Achieving Operational Excellence and Disaster Readiness

A “Total System-Dual Track” approach to Healthcare Operational Excellence and Disaster Readiness.

As many American healthcare organizations recover from the disruptions caused by hurricane Sandy, there is an opportunity for real innovation in both healthcare operations and disaster readiness. By taking a “total system-dual track” approach to measuring everyday healthcare operations as well as for disaster readiness, we can realize multiple benefits from one process. Just some benefits of taking a “total system-dual track approach” to measuring organizational effectiveness and Disaster Readiness are:

·         Improving everyday healthcare operations

·         Achieving a high correlation between operational effectiveness and Disaster Readiness

·         Deepening Medical Surge capacities and capabilities

·         Discovering countless opportunities to save time and money such as

o   Reducing wasteful practices

o   Eliminating redundancies

·         Improving safety for patients and staff

·         Improving the patient experience / patient satisfaction

·         Reducing administrative burdens of patient care providers

·         Invigorating an organizational sense of purpose, sense of community and dedication to mission

Organizational Change. Changes in American Healthcare are here to stay. Health outcome measurements will become increasingly tied to reimbursements, and healthcare organizations will be increasingly accountable for the overall health of their total patient mix. Eventually, those organizations which can adapt to meeting the needs of their entire community will be those who survive and thrive.

Measure Everything. If it isn’t measured, it’s not being done. Healthcare organizations need to understand all business processes and consistently look for better, safer, less expensive ways to accomplish their mission. Every department and patient care unit’s processes and policies must be examined with an eye to improvement and resilience during disasters.

The future will belong to healthcare organizations that are totally committed to remain in service to their communities by managing on purpose, rather than by habit. At the same time, healthcare organizations must plan and prepare for disaster contingencies in order to remain functioning for the communities they serve, both during the disaster and until normalcy returns.  They must do this to remain a viable organization that survives the disaster to continue as a resource that serves their communities.

Healthcare organizations’ longtime approach to Emergency Management has been focused on passing Accreditation inspections instead of building true disaster resiliency. Consequently, Healthcare executives have paid little attention to the changing skill sets required for Emergency Management Coordinators (The word Coordinator in the job title often means 30K-45K in salary). Healthcare leaders must revise the EM job requirements (and salaries) to reflect the many skill sets needed to:

1.    Ensure all hospital systems are:

Hardened: Facility mitigation against likely disaster scenarios, HVAC zoning, facility lockdown, generator capabilities (and what equipment is on the Generator power grid for long term operations), etc.

Enhanced: Staff (augmentees), Communications systems (redundancy), Materials Management (emergency provisions in all supplier contracts to deepen supply chains through stock redeployments).

Resourced: Contracts for Per Diem nurses and CNAs, security personnel, patient transport, food service vendors need to include emergency provision clauses. Likewise, medical materials and pharmaceutical contracts must include emergency clauses for redeploying materials into distribution centers supporting future disasters. Healthcare organizations should consider automated resupply contracts for medicinal gases, water (drinking, washing and chillers), food, generator fuel, laundry/linen and Environmental Services supplies and equipment. The Infection Control Officer should take a major role on the hospital post-disaster recovery team.

Coordinated: Coalitions of healthcare organizations, Emergency Medical Services, (EMS), Non Governmental Organizations (NGO), Medical Reserve Corps units and rescue services must train together in order to mount an effective disaster response. Protocols for Health Information Exchange (HIE), patient transfers and admissions must be consistent in both normal and emergency conditions. Federal Hospital Preparedness Program (HPP) grant dollars may be available from states to fund these activities.

Recovered: Private-Non-Profit healthcare organizations should develop a FEMA disaster grant package for post-disaster documentation. This package should include a list of in-use equipment inventory (linked to purchase orders for proof of ownership) and procurement policies such as Group Purchasing, procedures for off contract purchases, credit card policies and open bid processes. The package should also include a copy of Human Resources policies on extra hires, overtime and timekeeping etc.

2. Build strong alliances in the Community, including the Emergency Management Agency (EMA) staff, Police, Fire and Rescue, EMS companies, Nongovernmental Organizations (NGOs), Religious Congregations, Utility companies, Waste Management companies, etc. in order to enhance resiliency and surge support services from within the Community (Whole Community Organic Response System).

3. Build real coalitions with all Healthcare Organizations operating within the community. This means other hospitals operating in the community, but should also include surgical centers, physician and dental professionals and practices, physical and occupational therapists & practitioners and Medical Reserve Corps Units. It’s important to make sure all volunteers and extra hires are registered in the state’s ESAR-VHP system as well as privileged and assigned to an individual care team. Ensure ongoing competency training for all augmentees.

