Could the electric car be the straw that breaks the Power Grid’s Back? Here’s the scenario: The Year is 2015 and America has reached the goal of 1 Million electric cars. Many of those cars are in Florida and throughout the Gulf Coast states. A category 4 hurricane has set its sights on Florida. A voluntary evacuation in the Miami area has been issued and it appears the evacuation will become mandatory within 24 hours. So what do people do before evacuating? They stock up on essentials, do a few loads of wash, gas up their vehicles and now, they plug in their electric cars to make sure they have a full charge to max out their evacuation distance. All of this demand on the power grid causes a massive blackout, stopping gas station pumps, shutting off washing machines and cutting off power to those costly Electric Car batteries. It also halts evacuations of hospitals and nursing homes; all causing the man-made disaster just ahead of the hurricane’s natural disaster. Thus, we have the mega-disaster of 2015 which will serve as yet another learning opportunity for Emergency Managers and the folks at DHS charged with our Critical Infrastructure Protection. A post disaster congressional committee will find that America still suffers from a lack of imagination and we would have averted the Mega-Disaster if we had developed a comprehensive, strategic energy policy during the Eisenhower Administration.
America has known for 50 years that our power grid is over stressed and that oil from the Middle East was a risky proposition. Blackouts after blackouts have remained lessons Not Learned, since learning is hard and takes considerable effort and determination. The Oil Crisis of the 1970’s didn’t wake us up, since by the 1990’s we were indulging ourselves with HUMMERS and Oversized, over powered SUVs, while doing little to build American oil producing capacity. The fact that we were becoming ever more dependent on Middle Eastern oil didn’t scare us into exploring for much more oil at home-even though we know it’s there. Thus, we careen into the future with a more vulnerable power generating infrastructure than ever before in our history, at precisely the time when it appears our oil supply may well become a fugitive of the rebellions in the Middle East. With all of this going on, one would think we would recognize and act on our vulnerabilities right away. But it seems we are not vulnerable enough for us to awake from our energy coma.
Since most of our electricity is generated by coal burning, our Environmental Protection Agency has set its sights on American coal in order to clean the air and take a vital leg out from under our energy stool. Nuclear power has scared us to death since the infamous Three Mile Island accident, the “Not in my back yard” (NIMBY) folks have made it easier to transplant a face than it is to get a license for a nuclear power generating facility. America remains nuclear-phobic even while the French acquire 80% of their electricity from nuclear power. Remember, the French built the Maginot Line to keep the Germans out after World War I. While these folks are not normally seen as astute strategic planners, they beat us on this front and got it right on 21st Century Energy policy.
If energy from coal and nuclear sources are bad, oil is Satan. In our current state of denial, we are committed to solar power, oil producing algae and windmills to generate all the power that America needs for 21st Century prosperity. As we speed down those 50’s generation railroad tracks on our high speed trains toward an inevitable energy crash, it is important that we keep our electric cars plugged into those electric sockets-at least until the lights go out.
Monday, February 28, 2011
Friday, February 25, 2011
Getting Supplies and Equipment to Disaster Areas
Is anyone working with DHS in building a fully integrated Information Management System capable of merging “Situational Awareness” with a module which allows responders at all jurisdiction to order medical supplies, equipment, facilities, special needs products etc? I see many “communications’ systems which allows leaders to become aware of what is occurring, but none that allow Incident Commanders to place on-line orders for goods and services. I would be very interested in working with DHS contractors to provide an on-line resource ordering system. This system would also provide immediate inventory availability status for FEMA inventories, Government-owned Vendor Managed Inventories and Private Sector suppliers’ inventory.
I think with most of the IC systems, leaders at all levels of Government have the information available to be able to deploy SAR teams, firefighters, first responders etc., but I would be delighted to include the medical and non-medical materials systems and service contractors, mobile hospital suppliers and commodities like medicinal gasses, pain medicines and a host of special needs products. Knowing what is needed and getting those products and services to mass care centers, hospitals, nursing homes, etc. is quite a different matter.
