5.3 Programmatic Issues for the Healthcare Coalition

• 5.3 Programmatic Issues for the Healthcare Coalition
  • 5.3.1 Determining the Preparedness Administrative Body
  • 5.3.2 Establishing Political and Financial Support
  • 5.3.3 Establishing Key External Relationships
  • 5.3.4 Systems-Based Methods

Additional programmatic issues relevant to the Coalition EMP and EMC should be addressed before examining preparedness and mitigation activities.

5.3.1 Determining the Preparedness Administrative Body

An administrative body for the Coalition should be established concurrently with the selection of member organizations. It is important to distinguish the role of this body from the decision-making role of the EMC. The administrative body supports the Healthcare Coalition during mitigation and preparedness by fulfilling specific administrative needs that are distinct from those required during emergency response and recovery. For example, the administrative body may:

• Provide meeting space and administrative support for regularly scheduled meetings of the EMC
• Serve as a repository and financial controller for Coalition funds
• Manage document control and archiving for the EMC.

Options for the Coalition’s administrative body will vary by region, but may include the following:

• Hospital associations: Because they usually include all of the hospitals in a defined area, they already provide some measure of a “level playing field.” At the same time, they are limited by the fact that they lack representation of long-term care facilities, outpatient centers, private practitioners, and other potential Coalition participants.
• Local Emergency Planning Committees (LEPCs):^[7] While the original intent of LEPCs was to increase community awareness and response capabilities for hazardous materials, LEPCs have served in some jurisdictions as a valuable multidisciplinary platform to coordinate preparedness of medical resources. The Healthcare Coalition could be organized under the auspices of an existing LEPC.
• Administrative bodies constructed de novo for this role: Another option is to establish a non-profit organization to serve as the administrative body for the Coalition. While this may require more effort and cost to establish and maintain, it has the benefit of allowing specific by-laws for the organization to focus primarily on this preparedness role rather than attempting to piggy back onto existing missions (Exhibit 5-4).
• Individual partners of the Healthcare Coalition: A member organization within the Coalition may volunteer to serve as the administrative body. In such cases, care should be taken to prevent potential conflicts of interest.

Exhibit 5-4. Example of a non-profit organization serving as the preparedness body for a Healthcare Coalition*

The Northern Virginia Hospital Alliance (NVHA) is a non-profit organization that was formed in October 2002 for the purpose of improving community-wide preparedness for and response to mass casualty incidents. The NVHA serves approximately 12 acute-care hospitals (including one military hospital) and several free-standing emergency care centers in the region. The NVHA collaborates with hospitals and other emergency response entities from Washington, D.C., Maryland, and Virginia to address mass casualty medical response.

* Northern Virginia Hospital Alliance, Information about the NVHA, Accessed November 29, 2007 at: http://www.novaha.org.

5.3.2 Establishing Political and Financial Support

Certain types of “political” support may be necessary to ensure the success of the Healthcare Coalition. This may be particularly important during the initial development stage and may be addressed at both the healthcare organization (Tier 1) and jurisdiction (Tier 3) levels.

The executive leadership of Coalition member organizations will need to agree to the proposed principles (the membership, structure, and methodologies) for the Coalition during preparedness and response. This may require buy-in from their parent corporations and boards. Executive level briefings on the purpose, vision, and potential value of the Healthcare Coalition during emergency response can help secure buy-in and commitment from senior leadership at member organizations.

At the jurisdictional level (Tier 3), endorsement from public agency executives and elected officials should be sought. This can provide the “push” that is needed for the Healthcare Coalition initiative to succeed. Support from political leaders can be demonstrated in multiple ways, such as providing funding for Coalition development and maintenance or sharing information for preparedness. It may be helpful to conduct presentations for these officials on the mission of the Coalition and how it can benefit the community response. Some Coalitions may elect to invite public health and other public sector officials to participate in advisory positions.

