The People, Process, & Progress Podcast - This is How America Can Improve Its Hospital and Healthcare Emergency Preparedness | PPP #23

Episode Date: May 28, 2020

I go through the Normal Operations, Increased Readiness, Response, and Recovery phases Hospital and Healthcare emergency preparedness professionals can use. It should reference to prepare for and respond to emergencies like COVID-19.

Hey, everyone. Welcome to the People Process Progress podcast, where we tell people's stories or you get my two cents as the person. We focus on processes that can help us all make, you guessed it, progress. In this episode, this is episode 23, and we are calling this one Easy to Follow Phases for Hospital and Healthcare Preparedness and Response. Kind of a follow-up, I was very fortunate to, one, meet James Gearing, who's the host of the Behind the Shield podcast, and then be on his show. That's episode 316. So if you don't listen to James, please do. One, to my episode 316, which selfishly, you know, I was on. We had a great conversation,

talked about preparedness, public health, using the incident command system practically, not just conceptually through forms and classes and all that jazz. But also, you know, James focuses on in his podcast, mental and physical health for first responders. He's done great things. He's got over a million downloads. He's got a huge reach. So please go check him out. For this podcast, we are, you know, do incident management, all hazards, incident management, best practice, project management, best practiceshazard incident management best practice, project management best practices, interview folks from jujitsu or law enforcement or firefighting or real estate, just people who can share how they built a business, how they survived a house fire, how they've helped law enforcement adopt incident command, all these different

things. So again, the whole focus of the show is that people is what it's all about. Processes bring us all together. And together, if we do that, if we're working together, if we're one team, not your org chart, my org chart, my team, your team, but all together, we will no doubt make progress by sharing what's worked with us, what hasn't. So in this show, in this episode, and before we get into this, if you haven't subscribed, if you haven't shared this, please do. Please also throw us a rating. When we get higher ratings, we get the word out. We can share the insight from someone who's a Brazilian jiu-jitsu black belt for 20-plus years, the insight for a 20-plus-year law enforcement officer.

And there are folks out there that need to hear this, that need to help make change, that just maybe are starting in public safety or martial art, or they're just trying to get some good life lessons for themselves. And we have some great episodes with some of my guests and then some of my experience in 20 plus years in military medicine, public safety, public health, and a few other areas that you'll learn about if you listen to the episodes. But please do that. But we're going to really focus on as we are coming down from the peak of the curve, I will say, from the first wave of COVID-19 and not, you know, get into if it was

a big wave and this and that, you know, there's 100,000 deaths in the US, not good. So what I think I want to focus on, and I had the chance to share this with another group that's sharing COVID best practices, are some easy to follow steps, some easy to follow phases, as I call them, of hospital and healthcare preparedness and response. And what these are, are the phases are actually how I structured my emergency operations plan as a public health emergency coordinator into SOPs. The thought being, and if you've been an emergency manager and you've had a project in emergency management, you see emergency operation plans and they're super long and they have tons of administrative stuff, but the actionable parts where someone say, when we start hearing about a pandemic across the ocean, then it starts coming to the US, it's so big, unless you're the person that wrote it or was intimately involved in writing it, you can't just pick it up and then take action and then be ready. And if you haven't

practiced, hopefully everyone has that's listening. But if your organization hasn't practiced, the time to read through that big document is not then. So I followed the lead of a great emergency management friend and mentor, and she structured the locality's emergency operation plan into normal operations, then increased readiness, then response, and then recovery. So each annex, and I followed suit for the public health, ESF-8 public health and medical annex of that, which was my responsibility to mirror what the overall plan was. And so what I want to go through today is some things that

when it's a sunny day and we're fully funded and we're fully staffed and our PPE stock is 100%, what are things that we should all be doing for hospital healthcare? But you can apply this to whole locality preparedness, but that's the arena I work in now. So that's why I focused on it in the talk I did. And then what about increased readiness? What about when we start hearing rumblings when we start, you know, in particular now, like I mentioned, oh, there's an outbreak in China, and it's spreading through Asia, now Italy, and now New York. And what do we do when we start having to ramp up before we're in the next phase of response of, okay, now we have to do something about this. And then what do we do there? And how can we work together? And you'll hear some common themes if you've listened to this podcast,

