The Emergency Preparedness Committee
Introduction
The creation of an Emergency Management program is a huge task, one that the Emergency Manager should not have to complete alone. In any hospital or other healthcare facility, there exists a vast array of expertise regarding most parts of the facility’s operation, and the Emergency Manager must be able to harness this resource, in order to provide both an Emergency Plan and associated programs which can be operationalized and which meet the specific needs of that facility. The Emergency Preparedness Committee is the essential tool for the marshaling of expertise and the application of that expertise to the organization’s Emergency Plan and the associated procedures and training efforts. While such an entity is clearly valuable, it is not without its challenges. Conflicting priorities can make member recruitment/retention difficult, and the activities of the committee may not be seen as a priority by other members of the management group.
The Emergency Manager will be required to be a work director, a motivator, a conflict mediator, and a coach, and all for committee members who only report directly to the Emergency Manager on this single issue.1 Some may be in entirely different lines of authority, and some may even possess more day-to-day authority than the Emergency Manager. It is the job of the Emergency Manager to create a team which not only has the appropriate expertise, but which also remains committed, engaged, and productive, for without the active efforts of the Emergency Manager, the very continuation of the Emergency Preparedness Committee can be a challenge. The Emergency Manager must be both a team player and an excellent manager, one with excellent people skills and creative skills.2
Learning Objectives
On completion of this chapter, the student should be able to describe the step-by-step process for the creation of an Emergency Preparedness Committee for a healthcare facility. The student should be familiar with the processes of recruitment and selection of committee members, as well as the potential obstacles which may need to be overcome as part of the recruitment process. The student will be able to describe, in detail, the activities carried out by the committee members, both individually and in groups, and how to monitor those activities, provide feedback, and motivate committee members to produce the best possible work.
Building the Committee
The biggest single challenge to the creation and maintenance of an Emergency Preparedness Committee is often the ability to attract sufficient numbers of individuals with the appropriate skill sets and organizational knowledge from the workforce. A broad skill set is required, including program management, research, policy creation, and manual dynamics.3 In addition, the committee will need to be representative of all departments operating in the facility—at a minimum, organizational leadership, legal, nursing, security, human resources, chaplaincy, environmental health, security, laboratories, emergency department, public affairs, occupational health and safety, infection control, and engineering.4 In ideal circumstances, the physician group would also be represented and particularly the consultant/specialist group, although these are typically the most difficult groups to obtain representation from. In addition, past experience has taught that the inclusion and participation of any unions representing staff are also highly desirable.
There are several challenges that need to be overcome. The first of these is that the people who the Emergency Manager is attempting to attract to committee membership are normally busy people, usually with their own operating priorities, time demands, and specific areas of interest. Participation in another committee may require considerable powers of persuasion on the part of the Emergency Manager. One of the best methods for overcoming this reluctance is to raise the public profile of participation in the committee. Sharing regular committee status reports, such as meeting minutes and outlining the contributions of individual members, with senior management, can often have this result. Public acknowledgment of specific contributions can also produce a similar result.
Another challenge is that, however worthwhile the work of the Emergency Preparedness Committee might be, it is likely to be perceived as a secondary consideration, after the core business of healthcare. Healthcare facilities are a busy environment, with both high demands for services and limited resources with which to provide them. Any prospective committee members are likely to report to someone else, and that person is quite likely to be operating on a daily basis with a workload that exceeds available resources. Any request to “borrow” staff for any activity, and particularly for an activity not perceived as being an essential part of the “core business,” is likely to be met with a great deal of resistance. In this case, persuasion may consist of outlining the contributions of the department in question to an essential process. It may also be possible to persuade participation on the basis of staff development. At an absolute minimum, the wise Emergency Manager will be fastidiously respectful of the conflicting time demands placed on each committee member, ensuring that meetings are actually productive, that they finish on time, and that no unreasonable or excessive demands are placed upon the members’ time.