As noted earlier, every effort should be taken to keep the Coalition as lean as possible and many Coalitions will not require significant amounts of direct financial support. The main costs for developing and maintaining the Coalition will be the personnel time contributed by member organizations.^[8] Equipment costs may vary substantially based on the technological requirements of the particular Coalition. Radio communications, computer software, and paging systems could add development and maintenance costs. It is important to establish financial management processes in order to track costs and ensure transparency in how funding for the Coalition is spent. Some representative sources for funding of the Coalition are presented in Exhibit 5-5.

Exhibit 5-5. Potential sources of funding for development and maintenance of the Healthcare Coalition

• Federal programs: Federal programs and grants for emergency preparedness, emergency management, and homeland security may provide one source of funding for Coalitions. Grants made to jurisdictions to increase hospital preparedness can be distributed fairly to Coalition members, thus enhancing the “team” concept of the Coalition.^[9]
• Public sector support: Jurisdictional (Tier 3) or State (Tier 4) authorities may be able to provide some financial support for Coalition development and maintenance.
• Private sector internal support: In some situations, Coalition member organizations may provide direct or indirect funding support for elements of the Healthcare Coalition.
• Private sector external support: Donations from corporations may be available to assist with Coalition financing as a public service initiative.

5.3.3 Establishing Key External Relationships

Healthcare Coalitions should establish collaborative relationships with any external entities in their geographic area that are involved in emergency response. Coordination with these entities can enhance preparedness, improve service integration, and avoid perceptions that the Coalition is acting independent of the community response.^[10] The Coalition should consider relationships with the following types of external entities:

• Public health: Public health departments vary considerably from State to State and even between intra-State regions in their construct, capabilities, and procedures. Depending on where the Coalition is located and the public health capabilities in the area, it may be beneficial to have public health personnel participate as advisors in the Healthcare Coalition’s preparedness meetings.
• EMS: Emergency Medical Services are an important partner, like public health, in establishing viable processes and procedures for the Coalition’s response activities. Individuals representing EMS may provide key insights for the Coalition’s preparedness efforts.
• Fire Service: Fire and rescue services should be considered as well for advisory participation in the Coalition’s preparedness efforts. These services can play multiple roles during response, including providing direct support to healthcare organizations.
• Law Enforcement: Coordination with Law Enforcement can be critical for many reasons. For example, collaborating with Law Enforcement about which healthcare personnel should be allowed to cross security perimeters in an area of police action may be essential to maintain an adequate healthcare workforce during civil unrest, mass gatherings, and other incidents.
• Federal partners: The Healthcare Coalition should include appropriate regionally-based Federal personnel (e.g., HHS Regional Emergency Coordinator) in the Coalition’s preparedness and response efforts, even if just on an “information-only” basis.^[11]
• Nearby Healthcare Coalitions: Inviting a representative from a nearby Coalition to participate as an observer or advisory in preparedness efforts may strengthen regional coordination. This builds trust and familiarity that can be helpful in an emergency.
• Other medical support entities: Included in this group may be large vendors, laboratories, or other businesses that support multiple healthcare assets in the Coalition. Establishing formal relationships with these entities may promote a more robust commitment to support Coalition member organizations during emergency response.

5.3.4 Systems-Based Methods

Section 1.2 briefly described a systems-based approach to program development. This approach has tremendous utility for the Healthcare Coalition EMP. Establishing a set of sequential management steps to use during any major undertakings (e.g., EOP development) helps keep the projects focused and “on track” while evolving in a logical manner.

An example series of management steps as applied to development of the Coalition EMP is presented below for consideration:^[12],[13]

Step 1: Establish goals and objectives. The goal of the Healthcare

Coalition EMP process should be explicitly described. For example, a candidate goal statement might be to “establish and maintain a robust Healthcare Coalition response organization that is supported by a comprehensive and inclusive method to coordinate Healthcare Coalition partners across the phases of mitigation, preparedness, response, and recovery.” Objectives are then developed representing the interim steps necessary to achieve the goal (Exhibit 5-6).