or you've taken incident command system or incident management or had a good project team about objectives and working together, and I'll get into that. And then recovery. So we are trending, I would say toward recovery, there's still response, right? There's still on the street response going on, there's still hospital response going on, but we, by and large, are looking at how do we come out of this better? I saw a post on LinkedIn today and it was really pertinent. I think there's not necessarily a new normal because a lot of the stuff that we see on the news, the guidance we get, hand washing, distancing, cover your cough, stay home if you're sick, healthy exercise eat better none of these are new concepts right the biggest thing is the mask thing right so you know in america adopting some of the stuff

that folks in other countries do but the the most impactful stuff that helps with underlying health conditions or reduce them or remove them that keeps the surfaces clean, that has your hands not be full of, you know, what you just wiped on your nose, just, you know, all that kind of stuff that's been around forever. We just don't always pay attention to it now. Um, with the media blasting us and, you know, breaking, breaking, breaking outbreak, these numbers, these numbers, it's, it's a lot. And that's one thing I would encourage you all. And one thing I've tried to do is look at the numbers. The numbers are not pure and keeping up with data like this is super hard. So kudos to the folks trying to do it. No one can get this perfect ever. Just it can't. So I'll give

them that for sure. But there's a mix, right? There's a mix I've seen, particularly on the CDC site of a combination of COVID, pneumonia, and influenza. So they're not just pure COVID numbers. They're not just pure pneumonia, not just pure this and that. And so that gets to the debate of should we open, should you wear this or that? And I'm not getting into that right here. I have my own opinions and they're mine, and I'm sure you all do too. So what I'm going to focus on in this episode is how and what are some things that we should all be focused on as organizations, particularly in hospital and healthcare during normal operations. Then we're in an increased readiness mode. So picture a stoplight, right? Normal's green,

increases yellow, response is red. Then recovery is like the blue charging battery symbol on your phone or white on the phone. But in the slide I made, it's that. And I'll share this on the pupilprocessprogress.com website. So check that out as a resource. I'll post it with the episode when I put it up there. But what do we do? So let's jump into that. So normal operations, right? We are funded. We're kind of like typical people in the world or America. We're not as worried or as focused on some things. We may or may not be exercising, but here are things that I have seen that I know for a fact make a difference that I've been part of, that I've been taught, that I've learned the hard way.

So here's my list. In normal operations, hospital and healthcare preparedness and response should do these things. All hazards training. Why didn't I say hospital incident command system? To me, and I use the same antidote today, if we teach the hospital incident command system, it's good for folks who aren't really going to nerd out on incident management like me or incident command.

But to me, the analogy that I think of that is if I teach you HICS or hospital incident command system, I am giving you a fish. If I teach you all hazards preparedness or response or all hazards incident management I am teaching you how to fish which means it doesn't matter if the impact to your organization is a hurricane or a pandemic or anything else how do we run this the other thing is it just teaches you skills to troubleshoot better than what I find what I've found with Hicks is you know there's they say put these names in these boxes, call these things, calls these teams, these call these units, these, and there are some standard unit names for the

overall units in the in that kind of standard out of the box incident command system. But I think there's a little more flexibility, it's more how do you the whole point is in operations, make it work for you, you could call it, you know call it the gumdrop group if they're focused on distributing gumdrops. And you could have the lollipop kid group. You can call it whatever you want. You don't have to name it exactly what this one thing prescribes. And that's the value of it is you name things when you learn how to do this all hazards to what's going to work for you under particularly an operations section or something like that. So I think all hazards training has more benefit than a specific industry training. Second, I think for during normal operation, I touched on already, which is the whole premise for how this is laid out,

is create actionable standard operating procedures, which means if I hand this to somebody that doesn't even work here, they can walk through and figure out who to call, what actions to take, who do I escalate, what is the response, right? That's the whole point. Keep it simple. You know, there's some grandiose verbiage and emergency operations plans and other even project plans. And it's a waste of space on the page. And it certainly does not help productivity. You have to have a regular exercise cycle during normal operations, you have to you have to exercise and I touched on this on that behind the shield episode 316 with James Gearing, you have to exercise. And I touched on this, on that behind the shield episode, um, three 16 with James Gearing, you have to exercise like you fight, right? You have to practice like as close as you can to the real thing, or when folks

get to the real thing, they won't know what to do. And so you have to schedule that. You have to go from crawl, walk, run, Hey, we're going to talk about it. Now we're going to practice this one thing that we're going to do a full scale exercise. You have to do it. I've seen, you know, from folks that I've met through LinkedIn or other places because of this outbreak, because of, you know, the background I have or being part of these groups, folks that are just figuring this out in the middle of a surge. That is not the time to do it. That is not the time to practice or train people up. You're too late then.

