EP 39 Disaster Preparedness for Hospitals and Healthcare Organizations

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EP 39 Disaster Preparedness for Hospitals and Healthcare Organizations

[TODD DEVOE] Hey guys, how you doing? It’s Todd here, and we’re here with Nora O’Brien, from Connect Consulting Services, and we’re gonna talk to her about her journey into emergency management, and what they’re doing over there at Connect Consulting Services in the Hostpital and Healthcare space. So, Nora, welcome to EM Weekly.

[NORA O’BRIAN] Thank you very much for having us, we’re really thrilled to have this opportunity to share what we do, and how we can help people respond to, recover from, disaster as quickly and efficiently as possible.

[TODD DEVOE] So, Nora, tell me a little bit about yourself and how you got involved in emergency management, and then how you got to where you are today.

[NORA O’BRIAN] Sure. So, fifteen years ago, when 9/11 happened, at that time, I was working for a State Trade Association in California, representing the Non-Profit community clinics, who served low-income populations. And when you worked for a state trade association and had anything to do with health care access, we got asked to every meeting under the sun around, you know, reimbursement, and dental health, and medical, and everything. So, 9/11 then happened, the (inaudible) tax, and also, 9/11 really prompted Congress to act and create the hospital preparedness program. And in 2001, it took a while for those dollars and the requirements to trickle out to the state. So, by the time the states got rolling, it was like, February of 2002. I got out to go to this meeting my boss couldn’t go to, and said, “Hey, can you go? I heard they’re handing out emergency planning money for clinics, I don’t know. Go find it out and check it out. I can’t go to this meeting.” So, I knew nothing about emergency management. I knew how to spell it, I vaguely heard of FEMA at the time, we were working in health care access. My background is advocacy and community organizing. I’d done a ton of media, a lot of social issues in the past, and I didn’t know much about it at all. I just knew that the clinics, they’re supposed to be helping these other facilities, like hospitals, assist with disaster response. It sort of made sense to me that you kind of better understand what the process is. So, my framework of understanding emergency management, how I came here, is community organizing is very similar to emergency planning at the local level, and the state and federal level. There’s a lot of overlaps, so whether you’re getting a stoplight in a local community or you’re getting a piece of legislation passed at the state or local level, you need stakeholder involvement, you need empowerment, you need to have a drive, and also, you have to have (inaudible) from the locals understand what these processes are and how you’re gonna move forward. Emergency management is the same way. If you’re gonna get an emergency plan, you just don’t wanna have just the usual suspects at the table. You really need, if you’re gonna deal with people with disabilities, you’re gonna deal with people with language barriers, you’re gonna deal with people that… you know, seniors and kids. You kind of need to have everyone at the table. Same kind of deal. So, that’s the framework that I got to understanding emergency management. So, I think it made it easier for me because I understood those principles of emergency management, wrapped around the framework of community organizing. So, like I said, I knew nothing, I was representing our state association and our clinics, in the department of public health in California. And quickly fell in love with the field because of the past work, working in community organizing. So, by the time I left that organization in 2009, I had gotten a lot of planning tools developed, that we got funding for, in order to have planning tools for California. But that planning template for clinics was actually used not just in the US, actually, it was used outside. So, community clinics all over the country were using our planning templates, so it quickly became the national standard. We got about 28 million dollars from supplies and equipment, and planning dollars to plan with the local jurisdictions, to plan for disaster. Everything from personal protection equipment, to surge tents, and PPE, and deacon units. Because it was all specific around health. So, when I left, along the way, because I fell so much in love with the field, I was intending to get a Master’s in Public Affairs, with the concentration in disaster and emergency management, to kind of give an academic context of the planning work that I was doing, not just in California, but with my colleagues across the county. We were able to support each of the primary care associations in the country, there’s one for every state. We worked with our colleagues across the country to support each other during big events, like hurricane Katrina, etc. And also the big wildfires we had in 2007 in California. So, by the time I left in 2009, I left my job, and it was a great experience. And I just sent an e-mail to my colleagues, “I left my position, it was great working with you all across the country, and working with you in California,” and I was (inaudible). I was like, “Oh my god, you’re available!” At the time, it was in 2009, at the height of the H1N1 outbreak, and I’d been doing, at this point, pandemic planning for seven years. And way too many times, in meetings, these Debbie Downer meetings that were like, “Where are we gonna put all the bodies? Because of all the people that are gonna die from this pandemic,” and those kinds of things. We had these Debbie Downer meetings all the time, and a lot of time working with hospitals and long-term care, and EMS, and department of public health. Oh boy, I just see a lot of work here. But it was the height of the H1N1, people didn’t have plans, they didn’t know how to set up, or they were dispensing to some. They didn’t have enough vaccines, there wasn’t enough personal protection equipment available.


