Healthcare organizations use experience to develop, grow prep efforts

Dave Edwards, Premier

Dave Edwards, Premier’s vice president of supplier relations and business development, remembered the frustrations during and after Katrina’s dissipation.

"Premier didn’t have a tight plan to deal with [disasters] prior to Katrina," he told Healthcare Purchasing News. "We had direct links to CEOs of hospitals and suppliers and we played a role in distribution and transport."

Don Hancock, a former hospital administrator with a military background and Premier’s group vice president in charge of the field force, agreed. "We did not have it all figured out before then," he admitted. "We stepped up our responses after Katrina and Rita in 2005. How do we deal with the destruction? How is distribution affected? We were better prepared for Gustav, Hannah and Ike. Much better prepared. More proactive."

Don Hancock, Premier

Premier convened a stakeholder summit in Chicago to develop plans to prepare for and react to future disasters. "We met while it was really fresh and indelibly etched in our minds," Edwards recalled. "We wanted to make sense of what happened and how we responded. From the horrors of Katrina we learned a lot of lessons. We’re prepared for the next one."

One lesson they learned is that a public gripped by panic considers hospitals to be safe havens. "One thing hospitals didn’t expect was everyone using them as places to feel safe, whether they needed medical care or not," Hancock indicated. "They would go to hospitals for safety."

David Shimberg, Premier

Another problem involved communications. Downed telephone lines and cell towers hindered hospitals’ ability to reach employees and their suppliers, which inspired a spike in satellite telephone and text messaging, according to David Shimberg, Premier’s manager of business continuity and disaster recovery, who, ironically, lives in an area sandwiched by two nuclear power plants.

Premier developed strike teams, core groups of a dozen or so people with a variety of backgrounds and expertise to tackle problems. They include doctors, nurses, nutritionists, engineers, construction, among others. The alliance also fortified its national field force that works with hospital supply chain managers to maintain communication links between hospitals and suppliers, Shimberg noted. "We’re leveraging relationships with suppliers before, during and after an event," he said. For example, when the overnight shipping companies shut down for the safety of their own employees, Premier’s contracted distributors, such as Owens & Minor, continued making deliveries – because they had developed well-conceived emergency management plans, Edwards said. Also, one nurse was trying to get adult and pediatric nutritionals into Houston’s Astrodome post-Katrina, he recalled. "We contacted the Ross CEO who coordinated with Abbott to unlock what FEMA had stored," he said. (Ross Products Division of Abbott Laboratories is now known as Abbott Nutrition.)

Through Premier’s Washington, DC, office, the alliance works with the Red Cross, FEMA and CMS to learn where citizens were being evacuated ahead of time so that cots and supplies could be shipped, according to Hancock. They worked with CMS to alleviate cash flow issues when hospitals had to shut down their computer systems, he added.

Edwards remains optimistic. "Many hospitals are far more nimble and proactive and rehearsed," he said. "We are way past where we were. Disaster preparation is no longer just a box to check on the JCAHO surveys."

Tropical Storm Allison lingered for 15 days around Southeast Texas in early June 2001, dropping more than 40 inches of rain at its peak, flooding Houston, severely damaging businesses, homes and hospitals, and vexing Dan Humphries, the recently arrived system executive for supply chain services at Memorial Hermann Healthcare System.

"Tropical Storm Allison devastated the city of Houston," Humphries recalled. "It damaged our facility so much we were shut down for five weeks. We had to evacuate 600 patients by helicopter during the storm. It was a wake-up call for our system."

Roughly three months later, 9/11 occurred, startling a city that housed an oil refinery and potential terrorist target. Four years later, Katrina made headlines, motivating Humphries to attend seminars to learn what worked and what didn’t so he could apply that to his organization should another hurricane arrive. One would test his mettle and that of Memorial Hermann’s planning efforts to date, which he admitted still was less than adequate. Rita was approaching.

"We were expecting a full hit from Rita so we evacuated three of our hospitals," Humphries remembered. "We were prepared for it and then it turned."

But the city wasn’t able to control the mass exodus of panic-stricken citizens with Katrina fresh on their minds. They jammed the freeways with traffic and ground virtually all transportation to a halt. It was unnerving, Humphries said, because that meant delivery trucks, among others, couldn’t get through, resulting in shortages of such staples as gas, but also challenges in receiving medical supply deliveries. With semi-trailers stymied, Memorial Hermann relied on smaller leased box trucks and considerable assistance from Cardinal Health, its distributor.

