Wednesday, October 1, 2008

More Lessons from the Storm: The differences between Ike and Rita

As we are now on the other side of Hurricanes Gustav and Ike, it is appropriate to reflect on what were the differences between these most recent hurricanes and Rita, which we experienced three years ago and spoke about in a recent post.

For CHRISTUS Health, the main differences can be articulated as follows:
1. The management process in the hurricanes from both the system and regional command centers was much more organized, and at no time did the leadership team feel that the situation was out of control. This was because we spent a great deal of time and energy debriefing after Hurricane Rita and created tools and processes for improvement as a result.
2. The regions were much more proactive in determining the potential effects of these hurricanes and made plans to move their patients more quickly throughout the CHRISTUS system. It appears that a total of 13,859 patients were transferred or discharged (on their own care or to other facilities) over the Hurricane Ike period (Sept. 9-Sept. 15) from five of our sites as well as four long-term acute care facilities. Many of these were transferred to other CHRISTUS facilities, which created significant comfort for the patients and their families and expedited the knowledge of the new caregivers regarding the patients’ conditions and treatment plans.
3. Generators large enough to support an entire facility were in place much earlier and helped prevent much of the major discomfort which results in the almost immediate loss of electricity and water sources after a major hurricane.
4. Hurricane Ike covered a much greater cross-section of the Gulf Coast and had more intense strength in key areas for us including Houston, Lake Charles, La. and Beaumont, Texas. Consequently, we sustained about $125 million in damage to our facilities due to water intrusion. This is almost three times the damage we sustained in Hurricane Rita. In fact, the damage from Rita was mainly due to power interruptions and some water damage, whereas the damage in Hurricane Ike was due to predominately roof damage.
5. A larger number of our Associates were affected by Ike. We estimate that over 200 of Associates lost their homes due to the damage from intense flooding, and almost every Associate in our CHRISTUS Health Gulf Coast and CHRISTUS Health Southeast Texas regions (at least 2,000) along with our physicians and volunteers were without electricity for approximately 10 days after landfall. In addition to the personal burdens, which we are working to help alleviate, we understandably are experiencing some staffing issues because these people cannot quickly resume their work responsibilities.
6. It is our observation that the federal, state and local governments did a much better job in understanding their roles and responsibilities in this hurricane compared to Rita. There was much more clarity in their directions and much less overlap or disagreement about what each of their expectations were. However, again, the major problem that was similar to Rita was that the state would often report that supplies from the federal or state government were due at a certain time or were already in a specific location, and unfortunately we found that in numerous cases, this was not the case.

These were, then, the significant differences between hurricanes separated by only three years. The short timeframe between these occurrences is extremely concerning to us and other health care systems that have facilities and assets in the Gulf Coast, because since 1996, this frequency was unheard of for almost 50 years prior to Rita. In addition, weather forecasters are predicting a very warm 2009 summer, which is always the precursor to an aggressive hurricane season.

Therefore, based on our lessons learned and the predictions for more frequent hurricanes to potentially hit Lake Charles, La. and the Beaumont/Houston and Corpus Christi regions of Texas, CHRISTUS Health is undertaking three major activities as we continue our Journey to Excellence:
1. We will extensively and intensely debrief regarding our responses and processes in Hurricane Ike in order to make our future control centers more effective going forward.
2. We will continue to prepare our facilities in the potential paths of hurricanes so they all have generators and fuel supplies permanently in place to run their entire facilities so we do not need to depend on generators moving into these locations when a hurricane is predicted, which is usually less than a two-week timeframe.
3. As we renovate our buildings that were significantly damaged, we’ll take the opportunity to reflect on the best uses for those buildings gong forward and what programs should be grown and strengthened in them.

Although we have had devastating results from our hurricane experiences in the last several years, excellent organizations walk through these times with positive attitudes and utilize these events as significant learning opportunities to accelerate the Journey to Excellence. This is exactly what CHRISTUS has done in the past and will continue to do in the future.


MamawAnne said...

My husband and I were in the Christus St. Elizabeth facility in Beaumont during Hurricane Ike. We endured many problems there before being transferred to Baptist Hospital Beaumont at the request of my husbands' surgeon.
Suffice to say, Christus St. Elizabeth was NOT prepared for the hurricane. There was NOT a generator in place that was large enough to handle that hospital. There was virtually NO lighting in patient rooms and hallways and NO air conditioning. Floors were sweating with condensation, as were walls and windows, creating a fall hazard. A breeding ground for nosocomical infection was in the works!
In short, you have ALOT to review and improve on before next hurricane season. Good Luck!

Anonymous said...

Dr. Tom,
As an associate onsite at a facility that evacuated, there is truly a primary concern for the safety of the patient in all decisons made. The community, and ourselves, are part of the guessing game of the risks involved in 'waiting it out'. The coordination of state/federally provided ambulances is really an area that needs improvement. The community is also attempting to manage special needs patients and competing with the transport of the critically ill in the hospitals. We also know it is impossible to have enough generator power to have 'business as usual' and the minimum of a five to ten day outage of electricity after a storm really, really requires us to move patients out of the path of the storm. It is unfortunate that we had so many regions affected (13,000+ !!) but it is also credit to the state and CHRISTUS Health for accomplishing that feat and returning them home safely. Kudos to the hospital staff, clinicians, and physicians involved.