[NORA O’BRIAN] There was a big shortage on PPE and surgical masks, and M95 masks, and all that stuff. And so, I started working at a project in New York, a project in DC, a couple of projects in California, one in Georgia. So it was like, immediately like… and this was almost immediate. I was like, within three weeks of me leaving my job, I had four projects and clients. So, I’m like, “duh, this is a thing.” So, why I named our company, I did not want it to be Nora O’Brien and associates, I wanted it to be bigger than me. And so, I (inaudible) from when I had a natural (inaudible), which was connecting people to information and resources that support their planning process. And so, I liked the alliteration Connect Consulting, and here we are.

[TODD DEVOE] I have a couple of questions for you.


[TODD DEVOE] Kind of just built upon what you’re saying. So, one is, I do get a lot of questions regarding hospital readiness. And I just want to spend a couple of seconds or minutes on that.


[TODD DEVOE] What exactly does it mean, number one, hospital readiness? And number two, people that are looking for information on that, where could they go?

[NORA O’BRIAN] Thank you, that’s a great question. So, the issue is, is that there has been joint commission. And the joint commission really has had pretty stringent and pretty… I mean, emergency management standards were really built on emergency management principles, which

[TODD DEVOE] I see that being an area that we’re gonna have to be a little more focused on, because what I noticed, like anything else, like? Emergency managers come from all over the spectrum, and I have a few connections that I have that are nurses that now have moved in to the emergency management side, and like, everybody else, we’re kind of like, ok. You know, I came from… as a paramedic, that’s where I started, and moved into emergency management, right? So, same type of thing, right? So, you kind of stand there on your first day in the job, and you’re like: ok. I know kind of what I’m doing. And you know, help.


[TODD DEVOE] And I think, you know, like writing plans. Plan writing is an art, for sure. It’s not everybody who is an emergency manager who is a plan writer.

[NORA O’BRIAN] Oh, I like that! I’m with you on that, yeah. Yeah. And then, plan writing is an art. And what people don’t know is, and what people wanna see is, I’m checking the box. But to me, planning is, you know, like your dishes or your laundry are never done, your plan is never done. Because you know, we always help people all the time, with clients, like, you want to plan the dynamics of your organization, you know? We had one plan that an organization asked us to review. They served 100,000 patients in six counties, they had like, 11,000 employees, and they sent us a plan to review, and it was five pages long.


[NORA O’BRIAN] And I just tried to like, say, “you probably need something that’s a little more robust that will support effective response and recovery,” and I got killed for that. “You know, this is not California, blah, blah blah. We don’t need incident command.” I’m like, ok. You asked for my opinion and I told you! But you know, maybe they were super succinct, but the thing had not been updated since like, 1997. That’s the other thing, too. It’s like, we help people all the time have a plan that’s reflective of your organization. Half of your staff are referenced in your incident command system. They don’t work there anymore, you got a problem. You need to update that stuff.

[TODD DEVOE] Right. Yeah, and that’s one problem I see with a lot of plans, is that they try to make them evergreen, and it’s impossible to do so.

[NORA O’BRIAN] Right. I mean, the only thing you could do to that evergreen point is, we always tell people, put positions. Don’t put people’s names. Put positions.