The process of recruitment may begin with a general call for volunteers. If this approach works, the Emergency Manager may only need to pick from among the volunteers, supplementing them with specifically requested expertise resources, requested by the appropriate manager. If this is not acceptable, the Emergency Manager may need to resort to formal requests from the managers of staff representing the required areas of expertise and skill sets. Neither of these is ideal, but it is an inescapable fact that Emergency Managers in a healthcare setting are unlikely to have much staff reporting directly to them and are required to depend on the use of staff who normally report to other managers who have differing priorities.
It can also be useful to carefully schedule meetings, ensuring not to place too high a demand upon the membership, and to provide advance estimates of the time demands on individual members. The creation and circulation of a formal meeting agenda and meeting minutes may also aid others in seeing the value of the work being performed. Finally, committing to the actual terms of service for committee members, with defined terms of office, such as one or two years, may help to ease concerns among managers. That being said, the Emergency Manager must take care to rotate committee members’ service in groups, so that the continuity of the committee’s work is not lost.
It is essential that such a committee has the correct composition. Simply having the right knowledge and skills is insufficient; people have to want to be there, and they have to want to work together! Anything less leads to substandard performance on assignments, disruptive behavior in meetings, or even absenteeism. Also undesirable are the “resume surfers”—that group of employees who move from project to project, attempting to build their resumes, but not making any particular contribution to the committee. While such a practice may very well be an excellent “selling point” for recruiting committee members, one does not want members for whom this is the sole reason for membership. Those chosen for the committee must believe that the work of the committee is important and that they are capable of making a significant contribution to that work. The Emergency Manager needs people who, to sum it up, actually want to be there!
The Role of the “Champion”
Most Senior Management Teams are responsive to the presentation of good ideas. That being said, competing priorities, and limited time and funding in a healthcare system, will generally lead to the development of an “annual priorities” list for the organization, a list which Emergency Management often has difficulty in achieving a place on. Many on the Senior Management Team, like the rest of the management structure, typically tend to see Emergency Management as being “outside of the core businesses” of the organization and, as a result, rarely give it much priority. A culture has evolved in many healthcare settings in which Emergency Management will normally only receive serious consideration either in the months before an accreditation visit or in the months following a disaster. The unfortunate presence of such “windows” can make Emergency Management generally a difficult “sell,” particularly if approval or funding is required for some type of activity.
The good news is that members of the Senior Management Team of a healthcare organization almost always have their own priorities and “pet” projects. They typically talk about these issues at virtually every meeting and attempt to boost support for the projects among other members of the team. There may even be a system of “quid pro quo” operating, in which each member of the management team will support the project of another, as long as that support is reciprocated for their own project. The challenge is to find one’s way into this system. This can often be accomplished through the recruitment of a member of the Senior Management Team to the Emergency Preparedness Committee. To use a healthcare analogy, if one can “infect” a single member of the Senior Management Team with interest and enthusiasm about this topic, he or she may very well be able to “infect” others on the team! It is also in their interest for the Emergency Preparedness Committee to succeed; if it does not, there is a very real possibility (at least in their minds) that, since they are a significant leader in the organization, the stalling or outright failure of the committee might even reflect negatively on them.
Just as in the Six Sigma model, the recruitment of a “champion”5 from among the Senior Management Team can greatly help to enhance the Emergency Management process, as well as the status and contributions of the Emergency Preparedness Committee. Just as a Six Sigma champion is responsible for the implementation of that process and its practices across an organization in an integrated manner, a “champion” for the Emergency Preparedness Committee may very well be able to achieve the same result. To do so, the “champion” will need to be convinced that the information and requests being generated by the committee have evolved from the old-fashioned “just-in-case” risk management approach to the result of actual research and analysis, based upon recognizable processes, such as Six Sigma and Lean for Healthcare.
The “champion” will also need to be convinced that the projects being proposed will be subject to formal project plans and that they are intended to protect against loss and liability, preserve the public image of the facility, and demonstrate due diligence. In summary, they need to be composed entirely of methods that the “champion” can recognize and respect. This approach will not only satisfy the “champions” but also provide them with the precise material which they require in order to “sell” the committee’s requests and projects to the balance of the Senior Management Team and other critical hospital committees.
