Emergency Management for Healthcare: Staff Education

By Norman Ferrier

This series of books focuses on highly specialized Emergency Management arrangements for healthcare facilities and organizations. It is designed to assist any healthcare executive with a body of knowledge which permits a transition into the application of emergency management planning and procedures for healthcare facilities and organizations.

This series is intended for both experienced practitioners of both healthcare management and emergency management, and also for students of these two disciplines.

• Language: English
• Publisher: Business Expert Press
• Release date: Nov 29, 2022
• ISBN: 9781637422762

Norman Ferrier

Norm Ferrier is an award-winning practitioner, educator, and author who has worked in various aspects of Canadian healthcare for more than forty-two years, and for thirty-two of those years has focused increasingly on emergency planning for all types of health care settings. Norm was the 2013 winner of the Canadian Emergency Management Award and continues to write and lecture on the subject of emergency management for all types of healthcare settings.

Book preview

Introduction

This series of books is intended to teach the skills which have been traditionally associated with the practice of Emergency Management. This includes all of the skills involved in the assessment of risk, selection of Command and Control models, the writing of an Emergency Plan, the testing of that document by means of various types of Exercises, and the development of employee education programs which are intended to strengthen familiarity with the plan. However, no Emergency Plan is a blueprint to guide a community or organization through its successful response to a disaster. Every disaster is different in multiple ways and is extremely complex. If we could simply preplan and preprogram every type of emergency response from start to finish successfully, we would be in possession of crystal balls, and the need for Emergency Managers would be minimal.

This series of books differs from other well-written and useful Emergency Management textbooks in two important respects. First, it will deal exclusively with the practice of Emergency Management as it should occur specifically within a healthcare setting. Second, it will attempt to introduce the use of contemporary mainstream business planning practices to the practice of Emergency Management, something with the potential to build bridges between the Emergency Manager and the senior executive who has little knowledge or understanding of the subject.

The application of Emergency Management to a healthcare setting is essential. It can be argued that any healthcare institution is, in fact, a highly specialized community. It can also be argued that virtually every type of service or agency found in a normal community has some type of counterpart within the specialized community of a healthcare setting. It is also important to remember that the vast majority of a community’s most vulnerable population will typically be found within some sort of healthcare setting, whether an acute care hospital, a specialty care hospital, or a long-term care facility. In order to mitigate against such vulnerabilities and to protect those who possess them, a certain degree of understanding of the clinical context is required. The clinical context is, in the majority of cases, a substantive source of each individual’s vulnerability. This is not to say that the Emergency Manager must be an expert clinician, but they do need to possess an understanding of relevant clinical issues. In Emergency Management, the best Emergency Manager available cannot simply be dropped into a hospital to work, any more than they can do so in an oil refinery, a postsecondary institution, a busy international airport, or any other highly specialized institution.

This series of books will attempt to introduce several new mainstream business and academic concepts into the practice of Emergency Management. These will include formal Project Management, applied research methodology, root cause analysis, Lean for Healthcare, and Six Sigma. All of these concepts have a potentially valuable contribution to make to the effective practice of Emergency Management. Of equal importance is the fact that for many years the Emergency Manager has been challenged to affect the types of preparedness and mitigation-driven changes that are required within the organization or the community. Part of this has been the challenge of limited resources and competing priorities, but an equally important aspect of this has been the fact that the Emergency Manager has typically used a skill set and information generation and planning processes which were not truly understood by those to whom they reported and from whom they required project approval.

These mainstream business and academic processes and techniques are precisely the same ones which are used to train senior executives and CEOs for their own positions. As a result, the information generated is less likely to be misunderstood or minimized in its importance, because it comes from a process which the senior executive knows and uses every working day. This de-mystifies the practice and the process of Emergency Management, giving the Emergency Manager, and Emergency Management itself, dramatically increased understanding and credibility, potentially making the Emergency Manager a key player and contributor to the management team of any organization in which they work, and far more likely to be regarded as an expertise resource.