I think with most of the IC systems, leaders at all levels of Government have the information available to be able to deploy SAR teams, firefighters, first responders etc., but I would be delighted to include the medical and non-medical materials systems and service contractors, mobile hospital suppliers and commodities like medicinal gasses, pain medicines and a host of special needs products. Knowing what is needed and getting those products and services to mass care centers, hospitals, nursing homes, etc. is quite a different matter.
Sunday, February 6, 2011
How to: Perform a Comprehensive Healthcare and Public Health Gap Analysis
I thought I’d share an article I wrote some time ago on how healthcare organizations and public health departments can perform a quality “gap analysis” to identify unmet requirements and then to work on narrowing the gap between what is required versus what is on hand to build a robust and resilient disaster response. Also, since The Joint Commission (TJC) has significantly broadened and emphasized healthcare Emergency Management standards, this article may be timely for those preparing for TJC surveys.
Everywhere we look these days, there seems to be guidance suggesting that healthcare organizations should perform a complete “Gap Analysis” as part of their Emergency Management Program (EMP). What seems to be lacking, is a recommended process to perform the “Healthcare Gap Analysis.” This process is also relevant to Public Health Departments. The jurisdiction’s Emergency Manager’s participation and leadership in Gap Analysis is vital to this process.
There are four major components to a thorough Gap Analysis: (1) Identification of planning scenarios along with the number of anticipated casualties for each planning scenario; (2) Requirements development; (3) A listing of current resources (both organizational and Prime Vendor/suppliers’) surge support; and (4) Forwarding to the next higher support agency, the difference (the gap) between current resources and surge capabilities and the total requirements needed for each planning scenario. The following is an attempt to clarify the various components of a complete Gap Analysis process.
1. The Planning Scenarios and the estimated number of casualties (live patients). Which types of disasters or public health emergencies are likely to befall a jurisdiction and how many casualties (by category) will likely be generated by each likely scenario? To get to these data, healthcare planners must consult with the jurisdiction’s emergency management agency. The jurisdiction’s Director of the Emergency Management Agency (EMA) performs Hazard Vulnerability Assessments (HVA) for the entire jurisdiction. Based on these HVAs, healthcare planners can obtain a number of planning scenarios which the jurisdiction could reasonably face. While healthcare and public health planners may consider other scenarios (like SARS or a Pandemic), for this discussion we will base the Gap Analysis on the top 3-5 planning scenarios provided by the EMA. We all know there are too many “turf issues” in Disaster Readiness today. This fact is all the more justification for taking the lead in talking with jurisdictional EMA chiefs in order to close the profound Disaster Readiness Gap we face today.
For each planning scenario, healthcare planners must obtain estimates of the number of casualties which will likely be generated. The EMA can often estimate the numbers of casualties (patients) and fatalities (dead) from past national and international disaster events. The EMA Chief can also help with the categories of injuries (such as burns, blunt force trauma and blast), based on past disasters such as the London bombings or the Tokyo subway Saran attack. The local or state Public Health Officer is the source for estimating the numbers of infected patients generated by events such as biological warfare agent attacks, SARS outbreaks or a Pandemic Influenza. HHS and Public Health sources such as the Centers for Disease Control and Prevention may also provide estimated numbers of infected persons based on a jurisdiction’s population and may also offer advice as to the likely percentages of patients who will require hospitalization. The HHS’ Agency for Healthcare Research and Quality (AHRQ) has a variety of very helpful tools and documents to estimate casualties (by category) from a number of disaster events.