Rita then became a false alarm, which raised some new challenges. "We spent an enormous amount of money to prepare for Rita," Humphries said. "Prep work alone is in the millions. When the storm turned we had a lot of food and water and ice that we had to donate to employees and charities. But it’s better to be grossly overprepared than underprepared."

When Hurricane Ike hit in early September, Humphries said Memorial Hermann was ready to put all the planning to the test. "We were about as prepared as we probably could be," he said. "This time, a lot more planning was done with evacuations and pre-positioning zones. We were in zones and organized."

A key part of Memorial Hermann’s planning involved pre-positioning supplies, drugs and food for delivery and making sure enough people were on hand to pick orders for increased demand. "We have to plan early," Humphries said. "We can’t wait until a couple of days before the storm. Four days out, the disaster plan has to be done. All of this product has to be at the hospital pre-positioned and ready to go. It overburdened the hospital with supplies."

Cardinal Health pitched in with an on-site effort Humphries called "critical to our recovery." But even Cardinal had issues with its drivers, who are limited by federal regulations to 8-hour driving shifts, according to Freddie Bloomfield, Cardinal’s account executive at Memorial Hermann. "We had drivers stuck in traffic for 10 hours," Bloomfield said. "We had to work with authorities to get permits."

Added Humphries: "You really can’t imagine [all of the contacts you need to make] with the city and county."

One of Memorial Hermann’s hospitals, located in a mandatory evacuation zone, had to be vacated quickly, Humphries said. Another hospital picked up the slack but there never was an issue about supplies, drugs, food or even gas, he noted. Ice, however, was a challenge. So was communications.

"Cell phones went down because the towers went down," Humphries said. "During Ike, cell phone coverage was spotty." Memorial Hermann invested in satellite phones, which were distributed to key people in the organization, such as Humphries. "As soon as the storm approached, we were in contact," he said.

Ninety-minute conference calls happened every four hours after the storm hit so that executives and officials within Memorial Hermann’s system could share information, specifically about labor and staffing. Those calls eventually dropped to 30 minutes and less frequently as the storm moved on within two weeks. Memorial Hermann’s CEO maintained contact with local and state authorities to update them on capacity and also to request open roads and police escorts for hospital delivery trucks and transport vehicles. Even Novation and VHA Texas had people on call for purchasing assistance when needed.

Most of Memorial Hermann’s hospitals had to run on emergency power for days, according to Humphries. Unfortunately, some generators failed and water service was interrupted, which meant the air conditioning and chillers went down, affecting the operating room, endoscopy suites and central supply. As a result, temperature changes related to humidity – not flood damage – forced Memorial Hermann to get rid of millions of dollars worth of supplies at one facility.

"We made a call for patient safety," Humphries said. "The quality officer wanted all supplies removed and replaced. Every two hours we were washing walls down for two days and treating rooms. It was probably overkill but heat and humidity [can take its toll]."

Memorial Hermann had to change more than $9 million in supplies within 48 hours, according to Humphries, so that the hospital could be up and running fast. At the same time, Memorial Hermann’s corporate office, where Humphries’ operation is based, was shut down. So Humphries and his team set up a remote purchasing office near the hospital. A skeleton staff of employees that lived near the hospital handled purchasing duties until they were fully staffed within 24 hours.

Armed with wireless laptops, Cardinal reps onsite were able to access purchasing histories and inventory information from the automated systems at two Memorial Hermann hospitals to fill orders, Bloomfield noted. Cardinal used its Houston and Dallas hubs to reroute and restock $400,000 in suture on pallets for the two hospitals. Within 48 hours, they were above 95 percent fill rates, according to Humphries.

"Cardinal and we have to be lock step on this," Humphries said. "We got out of the warehouse business and just have small storage units. Our folks are accustomed to stuff showing up every day in the Pyxis units. Cardinal is a critical component to making this work. That’s why I insist they have staff on the floors working with us."

Humphries emphasized that disaster planning doesn’t stop when the crisis seemingly abates. In fact, there’s much more work to be done at that point. "Turnaround time is so critical during the recovery phase after a storm," he said. "You can be as prepared as you can be before a storm, but everything halts during a storm. You need to recover very quickly. We have a system executive for emergency services who ensures we are well-prepared for patient loads during and after a storm and maintaining capacity for triage. We can have mobile M.A.S.H. units up and running when needed."

Humphries noted that Memorial Hermann works with the city by participating in training exercises and drills. "Most revolve around storms and terrorist threats," he said. "That comes at a cost. It’s not cheap. We’re forced to be prepared no matter the cost. We are considered a community provider and are committed to the community. It’s important for hospitals to remain open during storms."