In one of the most competitive heathcare markets in the country, an acknowledgement of common goals was enough to spur innovation.
By Thomas W. Durso
To call the healthcare environment in greater Philadelphia competitive is an understatement. Hospitals of every type, many of them highly regarded, crowd southeastern Pennsylvania’s five-county region.
Networks pull together many of these institutions, along with outpatient clinical facilities, practice groups and more, into affiliated groupings. Advertising — in newspapers and magazines, on radio and tv, on local Web sites — is ubiquitous, and U.S. News & World Report’s annual issue on top hospitals regularly includes a healthy share of Delaware Valley names.
Yet in the midst of such intense efforts to lure patients and maintain prestige, the region’s healthcare community has coalesced around a unique collaborative drive to prepare for natural disasters, terrorist attacks and other emergencies with the potential to produce mass casualties.
Under the auspices of the Delaware Valley Healthcare Council, a regional advocacy and educational group representing more than 130 institutions in Pennsylvania, southern New Jersey and northern Delaware, the area’s hospitals have engaged in an impressive process of sharing best practices and building mutual trust that proponents say will pay dividends should a catastrophe strike the City of Brotherly Love or its surrounding region.
Try, try again Though rudimentary stabs at such collaboration had already been taken in years past, not surprisingly, the Sept. 11 attacks lent fresh urgency to the task.
As Thomas Grace, dvhc’s vice president for health services and emergency preparedness, notes, many had been keeping alert for “the next big, bad thing,” but “what 9-11 did was redefine what ‘big and bad’ is. It’s no longer just an airplane crash, but an airplane crashing into a stadium. It’s people blowing up subway systems.” Several of the area’s hospital ceos met with dvhc officials and reached a conclusion.
“There was a recognition that the hospitals, emergency medical services and departments of health of the city and state must work together to develop a plan to respond to emergencies in a timely, organized fashion,” recalls Sally Ziska, director of medical staff services at Jeanes Hospital in northeast Philadelphia.
And thus was born the Regional Disaster Preparedness Committee, which Grace describes as “a nongovernmental, grassroots effort to improve coordination and communication. There was a recognition at the front lines that we lacked the network and the infrastructure to coordinate a large-scale event. Together we had the capacity, but individually each of us would fail.”
(Since the dvhc is a regional office of the Hospital & Healthsystem Association of Pennsylvania, Grace explains that it made more sense to initiate the rdpc program just on the Pennsylvania side of the metro area. Though that includes 95% of the dvhc’s members, the rdpc also has built formal interfaces with healthcare organizations and state health departments in Delaware and New Jersey.)
In setting up this regional coordination system, dvhc first looked at the kinds of hazards that were both possible and likely to strike the Philadelphia region. Weather incidents, utility failures and transportation disasters were considered highly likely; nuclear, biological, chemical and other manmade disasters were considered of medium likelihood; and landslides, wildfires and failures of the region’s public safety/hospital radio systems were considered of low likelihood.
These incidents then were sorted according to which would require a regional response. Utility failures, incidents involving weapons of mass destruction, pandemics and earthquakes topped this list. Finally, the council asked some hard questions about preparedness, coordination among hospitals and agencies, communication, and surge capacity.
Zone defense The dvhc reflected on its experience during 9-11 and the subsequent anthrax incidents in opting to focus on these topics as it set about its task. A disaster preparedness task force met through the winter and spring of 2002, with work groups established to examine data, education, operations and logistics, public relations, communications, and long-range planning.
Various seminars and recommendations came out of that process, the most significant being the division of the area’s hospitals into 10 geographic Emergency Health Support Zones. The idea was to reduce hospital and governmental planning silos and to recognize that rapid response could be better facilitated in a crisis by smaller units segmented by location.
“The concept of dividing the metropolitan area into 10 regional zones was brilliant,” says committee member J. Mark Horne, senior vp for clinical and support services at Grand View Hospital in Sellersville, Pa. “It forced us to work closely with our sister hospitals and get to know our local emergency management officials and fire and police departments even better than we did.”
With the region’s hospital leadership buying into an unprecedented level of collaboration, committee members dove into the critical process of building relationships. They found that by meeting regularly and sharing information in an open, unguarded fashion, they could bypass bureaucracy and build trust in each other, something that has given them considerable reassurance in the face of whatever disaster may lie ahead.
“It has really pulled us together,” says Pete Schwarz, chair of the Central Montgomery ehsz and vp for materials management and clinical engineering at Holy Redeemer Hospital and Medical Center, Meadowbrook, Pa.
“We were always competitors in terms of business, but now we’ve begun to learn who each other is. We share policies and procedures on emergency management, and we’ve created all sorts of communications grids to share…. We’ve created mutual aid agreements between each organization, including the county and state departments of health, so we all know that when the craziness hits the fan, we’re there for each other.”
Committee governance Prior to dvhc’s partitioning of the area into zones, the rdpc comprised representatives from each of the council’s member institutions. But this proved unwieldy, Grace says, so once the zones were established, the committee was trimmed to include just zone chairs and their alternates, as well as representatives from select other agencies, such as the Red Cross, the fbi, the U.S. Attorney’s Office, and county and state public health and emergency management officials.