2. Requirements Development. Another way of phrasing this component is: “what are the “total resources” needed to treat the numbers and categories of patients injured or infected as a result of each of the top 3-5 planning scenarios?” NOTE: Planners should coordinate with the jurisdiction’s Mortuary Affairs/ Grave Registry Director for the management of mass fatalities) The requirements development component of Gap Analysis is the process whereby healthcare and public health organizational planners identify every resource that will be required to effectively treat the estimated numbers and categories of patients resulting from scenarios identified in the community HVA. Hospital requirements include: beds, staff, medical supplies and equipment (such as ventilators, specialty beds and surgical equipment), transportation, food, water, medicinal gasses, generators/emergency power capacity, fuel, medical waste treatment equipment or removal service, and any other resource required to keep the hospital operational throughout a disaster and capable of treating the numbers of estimated casualties for each of the top 3 planning scenarios. During this phase of Gap Analysis, requirements or “needs” of the organization must not be influenced by what resources the hospital has on hand or can readily purchase from its suppliers. The reason why the requirements development component must be separated from available resources will be discussed in items #3 and #4, below. While the requirements development portion of a Gap Analysis is not a difficult process, it is tedious and time consuming. Perhaps that is why the requirements process is often the most poorly defined component of the Gap Analysis and therefore the healthcare Emergency Operations Plan (EOP). Without a complete set of requirements, planners cannot accurately depict the actual Resource Gap for forwarding an actual list of unmet requirements up the support chain as required by the National Response Framework.
3. Current Resources and Capabilities. This component of the Gap Analysis process depicts the entirety of the resources the healthcare organization and its suppliers have at their disposal to treat the number and categories of patients during the likely disaster scenarios. Healthcare and Public Health leaders need to work with their suppliers as a major component of Gap Analysis. Stockpiling at the hospital or public health department level (beyond a start-up inventory) is a bad idea and counterproductive. Stockpiling skews the week to week usage histories because ordering trends often reflect stockpile replenishment, rather than actual usage. Thus, suppliers’ demand forecast models can’t actually forecast normal requirements for total supply chain planning. A better Disaster Readiness strategy is to share the healthcare or public health departments’ total “Requirements List” with suppliers. The suppliers can then develop an Emergency Stock Redeployment Plan” whereby, suppliers can rapidly redeploy medical materials throughout their distribution center network during surges in product demand at specific areas of the Country. The suppliers’ redeployment plan should be exercised (with a small but representative quantity of materials) during community-wide exercises. Thus, The Joint Commission and other accreditation bodies can see that methods and processes are in place and operationally capable of meeting Emergency Management Standards. Even with comprehensive advance planning with suppliers, there will be resource shortfalls. This is why the National Response Framework (NRF) assigns Emergency Support Function (ESF) missions to Federal Response Agencies.
Many healthcare planners feel that they must somehow obtain the additional resources needed to manage a given scenario. The reality is that the National Response Framework (NRF) anticipated that requirements will far exceed local and even state and territory resources. The Emergency Support Function (ESF) organization at the Federal level responsible for providing Public Health and Medical Services sustainment support is the Department of Health and Human Services (HHS) as the ESF-8 agency. In the NRF, HHS is tasked to provide the difference between city and state and territory available resources and capabilities and the total requirements and capabilities needed to medically manage large scale events…in other words ESF-8 is tasked to fill in the Gap. It is therefore imperative that local and state/territorial plans accurately depict the Gap which exists between the organization’s on-hand and supplier’s available assets and Total Requirements. Only then can HHS (and other Emergency Support Functions) properly plan, program and budget for closing the “Gaps” which exist in jurisdictions across America.
4. Forwarding the Requirements Gap. The “resource and capability gaps” for each planning scenario is the difference between available resources (including start-up inventories as well as suppliers’ redeployment plans) and capabilities, versus the total requirements. The National Response Framework requires that local healthcare organizations pass on requirements exceeding available resources to the local Emergency Management Agency (EMA). The requirements which cannot be met at the local jurisdictional level must then be forwarded to the state/territory or tribe EMA. Finally, unmet state/territory/tribe unmet requirements for resources and capabilities will be forwarded up the chain to the Federal agency responsible for providing the individual Emergency Support Functions (ESF). It bears repeating that backup support for Public Health and Medical Services, the Federal support function is ESF-8, and is provided by the Department of Health and Human Services (HHS). It is important for healthcare and public health planners and jurisdictional elected officials to cite the ESF-8 mission tasking when forwarding their “Unmet Requirements” up the support chain to HHS’, Assistant Secretary for Preparedness and Response (ASPR) for “Enterprise-Wide” accomplishment of their ESF-8 Mission Tasking.