So do it when you have full funding, when you have a whole warehouse full of stuff and you have time. Inventory management, right? We've all heard PPE is out, right? Everywhere. So you can only stock so much that's going to last long enough for if you are the place that happens to get thousands of patients like in New York, you can only staff up so much as far as inventory. But you should have a really good system to stay ahead of it and track it and request it and not just depend on places that may be heavily impacted like China, Asia, other places. Think about what are the suppliers we have that we can call on in the worst case scenario and have a directory of those. Conducting a threat and hazard identification and risk assessment or THIRA, which is where we look at for where our facility is, for where our organizations are, if you have multiple sites, big healthcare system.

For each of those places, you may have to do unique ones and then have one big one. But for each of those places, what are the weather things that happen here? What's the impact of a pandemic? What's the impact of a gas leak here? All those kinds of things. And then you go through and there's templates. So if you look up THIRA or THIRA, you'll find templates all over the place. And there's some prescribed ways to do that. But you rate the probability, the impact, how you're going to mitigate it, all those kinds of things. But you can have an idea ahead of time. And what that can help feed into is the other big part of this is doing continuity of operations planning. And this is another area I've touched on in a couple other episodes here and see is a huge lack of, well,

we don't have enough people to staff that position or the same person is asked to staff the same position in a command center or the incident command system or, you know, in some structure all the time. And I'm telling you, you can only do that for so long. And think about it, it doesn't rotate someone into the mix to help train them up to help create that redundancy and staffing. If you get sick, and you can't go there. Well, now if you're the only person that's ever trained there, or it's ever worked that position, now your continuity of operations is no good. And for continuity of operations planning, it needs to be pretty extensive.

Power, internet goes out, there's a flood, staffing is gone, alternate sites. There's a whole list. There's, again, great coop or continuity of operations plan templates out there, but it needs to be an active project of its own. It needs to be not a pencil-whipped coop plan, but a real one that has contacts and it's updated regularly. And there's ways to keep that evergreen, whether you keep the contacts in an online system or it's a document that you keep updated, but you need to have that people change even when there's not a pandemic. So you got to

be ready for that. You have to have those community relationships and they should be established when it's normal, right? When you're having your normal local emergency planning committee or, you know, hospital emergency coordination committees or whatever you're having is you need to have those regular relationships with community partners. And so when the stuff hits the fan like it is now, your first call isn't, hey, do you have any extra face shields? We ran out. The success of most efforts, including hospital and healthcare preparedness and response is relationship building, right? Personal, professional, and part of that relationship building, right? Personal, professional,

you know, and part of that relationship building will happen if you've done the other things, if you've trained together, if you've created plans together, if you've exercised together, if you did the assessments together, if you share inventory processes, that's all relationship building practices. And then the last and normal operations, and I'm going to carry each of these through these phases, just a little twist on each one of them. But the last one is to promote personal preparedness. James and I touched on this. I've said it before. If your first thought is to grab all the toilet paper you can and buy perishable food like chicken and milk and bread when there's going to be a disaster, whether it's a hurricane or a pandemic or something else, you clearly have not been educated on the best way to be prepared. So if you're a hospital or healthcare preparedness or organization, or if you are in the preparedness space for your hospital system, you need to make sure your folks know shelf stable food that won't

go bad, have extra water, have extra medication, do you have redundancy in daycare? If not, let's let us know that so we can help you all the things you need, especially in hospital and healthcare where we're essential workers, right that the hospital can't shut down fully, that so we can help you. All the things you need, especially in hospital and healthcare, we're essential workers. The hospital can't shut down fully. We can stop elective surgeries. We can not do outpatient clinics, which now these days, that's converting to virtual stuff. So you're still not stopping or may not need to in the future because we don't have to be near each other. But personal preparedness, and this isn't just for hospital healthcare employees,

but for the whole world and the United States needs to be something, you know, make yourself a kit, have a plan on what you're going to do, stay informed from, you know, a few different sources and cross-check them and get involved if you choose to. And that's a huge component of this. If more people were prepared the right way or knew how to prepare, then I think we wouldn't have run out of toilet paper and meat and stuff like that. And I'll tell you for me, my quarantine or self quarantine COVID diet has been microwavable bags of Uncle Ben's rice, those 90 second deals, and tuna packets. And one is actually not too unhealthy, high sodium, but I drink a lot of water because I exercise. But that's a great meal and they last a long time. So think about those kind of things.

