Basics of Disaster Planning for the Healthcare Practice

If you believe your healthcare practice will never experience a disaster and that planning for a disaster is a waste of time, consider my perspective as someone who ran a large oncology practice in New Orleans during and in the aftermath of Hurricane Katrina. I know first-hand the critical need for a disaster plan.

A plan is the starting point for any disaster recovery effort. Without a plan, you have no idea how you or anyone else in the practice will respond to the immediate needs of the disaster or recover from the disaster when it’s over.

As I stress in Think Business! Medical Practice Quality, Efficiency, Profits , a medical practice is a business that offers vital services to patients, employees, and the community. Consequently, physician leaders have a responsibility to address these constituencies in all the areas of their business.

If that’s not motivation enough to establish a disaster plan, think of your plan as an insurance policy. Take the time to list and allocate the resources to develop a plan, communicate it to everyone involved, and be prepared.

Plan Basics

A plan gives purpose and direction to the practice by answering several key questions:

• What needs to be done (major tasks).

• When it needs to be done (before, during, and after a disastrous event).

• How it needs to be done (internal and external resources).

• Who is to do it (assignment of responsibilities).

Your practice should develop two types of plans. A strategic plan addresses the broad overview or goals of the organization. For example, if your goal is to expand your practice to another location or add another physician within three years, that goal is part of your strategic plan. An operational or tactical plan provides the details regarding how to achieve the goals you outline in your strategic plan.

A goal of the practice’s strategic plan may be to survive a disaster and successfully re-establish the business. The tactical portion of the disaster plan would list the steps necessary to minimize the disaster’s impact and return the business to as normal a level of operation as possible as quickly as possible.

The owners and/or physicians and lay practice leadership must support the disaster plan at the strategic level. That support dictates the tone, resources, and nature of the plan.

The Planning Process

The planning process follows four steps:

1. Recognize the need for a plan and establish corresponding goals.

2. Clearly define the current situation.

3. Identify the barriers to accomplishing the goals and the resources available to overcome the barriers.

4. Determine a set of actions to achieve the goals.

   • Assess alternative courses of action.

   • Evaluate the alternatives.

   • Choose the best alternative.

   • Put the plan in writing and test its effectiveness.

   • Implement the plan in case of a disaster.

FEMA suggests that when organization leaders develop a plan, they think not only about the negative aspects of the disaster, but also at how their planning can produce a positive experience. This sounds like an oxymoron, but it does make sense. A plan:

• Helps the practice take care of employees, patients, the community, and the environment.

• Ensures compliance with laws, rules, and regulations that may emerge as a result of the disaster.

• Enhances the business’s chances of recovering and resuming a level of normalcy.

• Reduces liability risks that may result from the disaster.

• Sends a positive message to the community that the practice is responsive to patient and community needs.

• May save the organization money through effective management of insurance coverage.

The practice leaders should develop the disaster plan, preferably with the involvement of appropriate staff members throughout the process. The team should have clearly defined objectives formulated by representatives from the business side and the clinical side of the practice. The completed plan should include means to review and evaluate key points once the plan has been implemented.

Finding the time to meet to plan amid the daily activity of a practice is challenging. If possible, schedule a disaster planning retreat somewhere away from the practice and at a time when there are no responsibilities for patients. Being able to focus on the plan can help the team develop a plan more quickly.

The initial planning discussion should focus on the types of disasters that may affect the practice. If the practice has multiple locations, not all locations may share the same risk factors. For example, an office located near an industrial area may have a more heightened risk of explosions, train wrecks, or terrorism than an office located in a suburban neighborhood.

Locations with potential for disaster include offices located:

• Near a nuclear plant.

• Near natural gas or other pipelines.

• In an area frequently hit by tornados or hurricanes.

• In a flood-prone area.

• In a densely wooded area.

• Near a railroad track.

• Near an airport.

• Near or on a geologic fault line.

To help you understand the risks in your area, visit the FEMA National Risk Index (https://hazards.fema.gov/nri/map ), an online mapping application from FEMA that identifies communities most at risk to 18 natural hazards. This application presents natural hazard risk metrics and includes data about expected annual losses from natural hazards, social vulnerability, and community resilience. Users can drill down to the county level to view their community risk.

It’s also helpful to create a chart that lists the types of disasters that might occur and the time frame you will have to prepare for them (see Figure 1).

Figure 1. Example of disaster preparedness CHART

Find out how your community fared in past disasters. Contact your state emergency assistance department for information about the nature of previous disasters in your area.

Assessing what could happen to the practice and to each office location will be the foundation for the plan. As part of the process, identify the resources necessary to protect the key components of the practice. For example, consider questions such as:

• How will you protect patient information and ensure you have immediate and continuous access to this information?

• What are the key functions or services that you provide to your patients? Can these functions be part of the community disaster service or recovery plan?

• How will you gather and store employee information, including how and where you can contact them in the event of a disaster?