With well-defined Public Health and Healthcare Gap Analyses from jurisdictions across America, HHS can then analyze, plan, program, budget, procure, manage, pre-position and rapidly deploy additional resources needed to sustain and fortify America’s Public Health agencies and the Private Healthcare Industry during future emergencies and disasters requiring Federal ESF support.
Everywhere we look these days, there seems to be guidance suggesting that healthcare organizations should perform a complete “Gap Analysis” as part of their Emergency Management Program (EMP). What seems to be lacking, is a recommended process to perform the “Healthcare Gap Analysis.” This process is also relevant to Public Health Departments. The jurisdiction’s Emergency Manager’s participation and leadership in Gap Analysis is vital to this process.
There are four major components to a thorough Gap Analysis: (1) Identification of planning scenarios along with the number of anticipated casualties for each planning scenario; (2) Requirements development; (3) A listing of current resources (both organizational and Prime Vendor/suppliers’) surge support; and (4) Forwarding to the next higher support agency, the difference (the gap) between current resources and surge capabilities and the total requirements needed for each planning scenario. The following is an attempt to clarify the various components of a complete Gap Analysis process.
1. The Planning Scenarios and the estimated number of casualties (live patients). Which types of disasters or public health emergencies are likely to befall a jurisdiction and how many casualties (by category) will likely be generated by each likely scenario? To get to these data, healthcare planners must consult with the jurisdiction’s emergency management agency. The jurisdiction’s Director of the Emergency Management Agency (EMA) performs Hazard Vulnerability Assessments (HVA) for the entire jurisdiction. Based on these HVAs, healthcare planners can obtain a number of planning scenarios which the jurisdiction could reasonably face. While healthcare and public health planners may consider other scenarios (like SARS or a Pandemic), for this discussion we will base the Gap Analysis on the top 3-5 planning scenarios provided by the EMA. We all know there are too many “turf issues” in Disaster Readiness today. This fact is all the more justification for taking the lead in talking with jurisdictional EMA chiefs in order to close the profound Disaster Readiness Gap we face today.
For each planning scenario, healthcare planners must obtain estimates of the number of casualties which will likely be generated. The EMA can often estimate the numbers of casualties (patients) and fatalities (dead) from past national and international disaster events. The EMA Chief can also help with the categories of injuries (such as burns, blunt force trauma and blast), based on past disasters such as the London bombings or the Tokyo subway Saran attack. The local or state Public Health Officer is the source for estimating the numbers of infected patients generated by events such as biological warfare agent attacks, SARS outbreaks or a Pandemic Influenza. HHS and Public Health sources such as the Centers for Disease Control and Prevention may also provide estimated numbers of infected persons based on a jurisdiction’s population and may also offer advice as to the likely percentages of patients who will require hospitalization. The HHS’ Agency for Healthcare Research and Quality (AHRQ) has a variety of very helpful tools and documents to estimate casualties (by category) from a number of disaster events.
2. Requirements Development. Another way of phrasing this component is: “what are the “total resources” needed to treat the numbers and categories of patients injured or infected as a result of each of the top 3-5 planning scenarios?” NOTE: Planners should coordinate with the jurisdiction’s Mortuary Affairs/ Grave Registry Director for the management of mass fatalities) The requirements development component of Gap Analysis is the process whereby healthcare and public health organizational planners identify every resource that will be required to effectively treat the estimated numbers and categories of patients resulting from scenarios identified in the community HVA. Hospital requirements include: beds, staff, medical supplies and equipment (such as ventilators, specialty beds and surgical equipment), transportation, food, water, medicinal gasses, generators/emergency power capacity, fuel, medical waste treatment equipment or removal service, and any other resource required to keep the hospital operational throughout a disaster and capable of treating the numbers of estimated casualties for each of the top 3 planning scenarios. During this phase of Gap Analysis, requirements or “needs” of the organization must not be influenced by what resources the hospital has on hand or can readily purchase from its suppliers. The reason why the requirements development component must be separated from available resources will be discussed in items #3 and #4, below. While the requirements development portion of a Gap Analysis is not a difficult process, it is tedious and time consuming. Perhaps that is why the requirements process is often the most poorly defined component of the Gap Analysis and therefore the healthcare Emergency Operations Plan (EOP). Without a complete set of requirements, planners cannot accurately depict the actual Resource Gap for forwarding an actual list of unmet requirements up the support chain as required by the National Response Framework.