[TODD DEVOE] Yeah, but you still need to go back and make sure it’s…

[NORA O’BRIAN] Oh, always! No, yeah, yeah, yeah. Just look at it. All it takes is a little bit of looking at it, with a fresh set of eyes. And someone has to look at it every single year for 100 years.

[TODD DEVOE] Yeah. I looked at a plan one time, just recently. When I say one time, it makes it sound like it was a long time ago. Just recently. And the first, I don’t know, 10, 15, 20 pages, something like that, was just talking about what the incident command system was, what (inaudible) was, and why it’s important. And I asked the guy, I’m like: why is this in your plan? This is nice information, but I mean, you could put a link or something, or a website, if people are interested on it. Why are you putting all this information into your plan? And he’s like, “I don’t know, that’s the way the plan always was.” And I’m like, wow. You know, I’m not a plan writer, so I’m not gonna ever tell people that I am, but at least I know what a plan should be, and I think that’s one of the things where people just don’t know where to start. So, if somebody was gonna start a plan, like if today, I walked over and said, “I need a plan written about this city, or this company, or whatever.”

[NORA O’BRIAN] Right, right.

[TODD DEVOE] Where do you start?

EP 39 Nora O'Brian[NORA O’BRIAN] Ok. Very good point. In order for us to do a (inaudible), we gotta know what do you have now? So, we have to look and see. And honest to god, we’re working with a client, we’re working with someone, they sent us a whole list of policy and procedures that had not been updated since 1981. And we’re working on that. So we’re just… we first do a “let’s see what you have and let’s see where the gaps are.” And once we do that, we’ll see where the gaps are. Because the most (inaudible) things that are… you know, or an organization that has nothing. We (inaudible) hazard vulnerability analysis. Because that’s something that’s really important. Not a lot of people do it HVA, or hazard vulnerability analysis, which I can’t say a lot too many times very fast. But the HVA will get us a lot of information about what their external (inaudible) are, but what’s our internal process? Because it has… we really like the Kaiser. Both the 2014 and the 2017 tool, we like them, I don’t think we’ve ever seen the Kaiser Permanente HVA tool, that already has the formulas included, it’s an Excel spreadsheet. We like it just because it’s really clean, it kind of gives us questions of like, what’s the risk? What’s the probability that thing is gonna happen, whether it’s an earthquake, fire, or flood? Or data breach, or whatever those things are. And then, what has been your personal preparedness or community preparedness to address that particular event? And it spits out a number and it kind of tells you where you need to focus your attention. So, that HVA process, for us, that’s usually… we do a plan review and we do an HVA for almost every client that requests, because you kind of need to know what the risks are. It also gets to those questions of, what have you done for planning? You know, you’re in an earthquake country, what have you done for earthquakes on the internal side? Or do you have any idea what your community has done for earthquake preparedness? Etc.

[TODD DEVOE] Do you hold, or do you recommend holding, either way; a planning meeting with stakeholders of the company first, or do you recommend that emergency manager to walk around and do his own assessment? I mean, how would you tell that person to start that process?

[NORA O’BRIAN] Well, they’re doing it themselves internally. There’s two things. There’s two parts of the community that are really key. One, is you have to have senior leadership (inaudible). Nothing’s gonna happen once unless you have it. Because the senior leadership (inaudible) into the importance of planning, or training, or exercising, none of it is gonna happen. So, you need to talk all day to your (inaudible). So, that’s something that’s really key. So, senior leaders have to see the value of it. And of course, for the most part, we’re dealing with health care providers that are great when internally required. So, you know, we have (inaudible) a little bit more, because they can boost the ability to accept Medicare or Medicaid if they don’t have these plans and systems in place.


[NORA O’BRIAN] So, you know, whatever is gonna get their (inaudible). Whether they think it’s a good idea or, you know. And then the other piece of it is the engagement of the staff, that is not just, you know, the facilities guy and the janitor, and they go in a room and they come out two weeks later with a beautiful and color-coordinated plan. That doesn’t work.