CHAPTER 1

Emergency Exercise Design and Staff Education

Introduction

The staff of any healthcare facility cannot be reasonably expected to perform emergency procedures in any type of emergency or disaster setting without reasonable preparation, in the forms of training and practice. Emergency situations are not business as usual, and situations are likely to occur in which the standard operating procedures may not be available or even advisable. Moreover, it is precisely such unusual and emergent situations which are most likely to be the subject of detailed review after the fact, in the form of inquests, public inquiries, and civil litigation.

In such circumstances, it is frequently essential for the organization to be able to demonstrate due diligence that the facility had taken every reasonable measure to ensure that both the facility and its staff were trained and equipped to cope with the crisis which had occurred. Performance to a given set of expectations cannot be assumed in the absence of appropriate training. If healthcare facility staff are to perform to a specific standard in a given circumstance, it is only reasonable to expect them to be trained or otherwise supported to do so; staff will not do what they do not know.

One of the biggest challenges faced by the Emergency Manager in any type of healthcare facility is the education and preparation of all staff to cope with the various types of emergency situations which may occur. Healthcare facilities are busy places with important work to do, and the challenges of getting staff who are already busy to focus on yet another priority are not small. Moreover, the Emergency Manager must also be aware of the reality that such training cannot and should not distract staff and other resources away from the essential business of the facility. Finally, it is often necessary to overcome a resistance by the Senior Management Team of the organization which, in the absence of a legislative or regulatory mandate, is likely to be, in an environment of intense competition for limited resources, why should I spend staff time, money, and other resources on preparing for something which might never occur? This chapter will focus on the types of emergency Exercises and staff education which are possible in a healthcare environment, how to create and conduct each, the various strengths and weaknesses of each, and how to create and operate an effective, dynamic, and ongoing Emergency Management training and education program within a challenging environment.

Learning Objectives

In this chapter, the student will learn the use of emergency Exercises as a staff education tool. They will understand the various types of emergency Exercises and the purpose, strengths, and weaknesses of each. The student will learn how to create, prepare, conduct, and debrief each type of Exercise and how to use the findings generated to create an ongoing and dynamic Emergency Response Plan and Emergency Preparedness Program within a healthcare facility. Finally, the student will understand the documentation requirements for such a program, how such documentation can be used to support Accreditation processes, and how it can be used to support a demonstration of due diligence by the healthcare facility.

Research

With any effort in the creation of emergency Exercises or emergency preparedness education, credibility must be the bedrock upon which subsequent efforts are built. The staff of healthcare facilities are unique in that they are arguably among the best-educated populations of workers in any given society. They are also quite accustomed to functioning in environments in which conflicting demands are made upon their time. As a result, most have learned to be discerning in their response to education efforts, focusing only on what they find to be credible, interesting, and relevant to them personally. They are open to new learning, but, by the same token, will be unlikely to waste their time on any effort which they perceive as being far-fetched, unlikely, or simply nonsense.

All information, regardless of the method of presentation, must be authoritative, accurate, and relevant or the audience will simply be lost. All Exercises must be fact based, or they too will simply be wasted efforts. The author is reminded of an episode of the old, American television drama, E.R. In the episode, the hospital had decided to conduct an emergency Exercise with a scenario of an explosion occurring in a maraschino cherry factory. Throughout the episode, the staff progressively lost more and more credibility…there simply was no maraschino cherry factory, the injuries arriving at the facility were wrong for the scenario used, and the staff, who also had real patients to deal with, grew increasingly frustrated with the Exercise until the entire effort simply collapsed, largely due to staff indifference! There is a lesson there for all Emergency Managers working in healthcare facilities: do your homework, conduct your research, and do not, under any circumstances, insult the intelligence of the staff you are trying to serve, or your efforts will fail miserably!

Once again, the Emergency Manager is not a specialist, but, rather, a sophisticated generalist. The Emergency Manager working in a healthcare facility must be an effective researcher. It is necessary to be able to conduct effective and reproducible research on emergency events and to understand contemporary theories and methods of adult education. By achieving these objectives, the Emergency Manager will be able to develop and operate credible and effective Exercise programs and other emergency preparedness efforts which are well received by the staff.