To illustrate, the Emergency Preparedness Committee is recommending a significant change to the fundamental process of patient flow during a disaster. This might normally meet with tremendous resistance from the physician community and the chief nursing executive, particularly in the context of “we think that this might work better.” Now, as an alternative, the same proposal is presented, this time based upon Six Sigma-driven problem analysis or root cause analysis,7 which identifies the significant potential for errors, or outright flaws, resulting in potential liability exposures, and subjected to a Value Stream Map from Lean for Healthcare,8 in order to identify areas for improvement. The research and analysis were performed by an interdisciplinary team, which included both physician and nursing representatives. The report is then submitted along with a formal project plan for implementation;9 the result is very likely to be quite different. A “champion” can be an invaluable member of the Emergency Preparedness Committee, and an essential part of the Emergency Management process, as long as they can be supported by the tools which they need to do their job.
Keeping Things Organized
This is a good time to recall the project plan, which was described elsewhere in this work. The creation of an Emergency Response Plan is a daunting task, even for a committee. With so many planning tasks to be performed, it is a common problem for individuals or subgroups of the committee to become distracted or to lose their way. Such issues, while common, can be overcome with advance planning by the Emergency Manager. The entire emergency preparedness process has evolved tremendously, well beyond the traditional response plan, and should, if it is to be effective, reach into all aspects of Emergency Management, creating a Strategic Emergency Management Plan.
Figure 2.1 As Emergency Management becomes more complex, so does the job of the facility’s Emergency Preparedness Committee
*SEMP = Strategic Emergency Management Plan
Wherever possible, the skill set and knowledge which brought the individual members to the Emergency Preparedness Committee in the first place will probably determine workgroups and task assignments. It only makes sense for the Emergency Manager to exploit fully those strengths which they have worked so hard to add to the committee. If the Emergency Manager has obtained a decision from the organization to use the incident management system Command and Control model, this provides an opportunity to apply the same model to the entire planning process.
Consider which Command and Control model will be used within your organization. Command and Control models are originally intended to manage an emergency. However, what is less recognized is that a Command and Control model can also make a highly effective framework for the planning process, whichever model has been chosen. The incident management system model, for example, is an excellent framework not only for controlling an incident but also for preincident planning. The use of the Command and Control model for planning can also provide committee members with valuable skills and experience in its use, which are then directly transferrable to real-life incident management.
The Key Roles of the model are an excellent place to start. Each of these is intended to address one major issue that every organization, regardless of their role or core business, must at least consider during the response to a crisis. With that in mind, it seems only logical to divide planning responsibilities according to these major issues. As a result, a well-organized committee might very well end up with subcommittees that address Command, Public Information, Liaison, Safety, Operations, Planning, Logistics, and Finance aspects of the Emergency Response Plan.10 In such an arrangement, the majority of the provisions for that aspect of the plan will be created directly by those who are most likely to have to implement them in a real-life event.
Figure 2.2 One possible approach to committee organization
To illustrate, a safety subcommittee might well consist of those recruited from both Infection Control and Occupational Health and Safety because these are the individuals most likely to be involved in the safety function during a real event. This approach makes perfect sense because the individuals doing the planning already have the required expertise and the clearest and most comprehensive understanding of the associated issues arising in this role. There are those who advocate the preassignment of all incident management system Key Roles to those who perform a similar function on a daily basis; this is just another example of such an approach in actual operation.
On a similar note, it may be appropriate to subdivide the case-specific annexes into subgroups of the committee which are staffed by those with real expertise in the subject matter. In this manner, the work and instructions are similar to be generated by those who best understand the issues, what is possible, and what is not. To illustrate this in operation, a case-specific annex intended to provide instructions for dealing with a hazardous materials spill on the facility’s premises might very well be assigned to a workgroup or subcommittee consisting of Occupational Health and Safety, Laboratories, Environmental Services, and Engineering. Once again, these are the groups with the greatest vested interest in how this annex is crafted and in how well it will work.
