Predicting the Unpredictable
As emergency managers, we use a variety of tools and methods to predict the events most likely to impact our health-care facilities and then create a list of preparedness activities for mitigating them. The annual hazard and vulnerability analysis (HVA) helps us focus on the most likely high-risk events (as well as frequency and impact) that could affect our organization. Reviewing the HVA throughout the year, particularly following exercises, actual events or changes within the community further helps refine the predictions, as well as working with external organizations such as community response agencies.
Next, we document our findings in an improvement plan or corrective action plan as part of our after action report, which we then take identified deficiencies to the environment of care committee or our emergency management committee to assign or delegate someone responsible to follow up and close each item before our next exercise (although interim activities are allowed if they cannot be completed in time). Changes are made, the emergency operations plan is updated, additional training ensues and we document it all for our next survey. The same cycle goes on and on. In many ways, it’s like the movie, Groundhog Day with Bill Murray where he is forced to relive the same day over and over again.
I suppose it’s important to consider whether this is enough? After all, we are improving, albeit incrementally, and we’re avoiding leadership reprimand or worse, compliance jeopardy. For most emergency management coordinators or safety officers, just completing the planning process and following through with all the documentation is already overwhelming. Pile on the myriad of other responsibilities they have such as security, housekeeping, parking, environment of care, life safety, fire drills, work place safety, industrial hygiene, hazardous materials, grant management — it’s a wonder that they have any time at all!
Accelerating Improvement
The problem for many hospitals is where to start. With multiple forms, heavy documentation requirements and new terminology, it can seem like way too much to introduce. However, IAPs are based on the concept of “management by objective,” which is a parallel notion for any health-care department manager responsible for developing and assigning work plans and performance metrics. Once meaningful objectives are established, everyone on the IMT will align their activities to meet them. It’s a lot like “having everyone rowing in the same direction.” This can have a multiplicative effect on mitigating the risks better, faster and more efficiently. It also helps longer-term responses stay on target, despite personnel changes throughout the event.
To simplify IAPs, organizations may consider using only five, basic ICS forms, each designed to support the development and completion of the objectives. These forms include:
- 201 — Incident Briefing
- 202 — Incident Objectives
- 203 — Organizational Assignment List
- 214 — Operational Log
- 261 — Incident Action Safety Plan Analysis
Here’s a brief outline for implementing an IAP using these forms:
- To begin, form 201 captures and documents what has initially happened and any actions taken. It’s completed early and can serve as an assessment tool for determining whether activation of the EOP is warranted as well as providing early messaging information for internal and external stakeholder notifications.
- The second form completed is the 202, which defines the command objectives and identifies the first operational period. It helps determine what positions should be activated and serves as a road map for building specific strategies and tactics.
- The organizational assignment list form (203) documents all staff involved in the response. It helps keep track of staff time as well as accounting for the safety of all active responders.
- Form 214 is a chronological listing of all information and activities taken. This is wonderful way to keep track of expenses and decisions made.
- The final form is the 261. This is completed by the safety officer and identifies any facility or community hazards as well as mitigation activities and their status. It’s an essential tool for helping to ensure patient, visitor and staff safety throughout an incident.
While there are many other components of doing the IAP, a simple start such as the steps outlined above can help health-care organizations move away from solely addressing broad improvements with incremental changes to getting at more specific deficiencies with more immediate competency progression and to avoid reliving the same day like Bill Murray in the movie. Perhaps this Groundhog Day you might consider trying something new and implementing the IAP process into your next exercise?
Mitch Saruwatari is the vice president of quality and compliance at LiveProcess in Verona, N.J. Saruwatari is a recognized national health-care emergency management expert who co-chaired the development of the National Incident Management System compliant Hospital Incident Command System.