The practice of emergency management in a healthcare setting is a complex process. All of the skills and challenges of “mainstream” emergency management are also present in this setting, but there are important differences. While the “mainstream” Emergency Manager must prepare for the protection of a potentially vulnerable community, his or her counterpart, operating in a healthcare setting, is responsible for protecting what is arguably the largest concentration of truly vulnerable people within that same community. In the community at large, crisis requiring the attention of the Emergency Manager is a relatively infrequent occurrence, whereas, in the healthcare setting, although the crises are generally on a smaller scale, such as a missing patient, a suspicious package, or an angry and distraught individual, crises may occur several times per day. After all, healthcare facilities do tend to be in the business of crisis management.
In the public setting, an Emergency Manager tends to be not so much a specialist, but a sophisticated generalist, functioning in an environment of elected officials and municipal or government department heads. Each of these is an expert of sorts in the operations and services of their own departments, but who has limited experience in true crisis management. The mandate is to prepare a group of people, who, apart from the three emergency services (Police, Fire, and EMS), are probably not all that familiar with crisis management processes, to manage an infrequently occurring crisis of some sort.
Normal, day-to-day procedures and resource levels may require modification, and a process of guidance from the operation of “business as usual” to “crisis response mode” and back again. The role of the Emergency Manager, in such settings, is not that of “specialist” so much as “sophisticated generalist”; someone who has a working knowledge of the various municipal or government departments, and whose job it is to create and manage a framework within which these individuals may cooperate and collaborate, even when they are unaccustomed to doing so on a daily basis, in order to manage and resolve whatever crisis has occurred.
In the healthcare setting, the Emergency Manager must also be a sophisticated generalist, but also a specialist of sorts, functioning in an intensely competitive environment of highly educated specialists, in which all procedures and services are driven by a combination of “best practice,” research and patient outcome. Every single patient to whom services are provided is either the victim of a current crisis, or is recovering from the effects of an earlier crisis, and whether or not the people in such an environment have considered this before, the entire facility and its core business are all, in some fashion, about preparedness, response, recovery and mitigation!
In any crisis response, the scope of practice for medical and care professionals within healthcare facilities remains the same; what differs, is the scale of the operation. Front-line staff already know about crisis response procedures, but require guidance and advance planning, in order to be able to, without prior warning, suddenly manage a surge in demand, in which a normal week’s worth of seriously and critically ill or injured individuals arrives on the doorstep of the hospital in perhaps as little as two hours, and they must be able to do so safely, appropriately, and defensibly. In a society which is litigious, and this tendency is constantly increasing, the entire practice of emergency management within a healthcare facility has, arguably, as much to do with the ability to demonstrate “due diligence” after the fact, as it does with crisis response procedures.
Moreover, with technologies and services which are constantly changing and improving, the Emergency Manager must compete with highly educated and motivated department heads for limited funding on every project which is being considered or undertaken. In this environment, every funding and service proposal reaching the desk of the Chief Executive Officer has very likely been carefully crafted by an acknowledged “expert” in their respective field, and has usually been impeccably researched to support its position in every single argument. In this environment, nothing less is considered acceptable.
There can be real challenges for the Emergency Manager when competing with a new patient care technology or an expanded scope of diagnostic or care services for the funding required for something which “might never happen,” and the Emergency Manager working in a healthcare environment clearly requires an expanded skill set which “levels the playing field.” What is required is a move to a practice of emergency management which is increasingly research-based. The Emergency Manager must acquire and develop a working knowledge, and credentials, in both research skills and methodologies. In addition, the Emergency Manager in a healthcare setting can benefit tremendously from the acquisition of training in “mainstream” business techniques and skills. Any Emergency Manager, regardless of their location of practice can benefit from this expanded skill set, but in the healthcare setting, it is absolutely essential to successful practice.