[NORA O’BRIAN] Because the reason that doesn’t work is, the only two people that know the plan is the janitor and the safety guy, so that’s not gonna help. So, what we always say is, you know, emergency management is a team sport. Not an individual sport. And you really need to have every kind of department, or every factor of your business, or agency, or organization included at the planning table when you’re developing your plan, so that it’s reflected. Because when we talk about emergency response or business continuity, because we do both, when you’re talking about both of those, you know, what business continuity looks like to an IT person, versus a facilities or administrative person, like we work with a lot with health care, so a (inaudible) perspective. They think business continuity is very different to each of those different parties. So, you kind of need everyone at the table, to have them better understand, so that you have a plan, again, that’s reflective of your organization. And that (inaudible) is really important. And one of the things that’s really key to where you start and where you go from that, don’t make emergency management a standalone system that you have to do, right? You’re probably doing some kind of process improvement in your organization, and it could be organizational development, it could be doing a better client management system, I don’t know. Whatever kind of business or company you’re part of. Make that emergency management part of your existing process improvement, and just make it one other element that you work on. And you have a better short, if it’s a standalone, is this thing will never get (inaudible).

[TODD DEVOE] Right. Yeah, I find that interesting too, you say that. I found emergency management positions in really weird spots. Everything from…

[NORA O’BRIAN] I’m with you!

[TODD DEVOE] Everything from, you know, facilities – which make sense, to operations, which make sense. And then, like, even in the public side, I’ve seen it in public works. I’ve seen it in the fire department, in the police department. And the oddest one is, I don’t wanna say where it’s at, because it’s actually near and dear to me, it’s a city that I love, it’s in their human resources department.

[NORA O’BRIAN] I see that, I see that all the time.

[TODD DEVOE] And I asked, one time I was talking to the city manager, and I was like, “Why is it in your human resources department?” And he said to me, “Well, that’s where risk safety was, so it just made sense for us to put emergency management there.” And I’m like, that’s like…

[NORA O’BRIAN] I know.

[TODD DEVOE] Because they don’t have their own… they have their own police department too. They don’t have their own fire department. But that was like, really odd for me. But anyway.

[NORA O’BRIAN] Because it sits in different places, your planning focus is gonna be different, you know? Like, it used to be business continuity, it was this thing over there that IT folks did, because we wanted to get our data backed up. Both are long gone, it has to be. You know, and that’s something that we teach to our clients all the time, it’s about organizational resilience. Like, sure, you can get your… if your data is still there. But if your building is damaged and your staff can’t get to work because they’re evacuated and your supply chain is chocked, you don’t have a business! Or you don’t have a company! You don’t have an organization. You’re screwed. You know, like, you can have your data, but you can’t actually do the things you need to do.


[NORA O’BRIAN] You don’t have those other things.

[TODD DEVOE] That’s so true.

[NORA O’BRIAN] But I mean, it’s fascinating to me, about where it lives, because it’s always, you know… everyone’s got, you know, it works for them, great. We’re not gonna ever say, “do it this way or that way.” But you know, the key thing is that senior leadership (inaudible) and local engagement at the line level, are really key. Because I’m also a big fan of, never underestimate a good donut, a good burrito. Honest to god, that will help your planning process, seriously. It doesn’t cost a lot of money, you know. (inaudible), I don’t know. Whatever you want. If it’s like, a safety committee t-shirt, these people will do stuff for days. I don’t know. But the point is, whatever is going to engage people, give them a damn pen, I don’t know. But the point is that they need to understand sort of what their role is. And basically, I’ve always kind of been a fan of like, everyone… however you got to the party of emergency management, you all have something to contribute, so let them contribute, in my view.

[TODD DEVOE] The plan for me is the end result of something that you do together as a collaboration. And I really think that the process of planning is… I don’t say more important, but definitely, the (inaudible) of really what the plan is about. Cause the plan will change, we put it on the shelf, we bring it out a couple times to test it or whatever. But that process of getting from A to Z, I think it’s crucial in the plan. And if you don’t have the right people in the room; what I mean the right people, the decision makers, then that plan is not gonna get off the ground. Do you agree with that, or am I off-base?