So that's my normal operations, a quick rundown. So that's the first phase of four between normal operations, increased readiness, response, and recovery. My suggestion for the folks out there in hospital and healthcare, or you could apply this to general preparedness for your organization, all hazards training, actionable SOPs, exercise regularly, manage your inventory or set up that system to do it, complete the THIRA assessment. So what are the hazards and the risks or the impact of those? Continuity of operations planning, that's critical, which includes

continuity of business, continuity of how we do clinics, continuity of government, continuity of whatever it is you do. And when you do all those things, you're going to establish those community partnerships and relationships and you're going to promote personal preparedness. So if you have questions about just that piece I talked about, get a hold of me, right? PeopleProcessProgress.com. Have some resources. I'll have this up there. I am at Penelope KG on Instagram or on LinkedIn or peopleprocessprogress at gmail.com. Feel free to reach out. And I'm glad to share more resources, have more discussions and learn from you all as well.

Right. I don't certainly don't have all the answers. I have some pretty good ones, I think. I learned some pretty good stuff in the calls in today of great innovation. And so I would ask you all do the same. So now we've heard some things, some storms coming or there's a pandemic that's probably going to affect us. There's going to be a wave. We're going to have to plan for the surge. So now we're in this increased readiness stage. So if we've done

the training, if we've trained people, whether you choose to do hospital incident command system or general hazard preparedness, whatever, we need to review those assignments. So let's make sure with our people, we say, okay, you're going to be the planning section. Do you understand that the planning section chief or whatever position you are is going to set the operational period with command? They're going to do the coordinating action plan is one thing I've called, which is a replacement for the incident action plan. So if it's not an incident in particular or you're from an EOC, it's a great alternate.

But you need to make sure folks know what their jobs are if they haven't done them for a while or ever, and then give them guides to do it. You're going to walk through the standard operating procedures. So get your command and general staff together for the command center of your organization and walk through them. Hey, for surge planning, here's what we're going to do for, and then we're going to do the same thing for our continuity of operations. We're going to make sure those contacts are accurate. We're going to do maybe a call-down drill. We're going to make sure those contacts are accurate. We're going to do maybe a call-down drill. We're going to make sure our inventory is squared away. Do we actually have this number that our system says?

Let's go put eyes on it and check the system. If you don't have a system, maybe you can get one spun up pretty quick. We're going to confirm facility readiness, right? So in this age of remote work, imagine, I know my organization and many others, between increased iPhone, iPad use or other smart devices, Amazon, webcams, anything that's going to enable folks to do virtual care or virtual support or telework, extra licenses for your virtual private network or VPN or remote software. You need to make sure you have all that ready. Zoom licenses or other teleconferencing things, you need to make sure

that those are good to go, that your facility is ready too. Are we ready to stand up our hot zone, warm zone, cold zone if we have to stop visitation? How do we do that? And so you need to know that before you figure it out the day after, the day before you're going to, you know, institute a no visitation policy. You need to do that well before. I mentioned the coop contacts. Make sure they're up to date. You got to make sure the phones work.

Do a drill. There's so many automated alerting systems. And that's something we should be doing. I know I did in public health and then in healthcare is use those systems and do monthly drills and then track the percentage and then hold healthcare is use those systems and do monthly drills and then track the percentage and then hold people accountable. Hey, you know, we're going to review these. We're going to have, let the managers know, and they're going to talk to their people, make it educational, right? Hey, these are, these aren't just annoyances. We'll try and do a bit, you know, maybe not peak hours,

but also you got to do some drills that are at peak hours to test the system. What if, you know, because disasters don't wait for us because of our work schedule. So walk through those calls. You need to plan with local partners. So you've established relationship during normal operations. We need to get together early and say, okay, if this thing hits, if we have this surge, if we run out of this, if we need help coordinating that, what are we going to do and how are we going to do it? So this is a great opportunity to maybe do a, maybe you don't have to do a full kind of tabletop. You can just have a discussion base. And again, touch on key points in your localities, emergency operations plan, your facilities, SOP or emergency operations plan, and walk through those, but include all

