To command is to serve: Senior leadership and policy-making predict hospital ward functioning in emergency

To examine personal, ward and organisational factors related to the functioning of general hospital staff under missile attack.

The summer of 2014 is remembered in Israel for missile attacks from the Gaza Strip targeting the civilian population of southern Israel.

The study was carried out in two steps: (1) Qualitative-a focus group to identify the issues faced by the staff of a hospital under fire, (2) Quantitative-a cross-sectional study among 409 hospital workers to explore: (a) personal involvement in decision-making, (b) clarity of directives, (c) coping with emergency on the ward and on (d) the management level, (e) personal professional functioning.

A statistically significant positive correlation was found between personal involvement in decision- and policy-making, the clarity of directives and hospital ward functioning. A regression analysis demonstrated that executive management and leadership, clarity of directives and workers' personal functioning statistically significantly explained 46.1% (R²  = 0.461) of the variance in ward functioning during emergency.

Clarity of directives and executive management and leadership in emergency were positively associated with ward functioning and coping with emergency.

To ensure proper hospital functioning during emergency, managers must demonstrate personal involvement and leadership, providing clear directives.