Maintaining Focus
One of the challenges which can be associated with the creation of an Emergency Response Plan by a committee is that almost everyone who is on such a committee is very likely to have their own agenda for how they want the plan to work and to look. This pursuit of individual priorities can often distract or confuse committee members and has the potential to greatly slow the progress of the plan. Much of this can be avoided in advance through the advance preparations of the Emergency Manager. It can consist of process-related measures for subcommittee meetings, such as well-organized, publicized, and monitored timelines for the completion of each step in the process of plan creation. The project plan itself has a critical path and benchmarks for completion, and each subordinate step in that process should also have specific timelines of its own, with accountability for failure to meet the objectives. This can serve to make other subcommittee members less likely to quietly tolerate behaviors that waste work time.
Measures related to meeting organization, such as the keeping of meeting minutes or specifically limiting the time allocated to each speaker during a discussion, thereby avoiding the problem of any individual monopolizing a meeting in order to persuade, and in some cases, even browbeat, other members to support their agenda, can also be useful. The Emergency Manager may not be able to attend each and every subcommittee meeting (although regular visits are a good idea!); they can and should preappoint subcommittee chairs who they know to have a strong enough personality to control any disruptive behavior. The Emergency Manager must also be prepared to take decisive action, such as the removal of a committee member, if they demonstrate a consistent or repeated pattern of disruptive behavior that is slowing the process of plan creation.
A Well-Functioning Committee
Despite the obvious challenges which are inherent in committee work in general, there are also clear signs that the committee is doing its job effectively. For an effective manager of any type, the health of any committee should be relatively easy to judge objectively through the use of such signs. These are signs that the Emergency Manager should look for and should monitor on an ongoing basis, in order to identify and fix problems early and to ensure that the committee can continue to function effectively.
Figure 2.3 An effective Emergency Preparedness Committee. Note the diverse and representative membership
The first of these signs is that the purpose of the committee is clear to all. Does everyone on the committee understand the purpose of the committee clearly? Do others, not directly involved in the committee, understand its purpose, or is negative speculation about its purpose or activities present? These may be signs that the committee members have not received sufficient orientation from the Emergency Manager or that the work of the committee is not understood or valued by others. Such comments by others within the workplace may lead members of the Emergency Preparedness Committee to conclude that their work is not being understood or valued by their coworkers. Committee members are human, and everyone involved would prefer to be involved with a successful project.
The next of these signs is careful time control. As already stated, the committee members are all busy people with competing time demands, and no one likes to see their time wasted. Starting and finishing meetings on time shows that the Emergency Manager understands and respects the pressures placed upon committee members by the ever-present time constraints. The development of and adherence to the project plan, including specific timelines and time-sensitive milestones, is also important; they help the Emergency Manager to monitor progress effectively and permit individual committee members to see those specific areas of progress that are occurring as a result of the committee’s work. Therefore, they are more likely to continue to perceive the work of the committee as valuable and worthy of their time away from addressing other conflicting demands.
Good communication and mutual sensitivity among members are also important. Communication between committee members must not only be effective but also remain respectful and inclusive. While the formation of individually tasked workgroups is an essential part of the process, it must not become a basis for the formation of factions or “cliques” within the committee. If a member, who is not on the evacuation subcommittee, happens to bring forward an idea, concern, or perspective regarding evacuation, this should receive the same attention as it would if it had been raised by a member of that subcommittee.
The Emergency Manager should ensure that, wherever possible, the committee functions at all times in an informal and relaxed atmosphere. There are timelines, of course, and these need to be met, but the work of the committee must remain pleasant for the members. Bear in mind that these individuals are generally under constant time pressure and may even work in environments in which rigid discipline and hierarchies are the norm. Such pressurized environments often generate dissatisfied employees. Committee work needs to be done, but it also needs to remain a pleasant experience for the participants. Excessive formality and regimentation can cause committee members to view attendance at meetings as something to be avoided.
Good preparation for each meeting on the part of the chair and members is essential. It basically comes back to the concept of mutual respect for each other and for each other’s limited time. Each meeting should have a formal agenda, which should be created and circulated in advance. Individual members should have the ability to add items to that agenda. Specific times should be allocated for each agenda item. The Emergency Manager should ensure that whoever is dealing with each agenda item is contacted in advance and is ready to proceed. This includes the Emergency Manager! People tend to see disorganized meetings with unprepared presenters as largely a waste of their time. If the problem becomes persistent, they will often begin to seek reasons to discontinue their participation in the committee entirely.