[NORA O’BRIAN] Yeah, you know, you’re absolutely right. And what I always tell people about that, that’s something we tell people often, our clients, is that the planning is as important, if not more important, than the actual plan that ends up on paper. And the conversations you have around business continuity, and “Hey, what are we gonna do about…?” And that’s why plan testing is so important, it’s something that we do as well. We spend a lot of time (inaudible) people with muscle memory skills of evacuation, or… you know, just to tabletop exercise, and we really have them talk about what continuity would look like if we can’t get in your building for four months? Oh.


[NORA O’BRIAN] I hadn’t thought about that. You know, like, cause one thing that makes me… And I’ll give you some of my (inaudible) craziness is, people write these beautiful after-action reports, and they’ve got color codes, photos. You know, this thing is 30 pages long. And they don’t implement their improvement plans, and then two years later, they do another exercise and they’re saying, (inaudible). What do you know? Had you, scheduled or thought to actually use that information that was there to update your plan, you’d be in a better shape right now. So, those things, that’s crazy-making for me. Because that happens all the time.

[TODD DEVOE] It’s so true!

[NORA O’BRIAN] Completely crazy making. And my clients will know, I mean, I always give them a fair warning. I say, ok, I’m giving you a (inaudible), you can (inaudible) me out, like I’m your… you know, I already had a teenager who (inaudible) me out, why not a few more clients? But the point is, that’s the whole point of the exercise. It’s not because I check the box, and “I did an exercise!” No, you actually updated the plan with your findings, and now you don’t have that issue the next time you do an exercise. “Oh! That’s what that’s for, ok.” You know, that makes me nuts. That’s crazy making. So, does that sound crazy to you? Is it not so?

[TODD DEVOE] No, I’m right there with you. I did a fire drill for this organization I belong to, and we evacuated the building, and there’s some serious issues, right? Like, first of all, the fire alarm. One guy described it to sound like a buzzer going off on a dryer, you know? They weren’t really sure what it was. And you know, another person said they couldn’t hear it in their office, and there’s some serious issues with the fire alarm. And they have building captains and stuff like that, so the building captains really work by getting everybody out. So, in my after-action report, I wrote down that the fire alarm system needs to be changed.


[TODD DEVOE] And the guy who I hand it to tells me, he goes, “You can’t put that in the after-action report, that the fire alarm system needs to be changed.” I said, well, it does. This is a complaint that we found. And he goes to me and he’s like, “Well, no, because if we don’t change it, we’re gonna get in trouble if there’s a fire, and they found that we…” I’m like… so, knowing the problem is better than not. So, anyway.

[NORA O’BRIAN] Well, I mean, here’s the thing. It’s like, this is not a “gotcha”. People understand, it’s not about like, how much are people gonna be running around like chickens with their heads cut out. You’re testing the plan, you’re not testing the people. But if you can’t, that makes me crazy. Because the whole point… if you don’t find anything, you haven’t stressed your plan enough.


[NORA O’BRIAN] And it’s not gonna help you. You know, that’s the other thing too. “Oh, everybody got out, and five minutes later we go back to work.” No. No, no, no. You’re gonna have some findings. Even if you do it once a quarter, a fire drill. You know, “Oh, we never used patients before, or we only just do vertical, we don’t do…”


[NORA O’BRIAN] You know, “we only do horizontal, we don’t do vertical evacuation.” I’m like, then… you know, and you’re on the third floor, what the hell? Like, why are you doing that?


[NORA O’BRIAN] I mean, if you want to get to some… you know, the point is not trusting whether, you know, Maria knows her stuff, as an incident commander. That’s not what that is. Give the things that you did… (inaudible) your staff’s, you know, muscle memory, to say, “Ok, I remember we go on this hallway and not that one, because of x.”