3. Current Resources and Capabilities. This component of the Gap Analysis process depicts the entirety of the resources the healthcare organization and its suppliers have at their disposal to treat the number and categories of patients during the likely disaster scenarios. Healthcare and Public Health leaders need to work with their suppliers as a major component of Gap Analysis. Stockpiling at the hospital or public health department level (beyond a start-up inventory) is a bad idea and counterproductive. Stockpiling skews the week to week usage histories because ordering trends often reflect stockpile replenishment, rather than actual usage. Thus, suppliers’ demand forecast models can’t actually forecast normal requirements for total supply chain planning. A better Disaster Readiness strategy is to share the healthcare or public health departments’ total “Requirements List” with suppliers. The suppliers can then develop an Emergency Stock Redeployment Plan” whereby, suppliers can rapidly redeploy medical materials throughout their distribution center network during surges in product demand at specific areas of the Country. The suppliers’ redeployment plan should be exercised (with a small but representative quantity of materials) during community-wide exercises. Thus, The Joint Commission and other accreditation bodies can see that methods and processes are in place and operationally capable of meeting Emergency Management Standards. Even with comprehensive advance planning with suppliers, there will be resource shortfalls. This is why the National Response Framework (NRF) assigns Emergency Support Function (ESF) missions to Federal Response Agencies.
Many healthcare planners feel that they must somehow obtain the additional resources needed to manage a given scenario. The reality is that the National Response Framework (NRF) anticipated that requirements will far exceed local and even state and territory resources. The Emergency Support Function (ESF) organization at the Federal level responsible for providing Public Health and Medical Services sustainment support is the Department of Health and Human Services (HHS) as the ESF-8 agency. In the NRF, HHS is tasked to provide the difference between city and state and territory available resources and capabilities and the total requirements and capabilities needed to medically manage large scale events…in other words ESF-8 is tasked to fill in the Gap. It is therefore imperative that local and state/territorial plans accurately depict the Gap which exists between the organization’s on-hand and supplier’s available assets and Total Requirements. Only then can HHS (and other Emergency Support Functions) properly plan, program and budget for closing the “Gaps” which exist in jurisdictions across America.
4. Forwarding the Requirements Gap. The “resource and capability gaps” for each planning scenario is the difference between available resources (including start-up inventories as well as suppliers’ redeployment plans) and capabilities, versus the total requirements. The National Response Framework requires that local healthcare organizations pass on requirements exceeding available resources to the local Emergency Management Agency (EMA). The requirements which cannot be met at the local jurisdictional level must then be forwarded to the state/territory or tribe EMA. Finally, unmet state/territory/tribe unmet requirements for resources and capabilities will be forwarded up the chain to the Federal agency responsible for providing the individual Emergency Support Functions (ESF). It bears repeating that backup support for Public Health and Medical Services, the Federal support function is ESF-8, and is provided by the Department of Health and Human Services (HHS). It is important for healthcare and public health planners and jurisdictional elected officials to cite the ESF-8 mission tasking when forwarding their “Unmet Requirements” up the support chain to HHS’, Assistant Secretary for Preparedness and Response (ASPR) for “Enterprise-Wide” accomplishment of their ESF-8 Mission Tasking.
With well-defined Public Health and Healthcare Gap Analyses from jurisdictions across America, HHS can then analyze, plan, program, budget, procure, manage, pre-position and rapidly deploy additional resources needed to sustain and fortify America’s Public Health agencies and the Private Healthcare Industry during future emergencies and disasters requiring Federal ESF support.
Wednesday, February 2, 2011
Healthcare Material Managers and Healthcare Reform
Many Materials Managers are already recognized by their healthcare organizations as true subject matter experts in virtually every support area of the healthcare organization. I have to say that the future for Materials Managers is extremely bright. I do hope the title will change to Healthcare Logistics Manager to reflect the actual function more realistically.
