Minimizing the Potential Impact of a Crisis: Preparedness

Summary:

Preparation is crucial for achieving successful outcomes. This principle is especially relevant to healthcare organizations during crises. Without robust preparation, the impact of a crisis is likely to be significantly greater.

Below, we reinforce practical and actionable steps to ensure adequate preparation, including those endorsed by the Federal Emergency Management Agency (FEMA).(1)

Figure 1. FEMA's 12 Ways to Prepare

Using FEMA’s “12 Ways to Prepare” as the basis, we have adapted these steps to best align with a medical practice’s needs.

1. Sign up for alerts and warnings.

Individuals can sign up for alerts and notifications, such as those available through local and national emergency management offices (see specific examples later in this chapter) and/or leaders can connect with the people within their organization. Never has the concept of “management by walking around” carried more potential benefit than in its ability to identify problems before they develop into a driving force for a crisis. By interacting with stakeholders at all levels, in all roles, and across all departments, leaders can learn more about what is happening and be able to effectively take their staff’s pulse. Knowing when people seem stressed and learning what issues they see as important are essentially “signing up” to receive warnings of plausible matters as they arise.

2. Make a plan.

Planning, documenting, and widely sharing are critical tasks for leaders during a crisis and during non-crisis times. This plan should address the actions to be taken before, during, and after the problem; identify the crisis response team members; outline communication strategies (including sample language for various hazards); and provide complete contact information for key stakeholders.

3. Ensure access to financial support.

Regardless of the type of crisis an organization experiences, one of the most likely outcomes is financial expenditure. Whether it is fortifying a clinical building against a natural disaster or managing through the loss in revenue incurred from lower volume due to a reputation issue, the economic impact of a crisis can become overwhelming if a practice does not have money available to sustain itself in the emergency.

Because medical practices (particularly independent practices) often distribute all proceeds annually to minimize their tax implications, many do not keep significant liquid cash on hand. Recognizing that, an alternative is to have an open line of credit available through a debt financier (likely a local or national bank with whom the practice has an existing relationship) that can be easily accessed in an emergency.

4. Practice emergency drills.

Depending on your age and from which part of the country you hail, many of you grew up with practice exercises for responding to simulated emergencies such as nuclear warfare, tornados, or fire. These practice exercises are a critical piece of preparedness. However, it is essential that organizations use “deliberate practice,” which “involves attention, rehearsal, and repetition and leads to new knowledge or skills that can later be developed into more complex knowledge and skills.”(2) This type of practice contrasts with rote repetition, which by itself will not improve performance. The benefits of deliberate practice include the following:(2)

Increased likelihood of permanently remembering new information.
Increased automaticity (applying knowledge automatically, without reflection).
Increased ability to transfer practiced skills to new and more complex problems.
Acquisition of subject matter expertise, thereby distinguishing novices from experts in a given subject.
Enhanced motivation to learn more.

These benefits allow people to respond more quickly, more effectively, and more confidently in times of crisis.

Organizations can simulate actual events using unplanned emergency drills (where practical and appropriate, without causing unintended harm to patients or staff), plan in-service time to walk through a “dry run” of what actions to take in an emergency, or ideally, use a combination of both. The tabletop exercises should bring stakeholders together to walk through mock emergencies, with everyone acting out their role in the response. These activities often uncover gaps in the crisis action plan and, when completed routinely, help keep the plans “top-of-mind”, so they are better remembered.

Deliberate practice should always be accompanied by ample guidance and followed with immediate and comprehensive feedback. Also, allow the training to build upon itself. Do not rush into an overwhelmingly complex simulation scenario before first developing some of the initial knowledge and skills (and confidence) that stakeholders will need to be successful; doing so could lead to frustration and an unwillingness to participate.

5. Test communication plans.

Communication plans should be routinely tested to ensure stakeholders receive critical information when they need it. Testing may include distributing automated test emails, automated test text messages, and automated phone calls. If the organization uses a phone tree as part of the overarching communication plan (often used by management teams within smaller medical groups), this should be tested as well. If the communication plan uses social media or an info@XYZ.com email address to receive and distribute messages, ensure the appropriate accounts and platforms are established, functional, and ready for use.

Within the testing process, audit the intended recipients to ensure they receive all test messages. If messages are not being received, determine the cause and provide additional education or change the program.

6. Safeguard documents.

Countless medical practices have lost vital paperwork in the regular course of business, ranging from the initial articles of incorporation to the current operating agreement to letters of non-renewability or certificates of need. Even physician employment agreements have gone missing as offices are moved or administrative leadership changes. It is easy to understand how records can be lost or destroyed during crisis times. Thus, a plan should be established for safeguarding critical documents. This may include physical security measures such as storage within a locked closet or a waterproof and fireproof safe, electronic archiving to avoid having to find an original paper document, or relocation to a secure, off-site location.

7. Plan with potential collaborators.

When a crisis hits, it often is reassuring to know you are not in it alone. One way to ensure your organization is not left flying solo in the face of a crisis is by forging relationships with peers during the pre-crisis planning stage. For medical practices, this could include creating a professional network with representatives from peer groups in your market who meet at least quarterly to discuss operational and strategic topics. At least once per year, network members should address crisis planning, with constituents sharing their own best practices and strengths, as well as an outline of their crisis plan. This provides an opportunity for all organizations to learn from each other’s expertise and identify subject matter experts who are available for support in the event of an emergency. While these peer groups are often also seen as competitors within a given geographic market, there are many professional benefits to forming alliances. Take the time to build the relationships before you need the support.

