HealthJune 26, 2020

Medical crisis management: How to adapt during disaster

By: Bana Jobe

Mighty though it may be, your medical crisis management handbook doesn’t cover everything. Sometimes you’ll just have to adapt as you go. Here’s how.

A crisis can shake a medical practice to its core. It can impact care delivery, jeopardize the business and push providers to the very brink of burnout.

It can also shapeshift and come without warning, which makes adaptability a must for medical crisis management. From mass casualties and natural disasters to global pandemics, calamity can strike at any time. How well (and quickly) you pivot and take action can directly impact how well (and quickly) you come out on the other side.

And yes, there's a lot that happens when you click into crisis mode, much of it event-specific and dependent on guidelines such as the American Medical Association's crisis standards of care. Still, there are some best practices that every facility should implement amid catastrophe, no matter what.

Appoint new decision-Makers

You can't do and be everything in a crisis, which means you'll have to delegate —and quickly. As the Harvard Business Review reports, one Seattle health system has institutionalized delegation amid COVID-19 with a model called RACI. This method documents who is responsible (R), who is accountable (A), who is consulted (C) and who is informed (I) on decisions so that more stakeholders can swiftly act without waiting for leadership's green light.

With more staff decision power and fewer bottlenecks, it also welcomes innovation. The Seattle health system, for example, ran with a nurse-introduced idea of keeping infusion pumps in the hallway so that nurses don't have to wear PPE each time they check or change them.

Prioritize communication

Crisis may occupy resources, but it's not a time to get so busy that you fall radio silent to your staff, patients or members of the community or media. As one practice management consultant emphasized in KevinMD, if stakeholders don't hear your truth, they'll create their own.

For staff, that means early and frequent check-ins about changes in medical practice, even when you can't see each other in person. Stop the rumor mills by addressing what you can and acknowledging what you don't yet know.

Patients need to hear from you, too, if not directly, then via email, newsletters, social media and other channels. If the media gets involved, one writer from Becker's Hospital Review advises prompt and regular response, either through a PR spokesperson or a single voice from the top as updates progress.

Support emotional resilience

The stress from a crisis can have short- and long-term impacts on a healthcare worker's mental health, from burnout and insomnia to depression, anxiety and substance abuse. MDLinx reports that 15% of physicians have PTSD, even if they don't know it—that's far more than the 3 or 4% of the general population that has it. Sobering anecdotes from the 9/11 attacks, shootings and even previous epidemics all illustrate the hazards of repeated exposure, according to an article in Emerging Infectious Diseases.

As the AMA counsels in its guide to resilience, organizations have the opportunity and the obligation to defray that emotional toll before, during and after crisis. For example, you should appoint a "Chief Wellness Officer" to help prioritize staff needs and always do a rear-view assessment to record lessons learned.

And keep in mind that emotional trauma can outlast the event. The AMA's recommendations underscore the need to maintain ongoing support for six to 12 months after the crisis subsides.

Learn lessons from others

Every medical crisis management response is somehow inspired by what someone, somewhere did before.

When emergency clinicians in Las Vegas treated victims of the 2017 festival shooting, they leaned on the learnings of their Florida counterparts, who a year prior had treated those injured in the Pulse nightclub shooting. That's how the hospitals knew to place wheelchairs and gurneys outside the doors so they could assess faster and reduce crowding inside, the Advisory reports.

Whatever crisis you're managing, the chances are unfortunately very high that something similar has happened before. Take a page from existing playbooks and adapt from there.

Make space for agility

Ultimately, best-laid plans still go awry. Whether that's emergency facilities coping with volume or clinics financially jolted from paused elective procedures, crises like the pandemic and other events can throw wrench after wrench in even the most robust of disaster response handbooks.

Exhibit A: PPE. Single-use wear is a mainstay of infectious disease protocols, but equipment shortages have forced providers into resourceful thinking, like the U.K. doctors who acquired thousands of 3D-printed face shields, as reported in the BMJ.

The lesson? Don't lock yourself into a preexisting plan. Instead, leave room for agility and nimbleness and it might even make way for innovations you hadn't considered before.

After all, mighty though it may be, your crisis manual doesn't cover everything. Sometimes, you'll just have to adapt as you go.

Bana Jobe
Lippincott® Medicine
Lippincott is a leading international medical publisher of professional health information for practitioners, faculty, residents, students, and healthcare institutions with a full suite of essential medical products, from books and journals to digital solutions.
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