The Repetitious Cry: Don’t Wait for the Cavalry

Recently, I heard a local business owner who had been affected by the BP oil spill in the Gulf repeatedly state on a national TV interview that the government’s intervention to address this disaster has been minimal, disorganized and ineffective, often hampering the positive actions of the local inhabitants and volunteers. In essence, he was giving the same advice not only CHRISTUS Health, but others have given when facing disastrous events: Do not wait for the cavalry.

We first heard this cry when we visited New Orleans in 2007 on one of our learning journeys as part of Futures Task Force II. We heard over and over again from the leaders of a local hospital system that they got little helpful assistance in facing the significant negative results of the storm, including the large number of critically ill patients who needed to be evacuated. They, appropriately so, decided they needed to take control of the recovery plan and implement it themselves.

CHRISTUS Health had a similar experience in the Houston flood in 2004, Hurricane Rita in 2006 and Hurricanes Gustav and Ike in 2009. Our plans for evacuating patients, obtaining generators and garnering emergency supplies worked well because we had plans, teams and strategic relationships in place in the affected areas. Local systems that are efficient and effective appear to be easier for us to implement than the government, so we first and foremost rely on our resources and planning.

And unfortunately—but not unexpectedly—we experienced the same in Haiti. To overcome the lack of governmental plans, scores of volunteers have, and continue, to provide the most needed medical care and recovery efforts for those in need.

So what does this tell us as leaders in health care? First, it is imperative to have a well thought out and documented recovery plan in place. Second, these plans should be reviewed and drilled annually. Third, when disasters occur, get as much of the plan implemented as possible before the government intervenes. And fourth, don’t ever forget the leadership imperative: do not wait for the cavalry!

Preparing for Biological Disasters

I have blogged before about the CHRISTUS Health experience with hurricanes multiple times. As many of our facilities are located on the Gulf Coast, we learned first-hand the importance of having a clear disaster response strategy in place.

This commitment to a disaster response strategy extends beyond just hurricanes, though. The world’s experience with H1N1 flu last year reminded all of us how important it is to be prepared to offer an immediate, well-coordinated response to pandemic and biological disasters as well.

At the end of March, the CHRISTUS Health Pandemic Committee conducted a system-wide drill after several months of development and revisions of its influenza/biological pandemic plan. The mock scenario was an outbreak of unusually severe illness; specifically, a particular strain of H1N1 influenza that had been identified by the Centers for Disease Control as Phase 6 (widespread) in many states including Texas, Missouri, Louisiana, Arkansas, Georgia and Utah – all regions in which CHRISTUS Health operates.

The exercise, was launched by the system Senior Leadership Team in the corporate command center in Dallas, and we immediately began assigning and prioritizing incident response activities.

Team members quickly solidified our roles and began responding to approximately 35 mock requests for assistance that were being phoned in or made via e-mail directly to the command center from across our regions and facilities. Regional emergency preparedness coordinators from the CHRISTUS Health Southeast Texas, Southwestern Louisiana, Central Louisiana and Ark-La-Tex regions, as well as CHRISTUS Spohn, CHRISTUS Medical Group, CHRISTUS St. Vincent, CHRISTUS Santa Rosa, CHRISTUS Health Utah, Infection Control and Risk Management were among those participating in the drill.

Through this exercise, we aimed to build system-wide competency and familiarization of the revised CHRISTUS Health influenza/biological pandemic plan; provide an opportunity to exercise system pandemic reporting applications (EMResource, CHRISTUS Health emergency Website resources) with participating CHRISTUS facilities and the corporate command center; and practice emergency communications protocols by relaying vital information between responding entities.

The exercise lasted approximately three hours, including a debriefing and “after-action” review to identify what went well, opportunities for improvement, gaps in our emergency preparedness planning, and policies that will be addressed. We’re also investigating how to build social media tools into our existing disaster response communication plans, realizing the need for additional communication tools in our arsenal that can be quickly updated and are easily accessible by displaced Associates via home computers or mobile devices.

Day 1: Disaster Preparedness, Health Care Reform and Health Care IT (written by Abby Lowe)

Wow. I obviously should’ve worn more sensible shoes today.

I’m exhausted, but Dr. Royer just keeps moving right along. (“I’m not tired until the work is done,” he says. And even though I’m 30 years younger and even though he probably woke up around 4:30 or 5 this morning, I seem to be the one dragging.)

It was a great first day of meetings, though. We met with the staffs of 2 senators and 1 congressman, an expert in health care IT who is charged with helping HHS regulate recent funding requirements and some of our friends at the Catholic Health Association who are very involved in health care reform and have attended quite a few meetings at the White House.

We talked some health care reform today, but mostly carried messages about disaster preparedness—how state and local governments could work better with us and with FEMA to help us be more effective during hurricane evacuations and help us better care for our patients, and the legislative changes we’d suggest to help that process along. Obviously we talked about health care IT--the American Recovery and Reinvestment Act of 2009 (ARRA) provided approximately $19 billion for Medicare and Medicaid Health IT incentives over five years, so we and other health systems want to stay engaged in those discussions.

I might take some time later in the week to delve into health care IT and disaster preparedness, but I learned quite a bit about health care reform today that I think you’ll find interesting.

My head is still spinning, and I can say that even though I do my best to keep up with the health care reform discussions, I have trouble keeping up with who said what, what’s included in a suggested bill, what’s not, what’s been thrown out, who’s working with whom, who feels like they haven’t been invited to the table, etc. It’s a dizzying mix of conversations, negotiations, he said/she said, and it all feels like it’s moving very, very quickly.

