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.
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