Is your practice really prepared for a disaster?

The news is full of reports on increasing weather events, natural disasters and emergency scenarios striking across the United States — everything from floods and tornadoes to extreme heat and wildfires, as well as increasing incidents of workplace violence. A logical question to ask is whether you are prepared if one of these disasters hits your practice? Even if you have thought about it, the answer is likely is “no.” So, with myriad things to consider, how do you get started? This article will review the basics of a disaster plan and take you through an exercise to determine whether your plan prepares your practice for an eventual disaster. Remember, no one is immune. 

There is an endless list of disasters that may occur directly to your practice or in your community: 

Hopefully, none of these (or others) will occur in your community. But if they do, are you and your team prepared for any or all the events that may happen? 

Regarding your practice’s preparedness, think about your practice from two perspectives:  

1. Your mission. Your goal is to care for patients, which means your practice must be prepared to respond to an event.  
2. Your role in the community. Even if the event does not directly impact your operations, think about the impact on your community and what you can do to assist in the recovery. 

The four Ps and disaster readiness 

The key to any response plan is anticipation and preparation. As you consider which of the disaster possibilities may impact your practice directly, begin with those that are the most likely. A general disaster plan approach is a great way to start since similar actions will be necessary for many disasters. However, the nuances of a specific disaster will create a slightly different response. This can be considered during your annual review to ensure there is awareness of the most effective approach. 

There are four Ps to follow when considering a disaster that may impact your practice. 

• Plan — Develop a business continuity plan (BCP), for which you work through the details and document practice needs and responses. Plan goals include: 
• Anticipate as many issues as possible and develop plans to address each issue. 
• Provide a document as a guide for leaders. 
• Develop a training and communication plan for all practice personnel. 
• Establish a mechanism to effectively communicate with all patients. 
• Review the plan following any drill or real event to ensure it is as complete as possible. The plan should be regularly reviewed and updated as needed. 
• Prepare — An event is imminent. For example, the National Weather Service has issued a tornado warning. A watch means that it is likely; a warning means to take cover. 
• Your plan should address who is in control, and who will decide to activate the plan. 
• Staff should respond accordingly based on their training. 
• The leadership role starts here and will remain critical throughout the entire event. 
• Participate — The event is occurring and is complete. This begins the recovery process. How do you accomplish that? 
• What is the team that will assist with active recovery, and what are their roles and responsibilities? 
• Ensure resource availability to communicate and reconstruct, as necessary. 
• Post — After the fact, recognize the impact will linger and things may never be quite the same. 
• After-action review: what went well and what could be done to be better prepared for the next incident. 
• Post-traumatic stress disorder: recognize some of the lingering effects that will impact your personnel. 

As you develop/review your plan, key areas to focus on include: 

• Establishing an incident response team (IRT) and identifying an alternate location(s) for an emergency operations center.  
• The IRT should be three to five members; in smaller practices it could be everyone. 
• Identifying the “how, what, when and what” for communication. 
• Consider information and data systems access and support. 
• Employees — ensuring their personal safety and determining if they are available to assist in recovery efforts. 
• Patient needs — how to communicate with them, and when and where they can be seen. 
• Vendors — depending on the incident, establish vendor plans and determine whether they will be available to provide the supplies necessary to operate the clinic. 
• Defining the plans and requirements of your partnered healthcare facilities. 
• Adequate insurance coverage for facility damage and business interruption. 
• Current financial picture and what cash is available to carry things forward until you achieve the new normal (the best time to obtain a line of credit is when you do not need it.) 
• Important documents that may necessitate extra protection. 
• Are they appropriately backed up?  
• Should they be stored off site? 
• Relationship with the local media and their openness to keep your patients and staff informed as to the status of the reopening plans. 
• Above all, consider employees’ families and their safety and security, because that is where their focus will be. 

Do an exercise 

Once you have developed or revised your BCP, what is next? The best way to determine your preparedness is with an exercise simulating a disaster to evaluate the plan and determine if it would work. Running an exercise can be beneficial for: 

• Assessing the capabilities 
• Providing a gap analysis to identify deficiencies for the BCP 
• Familiarizing participants with the plan 
• Preparing the IRT and others for coordination with outside agencies 
• Increasing confidence that if a disaster occurs the practice is “close” to ready (remember, each event is different!). 