[NORA O’BRIAN]have to have… they have to conduct a hazard vulnerability analysis. A lot of these folks don’t know how to do that. And they have to develop a plan based on your risk and your outcomes every HVA. And the system has to be all hazards. You can’t say, “I only have a fire drill plan, I’m good to go.” You have to develop policies and procedures. Now, it’s fine if you’re a hospital and you’ve had these for a million years. But if you’re a home health agency, if you’re a psychiatric unit, if you’re a community mental health, you probably don’t have these very specific policies and procedures for your providers, or 17 providers that are impacted. And all of us had to be in a place by November 15th, 2017, and the policies, so like, there’s nine policies for hospitals. Long-term care has… nursing has 8, and (inaudible) for the elderly have 10 policies. So, they have to have all these policies and procedures in place. They also… and they have to review them and update them every year, they have to have an HVA done every year, and they have to update it every year. They have to have a communications plan. And this really came out after events like hurricane Sandy, and hurricane… you know, going back to Katrina, where these smaller hospitals, they got pretty robust communication systems, you know. And a lot of these smaller agencies, they think that a cell phone is redundant communication. So, they’re gonna have to have… which is true. I mean, you laugh, I’m sorry, It’s the truth. And they have to have a way to notify staff and patients, they have to have a way to communicate with local, state, and federal, and tribal agencies, and have a relationship with them for the first time ever.


[NORA O’BRIAN] And they actually have to have redundant communication, that’s a big one. Because a lot of these folks don’t know the difference between a 7mHz radio versus a satellite phone, you can put them in front of you, they have no idea unless they’re actually centered on the device itself. And then they had to do a training and testing program that trained all their employees, their contractors, their volunteers. And their testing program is gonna have to do two exercises a year, one of them has to be what CMS defines a full-scale exercise, which is an operations-based training. Operations-based exercise. And you know, if you know how to spell emergency management, like I was fifteen years ago, and these people that are contacting us and many other consultants around the country, these people are like, the executive directors’ secretary.


[NORA O’BRIAN] And say, I was assigned two weeks ago, I don’t know what to do. Boy. You know, and they’re gonna have to conduct a full-scale exercise. So, at this point, we’re past the November 15th deadline, and people still have to have these systems in place. And so, from this point on, after November 15th, the surveyors, when they come by to survey you, they’ll now add all of these elements to all the other things they survey you on. Either your state or CMS survey. And you’ll have to have these in place. If they don’t have these systems in place, and they don’t have their plans, and their PMPs, and training and testing done, they can get a corrective action plan, and they only have 30 days to comply.


[NORA O’BRIAN] And they’ll have to get it in place. So, if they don’t do that, then they can lose the ability to accept Medicare or Medicaid. So, there’s no joke here, it’s serious. And I think in the long run, I think it’s gonna be good. I think it’s gonna be a bumpy couple of years, while they figure out, and this is something they’ll have to do each and every year. I think all of these things are great; none of this stuff is crazy, this is all I have a plan, have PMPs, communications plan, train and test. Those are standard EM things. I think in the long run, I think it will help make regional medical surge better than it has, you can’t have just people closing their doors and saying, “I’ll be back in two weeks, when the event is over.”


[NORA O’BRIAN] They’re not gonna be able to do that anymore.

[TODD DEVOE] Do you think that hospitals should be looking at hiring professional emergency managers to come in to their area? Or do you think it’s ok for them to grab the… you know, executive director of the hospitals… executive assistant, and having that person start writing the plan? I mean, my feeling, obviously, as an EM, I’d like to see the profession go in there. But I don’t know, you know.


[TODD DEVOE] What do you think?

[NORA O’BRIAN] I’m with you on that. I think that we both know what it takes to be a local EM. You guys sit around and wait, you know, drink coffee and wait for an event to happen. I know. You know. Ha-ha-ha-ha. We know that’s not the truth. We think we’re gonna see more healthcare systems, because what happens is, you know, they’re serving 17 provider types. A lot of these hospital systems, they’re not just hospitals, they have… I know one health system in the East Coast, they have every single provider type within their health care system. They serve a huge part of Pennsylvania. And we’re gonna see more and more of these emergency management programs, be more integrated. And I think in the long run, I think they should. The other thing, I think what’s gonna kind of drive this, is some of the big organizations, like Skilled Nursing. Because I think Skilled Nursing has the most, it’s like, 17,000 of the 72,000 providers that are impacted. If some of them actually loses the ability to accept Medicare or Medicaid, you’re gonna get a huge ripple effect of, “oh my god! They’re really serious! Ok, now we have to get our act together.” And now, they’re gonna announce they all of a sudden have emergency management programs. I think it’s a good thing. I think it would still be a good thing for response and recovery to have more of a focus in operationalizing plans, and a focus on that. I think that’s gonna be a good thing, I think it’s just, until people kind of get with the program, I think in the next couple of years, we’re not gonna see how it all comes out. But I think in the long run, I think it’ll be good. So, that was a long answer to your short question, but I think it’s gonna be a good thing.

