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]},{"name":"Institute for Medical Psychology, Center for Psychosocial Medicine, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaas","family":"Franzen","sequence":"additional","affiliation":[{"name":"Medical Clinic III, University of L\u00fcbeck","place":["L\u00fcbeck, Germany"]},{"name":"Airway Research Center North (ARCN), German Center for Lung Research (DZL)","place":["L\u00fcbeck, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Geoerg","sequence":"additional","affiliation":[{"name":"Strategic Management in Civil Protection, Akkon University of Applied Sciences","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Weykamp","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ)","place":["Heidelberg, Germany"]},{"name":"Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ)","place":["Heidelberg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Popp","sequence":"additional","affiliation":[{"name":"Crisis and Disaster Management Unit, Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]},{"name":"Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University","place":["Heidelberg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janna","family":"K\u00fcllenberg","sequence":"additional","affiliation":[{"name":"Institute for Innovation, Transformation, and Sustainability, FHNW School of Applied Psychology","place":["Olten, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1016\/S0140-6736(17)32464-9","article-title":"The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health","volume":"391","author":"Watts","year":"2018","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1016\/S0140-6736(22)01589-6","article-title":"How prepared is the world? 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