Several factors affect corona crisis management in health systems. However, few studies regarding the coronavirus have been focused on the management of the crisis based on disaster management principles. The present study aimed to evaluate various aspects of corona management and command in two groups of the DHNs covered by the PMUs of Iran. A key strength of our study was the evaluation of various dimensions of corona incident command based on a global algorithm, which encompassed all the aspects of incident command and management in an emergency.
According to the current research, the DHNs with an active HICS system had more favorable organizational support compared to the DHNs without an HICS or those that had not activated the HICS. Overall, an HICS has multiple functional areas with specific purposes. The goals of each region are hierarchically in line with the basic goals of the system and programs set by the upper echelons, so that the presence of HICS functional areas could ultimately enable the organization to achieve multiple goals (26), which in turn improved organizational support.
The value of the HICS system in the reduction of organizational differences has been an issue raised in this regard, especially in large-scaled events (27). This could be due to the fact that the mere existence of an HICS does not guarantee organizational success and may not enhance organizational support. In fact, the strong commitment of organizational executive leaders, culture of organizational promptness, budget to support planning, training, and practice significantly impact executive commitment and the success of HICS, which in turn promote organizational support (22). Furthermore, determining the organizational hierarchy of the HICS structure based on application requirements rather than the titles and positions of individuals plays a crucial role in organizational success (28).
The HICS is an accurate, broad-spectrum management system in public health environments to define operational specifications, interactive management components, and incident management structures (26). This framework is also a standard system for disaster response (29), as well as a standard management system (30). Nevertheless, Stephen S. Morse has claimed that many health organizations are not comfortable with the use of this system (31). In another study, Burkle F. M. et al. discussed the application of the framework in health-related disasters on a large scale, especially in an epidemic (32). In this regard, our findings indicated that the executive operation score of the DHNs with an active HICS was significantly higher compared to the DHNs with an inactive HICS or no HICS during the corona crisis. In fact, the HICS has been observed to improve organizational operations during disasters through prioritized operation checklists, identifying positions, and teamwork (14). In addition, the framework is considered proper for complicated and multidisciplinary operations (33), so that the failure of one component of the HICS would not lead to the failure of the other components (34). The efficiency of the system and its operations could enhance by measures such as promoting the culture of familiarity with the HICS (12), familiarity with the organizational structure of the HICS (35), and the scientific and practical training of staff regarding the framework and implementation of training (36). The HICS provides a standard response format and increases coordination since it could be recognized by the organizations and various sectors that are responsible for incident management, thereby affecting the response rate (14).
According to the results of the present study, the HICS could improve the coordination status in the corona crisis management, and the coordination score of the DHNs with an active HICS in the coronavirus pandemic significantly differed with the DHNs with an inactive or no HICS. In fact, the framework provides the opportunity for the coordinated response to emergencies (33, 34, 37, 38), as well as the multidisciplinary coordination for response to public health threats (33). In addition, the system creates unity in severe crises by enabling the use of reciprocal efforts (27, 39).
In the current research, the DHNs with an active HICS had better communications in the corona crisis management, and the difference between the DHN groups was considered significant in this regard. In general, the HICS is a communication system (40), which enables the communication and sharing of resources between health institutions and organizations (37). The framework also promotes administrative communications (22) through establishing clear inter-organizational associations (38) and preventing unnecessary communications (41), while also facilitating communications between hospitals, medical emergencies, and other response systems (40, 42) and foreign organizations (43). Although this system is not an actual disaster plan, it acts as a guide to the proper organizational management of an emergency (37, 40), thereby increasing the ability to retrieve scheduled and unplanned events (44) and remarkably facilitating responding, planning, decision-making, and documentation (13).
In the present study, the PMUs with an active HICS had better planning, while none of the DHNs with an inactive or no HICS had a high planning score. Among the studied dimensions, the lowest corona crisis command score in the DHNs in Iran belonged to the planning dimension. Considering that the HICS improves planning, it is essential to assess its activation and correction in organizational planning prior to an incident or disaster (22) and cluster the obtained data based on the actual response stage method in order to improve the efficiency of the HICS structures and activities in the planning stage (32). Moreover, the framework could help eliminate the lack of the executive commitment of the system in the planning department (22).
According to the results of the present study, the weakest incident command dimension in the Iranian DHNs was the logistics dimension. In other words, the lowest score was obtained in this dimension, which might be due to the international sanctions against Iran during the current pandemic (2). Considering this issue, the elimination of the financial barriers of the health system and financially supporting the establishment of the HICS improve the efficiency of the framework (45). Despite the international sanctions, the DHNs with an active HICS had extremely better performance in the logistics field in the current research. On the other hand, the DHNs with an inactive HICS or no HICS had improper performance and could not obtain high scores in any of the dimensions. Therefore, it could be concluded that the system is able to reduce the loads of logistic problems during crises by exploiting all the resources for problem-solving (28), supply needs, resources, and equipment (46), thereby providing the health facilities required for emergency management (30).
According to the results of the present study, the human resource management of the DHNs with an active HICS was significantly better than the DHNs with an inactive or no HICS. In addition, none of the DHNs with an inactive or no HICS obtained a favorable score in this dimension. By providing services in the shortest possible time (12), identifying the areas for expanding services during patient overload periods (46), preventing rework (38), and using human resources regularly (39), the HICS encourages individuals to take on the necessary responsibilities in a timely manner (45), which in turn results in effective human resource management, as well as adequate and efficient human resources (38).