[TODD DEVOE] Right. I don’t think there’s an easy answer to any of these questions, and I think you’re doing a great job handling them.

[NORA O’BRIAN] Thank you!

[TODD DEVOE] So, we’re coming here to the end, and before we let you go, there’s a couple more questions I have for you. But this one here, so. We just said that this is gonna impact hospitals and other type of care providers drastically.


[TODD DEVOE] If somebody’s interested in getting a hold of you, how could they find you?

[NORA O’BRIAN] Sure. They can go to our website, which is connectconsulting.biz. We have a whole CMS section, we’ve got a blog, we also have a Connect Consulting page on LinkedIn. You can find us there, you can find us on Twitter, which is Engage, Prepare, Recover. Or my Twitter account, which is Nora Connect. If you want to, you know, a lot of people are like, “I don’t even know where to start” kind of thing. What we try to do is make it as easy of possible, so we come up with a number of compliance packages. For some people, we’ve already developed all the planning tools, an implementation guide, a simple policy procedures for nearly all the provider types. So, people who just want to purchase our material, we call that a “do it yourself”. There you go. And then some people just want some support, so we call that a “do it with you”. And there are certain people that have the resources but don’t have the time, they say, can you just do it for us? Can you write our exercise? Can you write our plans? Can you like, guide us through the process? You know, we’re certainly happy to do that. And we work with a lot of other consultants around, so we currently have clients in about 26 states, and we have colleagues all over the country. What we hope is that, you know, the surprising thing actually in the rule, it says you might need a consultant, which is shocking, I’ve never seen that in a federal register, which really surprised me to see that. I know! It’s like… well, certainly, you’ve never done it, and this is new to you. I think… I was actually surprised to see that. You generally don’t see that much, you know, frankness in a federal register. The other is that there’s actual comedy in the federal register. It also says that they tried to estimate how much it’s gonna take for like, for an organization to put together an emergency plan. They actually wrote, kid you not, which is nearly about every provider type, eight hours. Eight hours it will take you. That’s just a plan. To do the ATA, that’s six hours. And to do a full-scale exercise, that was ten hours. Honest. I’m like, maybe (inaudible) you’d need the ten hours to do the full scale… I mean, that was true comedy in the federal register.

[TODD DEVOE] That’s awesome.

[NORA O’BRIAN] I was like, are you kidding me? And then, they estimated a cost! Honest to god. This is gonna take this many nurses in this facility. And they actually came up with a table with the cost, of what it will cost for all 72,000 providers, and exactly how much they’d have to spend to get to compliance, and it was $373 million. And it’s based on those eight hours and ten-hour estimate to (inaudible).


[NORA O’BRIAN] I think that number is probably 10 times that. So that was kind of interesting and kind of cute they actually tried. You know, I was like, aww, that’s cute. You’re completely off, but hey, that’s ok.

[TODD DEVOE] Good try. Awesome.

[NORA O’BRIAN] Yeah, good try.

[TODD DEVOE] Alright, so here comes the toughest question of the day. Somebody starting off in the business, and since we’re talking about hospitals, somebody started off as a hospital emergency manager. What book would you hand in and say, “read this and you’re gonna be on your way”?

