Disaster and Contingency Planning Lessons from the ICU
March 14, 2018
Topicsdisaster planning, Management, Resources, Responsibility
In a hospital, lives are saved or lost long before patients’ treatment plans are written and implemented.
Planning is Impersonal
Stefan Swanepoel advises leaders to “see the whole [chess] board” strategy-wise. Are you a leader tasked with planning for routine operations along with the response when routines are disrupted in ways big or small? Then you need to remember that success, in Swanepoel’s words, “isn’t just the next move - it’s what you do three, four, even 10 steps after that really counts.”
Reality is Personal
Once a problem occurs, those generic pieces on a board turn into real people. Real people whose issues hold emotional and financial consequences.
When my mom was hospitalized for two months, I would sit in her room and stare at the array of machines and tubes surrounding her. Oxygen flowed from a wall panel. It seemed to come from nowhere and be unlimited in supply.
A hospital may have plenty of modern equipment at its disposal, but events can spiral out of control quickly. Human administrative failures and infrastructure inadequacies are not a match for mother nature sometimes. That was the case for Memorial Hospital after Hurricane Katrina in 2005.
When Plans Fail
It’s inaccurate to accuse Memorial Hospital of not having a disaster plan. Theirs was 246 pages long. They had a designated disaster coordinator.
What they didn’t have was a leader who had looked ahead multiple steps. They also failed to convert the generic pieces into living, breathing human beings whose survival hinged on what moves they made next.
No one at Memorial knew that the surrounding levees would break after Katrina, isolating the hospital. That the generators, whose move to a higher floor had always fallen to a lower budget priority than some other need, would be incapacitated by flooding. That the presence of patients of a provider that was leasing the seventh floor would multiply the census of extremely ill patients exponentially.
Everyone’s Loved One is Number One
One physician took primary control during the Katrina crisis at Memorial. She implemented a makeshift triage plan and decided to put patients in three categories to organize the order in which they would be rescued as helicopters arrived. Patients in relatively “better” health were designated one’s. The patients with more severe issues got a two designation. Patients with DNR orders or other grave conditions were placed in the last priority, given the number three.
That same physician was subsequently charged with second-degree murder. She was accused of choosing to euthanize the sickest patients without their consent (the charges were later expunged).
A comprehensive review of the situation indicates that, at a minimum, people in authority were scrambling to deal with their pieces of the game. No one was watching the whole board.
Small Decisions and Omissions Matter Too
My mom’s cardiac ICU room was in a brand-new tower of a major hospital complex. This tower was across the street from the original facility, which still served medical ICU patients. Amid her medical crisis, the respiratory therapists and staff were having difficulty finding a bipap mask to fit her face and keep the air in. They decided a mask with a silicone seal may work best. That mask, though, was “across the street.” A discussion ensued about whether it made sense to go hunting for it.
Would a major teaching hospital really let a patient slip closer to death for lack of having assured adequate inventory when they moved facilities?
One Piece Does Not a Chess Game Make
If you are a leader, look at your organizational chess board at a calm time. If you are a line employee, acquaint yourself with your organization’s contingency and disaster plans. Get on the planning committee. Become an advocate.
No matter where you are on the org chart, keep sight of the fact that each piece on the board is an individual with dignity.
My mom would probably have been a “three” under the Memorial “triage” system, at best a two.
A crisis is not the time to decide who is a one and who isn’t.