the partners that you need to. And remind your staff and patients and family, because if you haven't shut down and increased readiness stage, and you're still having visitation, just have some reminders of personal preparedness reminders, right? Simple flyers, you know, make a kit, have a plan, stay informed, get involved. That's the mantra of preparedness across this whole country, right? That's the ready.gov stuff. And it's a simple thing. There's checklists for all that kind of stuff too. So again, for hospital and healthcare though, we know we are going to have to work through this whole thing. So let's make sure that our folks know what are the best things that we can do to get us prepared because we're going to be working

long hours, irregular hours, and we're going to be impacted. All right, here we go. Here's the part that hits us all that we're all tapering off from, I hope so, somewhat. Response, right? We've gotten ready and all the sunny day stuff and normal operations. We've dusted off plans, walked through things, talked through things, reminded us of things, updated contacts, made sure our folks are prepared. Now we've got to respond, right? Now we have to deal with this because the surge is coming or it's here or the storm came through or whatever

it is. The first thing that we all need is leaders intent, right? What do our leaders want us to focus on? And we all probably have a pretty good idea, right? Provide the best care we can to treat COVID patients. But you know what? The majority of patients in healthcare systems weren't COVID patients. They were the most high profile and potentially infectious, but a lot of healthcare systems were not overwhelmed with COVID patients across the country or their census wasn't dominated by COVID patients. However, a big deal when you have a biological disease of public health threat, that's no big deal. Or that is a big deal, whether it's no small thing. So in any response, but in particular for this, since we're in COVID land, is establish leader's

intent, right? We have to know from the highest levels to your direct leader, what's the intent throughout this? And like for me, it was, hey, go help this group because they need help organizing. So I had to put kind of my disaster response hat on and project management hat on. You know, not a great way to have me do that. But for me, I kind of, you know, I fit right in doing it and it was helpful. So the intent was help these folks get organized from the whole organization. We all collectively, right, it was, you know, deal with the surge, plan for the surge, provide communication for families, just a whole bunch of things, but it should be spelled out.

And if possible, again, put in those coordinated action plans or an incident action plan or something that we all know what's happening and we can see it and we get it updated. We need objectives and that's going to help shore up the leader's intent. There's smart objectives, there's specific, measurable, achievable, realistic, and time-based objectives. So everyone knows we are all throughout this whole time working toward these objectives. And they're not like the goals or the mission statement for the organization. That's a whole kind of different thing. These are going to be objectives that we are going to actually develop strategies and tactics to and devote people and stuff to and time. These are super actionable things. We're also going to set

operational periods for our planning cycles. That's what we should do for response, whether it's a pandemic or tornado or anything is say, and you know, what makes sense is unless you're getting, you know, a trauma or a tornado that creates trauma is a more tactical thing than the kind of long game of pandemic, right? So what I mean by that is say you have a mass casualty incident that's going to impact your organization, your health care organization, probably not going to last too long for the initial traumatic stuff, barring a 9-11 style thing, but say it was a bus crash or it was a tornado that went through a neighborhood, something like that, right? So you can set operational periods that are, you know,

12 hours at a time, 24 hours at a time for something like this week long operational periods make sense. This week, here's our objectives. This week's here's who's who in the org chart this week's here's, you know, what we're going to focus on and coordinate with your surge committees and your infection preventionists and all the folks you need to, but everyone knows here's our planning tempo. Here's our operational periods. Here's our objectives for this. And everyone gets it. And work the process, right? I have said, I said this on, again, you know, behind the shield 316 with James, and I've said this before, there are parts that you don't need to do from the official all hazards planning process, like every form and every step step but we need to work the process to at

least talk through it okay let's revalidate the objectives from last week do we want to change these we want to keep them what's changed and go through it not just kind of keep going without updating it because stuff changes for sure it changes hourly daily weekly 100 during a time like this um for response i mentioned reviewing incident command system assignments or hospital incident command system assignments if you're using that what we need to do for response, I mentioned reviewing incident command system assignments or hospital incident command system assignments. If you're using that, what we need to do for response, if we're going to send people to an emergency operations center, if we're going to send them to a command center or work the

base for logistics or whatever, we need to give them guides on what that position is supposed to do. So hopefully we've already done training for them. Hopefully we reviewed it for them, but let's give them a one pager that says, here's your job for the next 12 hours. Call these people, here's what's it, and then you're coordinated. You know any logistics requests for the organization is coming through here. Here's some resources you have, call these people if you need help, and on and on. You can do that for planning and finance and all those things and all the different public information, whatever.

