Andrew: Christine, thank you so much for joining us today to talk about some of the administrative aspects of hospital emergency preparedness. I was hoping we could start by just hearing a little bit about yourself.
Christine: Sure. It's always a pleasure to talk about this emergency preparedness work and disaster response. I am a nurse practitioner by training. I started my career in New York actually, out in Rochester. And I had the good fortune when I was out in that area to have both clinical and operations leadership roles. After the events of September 11th, I was first connected to disaster response work and concurrently had been supporting the hospital in emergency preparedness operations. Today, I serve for the American Red Cross in the State of Massachusetts as the Disaster Mental Health Lead and the Chief Nursing Officer at McLean Hospital and Vice President of Nursing for Mass General Brigham Hospital, Behavioral and Mental Health. That's where I find myself today.
The conversation with Christine touched on numerous topics, including what she sees as the most pressing challenges facing hospital emergency management, staff having to manage multiple roles, impacts on staff following a response, and emerging threats in the disaster recovery landscape. One section of the discussion that we wanted to share with you in this edition of The Frontline Review touched on aspects of continuity of care during emergency operations responses. The following is an excerpt from that part of the discussion.
Andrew: Could you say more about the continuity of operations piece? How you've seen that play out when events have transpired, both big and small.
Christine: I think that in terms of the continuity piece, what's really the question is if a particular service is affected directly and how we're managing that. Also consider if that person is responsible for a large scope of services and some of those services are not disrupted and they just need to continue, or if they're diverting their attention to the management of the specific response.
Once again it varies depending upon what the impact is. But for example, a technology issue or an electronic health record downtime, are there plans in place to be able to switch over to using downtime procedures? Is there an organized process for decision-making as to when to flip over to that [downtime] process and when to have everybody operating in that fashion? A situation like that would require an incident management team or an incident command structure activated. The questions that are coming up about being able to deliver clinical care directly will be managed at the patient level as well as at the system level.
Andrew: So, having clear guidelines as to when that execution happens, when to move to that emergency procedure, and then knowing what your role is within that procedure, right? And how to change those operations to be able to meet those patient needs?
Christine: Right. And in the spirit of the best laid plans, there are times where the plans don't always meet the need of that particular event. And that's when the course correction and updates will happen. That's why having that incident command structure is just so important, to be gathering feedback from the patient level or the field, so to speak.
Andrew: Have you seen challenges with maintaining continuity of operations for other patient needs that aren't related to the major event? I've heard that during COVID, there were other patients dealing with other things that weren't COVID. And so how do you manage the surge that you might see – the big demand of the current moment – while also maintaining continuity of operations for other patient needs?
Christine: It's quite interesting as you think about maintaining the other types of services. COVID is a great example where there were several elements of care that were affected for everyone. So, for example, there was a period of time where visiting patients was restricted for everyone, and the PPE that was necessary for a period of time was needed more universally. In these instances, we were really adjusting the care processes for everyone because they were more broadly applied, as compared to somebody who was directly in isolation, where certain aspects of their care were are driven because of the disease state.
When it gets right down to it, one of the major elements that keeps things stable and moving forward from a continuity perspective like that is communication, specifically two-way communication. We found during that period that there was excellent communication, important policy updates, and in the moment procedural communications. If it was just a simple one-way communication out to the care delivery team, we would have missed opportunity for dialogue and for questions like: ‘What does this really mean? Has it been thought about in this scenario? How would we handle it?’ We found that this exchange and dialogue was really critical. Because to your point, some of those protocols are really about those people directly affected by the event but it's a policy that spans all of the care areas. So it is important to welcome lots of questions and have opportunities for good dialogue to clarify.
Andrew: I think that's a great point to bring up, especially when you’re talking about the best-laid plans that don't always go well. To have that two-way dialogue so that people in positions of leadership can get feedback from the ground about what's working and what's not working and then adjust the plans accordingly. When you have something that was as long-lasting as COVID, you couldn’t just implement the process, do a hot wash, and then be done. Because that end time, for a while, was unknown; we didn't know when this was going to be over. And so having to adjust on the fly, I'm sure that two-way communication makes that much easier to do. It facilitates that process.
Christine: I think that applies to a lot of different types of events where those principles of effective communication and crisis communication really apply. Trying to craft a message right from the beginning, that is clear, gives people information about what's actually happening in the event and what's being done about it, in the spirit of what we know and what we don't yet know, is important. Having communications delivered through trusted and reliable channels often makes a big difference. Then it is important to have that opportunity, as we pointed to, for clarification and an opportunity to provide feedback, so people feel like they have the tools to manage the situation. I think it's not insignificant that in times of specific critical events or disaster incidents, there could be worry, fear, and anxiety for a variety of different reasons. But at its core, people feeling impacted need an opportunity to be able to access those tools, those protocols, and people to review them with.