The members of the committee must remain interested and committed to the committee’s work and objectives. There is little point, or value, to populating a seat at the meeting with someone who sees no value in what is occurring and who would really rather be somewhere else, working on something which they find more interesting. There are those who attend meetings and never make a contribution of any type; they may lack confidence or feel that they have nothing to contribute, or they may be either using committee membership as a means of obtaining a “break” during a hectic schedule, or simply one of those people who like to add committee memberships, in order to “pad” their resumes, but who have no real interest or commitment to the work of the committee. Such people tend to frustrate the more committed members of the committee and, in extreme cases, may even become disruptive for the purpose of entertaining themselves, if they become bored. As a result, the membership of such individuals in the Emergency Preparedness Committee should be avoided, wherever possible.
An effective committee keeps and circulates meeting minutes that are both complete and concise. The minutes can provide a valuable source of information regarding the activities of the committee. Such minutes can not only demonstrate the positive progress being made but also be used to showcase any outstanding contributions by individual committee members. This reinforces for the management team the positive value of the committee’s activities and may also raise the profile of Emergency Management as a management priority. It can provide a level of transparency that has the potential to raise the committee’s contributions in the estimation of the management team. It can also help to raise the profiles of individual committee members, thereby reinforcing the positive effects of committee participation. It is often insufficient to simply do good work…one must be seen to be doing good work!
An effective Emergency Preparedness Committee provides new opportunities to learn and exercise skills that have the potential to lead to career advancement for members. Such courses should include not only traditional Emergency Management topics, but also essential supporting skills with application to their daily work, such as Lean, Six Sigma, Project Management, and Applied Research Methodology. These may include the facilitation of provincial, state, and local course training, FEMA distance education courses, or even diploma or degree programs.
Periodic frank and open assessments of the performance of both the committee itself and of individual members will permit the Emergency Manager to build a base of support among the membership, and, with appropriate recognition of the contributions of individual members and subcommittees, all involved receive positive reinforcement and understand that their contributions are being both recognized and appreciated. At the same time, such transparency within the committee’s reporting to the Senior Management Team ensures that the work of the committee is accepted and contributes to the organization which is increasingly seen as valuable.
Conclusion
The creation and operation of an Emergency Preparedness Committee can be a significant challenge for any Emergency Manager operating in a healthcare setting. When operated correctly, it can become a recognized pool of residential expertise in the creation of the Emergency Plan, the acquisition of emergency response resources, the training of staff, and, in essence, all things related to emergency preparedness. When operated incorrectly or when the support of the Senior Management Team is lacking, it can become yet another temporary committee, struck a few months prior to accreditation, and then immediately disbanded, losing all of the expertise which had been developed. To achieve the goal of a respected, permanent committee producing work that is valued, the Emergency Manager must become a highly effective project planner, a leader, a mentor, a coach, and a mediator. Skills in the areas of Project Management, research, managing people, and even conflict resolution will be required. With these realities in mind, when formulated and operated correctly, an Emergency Preparedness Committee can become an invaluable resource, not only for the Emergency Manager, but for the organization itself.
Student Projects
Student Project #1
Create a document describing the process of selection and recruitment of Emergency Preparedness Committee members for a new committee to be established at your facility. Outline the measures which will need to be taken in advance to ensure the success of the committee. Describe the entire recruitment and selection process, up to the inaugural meeting, using the techniques of Project Management. Be sure to cite and reference appropriately, in order to demonstrate that sufficient relevant research has occurred on this project.
Student Project #2
Create a formal Project Management plan for the creation, recruitment, and inaugural meeting of a new Emergency Preparedness Committee for your facility. Identify potential candidates, according to both position in the organization and desirable skill sets. Describe any potential problems which are likely to occur in the process of creation and provide at least one method of response to each potential problem identified. Be sure to cite and reference appropriately, in order to demonstrate that sufficient relevant research has occurred on this project.