• How will you handle the business side of the practice, including accounts receivable and general accounting data?

• What happens to the practice if the main office location is damaged? Does the practice have an adequate alternative “main” office location?

It would be easier if organizations could adopt an already established one-size-fits-all plan, but no single disaster plan will work for everyone. Each organization must answer the questions of when, how, and who based on its unique needs.

Planning for Recovery

A second aspect of the disaster plan is recovery. This part of the planning document should address the resources, actions, tasks, and information to manage all business recovery activities after a disastrous event. The obvious goal is to get the practice back in operation as quickly as possible and ensure the continuation of care for patients.

After the team has developed a written plan, will the plan stay on the shelf? Or, will there be drills to demonstrate its implementation? Each disaster is unique, and the best proposed plan may not be practical in all instances. But if you put thought into your plan and practice for the various scenarios that could occur, your odds are better that you will be prepared when disaster strikes.

A successful plan also includes the community. Be aware of the resources and plans others in the community provide to care for patients. Specifically, your practice should define its role in the community by asking:

• Can you serve as a triage site for pre-hospital care?

• To what level can you provide hospital and acute care, and do you have room to house patients?

• Are you able to serve as an alternative care site for long-term acute care or for chronically ill patients who were hospitalized at the time of the disaster?

• Can you provide palliative care in your community?

Your community disaster plan can help inform your disaster and recovery plans. After Hurricane Katrina, the New Orleans area was under “civil authority,” which meant that we could not do anything in our community without official government approval. Consequently, we could not immediately implement our clean-up and recovery program. Being aware of such restrictions before a disaster strike is helpful.

Comprehensive Commitment

Your disaster plan should be part of the new-hire orientation program, so all employees understand the plan and their role in its implementation. The plan should also be a part of the annual office training program. During training sessions, when it is time to address OSHA compliance and other operational matters, include a discussion of the disaster plan and the employee role in its implementation.

Ensure everyone knows where a copy of the plan is located, whether it’s stored electronically or in an old-fashioned three-ring binder. Each office should have a hard copy, and employees should be encouraged to review it periodically.

A disaster plan requires commitment and front-burner attention. Too often, we don’t think about a disaster until it’s too late. June 1 starts hurricane season, for example, and practices on the Gulf Coast and the Atlantic Seaboard may not start thinking about disaster preparedness until then. Too often, practices regret, in hindsight, not having taken time to review the plan before they are involved in a disaster event.

Key strategies for developing an effective disaster and recovery plan include:

• Be proactive — that means good planning.

• Build and maintain relationships. Create partnerships locally, regionally, statewide, and nationally, as necessary and appropriate.

• Devise, model, and exercise your plan. Everyone needs to understand their role.

• Establish clear channels of communication with anyone and everyone you deem important and appropriate.

• Identify and clarify the process for leaders and decision-makers.

Also, consider:

• Financial implications of the disaster and recovery.

• Vulnerable populations: employees, patients, fellow citizens.

• Security plans. Be prepared for chaos, confusion, and people who will take advantage.

The disaster and recovery plan you put in place for your practice will not be as effective if you and your employees do not have their own family disaster plans. If an individual’s family is in jeopardy, their overriding concern will be for the family rather than for the business; therefore, a key part of your practice disaster plan will be to offer your employees resources and support to meet their family needs.

Considering Costs

Lastly, it’s important to understand the costs associated with your plan. As you go through the planning process, determine what is optional, desirable, or essential based on priorities and cost. This list includes developing the plan itself, protecting practice assets, determining communication options, training staff, and possibly renovating the office itself. It’s a good idea to think about some parameters and set priorities when you begin to put your plan together.

For example, consider these concerns, which are not actual expenditures but involve time away from professional assignments:

• Developing the plan itself.

• Meeting with the practice’s insurance agent.

• Meeting with other individuals identified on your vendor or contact list.

• Researching disasters and their implications.

• Securing disaster resources for the practice, its employees, and their families.

• Training staff.

Items that typically are valued up to $1,000 include:

• Fire extinguishers, smoke and heat detectors, and emergency supply kits.

• Website updates, including secure access.

• CPR training and equipment for staff members.

• Safe-guarding records to prevent storm damage.

Items valued at more than $1,000:

• Increasing insurance.

• Installing an emergency generator.

• Installing a sprinkler system.

• Upgrading mechanical and electrical equipment and storage/housing areas.

As you review your needs, use this list as a starting point. You will probably find that you will think of additional items. Evaluate each item to decide which, if any, will be necessary, what the cost will be, and what benefit you expect to gain in return for your money.

Key Points in Planning for a Disaster

1. Commit to a written disaster plan and disaster recovery plan.

2. Take the time to outline a plan.

3. Identify the planning team and challenge them to create the plan.

4. Write the plan.

5. Communicate the plan.

6. Train employees on the contents of the plan and their responsibility to implement the plan.