The Materials Manager will be a critical leader as we move toward healthcare reform, no matter which form healthcare reform takes. I think the Air Force experience with Healthcare Logisticians will be replicated in the Private Sector sooner rather than later. Materials Managers will provide the expertise needed to measure all healthcare costs and serve as the leader in implementing major cost containment efforts. Many healthcare organizations may not survive in the future, but those organizations with the desire to survive reimbursement reductions and continuing service to their Communities, the Materials Manager's experience will be invaluable.
The Air Force started moving Healthcare Logisticians into Commander (CEO) positions in the 1970s. The Air Force Surgeon General’s Office was amazed at how well we did as CEOs. We had an inside joke that we were naturals for the job. We never had the staffing levels we were authorized; we dealt with Defense Department medical depots as our Prime Vendor and dealt with 30-45 days order-ship dates. We also had to work with the Base Finance Office, Procurement Directorate, Information Systems Office and the Non-Medical Supply Officer (Base Supply) to get the supplies, equipment and services for our hospital or medical center. The feeling was if we could jump all those hurdles and accomplish “additional duties” such as Director, Environmental Services, Linen & Laundry, Central Supply, Plant Operations, Biomedical Equipment Management and serve as the United Way project officer, how hard could the CEO job really be?
I know that the future for the Materials Management career field is very bright indeed. It’s only a matter of time until Corporate Offices recognize what most of us are already doing and move us into the C-Suite. After all, the Air Force did that over 35 years ago.
The Materials Manager will be a critical leader as we move toward healthcare reform, no matter which form healthcare reform takes. I think the Air Force experience with Healthcare Logisticians will be replicated in the Private Sector sooner rather than later. Materials Managers will provide the expertise needed to measure all healthcare costs and serve as the leader in implementing major cost containment efforts. Many healthcare organizations may not survive in the future, but those organizations with the desire to survive reimbursement reductions and continuing service to their Communities, the Materials Manager's experience will be invaluable.
The Air Force started moving Healthcare Logisticians into Commander (CEO) positions in the 1970s. The Air Force Surgeon General’s Office was amazed at how well we did as CEOs. We had an inside joke that we were naturals for the job. We never had the staffing levels we were authorized; we dealt with Defense Department medical depots as our Prime Vendor and dealt with 30-45 days order-ship dates. We also had to work with the Base Finance Office, Procurement Directorate, Information Systems Office and the Non-Medical Supply Officer (Base Supply) to get the supplies, equipment and services for our hospital or medical center. The feeling was if we could jump all those hurdles and accomplish “additional duties” such as Director, Environmental Services, Linen & Laundry, Central Supply, Plant Operations, Biomedical Equipment Management and serve as the United Way project officer, how hard could the CEO job really be?
I know that the future for the Materials Management career field is very bright indeed. It’s only a matter of time until Corporate Offices recognize what most of us are already doing and move us into the C-Suite. After all, the Air Force did that over 35 years ago.
Tuesday, February 1, 2011
Healthcare Executives-Take a systems approach to Healthcare Disaster Readiness
I attached a briefing that I think will help healthcare leaders take a “Systems Approach” to preparing healthcare organizations for future disasters and Public Health Emergencies.
https://docs.google.com/present/view?id=dg3kckdd_29c2vmh8fj
Monster Snow and Ice storm February 1st 2011
The monster snow storm is likely to cause loss of life and widespread suffering. I have been advocating for years a Federal Government (likely FEMA) to air public service announcements (PSA) on citizen Disaster Readiness. I hear a lot of comments that the Folks would panic and in essence the Folks can’t handle the truth. Government officials may point to the “We advise people to stock up on plastic wrap and masking tape” fiasco after 9-11. While there will always be a few people who take things to extremes, in that case the message was very poorly crafted.
I believe is FEMA had a number of geographically pertinent PSAs on likely scenarios and specific actions citizens should take; we would be much better served. I think there are too many people in power who have a serious level of distain for the average American’s ability to understand risk communication and take appropriate action. I think Federal officials should use a good “Risk Communications Specialist” to write the copy which could be used to educate the Public on appropriate actions to take in advance of various disasters, attacks or Public Health Emergencies. It’s too late for the current snow and ice storm, but not too late for future events.
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