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Get your hospital back on its feet after a disaster


July 1, 2010

Hospitals spend a lot of time identifying risks and preparing so they’re ready to respond when a disaster strikes. But one phase of emergency management you may overlook is recovery: how to get back in operation after a hurricane or flood assaults your facility.

Typically what happens during major disasters, such as Hurricane Katrina or the recent earthquake that devastated Haiti, is a period of intense response that follows when people rally to help. 

“And then we tend to forget about it and assume life goes back to the way it was,” Joseph L. Cappiello, MA, BSN, chair of Cappiello & Associates in Elmhurst, IL, said during his presentation at the 4th annual Hospital Safety Center Symposium in Las Vegas May 6.

Often it takes a number of years to even get close to returning to normalcy, said Cappiello, former vice president for accreditation field operations at The Joint Commission (formerly JCAHO), who went to New Orleans after Hurricane Katrina and later helped develop the accreditor’s EM standards.

He recalled the fate of the Memorial Hermann Hospital in Houston that was hit by Tropical Storm Allison in 2001. The 850-bed, Level 1 trauma center had to evacuate its patients, and the damaged facility had to close for six or seven months. Furthermore, there can be a lasting emotional impact after the disaster. 

“We think if we work very hard post-disaster that everything gets back to normal pretty quickly, but that’s not true,” Cappiello said.

Why you shouldn’t forget about recovery

There are four phases to emergency management: mitigation, preparation, response, and recovery.

“Recovery is the most overlooked of all resiliency functions,” Cappiello said.

In fact, a U.S. Commerce Bureau study found that organizations hit by disasters without a well-thought-out recovery plan fail to reopen or go out of business within two years.

“Building self-reliance and redundancy is the key,” Cappiello said, such as well-backed-up information systems, battery-powered lights and exit signs, and emergency generators. However, redundancy is expensive, he noted. With limited budgets, it is important that safety officers and emergency management coordinators think through which systems take priority and where your investments in redundancy are going to be.

“You usually cannot recover by yourself. You need outside help,” Cappiello said. That may come from the community or engineers or your local fire department.

The goal is to restore essential functions quickly and by priority as defined by your organization and the needs of the community, Cappiello said. “Those two are not inseparable. They have to be melded together, ” he added.

You must also create a safe environment for your staff and patients following any disaster. You may need help from many corners to get your hospital back to business as usual. 

“One of the most important things we can do in healthcare is build coalitions” whereby the hospital is a community resource, Cappiello said.

Recovery phase goals

According to Cappiello, there are a number of goals that hospitals must keep at the forefront when it comes to recovery, including the following:

  • Return to function as quickly as possible
  • Vacate all unsafe areas and clear them of patients
  • Ensure the continued health and safety of patients and staff members
  • Provide adequate resources, personnel, and supplies to meet the needs of patients who remain in the facility
  • Obtain certification from appropriate governmental agencies to return to damaged structures
  • Secure community firefighting services to provide interim life safety measures if you cannot do so yourself

Keep in mind that you will face a lot of pressure to reopen your facility as soon as possible, Cappiello warned. The longer a facility is closed, the longer the hospital is without revenue and can face financial hardship. Also, the longer you are closed, the longer your employees, including physicians and nurses, are out of work.

Be sure to protect staff members who are tempted to do heroic deeds during disasters, Cappiello said. Restrict staff from unsafe areas and urge them to use caution. 

When it comes to government agencies, try to get them to work cooperatively. In the days after Hurricane Katrina, CMS, state, and Joint Commission officials worked together to develop a set of criteria that hospitals had to meet to reopen, Cappiello said. If facilities met the agreed-upon criteria, they could resume providing care without the need for an inspection and approval from three separate agencies. 

Offer support to people

Finally, be aware of the emotional toll a disaster or emergency takes on people and don’t overlook the recovery of your staff members. Provide rest, reassurance, relief, and reflection to help ease the impact of stress, Cappiello said. 

Staff members may perceive a stigma and status loss if they seek support after a disaster. Look for signs that staff and volunteers are not emotionally healthy after a disaster. 

Be prepared to continue staff support in a variety of venues long after the resolution of the disaster. It could be several years before the emotional recovery occurs for some. Mental health intervention is historically lacking after disasters, Cappiello said.

“No matter how well you plan, confusion and miscalculations occur,” he said.


Seven keys to your recovery strategy

Hospitals need to develop an effective recovery strategy following a disaster, said Joseph L. Cappiello, MA, BSN, chair of Cappiello & Associates in Elmhurst, IL. Cappiello presented at the 4th Annual Hospital Safety Center Symposium in Las Vegas May 6–7. 

The seven keys to recovery are as follows:

  1. Build a resilient organization
  2. Be compliant with regulatory and accreditation requirements
  3. Build trust with employees and medical staff
  4. Prepare for the unexpected
  5. Plan on escalating and compounding events
  6. Be prepared to be the sole provider of medical care
  7. Exercise, exercise, exercise

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