Exhibit 5-6. Sample programmatic objectives for the Healthcare Coalition EMP

• Establish a Healthcare Coalition response organization to effectively manage the coordination between healthcare organizations and the Jurisdictional Agency(s) during incident response and recovery.
• Create and maintain a preparedness organization (EMC) to manage Healthcare Coalition participants’ mitigation and preparedness activities.
• Conduct a joint Hazard Vulnerability Analysis and share the information as a basis for coordinated, consistent preparedness and response efforts.
• Establish guidance for participating healthcare organizations to enhance their individual EOPs so they can fully participate in Healthcare Coalition actions during incident response.
• Conduct joint training, exercises, and other preparedness activities with local response agencies to integrate the Healthcare Coalition into the local emergency response community.

Step 2: List key assumptions about the environment, organizations, and other factors that might influence development of the Coalition. Sample assumptions may include the following:

• Incidents that could impact Healthcare Coalition member organizations may occur suddenly and without warning.
• Each Coalition member retains decision-making authorities inherent to their organization.
• Jurisdictional authorities (Tier 3) have responsibilities in supporting the Healthcare Coalition, and the Coalition has responsibility for supporting these authorities, as indicated by incident circumstances.
• Funding will be necessary from government or non-government sources, as well as the member organizations themselves, to establish and maintain the Coalition.
• Long-term funding may be limited and sustainability is an important consideration in designing the Healthcare Coalition. The Coalition should be as lean as possible while maintaining the ability to fulfill its mission requirements.

Step 3: Develop a System Description and Concept of Operations. The System Description outlines how an effort will be organized. For the Coalition EMP, it is worth first considering the intended function of the Coalition during emergency response (i.e., defining the Coalition’s response objectives). Then, the programmatic issues can be delineated, such as the construct of the EMC, how representatives are selected, and who the EMC reports to beyond the administrators at the individual organizations. The Concept of Operations describes the processes and procedures that the Coalition will use to achieve its goals. For the Healthcare Coalition EMP, this may entail outlining the specific methods for meetings, response coordination, and interaction with senior executives at member organizations (Tier 1) and jurisdictional authorities (Tier 3).

Step 4: Identify resource needs (personnel, facilities, equipment, supplies, etc.). Needs are identified to staff, equip, and operate the EMP, including the organizing body or support organization(s).

Step 5: Implement the system. Upon completion of the preceding steps, the Coalition EMP must be implemented and maintained.

Step 6: Develop and conduct education and training designed to familiarize personnel with the system. For the Healthcare Coalition EMP, implementation may require briefings to executive leaders of member organizations and public agency officials supporting the effort.

Step 7: Exercise, evaluate, and revise the system. A process should be established to continually exercise, evaluate, and improve the Coalition EMP.

7. The Emergency Planning and Community Right-to-Know Act, also known as Title III of the Superfund Amendments and Reauthorization Act (SARA), established the requirements of LEPCs.
8. The contribution of personnel time is a significant issue that Coalition organizations should address at the outset. Those who contribute significantly to the development and maintenance of the Coalition should have their efforts recognized and acknowledged by their employer as an important cost of doing business.
9. An example is The Hospital Preparedness Program, which is administered by the Office of the Assistant Secretary for Preparedness and Response within HHS. Additional information on this program is available at: http://www.phe.gov/Preparedness/planning/hpp/Pages/default.aspx.
10. The participation of these entities in Coalition preparedness may vary from full participation (e.g., assistance in developing work products and attendance at all meetings) to more limited participation (e.g., review of select work products).
11. Contact information for HHS Regional Emergency Coordinators is available at: http://www.phe.gov/Preparedness/responders/rec/Pages/contacts.aspx.
12. Barbera JA, Macintyre AG, Shaw G, et al, Emergency Management Principles and Practices for Healthcare Systems (2006); Available at: http://www1.va.gov/emshg/page.cfm?pg=122.
13. It should be noted that these same steps can be used to develop the Coalition EOP or other major EMP products.