Breakout Session 3: Leadership Structures

Establishing leadership and management structures for alternate care facilities (ACFs) presented governance challenges distinct from those of conventional hospital operations and were frequently shaped as much by political and inter-organizational dynamics as by clinical need. Symposium participants summarized operational lessons from leading ACFs across multiple jurisdictions and partnership models. Participants reported that effective ACFs typically mirrored hospital executive structures while operating under hybrid governance models that distributed authority, liability, and resources across multiple hospital systems and state agencies. Hospital Incident Command System (ICS) provided necessary scaffolding but was insufficient on its own; success depended on pre-existing inter-agency relationships and on credible leaders with the gravitas to mobilize resources across organizational boundaries. Persistent challenges included credentialing and electronic medical record (EMR) access delays, political directives that superseded clinical judgment, and severe interpersonal conflict that overwhelmed leadership without embedded human resources support. Recommended best practices include pre-identifying and training a cadre of ACF leaders, embedding human resources and behavioral health support within the leadership team, and clearly defining and protecting the ACF mission throughout activation and operations.