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U.S. Department of Health and Human Services

7.1 The Need for Healthcare Coalition Operational Documents

Many healthcare organizations in the U.S. are privately owned and may view themselves as business competitors with other local healthcare organizations during normal operations. The case can be made, however, that agreeing to work within a common framework during emergency response is a good business practice. It will typically result in both better patient care and reduced risk for the organizations (business, reputation, and service delivery).

A common framework that describes the relationship between healthcare organizations during emergency preparedness and response should be developed and clearly documented when establishing the Healthcare Coalition. This goes beyond the EOP and other operationally oriented documents. It describes the overarching Healthcare Coalition EMP and includes written instruments that address a wide range of issues – operational, legal, and financial –between the participating organizations.

The complexity of the healthcare industry must be addressed when developing the relationship between Coalition member organizations. For example, it is common to have an integrated healthcare system with multiple semi-independent healthcare facilities under its corporate structure. Does each facility receive one Coalition vote in preparedness decisions or does the integrated healthcare system receive a single vote? How is funding (both preparedness and response) equitably distributed between Coalition members? Other examples of special relationships that may exist within a Coalition include the following:

  • Healthcare organizations that are independent but maintain close ties due to patient referral patterns, joint projects, or other activities.
  •  Healthcare organizations that, because of proximity, shared risk, or other factors, have developed “priority” mutual aid or other promises to assist each other before seeking help from the broader Coalition membership.

These and other pre-existing conditions should be acknowledged and addressed through written agreements, policies, and response processes for the Healthcare Coalition. This chapter provides general guidance in sorting through these issues and includes examples of written instruments that may be considered in developing a Coalition. This should not be construed as legal or liability advice, and each Coalition member organization should involve their legal or liability experts in all facets of developing and implementing a Healthcare Coalition.

Exhibit 7-1. Addressing legal issues within the framework of a Healthcare Coalition*

The King County Healthcare Coalition in the State of Washington has formed a Legal Workgroup, whose members include attorneys representing hospitals and government agencies in King County. The workgroup’s primary objectives include:

  • Provide guidance to other workgroups, the Executive Council, and Steering Committee about current State and Federal laws/rules that are related to public health emergencies
  • Develop products and strategies for education of the legal community, including attorneys who advise Coalition members and members of the judiciary.

* King County Healthcare Coalition, Special Advisory Groups/Clinical Planning Groups; Available at:

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  • This page last reviewed: February 14, 2012