[NORA O’BRIAN] There’s a blog, that I subscribed to, it’s free. Recovery Diva. I don’t know if you know Claire Reuben. Or know of her. Ok. She’s been working in the field of recovery for like, 30 years, and she’s got this great blog. What I love about her blog is that I… it’s like, five times a week, I think. Or at least three or four times a week, we get an email for her, and she comes up with reports. And this is not just US focused. So, it’s reports around the world, and resources, you know, on the federal side, on the public sector side, on the private sector side, these great resources that I have, so many times, used. That have been so helpful to me, that I was like, oh my god! Or it could be a Bloomberg report, or it could be a GAO, Government Accountability Office report, or a Congressional report, or something like that, that were just really helpful to kind of understand. Because it’s not just specific to… don’t just think: oh, it’s recovery, I’m only thinking about business continuity. No. Cause really, it’s about response and recovery, and I’m a big fan of Claire Reuben. And I met her before and, you know, kind of (inaudible) myself for her, and said, “you’re just great at what you do.” So, and you know, I just can’t say enough good things about Recovery Diva. So, there’s a lot of good lessons learned there.

[TODD DEVOE] Awesome, cool! And you know, for everybody who doesn’t have their pencils sharpened right now, we’re gonna go ahead and put all those links and including Recovery Diva, in our links down at the show notes, so don’t fret over that. So, awesome. Thank you so much for the Recovery Diva as the book or publication that you recommend.

[NORA O’BRIAN] One last thing. We actually want to give your readers a discount. So we want… so actually, two things we can give you. We can give you a 12-point free assessment, of where your organization is, in terms of your training, planning, and exercise gaps, we’ll be happy to send you that. You send us an email. But also, we give you a 10% discount on our services, for listening, and letting us know that you heard about us on EM Weekly.

[TODD DEVOE] Awesome! Thank you, thank you. And everybody, did you hear that? So, if you want to use their services, go ahead and click on those links that we’re gonna have down there. And email, say you heard it here, and you get a little discount. Thank you so much for that, that’s a wonderful early Christmas gift, I guess. Awesome.


[TODD DEVOE] Cool. I was about to say if you had anything else you wanted to add, but you did that. And so, thank you so much for being on the show today, looking forward to hearing from you again.

[NORA O’BRIAN] Thanks so much, Todd. Thank you a lot. Thank you so much for having us.


Website – www.connectconsulting.biz

LinkedIn: linkedin.com/in/noraobrien

Twitter: NoraConnect

Email: nora@connectconsulting.biz

HVA Tool from Kaiser Permanente



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2 thoughts on “EP 39 Disaster Preparedness for Hospitals and Healthcare Organizations”

  1. I enjoyed the attention paid to healthcare preparedness especially in light of the new CMS rules. I think there was a missed opportunity by your guest and your self by not highlighting the work that ASPR and the role that Healthcare Preparedness Coalitions are playing in helping all 17 provider types becoming more prepared for all types of events. In my travels across the east coast I have seen in most cases that hospitals have their act together when it comes to emergency management and or at least emergency preparedness; (it still might not meet the exact standards of CMS)it’s a far better than where they were before hurricane Katrina (again something that wasn’t mentioned during your podcast, or the book 7 days at memorial). Where the big issue is when we are talking about healthcare infrastructure preparedness is when we bring in long term care, home health, assisted living, etc facilities, again not mentioned during the podcast were the facilities in Houston with the seniors sitting up to their waist in water waiting to be rescue (I bet their emergency plan was to call Emergency Management and when they did they were placed on a priority list, they were lucky that someone was smart enough to take a picture and post it on social media and it went viral) or the nursing home in Florida where a bunch of residents died due to lack of power when the hospital was across the street. It is sad that these for-profit facilities are kicking and screaming their way to emergency preparedness especially in the wake of recent disasters where simple measures literally could have saved lives.

    I look forward to your next podcast, you keep reaffirming that I’m still up to date with trends going on in the field of Emergency Management and/or teaching at least one new thing I can be doing to improve how to impart the skills and knowledge of emergency management/preparedness to my community.

    Keep up the good work!

  2. Thank you for your post. I think we all can learn more about what the trends are in healthcare EM. I will look for an expert from the ASPR to come on the show,

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