Adult Education

A good deal of the practice of Emergency Management involves adult education. It is essential for the Emergency Manager to understand some basic theory regarding this subject, as this will assist greatly in the development of the required staff education programs. Being able to stand up and recite facts is simply not adult education. Every effort should be a carefully thought-out and planned event, with a specific set of learning objectives, a method of delivering these, and an understanding of how they are likely to be received and processed by the student(s). Moreover, particularly in the case of adults, not all learning will necessarily occur in the classroom nor will it be unidirectional.

Dr. Benjamin Bloom was a leading educational theorist who taught and conducted research at the University of Chicago and worked from the 1940s to the 1980s.¹ He developed a taxonomy of learning, known as Bloom’s Taxonomy, which, in simplest terms, explored the methods by which human beings learn different types of information and skills at different stages of their lives. This work continues to be foundational in the study of education. The processes are both detailed and complex, and too detailed for this text; indeed, entire university courses are dedicated to this single subject. For more detailed reading, Bloom’s work and the subsequent analysis of it is commended to the Emergency Manager.²

In summary, for the purposes of Emergency Management education, adult learners learn best by doing. Moreover, learning which has an emotional component will be absorbed and retained better than learning which does not.³ These types of cognitive learning⁴ represent the foundation upon which the entire use of emergency Exercise play as education is built. Any Exercise which is completely credible, practical, and hands-on, and which succeeds in facilitating the emotional buy-in of the participants, will result in learning outcomes, including both the short-term and long-term retention of both information and developing skills, which are almost as good as if the participant had taken part in the actual event, instead of merely an Exercise. They key words, once again, are factual, credible, practical, and emotional. All Emergency Management education efforts should attempt to embrace each of these concepts as essential to any program.

Setting Priorities

In almost every Emergency Management education program, there are many projects which could potentially occur. All have the potential to compete for the attention of the Emergency Manager and for the availability of staff to receive the training. Moreover, particularly in healthcare, for most Emergency Managers, this area is not their only area of responsibility; almost all have at least one other major role within the organization, with Emergency Management activities intended to occupy half or less of their working day. Many Emergency Managers attempt to prioritize, using such variable, opinion-based categories as need to know, nice to know, and even maybe someday. Such systems do not function in a vacuum, and both decisions and priorities regarding Emergency Management activities are too often driven by political and other considerations, such as Accreditation, negative press, and public opinion, instead of legitimate need.

Too often, there is a pressure, particularly when Accreditation is approaching and an Exercise is mandatory, to just do something uncomplicated and easy, just to tick off a box on a checklist. This often results in an Exercise such as a bomb threat, even when the facility’s own Hazard Identification and Risk Assessment will demonstrate that they are at no particular risk from this type of event. Similarly, there is a belief that nothing short of a fullscale Exercise will meet the need, and facilities will stage such an Exercise when they are nowhere near ready for such a test, usually with disappointing results. Most Accreditation standards in fact call for a demonstration of process, not project, and most such efforts do not really satisfy the intent of the standard in question.

One of the principal reasons for conducting Exercises is to encourage and develop regular and consistent positive behavior. Skills not practiced on a daily basis require reinforcement, or there is a good chance of a bad outcome. Outcome is a matter of both performance and process, and the purpose of any Exercise is to ensure that those playing key roles do the right thing, do it correctly, and do it consistently. As the following matrix suggests, there are a variety of potential outcomes to any decision to act, and we want to encourage the correct outcome to occur as consistently as possible, particularly during a crisis.

Similarly, there is a perception that an Exercise which identifies problems is a failure and represents potential embarrassment to the organization. Such a result can often stop an effective Emergency Management program in its tracks, as senior managers make damage control decisions regarding processes that they do not fully understand. The first thing that the Emergency Manager in a healthcare facility must make Senior Leadership understand is that any Exercise which identifies potential problems is, in fact, a tremendous success. This permits the organization to identify and fix one or more serious problems without any human cost, before they actually occur. Such efforts are intended to drive the Emergency Management program, including education, and the Emergency Response Plan, making them evergreen documents which are subject to a process of continuous quality improvement.⁵ Any