The committee meets quarterly and conducts monthly regional drills via E-Team, a Web-based incident management and coordination system. The zones themselves meet monthly. In addition to an annual region-wide full-scale exercise, zone and multi-zone exercises are conducted three to four times a year. A dvhc representative is present at each meeting and each exercise. The gatherings are numerous and meant to allow participants to continue familiarizing themselves with best practices and sharing disaster plans and other important information.
In addition, Ziska says, individual zone committees “give us an opportunity to get know one another and to feel free to express concerns and needs.” The fact that the full rdpc pulls all the different agencies together with a focus on emergency preparedness is a primary reason for its success, says Frank Sullivan, emergency preparedness coordinator at Children’s Hospital of Philadelphia.
“In our area, that’s the first organization to do that. There’s a variety of items and issues that have come out of that since we started working together…. Mutual aid agreements have come out of [the zones], and we’re now looking at agreements to cross the zones and cover the different zones throughout the region.”
Members of the Northwest Philadelphia/Montgomery County ehsz, for example, signed a mutual aid agreement that “signifies the belief and commitment that in the event of a disaster, the medical needs of the community will be best met if the undersigned hospitals cooperate with each other and coordinate their response efforts.” The agreement sets protocols for communication between hospitals, both routinely and during a crisis:
forced evacuation of a hospital,
response to activation of the National Disaster Medical System,
reporting bed capacity and capability,
auxiliary hospital and casualty collection location, and
staffing and medical and pharmaceutical supplies in the event of a disaster.
“We have worked on a lot of educational things, looking in general at the command structure and how our places were set up,” says Southern Bucks ehsz chair Mary Parsons-Snyder, director of operations at Frankford Hospital’s School of Nursing. “In the Bucks County zone, we have reviewed each and every one of our disaster plans for the hospitals, and we helped each of the zones pick a couple of different topics and participate in the development of a regional disaster plan, which includes ems and public health people.”
No instant gratification As successful as the committee has been in establishing an infrastructure for collaboration and communication, the effort has not been without its challenges. First and foremost, Grace says, the process has been lengthy. “Change is slow, and we’re dealing with basic culture changes. Many in health care are used to instant results: You put in an iv, and the patient’s blood pressure drops.
“We work on three- to five-year horizons. Not a lot happens in one year…. This is not an instant-gratification field. Managing an emergency can be instantly gratifying or instantly terrifying, but the preparation requires dedication and patience.”
Related to that, each committee member interviewed, to a person, talked about the difficulty of maintaining enthusiasm among incredibly busy professionals consumed with their own jobs, not to mention in the face of such long-term prospects and with the urgency of 9-11 having faded.
“Motivating people to continue to come” has been a challenge, says Parsons-Snyder. “One of the things you have in health care is turnover. You end up with new people and have to bring them up to speed.”
Lou Guardiani, chair of the Chester/Western Montgomery ehsz and vice president for support services at Chester County Hospital in West Chester, Pa., says that one solution has been to focus on the achievable. “The ceos in all the hospitals support the activity. My challenge as chair is to continue to set realistic goals that people feel engaged with and understand the importance of. That’s what we tried to do with our goals for the coming year.”
“The biggest thing is to get together on a regular basis,” advises Schwarz. “We meet on a monthly basis. Pick an item, decide what your goals are going to be and work at it. Meet and plan, meet and plan, talk, share. Nothing’s proprietary anymore when it comes to this stuff.”
Finding funding Less easily solved is the issue of funding. While dvhc was able to secure a $70,000 grant from the Centers for Disease Control and Prevention a few years back to support the committee’s work, there is no dedicated funding source. Participation on the committee is voluntary, with the hospitals, in effect, loaning their staffers’ time to the group. “In the future we anticipate getting regular grants,” says Grace. “We’re negotiating to establish ourselves as something to be funded. At this point it’s voluntary. The members pay for their people to be motivated. These people are involved because they want to be. That they’re voluntarily doing it, at their own expense, makes it remarkable.” Remarkable, but also challenging. Each hospital received U.S. Health Resources and Services Administration funding through the state department of health, but with the funding come a fair number of mandated drills that can “sometimes become overwhelming,” according to Parsons-Snyder.
Additionally, hrsa doesn’t allow the funding to be used for facilities or staffing. “At my own facility,” says Parsons-Snyder, “I’d like to pave over an empty lot to convert it to a parking lot with electricity for lighting and water for decontamination in the event of a disaster. But hrsa doesn’t allow the funding to be used for those kinds of projects.”
In the meantime, the committee as a whole and the individual zones continue to identify and attack common issues. Current projects are examining how to boost surge capacity, bring long-term–care facilities into the mix, and iron out technical problems associated with the E-Team software.
The competition for patients will continue. The ads will still run. Yet the same ceos who crave desperately for their hospitals to be recognized as Philadelphia’s best have made a commitment to one another and to the region to prepare together for the most dire of situations.
“From a public standpoint, we’re all trying to do the same thing: take care of patients and our community,” says Horne. “The healthcare situation is what people will look for in a disaster.”
Thomas W. Durso is a freelance writer based in the Philadelphia area.
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Homeland Protection Professional magazine’s mission is to assist members of the American emergency response community in preventing, preparing for and responding to acts of terrorism and other disasters, whether natural or man made. Subjects covered include both management and operations topics
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