8. Make your facilities safer.

In the aftermath of the 9/11 attacks, many facilities instituted new security measures to make them safer. Within healthcare settings, physical security should consider three key areas: access control, surveillance, and testing. Routine audits of physical security that assess these key areas are critical to identify areas that are vulnerable and need reinforcement and potentially detect any breaches that have already occurred. One example of an effective physical safety measure is badge access to clinical sites and critical support departments such as HR or finance.

9. Know evacuation routes.

Knowing how to safely exit a building from specific locations (as would be necessary in an active shooter situation) and vacate a geographic region (which could be essential with imminent flooding) is vital. In addition to displaying signage that clearly marks exits and evacuation routes, educate staff about evacuation routes and the protocols for evacuating patients and staff.

Many organizations publish guidance on evacuation procedures and even evacuation templates and checklists. (While hospital-specific, these can be adapted for use by medical practices, surgery centers, and other clinical spaces.) Examples of these resources include:

Hospital Evacuation Checklist. Published by the California Hospital Association and accessible at www.calhospitalprepare.org/post/hospital-evacuation-checklist
Hospital Evacuation Toolkit. Published by the Commonwealth of Massachusetts Department of Public Health and accessible at www.mass.gov/doc/evacuation-toolkit-planning-guide-0/download
Hospital Evacuation Plan Template. Published by the American College of Emergency Physicians and accessible at www.acep.org/globalassets/uploads/uploaded-files/acep/by-medical-focus/disaster/hospital-evacuation-plan-template.doc

10. Assemble or update supplies.

Not every organization has ample space to keep excess inventory or supplies. Many medical practices operate on a “just-in-time” system, keeping necessary supplies on hand and replenishing the stock as needed. Thus, keeping supplies on hand “just in case” may seem like a luxury of space and dollars that cannot be afforded. However, even if it is a minimal supply, items such as personal protective equipment, bottled water, and batteries should always be readily available. The documented crisis plans should also include details about how to obtain additional supplies in an emergency.

11. Get involved in your community.

Many communities look to hospitals and medical groups as the single source of truth and often as a primary resource for support in the event of an emergency. In response, healthcare organizations must do their part to build connections with their communities. In many cases, this is a defined responsibility of the CEO, who manages the external relationships, supported by a COO, who manages internal functions. In the absence of a CEO, designate an individual who will consistently and positively act as your organization’s “face.” Encourage this person to participate in professional, faith-based, and/or civic organizations to carry messages to and from the community. Common examples include Kiwanis, Rotary, and Lions clubs, and local affiliates of national healthcare societies such as the American College of Healthcare Executives (ACHE), the Medical Group Management Association (MGMA), and Healthcare Financial Management Association (HFMA).

12. Document and insure the property.

It is essential to routinely inventory critical assets, document them with photos or videos, and detail their model numbers, purchase price, purchase date, and other relevant information. Then store the records in a secure place. Also, have the contact information readily available for the various insurance companies/agents, along with your policy number and filing instructions.

For a quick review, FEMA publishes a summary document that outlines what various policies cover, accessible here: www.ready.gov/sites/default/files/2020-03/ready_document-and-insure-your-property.pdf.

In addition to FEMA’s recommended 12 steps, a 13th is necessary for the healthcare industry: develop a plan to care for the caregivers.

A survey(3) completed at a recent Society for Health Care Strategy and Market Development (SHSMD) conference asked respondents to share their best tips on crisis responsiveness, including key lessons learned from those who recently experienced crises. Their aggregated input centered around three themes:

Plan and prepare.
Train and practice.
Take care of your team.

While the previous section highlights the first and second steps in the 12 steps outlined above, it is the necessity of the third theme that makes the healthcare industry unique in so many ways. With physician burnout at an all-time high, the importance of taking care of clinical, operational, and administrative support teams within healthcare delivery organizations is growing. In one example of day-to-day crisis management, Kaiser has begun rolling out a “purple scrubs” initiative. On every shift, one person who has mental health support training and is knowledgeable about available mental health resources wears purple scrubs, designating them as an accessible resource for anyone on the staff who may be in need.

If your organization does not have the internal resources to support your caregivers, consider educating staff on the availability of the Disaster Distress Helpline. This toll-free helpline provides crisis support services via telephone or text to those experiencing psychological distress resulting from man-made or natural disasters. It operates 24/7/365, is free, and has multilingual support. (To learn more, visit www.samhsa.gov/find-help/disaster-distress-helpline.)

Mental health support initiatives for caregivers are necessary every day and even more so during a crisis. Identifying care methods for the caregivers should be a crucial step in the overall crisis preparation process. Knowing how team members will be supported and sharing those methods in advance is extremely important in a field that has such a significant human element.

The intent is that this focus on preparedness will change how people think and ultimately act, so when the time comes and they need to spring into action, they are primed and ready to do so.

Excerpted from Effective Crisis Leadership in Healthcare: Lessons Learned from a Pandemic by Aimee Greeter, MPH, FACHE and Max Reiboldt, CPA.

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