The “mainstream” business techniques which have proven useful in emergency management include, but are not limited to, several internationally recognized processes. The first of these is the process of Project Management. By utilizing internationally recognized processes, such as Project Plans, “Ishikawa” or “Cause and Effect” diagrams, Gantt Charts and a “Critical Path” approach, complex projects such as the Hazard Identification and Risk Assessment, the Emergency Response Plan, the development of critical response procedures, and the creation and staging of emergency exercises, become more efficient, effective, and manageable. These processes and associated techniques can even be applied to the operation of the Business Cycle of the healthcare facility’s Command Center, with tremendous effect. For example, the use of both Gantt charts and Ishikawa diagrams can also be used to support the Incident Manager in the critical function of the monitoring of assignments for completion and actual progress throughout the Business Cycle, during the emergency itself.
The technique of “root-cause” or “failure-mode” analysis, which can be used to analyze past problems and hopefully, mitigate against their recurrence, also has a role to play in this setting. The use of such Project Management techniques as the Ishikawa diagram can also contribute to an effective analysis process. Such processes can be used during the Business Cycle to analyze problems which are occurring on an ongoing basis during any crisis. They are also highly effective, after the fact, in order to help determine what went wrong and why, so that procedures can be improved and mitigation measures put into place, so that the response to the next emergency is less problematic and more effective.
The use of the techniques of the concepts of Six Sigma and Lean for Healthcare can also be used to great effect in preparing for any type of crisis response. The application of the principles of Lean for Healthcare can be used to create an Emergency Response Plan in which information and required instructions are far easier to both find and understand, making it much more likely that procedures and instructions in the Plan will actually occur during the response to any emergency. The creation of predesigned Job Action Sheets as “standardized work” checklists, means that when a crisis does occur, the response will be predictable and correct, first time and every time, and that it will also be thoroughly and admissibly documented, within every branch of the organization. Together, these techniques can take the facility’s Emergency Response Plan, in the minds of front-line staff, from a confusing document in which it is difficult to find anything, to a trusted resource, and a “toolkit” containing almost everything that might be needed, to be relied on in any type emergency.
Of equal importance is the fact that the use of such “mainstream” business techniques can also forge an important link between the Emergency Manager and the Senior Management Team of any healthcare facility. Most healthcare administrators are trained in Business Administration; they are not, or only rarely, clinicians themselves. Their jobs, like that of the Emergency Manager, are, in each individual case, to both create and to operate the various aspects of the actual environment in which the clinicians work and provide their services. As such, almost all have had some level of prior exposure, including, in some cases, in-depth training, in the various “mainstream” business methods which have been proposed in this book as tools for the Emergency Manager. Information which has been prepared using these techniques will contain both familiarity and credibility for the target audience, and will provide the input of the Emergency Manager with potentially far greater weight and influence in the management process.
The days of the Emergency Manager as a retired “Cold Warrior” have passed. Increasingly, instead of being trained on “short-courses” or drawn from the various emergency services, Emergency Managers are university-educated in their own specific discipline. Within healthcare, individuals used to become responsible for the Emergency Plan almost by accident, and in addition to a long list of “regular” duties! Today, the Emergency Manager is increasingly recognized and respected as a professional, and as a subject-matter “expert,” in many of the various fields in which they practice. The field will continue to grow and evolve, conducting research, reporting results, and, no doubt, developing its own new body of knowledge and techniques in its own right.
The practice of emergency management within any type of healthcare setting is certainly no exception to this evolution of the field. In fact, in the right circumstances, it has a potential to provide some level of leadership to the rest of the profession. While the use of the mainstream business tools and techniques described in this book for use in the healthcare setting are beginning to occur in some locales, they should become standard practices. While obtaining the training required in these techniques will require a good deal of effort by the individual Emergency Manager (it should become a part of basic education), it is clearly worth doing. In doing so, the practice of emergency management, wherever it occurs, can potentially become more efficient, more effective, and more credible. Emergency Managers, within the healthcare setting and beyond, can evolve into respected and essential contributors to the management processes of all types of institutions and environments.