Lived experience of tactical command in NHS hospitals during sudden-onset critical and major incidents: a qualitative study

Background/Aims There is a lack of literature on the experiences of those in tactical command during major or critical incidents in the NHS. This study explored sudden-onset incidents in NHS hospitals, seeking to understand the lived experience of individuals in tactical command roles during these incidents, the concerns that they had and how they addressed them. Methods A total of 13 staff members participated in semi-structured interviews as part of research into 10 sudden-onset critical or major incidents that took place across seven NHS hospitals. All participants had held tactical command roles during the incident. Data were transcribed and analysed using constructivist grounded theory methodology. Results Participants described a series of challenges and requirements in tactical command roles. They faced high levels of uncertainty and were expected to take on leadership roles with substantially raised levels of personal accountability, while operating with teams made up of internal and external staff. Eight key themes were identified: navigating an unfamiliar landscape; lack of preparedness; absorbing accountability; effecting cultural change; seeking reassurance; constructing a single version of the ‘truth’ challenging previous assumptions; and responsibility for the organisation. Conclusions Safety was one of the key factors directing the responses of those in tactical command during sudden-onset incidents in NHS hospitals. Individuals in these roles felt responsible for balancing the responses at operational level with the wider impact across the hospital and broader health economy. Implications for practice Training and preparedness among individuals who may assume tactical command roles during incidents should be reviewed and needs to cover more than the major incident structure and procedures within a hospital. Training and response protocols should be aligned more closely to the actual behaviours of commanders.