But we met today--and will continue to meet--with legislators on both sides of the aisle—Democrats and Republicans, conservatives and liberals. We also heard from some of our colleagues at the Catholic Health Association who speak on our behalf. Here are some things I learned:

1. You can’t let perfect be the enemy of good. The bills being bandied about on the hill aren’t perfect. No bill of any kind on any subject ever will be, but the 46 million Americans without insurance can’t wait. A recently released report by the Institute of Medicine makes clear that Americans without health insurance live sicker and die sooner. And they can’t afford to wait 15 more years for real health care reform.

I also learned that 28 million of the uninsured are small business owners and employers. And it sounds like many of them would be happy about being able to afford insurance coverage.

2. A solution crafted this year won’t be a permanent fix. The bill that is crafted now may work for the next 10 years or so. But given the advances we expect to see in medicine and technology, it may not be appropriate for the 10 years after that.

3. We aren’t here asking for no cuts to Medicare/Medicaid, but we have drawn some lines very firmly about what we will not accept. Hospitals have agreed to $155 billion in cuts over the next 10 years. It sounds like we will be able to cover these costs, provided that the majority of Americans emerge with health insurance coverage. However, we would never stand for cuts in dollar amounts that we could not manage. (We could not shoulder cuts that reached as high as $300 billion, for instance. And after all, what good is insurance if no hospitals can afford to stay open to provide care?)

As a Catholic system, CHRISTUS would not support any kind of reform efforts that included threats to life like abortion. From what we heard today, it does not sound like the current discussions will form a bill that addresses abortions in any way.

4. I heard someone say today that health care reform will cost $2 trillion. $2 trillion is a whole lot of money. It sounds like WAY too much to pay for anything, no matter how it is financed. (Including health care reform.) But the insured of our nation are already carrying that kind of burden. Did your insurance costs go up this year? Mine did. Apparently our costs have been rising for years and CHRISTUS has been carrying that cost, but it got too large for CHRISTUS to carry anymore. So some of that cost was shifted to me and the rest of our Associates on the CHRISTUS plan. Insurance premiums will continue to rise, because insured patients carry much of the burden of health care costs. They don’t carry it all by any means, but many people treated in hospitals cannot pay for their care, and that cost is passed on to those who can.

I also understand that $2 trillion is probably not the most correct cost. I believe the Congressional Budget Office estimated the cost closer to $1 trillion, which does not at all include new accounting rules or the concessions made by industries like hospitals. Legislators are also still working on the final plan, and I believe more cuts in that nunmber will be made. For more information on this, I suggest this article.

5.Being here obviously brings back some Schoolhouse Rock! memories. I have “I'm just a bill / Yes, I'm only a bill / And I'm sitting here on Capitol Hill” stuck in my head.

But we have three more days of jam-packed agendas to get to, and I’m exhausted but excited to see what comes next. Stay tuned! ~Abby

Lessons Learned from Hurricane Rita

In the aftermath of Hurricanes Katrina and Rita, CHRISTUS Health leaders were asked to debrief and share learnings of how we could be better prepared to address hurricanes or other natural disasters going forward.

We witnessed many wonderful examples of our Associates simply doing whatever it took to extend the healing ministry of Jesus Christ during the hurricanes and afterward. These incredible efforts involved overcoming challenges of nature, bureaucracy and some of our own processes. Therefore, while our memories were still fresh, we took time to look at what we did right and what we could improve upon. The debriefing work also helped us approach our government advocates regarding storm relief efforts and future planning.

To organize their thoughts, leaders were asked to reflect on 11 areas:
1. General hospital operations and community preparedness
2. Evacuation issues, including staff evacuation
3. Before, during and after storm patient care and transfer, and patient tracking
4. HR and staffing issues, including Associate housing
5. Communication: CHRISTUS internal; CHRISTUS entity and governmental; intergovernmental; public safety
6. National Disaster Medical System (NDMS) and Federal Emergency Management Agency (FEMA) issues
7. Logistics, Materials, Supply and Transportation
8. Financial and Claims: tracking expenses; reimbursement; funding for storm costs; documenting and valuing insurance claims
9. Regulatory issues, including waivers
10. Decision making: authority, leadership at CHRISTUS, local, state and federal levels
11. Public health issues

A hurricane debriefing report was compiled from over 30 sources and comments in an effort to identify commonalities. Based on this report, an extensive planning document that detailed important duties relative to emergency preparedness and the local/regional responsibilities and system responsibilities in response was prepared, and has been very helpful in our ongoing preparations.

We were also able to identify areas that would probably be issues during and after major storms in the future. These included many activities which must be coordinated through other entities (such as state and federal agencies), like transporting patients, power concerns (including securing generators as well as fuel) and transporting necessary supplies to our affected facilities following a storm. In addition, we know that staffing may be a concern, as many of our Associates were ready and willing to come back to work, but unable to return to the area because of blocked or damaged roads. In addition, if the affected area is without power, we must find a way to provide housing, food, etc. to Associates who stay or return immediately following a storm.

In addition, our Risk Management department has also devoted much time to the study of our response to Rita. As a result, we have gathered many resources and materials that have been on hand during the following hurricane seasons and have implemented disaster preparedness training as well as an alert system.

Obviously, in any disaster or large-scale emergency, much of our planning will be rendered ineffective, no matter how well thought-out it may have been. However, it is ultimately the resourcefulness and commitment of our CHRISTUS leaders and Associates that allow us to continue our mission of extending the healing ministry of Jesus Christ even under the most difficult circumstances.