Wednesday, April 15, 2009

Learnings from 2008 Hurricanes Affecting CHRISTUS Facilities

In keeping with our continuous improvement initiatives, I asked one of John Zipprich, CHRISTUS senior vice president of legal and governance services, to gather additional learnings from the three hurricanes in 2008 that impacted CHRISTUS facilities. I thought that our learnings and recommendations, which were based on input from some of the affected facilities, as well as from the system level, might be useful to other health care systems that may be affected by hurricanes or other disasters. Perhaps most importantly, there is a broad recognition for more system approaches to contracting and coordination of assets needed during and after a storm event.

1. Regularly advise Associates of the HR hotline and Websites, require updated information in our online internal phonebook, and explain the use of the Send Word Now tool for enhanced communication with evacuated or displaced Associates. Also, evaluate the latter’s effectiveness as it was reported that the program was not fully utilized.

2. Confirm that Associate and staff commitments are clear and three tiers of responder teams (A, B and C) are in place before storm season in all vulnerable facilities and operating work groups; establish Human Resource policies for bonus and incentive pay during and after a storm, and whether pets are allowed and if so, in what locations.

3. Use armbands for the “ABC” teams who will be working for easy identification.

4. As appropriate, discharge or transfer patients as the storm develops to reduce hospital census, beginning with the most critical, and do this as soon as possible. If feasible, when sending patients to other CHRISTUS facilities, send the nurses, technicians and physicians with the most critical of those to continue care on arrival at the receiving CHRISTUS facility. Develop a system approach to patient transfer to other CHRISTUS facilities before FEMA, state or local Command Center takes control, facilitated by coordination at the system level.

5. Cancel elective procedures when storm impact projection date would not allow patient to be discharged in advance of anticipated evacuation orders.

1. Back up all information operating systems and begin implementing the information management disaster plan in expected affected facilities.

2. Regularly, such as monthly, test generators with full power load, and confirm that power transfer switch and UPS are in working order.

3. Before storm season arrives, secure additional generators, fuel, food, water and other supplies (recognizing that this has a cost factor) in expected affected facilities sooner rather than later, with generators, fuel, food, water and other supplies deployed by the system command center based on negotiated contracts for prearranged locations ( for example, availability of a fuel tanker on site in advance of a storm), which requires collaboration between the region and/or facility and system Supply Chain Management.

4. Regions in potential storm zones participate in a risk pool for contingency supplies and assets, and when and where deployed, manage these from the system level, even though this may not be an expense covered by insurance in cases where a storm may not impact a CHRISTUS facility or if it only creates nominal damage, which requires collaboration and funding decisions at the regional and system levels, coordinated by System Supply Chain Management and Risk Management.

5. Keep system daily calls for resource coordination and resource deployment, and reconsider the need for satellite phones.

1. Implement Dubuis, CHRISTUS HomeCare, CHRISTUS Medical Group office and retail operation disaster plans in same timeframes as facility plans or in accord with longer time plans if necessary because of the services provided.

2. Coordinate before storm season and during specific storm alerts with utility providers and local governmental disaster management teams, with particular plans for contingency water supplies both potable and for other purposes, and develop MOUs with the police, fire department, sheriff, utility providers, etc. possibly offering shelter in return for services.

3. Consider investment in plastic window film which was utilized at CHRISTUS Hospital - St. Elizabeth during the last round of storms. The film seems to be effective, as the hospital saw no window breakage. During storm alerts, timely implement plastic-wrapping, including everything (equipment and supplies) you can that might be vulnerable to water and move everything (equipment and supplies) you can to higher levels or areas if first floors or other areas are vulnerable to water intrusion; hire outside labor if necessary for this as well as sandbagging, shuttering windows, etc.

4. Gather all as-built plans, asbestos plans, MEP drawings, and roof plans in one secure facility location, and consider a backup copy at system level with construction management.

1. Arrange for remediation teams (which could include project management, roofing and structural engineers, MEP engineers, environmental engineers, architects and contractors) and vendors to respond immediately after storm event, with system-negotiated contracts as possible, but in all cases this must be in collaboration with the region/facility and System Risk Management (which must get insurer’s permission for remediators if covered by insurance) and Supply Chain Management.

2. Keep track of all pre- and post-hurricane event-related expenses at the system, region, facility and operating entity according to Accounting and Risk Management requirements for insurance and FEMA claims.

3. The CHRISTUS Emergency Preparedness Website should be updated with the HIPAA waiver provisions, contacts for the Texas and Louisiana health professional licensing contacts information and updated CHRISTUS system contacts and information, coordinated by Risk Management.

4. Re-form the CHRISTUS Emergency Management Council and have quarterly phone conference calls, as well as just prior to the onset of storm season, coordinated by Risk Management.

During our experiences with Hurricanes Gustav, Humberto and Ike, our facilities benefited from being part of a larger system, especially one in which all Associates share the commitment to our mission of extending the healing ministry of Jesus Christ. In many cases, CHRISTUS hospitals in other regions accepted patients transferred from those in the direct path of the hurricanes and stood ready to provide staff or other resources necessary to care for our patients and for each other. CHRISTUS Associates continue to go above and beyond the call of duty in their responses to the hurricanes and their willingness to serve patients as well as fellow Associates. The best-laid plans for dealing with hurricanes and other emergencies can sometimes be rendered ineffective by the swiftly changing nature of these events, but it is our Associates, who, through dedication and the willingness to do whatever needed to be done (regardless of whether or not it was included in their job description), truly demonstrated our mission in action.

Because of the past experiences CHRISTUS regional and system staffs understood how to carefully track the progress of hurricanes Ike and make preparations. Based on the past experience with Gustav, Humberto and Ike, the tools developed in the aftermath of Katrina and Rita need only some updates and “tweaking” as part of continuous improvement processes.

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