What constitutes an exercise and how could you go about doing one? There are a few options to consider. 

• Train staff: 
• Include in onboarding. 
• Provide annual review of the plan at an employee meeting. 
• Conduct a full-scale exercise: 
• Simulate an incident. 
• Implement the BCP. 
• Institute work from an alternate location or employee homes. 
• Coordinate with repair services. 
• Contact insurance carrier, bank, post office, etc. 
• Drill: 
• Select a department or work area and “act” out as if there were a disaster. 
• Functional exercise: 
• Select a department but run an actual interactive simulation, with time pressure included. 
• More intense than a drill. 
• Run a tabletop exercise: 
• Analyze an emergency event in a less formal, stress-free environment where parties talk through the event. 
• A scenario is provided by a facilitator whose job is to provoke thought and elicit responses to the “what if” questions. 
• Identify and clarify roles and responsibilities of the individuals involved. 
• Encourage open and honest discussion about the scenario, as well as deficiencies and what needs to be addressed. 

Once an exercise is complete an after-action review (AAR) is necessary. At this point you examine what happened during the exercise. With an AAR you should: 

• Do it immediately 
• Include everyone 
• Assign a recorder 
• Discuss the positive and negative things that occurred 
• Allow time and encourage an open discussion 
• Assess whether the goals of the exercise were achieved 
• Create a report with the items discussed and include them in a revised BCP. 

Exercise complete 

We recently conducted a tabletop exercise with an organization based on a well thought out and well written BCP. The process was fascinating. Even though this was the third annual exercise the group conducted, it revealed gaps to be addressed. 

The leadership team and their designated alternates gathered to enact the exercise. The scenario was a CAT 3 tornado with 150-mph winds that started at 7:30 p.m. and was on the ground for approximately 10 miles and 15 minutes. The simulated tornado went directly over the office building, which is a three-story structure. The National Weather Service issued a watch at 6 p.m., and updated to a warning at 7 p.m. 

The exercise included the following rules of engagement: 

• The exercise is not a test but a validation of the plan. 
• Treat the scenario as a real event. 
• Participants will not be judged or graded on their performance. 
• Participate openly. 
• The more participants ask questions and present their thoughts candidly the better the exercise will be. 
• Leave titles at the door — everyone’s input is needed and valued. 
• No outside interruptions are permitted. 
• Silence indicates agreement. 
• Scenario can change as needed. 
• The facilitator has the right to table any issue for later resolution. 

The exercise started with the announcement that there was a tornado watch and warning. It continued with a call from the building manager to the CEO indicating that the building was damaged and not accessible at this time, with no estimate as to when it would be available. The exercise continued with open discussion, with each manager reviewing what they would do if the scenario were real. 

Among the items noted in the discussion and at the AAR were gaps about external questions, including: 

• What happens if the local bank or post office were also damaged?  
• What would happen if key members of the leadership team’s homes were damaged and unavailable?  
• Is there adequate cybersecurity protection since staff would be forced to work from home? 
• Is there adequate insurance coverage for business interruption and building repair? 
• Has the staff been adequately trained? 
• How will communications be managed within the practice as well as in the community? 

The exercise revealed that the “who, how, when and where” surrounding the IRT and when to act was lacking. The outcome was a detailed report provided to leadership, which led to revisions of the BCP and an increased comfort level with the updated plan. Exercises and reviews will continue annually in the future. 

Summary 

Where do you go from here? There is no time like the present to pull out your BCP and review it. If you do not have one, review the details above and develop a plan. No one is immune to a disaster and being prepared is essential — this is relevant to a solo practice as well as a large group practice. As Dwight Eisenhower said, in his role as general during World War II, “In preparing for battle I have always found that plans are useless, but planning is indispensable.”  

No disaster will be as planned, but being prepared will go a long way in relieving stress and resuming care for your patients.