But make sure if folks haven't done that before in that environment, that they have guides on how to do it and who they need to talk to in a phone directory. Simple things, right? Who's sitting at what position and what's their phone number? Like, just make sure you've empowered folks during response to have that. Follow your standard operating procedures, right? Unless you find some egregious thing, which hopefully you already found through exercise and hope you already found through reviewing it.

Follow the SOPs. That's why you wrote them. There is not one scenario that I can think of that has happened so far in this pandemic that public health and health care hasn't already planned for and exercise and staffed for and bought stuff for. There's not one. Surge planning existed. Pandemic planning existed. The street international stockpile existed.

Crisis standards of care existed. Mass casualty care existed. Pandemic planning existed. The street international stockpile existed. Crisis standards of care existed. Mass casualty care existed. Mass fatality management existed. All of it, right? The difference is who practiced and who didn't, who staffed up and who didn't, who was ready and who wasn't, right? That's a huge thing. And, you know, we'll see. My biggest hope is there are just outstanding after action reports, and we'll get into that with recovery, that help us shore those up. But there were plans and SOPs and playbooks, whatever folks want to call them, for every single thing that we've been through so far. Right? All of it. So the scale of it, that hasn't even been mentioned.

Right? You don't pandemic flu plan and not think it's not going to be tons of it. Plus, again, we've had pandemics and recent pasts. I got into public health in the midst of H1N1 and we gave over 30,000 vaccines in schools. That's a ton, right? And that was huge. So follow the plans that you worked so hard to put together and coordinated relationships and all that kind of stuff. Coordinate logistics, right? Don't silo yourself because maybe, you know, you have and others don't or you don't and others have. And that's a hard thing for sure as an organization. But coordinate logistics with your organization because that's another thing too,

right? Is folks are going to want solutions to their problems for virtual visits, for more PPE, for whatever. And if the organization doesn't provide that solution, someone's going to find their own way to do it. So you might as well set up the right way and say all logistic requests for supplies, technology, whatever comes through here. And then you've built that into your incident command system and you're working through that org structure, right? It makes a huge difference. Otherwise, you will get hammered with hundreds of desperate requests, you'll have stuff that shows up in the

environment that nobody knows about. And you know, if it helps at the time, treat a patient better, great. But who knows how secure that technology is? Who knows where that PPE came from. There's a whole lot of factors to it. And it's not that hard to coordinate logistics together. Activate your continuity operations plan, right? During normal operations, we put a plan together, we worked through it, we talked through it. In increased readiness, we made sure the contacts were good, we were ready, we were three deep, which means we had primary, secondary, tertiary people. So activate it, right? If you need to, if folks are sick, if they have to be remote, if someone can't come in, if they're scared to come in, all these different factors.

Okay. Who do we go to next? Or how do we get them to work? What's our alternate facility? What's our, you know, is our VPN ready to go? Follow your acute plan. So if you've put the work in early, all you're doing here is doing your, you're taking action on the work that you've already done. And it's really helpful. Monitor staff needs, right? This is a huge thing and kudos to the folks that I work for. They're doing a great job of this. You've got to monitor your folks, long shifts, particularly for the medical providers, but also, you know, I know folks that are doing field work and they are working just as many hours to keep folks working as the folks that are wearing the PPE in the room. So there's folks doing tons of great work all over the place, but we have to pay attention to them.