Test Your Knowledge
Take your time. Read each question carefully and select the most correct answer for each. The correct answers appear at the end of the section. If you score less than 80 percent (8 correct answers) you should reread this chapter.
1. An Emergency Preparedness Committee is an essential tool to assist the Emergency Manager in obtaining specific types of expertise related to the facility and its work and:
(a) Permitting input into the process of Emergency Plan creation
(b) Obtaining champions for the Emergency Plan
(c) Addressing specific issues relating to the facility and its work
(d) All of the above
2. It is essential to attempt to recruit at least one committee member from among the senior management group, as this person may:
(a) Fill the role of champion for the committee’s activities
(b) Provide detailed explanations of policies to committee members
(c) Provide ongoing work direction from senior management
(d) All of the above
3. One way to attract candidates to committee membership is through:
(a) Turning committee membership into a high-visibility showcase of skills
(b) Appealing to the egos of candidates
(c) Requesting managers to assign staff to the roles
(d) Both (b) and (c)
4. In order to convince managers to permit candidates to participate in the committee, the Emergency Manager will need to be:
(a) Very persuasive
(b) Always respectful of the existing time and work demands on the employee
(c) Prepared to share credit for accomplishments with the manager
(d) All of the above
5. In order to ensure that the committee remains focused on the project, it will be necessary for the Emergency Manager to:
(a) Have an advance plan and objectives for each meeting
(b) Exert control to keep the members focused on the actual agenda
(c) Politely but firmly put an end to any disruptive behavior
(d) All of the above
6. One of the best methods for the Emergency Manager to showcase the skills and contributions of individual committee members is to:
(a) Have regular meetings with the member’s manager
(b) Share copies of meeting minutes with senior management regularly
(c) Create a committee newsletter
(d) All of the above
7. Breaking the committee into job-specific workgroups permits the Emergency Manager to:
(a) Isolate those who may be causing disruptions
(b) Focus the member’s known expertise on specific tasks
(c) Permit key elements of the project to occur concurrently
(d) Both (b) and (c)
8. One way to ensure the completion of committee projects on time is through the use by the Emergency Manager of:
(a) Clearly understood and monitored timelines for each element of the project
(b) Checking on project progress on a daily basis
(c) Regular reminder e-mails to committee members
(d) Both (b) and (c)
9. The most effective method of obtaining optimum performance from committee members is through the use of:
(a) Regular positive reinforcement, feedback, and coaching
(b) Regular monitoring with reports to the member’s regular manager
(c) Signed memoranda of understanding
(d) All of the above
10. The easiest method of ensuring the continued participation of committee members is for the Emergency Manager to:
(a) Permit committee members to work on other projects on committee time
(b) Publicly acknowledge each member’s accomplishments and contributions
(c) Make the committee member feel that their work is valued
(d) Both (b) and (c)
Answers
1. (d)
2. (a)
3. (a)
4. (b)
5. (d)
6. (b)
7. (d)
8. (a)
9. (a)
10. (d)
Additional Reading
The author recommends the following exceptionally good titles as supplemental readings, which will help to enhance the student’s knowledge of those topics covered in this chapter:
Barr, J. and L. Dowding. 2015. Leadership in Health Care. London: Sage Publications.
Etter, R. and P.A. Robinson. 2010. Writing and Designing Manuals, 3rd ed. Boca Raton, FL: CRC Press.
Joint Commission Resources Inc. 2002. Guide to Emergency Management Planning in Health Care. Oakbrook Terrace, IL: Joint Commission Resources.
Lowenthal, J.N. 2002. Six SIGMA Project Management: A Pocket Guide. Milwaukee, WI: ASQ Quality Press.
Norman, S. and J. Stuart-Black. 2006. Health Emergency Planning: A Handbook for Practitioners. Norwich, UK: TSO Publications.
Reilly, M.J. and D.S. Markenson. 2011. Health Care Emergency Management: Principles and Practise. Sudbury Mass: Jones and Bartlett Learning.
Veneema, T.G. 2013. Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and Other Hazards. New York, NY: Springer Pub. Co.