4. Develop a full pre-disaster documentation package of hospital assets (consider pictures) which complies with what FEMA will need to review as part of the Public Assistance grant program. Lots of work here, but it is well worth the effort should assets be damaged or destroyed in a disaster. 

 FEMA’s Immediate Needs Funding (INF):  Private-Non-Profit Healthcare organizations that have developed a pre-disaster FEMA documentation package will be far ahead in quantifying and supporting FEMA’s Preliminary Damage Assessment (PDA) and in justifying accelerated funding through FEMA’s Immediate Needs Funding (INF) program. This package will also streamline and accelerate the FEMA Project Worksheet process and optimize Public Assistance grants.

Conclusion.  By taking a “total system-dual track approach” to measuring Organizational Effectiveness and Disaster Readiness, healthcare leaders will be ready for future disasters and for whatever challenges lie ahead for American Healthcare.

A Lack of Imagination………Again?

Salado, Texas.  Do our Biosafety (BSL) Levels 3 & 4 Laboratories provide terror groups with a more horrible and more lethal weapons delivery platform than the aircraft they used on September 11^th, 2001?

I’ll never forget the Public Statement Release of 9/11 Commission Report from the Hon. Thomas H. Kean and the Hon. Lee H. Hamilton on July 22, 2004….. “But on that September day we were unprepared. We did not grasp the magnitude of a threat that had been gathering over time. As we detail in our report, this was a failure of policy, management, capability, and – above all – a failure of imagination.”

The General Accountability Office (GAO) released reports and recommendations regarding “High Containment Laboratories” in 2007, 2008 and 2009, but as of this writing, I can find no single Federal agency responsible for developing and measuring the standards to ensure the security of all agents used in our BSL-3 and BSL-4 laboratories. Is it HHS/CDC? Is it the DOJ/FBI? Is it DHS…or is it all of the above?  My motto is: “If everyone is responsible, no one is accountable.”

Is this a “Back to the Future” moment? Could the proliferation of Biosafety Laboratories across America and the World present an irresistible opportunity for terrorists?  Can we “Imagine”:

·         A terrorist group notifying the Federal Government that they have acquired killer biological agents from our BSL labs and prepositioned the agents with their terror cells in cities across America?

·         A threat from a terrorist organization warning the United States to take (or not take) actions against Iran, lest they unleash the killer agents on our population centers?

·         A directive to release terrorists from US custody or face a retaliatory attack for every terrorist held by American officials?

I can surely imagine these scenarios since there are a lot of folks in the world that would love to do us great harm.

Is it too late to put stringent measures in place?  If not, here are a few recommendations for limiting the unauthorized removal of dangerous biological agents from BSL 3 & 4 laboratories.

1.      Implement strict initial and periodic FBI background checks on every person who has access to a BSL 3 or BSL-4 laboratory.

2.      Require every BSL-3 and BSL-4 to implement a Personnel Reliability Program (PRP) and the Human Reliability Program (HRP).  I have heard academics claim that PRP/HRP programs haven’t proven effective deterrents. They are wrong. Contact the US Air Force PRP/HRP offices and (if cleared) they will present researchers with all the proof they need.

3.      Prevent unlawful agent transport by requiring all vials, or any other container be easily detected as anomalies on whole body scanners (or require industry to manufacture these vials.

4.      Install whole body scanners at exit points (and strictly restrict exit points) in BSL3 and BSL-4 laboratories. I have found no exit security measures in place to prevent agents exiting BSL 3 or 4 laboratories to prevent smuggling agents out through body orifices.

5.      Prohibit the resale of any equipment declared excess from BSL-3 and BSL-4 laboratories.

6.      Tightly control the resale of any excess equipment from public health laboratories, hospital labs and pharmaceutical manufacturing equipment which can be used to unlawfully manufacture and transport biological agents. (Centrifuges, mixer/investors, warming units etc.).

7.      Scrutinize all procedures for BSL-3 and BSL-4 laboratories in jurisdictions vulnerable to alternative points of entry into America. Suspect international deep sea ports (crews on liberty), cruise terminals (crew disembarking) etc., where biological agents can be handed off from a terrorist scientist to a terror cell member for transport out of area to other areas of America.

Every time I take my shoes off at a TSA screening point, I think of the shoe bomber and every time I pack shampoo, mouthwash and other toiletries, I think of the liquid bomb mixing terrorists. Every time I go through a body scanner, I think about the underwear bomber and wonder what the next after-the-fact screening measure might be in store for us.

The fact is, each of the above measures was a reactionary measure. With the lethality of agents used in our BSL 3 and BSL 4 laboratories, reactionary steps will be too late. The number of fatalities caused in a biological attack with an agent that may not be treatable, will be so horrific, these labs may be closed down and moved offshore. Any reactionary action will be too late to save the countless lives lost because of……A failure of imagination-Again.