Are we working them too much? Are they working on their own too much? Make sure they know about that EAP, that Employee Assistance Program. Set up maybe a debrief, right? Daily debrief. Hey, if you want to talk to somebody from your counselors or just peers, you know, peer support programs are fantastic. You know, a nurse, I have medical background, but I'm not a nurse. So a nurse probably wants to talk to a nurse, right? So set that kind of stuff up. Think about how we're

going to meet the needs of our folks that are just, they're dealing with end of life constantly. It could be the first time this nurse or this doctor or this care partner or whoever has seen someone die that was their patient. It could be their 200th. They've been around for a while, but you don't know when the trigger is going to be that that person is going to just be in despair and lose it and have a problem. So we got to keep up with that. If you're their leader, keep tabs on your staff. You know, you could have at shift change, right? Checking people out,

kind of meet with folks five minutes at a time. How are you doing? What do you need? All that kind of stuff. And just consider that. So we're in response at the same time, we got to look at folks. And you know, this is no exception for sure with the long hours and the concern and, well, I take this home and just so many different things. So that is, again, the most important component of this is our people, right? That are doing the work in all facets of your healthcare organization from clinical to technical, to business, to finance, to cleaning, to food, to whatever. All of them are integral cogs in the machine that keep your organization going. going. That didn't sound very uplifting,

but you know what? We're pushing hard. We're doing good. America, world, just listen to this, everyone. That's what we can do, right? This thing pops up. We can't see it. You can't put water on it like a fire. You can't put more security around it like a bad guy, but we can wash those hands, stay apart, stay home if you're sick, take care of each other, plan well early for where we are now, keep getting those lessons learned. So let's segue into recovery, right? So we are going to get better. We're going to get better collectively in America, in our organizations, in the world. And here are some things that I think that we could do,

particularly in the hospital and healthcare space, but really could apply anywhere in recovery. So we have to conduct objective after action reviews. We have to be honest with ourselves. I've been in after action reviews for incidents or planned events that I know for sure didn't go well. There was poor communications, wasn't really good work.

And you would think it was the greatest thing since sliced bread, because no one wanted to admit it. No one wanted to call themselves out, let alone just be honest. It's not a finger pointing exercise. But you know what, sometimes we need to get that feedback. I've gotten feedback from a great friend of mine that's like, Hey, man, you're really good. You know what you're talking about, but you got to work on your delivery. Sometimes it's not great. That's from one of my one of my best friends, right. And you know, someone that was a mentor to me. So we have to be willing to do that, whether you're close with someone or not. And that's where that starts in the after

action reviews. And we have to, you know, whether it's an online survey or a virtual one, since we're probably not going to get 200 people in an auditorium anytime soon, or it'll be hard to hear them because we're all messed up, but you know, get that survey, ask for three up and three down. What are three things you think we did during this? What are three things that we can improve on? And then put those in that Homeland Security Exercise Evaluation Plan, or some kind of format of an after action improvement plan, right? So it's what's the after action stuff we need to fix,

but you also have to tie how are we going to fix it and by when or when do we think. You're going to revise your SOPs, right? So all those actionable plans you made that you walked through and that you followed there's got to be changes or you shouldn't have just made them right if you're just going to keep them and go that's perfect it never needs updated that plan is out of date the minute you hit send to get it approved right or the minute it's approved so particularly now with the lessons learned and the new world of virtual you know everything um or increase in virtual stuff we're going to have to revise those standard operating procedures our emergency operations plans policies etc we need to exercise the areas for improvement so if we said we need to get better at this thing we need to get ready to practice that thing so this recovery cycles right into normal improvement. So if we said we need to get better at this thing, we need to get ready to practice that thing. So this recovery cycles right into normal operations,

right? So if we identified something we need to fix, we need to prepare an exercise, whether it's discussion based or in person, and then practice it, right? So that's how the cycle goes. Restock the inventory, right? I mean, now, I imagine personal protective equipment, PV costs a little bit more than it did six months ago whether it's tyvek suits you know surgical masks etc so we need to look at though how do we replenish this and again is it from a reputable provider because we've also seen some masks that aren't up to snuff that don't actually protect uh particularly health care workers really hospital health healthcare that

are sold from some non-reputable folks. So we need to make sure they're validated. And the good thing is the FDA, sorry, Food and Drug Administration, you know, vets those or doesn't and says, yeah, don't use these. So good source to check there. We need to update the THIRA or the Threatened Hazard Identification and Risk Assessment. You know, did the impact you thought this pandemic was going to have actually happen? Was it more? Was it less? Likelihoods change? Oh, the storm actually came through.

Okay, we need to do that. So as you can see in recovery, we're coming back to the stuff we made in normal operations and we're applying reality to it. What actually happened? What did we see? Update the Continuity of continuity of operations plan well you know what our coop worked great we had everybody backups we had alternate facilities we knew what to do of half the people remote or not or everyone remote or we didn't prepare for any of it we didn't train anybody we didn't you know and fix it it's easy the good thing is a lot of the training for how

we coordinate a lot of the how do we get you you know, a couple of folks that can do your job and then, you know, backups. And you can't. One thing I would say with the Coop plan is don't have the same person's name in like 10 different places. That's not cognitive operations to the best that you can. You need to have different names, you know, three across for each position that you're going to do for the incident command system positions and for the day-to-day business positions, right? Because you still, let's say there's not, we're not standing up incident command. We're not in this huge thing. You still need to have a good continuity of operations plan because what if someone was in a car accident and they're out or they just left? What if they left to go somewhere else? Now that

one person you relied on is gone and you have no one else to fill those shoes. Now you're going to scramble just to keep the clinic going, right? So that's an issue. We certainly want to maintain those community relationships. So, you know, just because during response, we all hands on decked it, right? We all got together. Everyone all hands on deck. Let's do it. We got to keep those relationships because one, it's the best thing to do. And we're all in this together now, right? So we got to maintain those. If you didn't have standing meetings set up with your community partners, either that are providers, suppliers, emergency management, police, fire, whomever with your healthcare, make sure you're part of them now. Make sure you get included in those now

and keep going there. You'll all have a better common operating picture of what's coming down the pike, what's affecting who. You'll have better partnerships. It will just be a much better experience. And this last one is exactly like the last one of normal operations. Promote personal preparedness. If we are all, as citizens of the United States, prepared to take care of ourselves to some extent, right? We can't necessarily, unless you're living off-grid, provide your own water or some other facilities. And it's possible, but possible but again you gotta that's a lot of work we need to be able to have food that's not going to go bad you know during this crisis there were still natural disasters across the world and in the united states that took people's power out

so just because there's a disease of public health threat, an outbreak doesn't mean that nature is going to listen. It doesn't mean that you're not going to lose power. So again, if you stock up on food, that's going to go bad in a few days, if your power's out, you haven't prepared yourself. If you don't have a basic first aid kit, you're not ready. Because again, the good thing is hospitals didn't get largely across the country in some areas, they did. Totally overwhelmed. So if you cut yourself real bad, you could still go to the hospital. But think about it.

Who wants to go to the hospital? Where's the one place the sickest COVID patients are at the hospital? But again, it's also the best place to go if you get hurt. So we saw that with some reports from emergency medical services from hospitals. These folks actually didn't get stuff that was pretty bad treated because they were afraid to go there and they should have. So if I can promote some personal preparedness with maybe basic first aid for your staff, first aid kits, you build your own first aid kit. There's, you could Google and YouTube that, and there are tons of great things. A lot of healthcare and hospital organizations provide

CPR training. They provide first aid training because, you know, they want their staff to be ready. So think about that as well. Water, you know, again, for a pandemic, the water system wasn't really hit, but for a natural disaster, it could be so just all those things that get the plan, the staying informed and the being involved, huge things that in recovery, we need to make sure we reiterate and it's unfortunately, an opportune time to say, hey, remember how there was a run on the stores and everyone bought these things? Well, here are the things that actually everybody should focus on. And, you know, it's like after every other thing, every other bad thing, whether it's a pandemic or 9-11 or Hurricane Katrina or, you know, dealing with

shooters or mental health or just whatever else has impacted us, that's unfortunately sometimes the catalyst for us all to get better. I hope that me as a person, as someone that's in the hospital healthcare space that's been around disasters and incident management for a little bit has shared a helpful process here to consider, you know, focus on these things in normal operations and then increase readiness, review those things, make sure they're valid in response. Hey, let's use these things we set up. Let's make sure everybody knows what their job is. If not, let's help them out. And then in recovery, we got to circle back and see what we did well, see what we didn't do well, learn from it, update our plans, update our staff, make sure our people are prepared, and all of us make progress, right?

We are all making progress, but it doesn't feel like it. We're in the mire, in the muck of being at home, of homeschooling, of losing our business, of mandated masks here or there, whatever it is. It's a tough time, but we are in the recovery uptick, I would say, of the phases of preparedness and response. So let's keep that focus. Let's do what we need to do. If you all have questions, comments, concerns about this, please let me know. Subscribe. We'll keep putting out good stuff here, interviewing great people. Thank you so much for all that you do. Please everyone out there, stay safe. And I will leave you with the best public health tip

ever. Wash your hands.