Learning Risk-Based Thinking from your Hospital Emergency Management Team
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By: Kate Uraneck, MD
May 24, 2016 In my years working with hospital executives and emergency management professionals I often dealt with complaints that emergency planning is a financial burden, non-reimbursable, and under appreciated. The only times that EM shines is when the lights go out, or the tornado hits, or a bomb goes off. But EM can offer hospital executives and managers coping with the transition to ISO 9001: 2015 additional ROI by providing an example of risk-based thinking in its daily operations. |
Hospitals are steeped in risk-based thinking: from the quick, sometimes intuitive, decisions that triage nurses make in the emergency department to the deliberations of the pharmaceutical and therapeutic committee determining the use of a new third generation antibiotic. All of these decisions are made using some type of risk assessment. Often these processes are not well defined or consistent in their methodology, and therefore the results can vary based on individuals rather then a system. But this is not the case in emergency management in most hospitals.
Emergency management (EM) professionals understand that it is impossible to manage and plan for every conceivable disaster that a hospital might face. What has to be decided is “What are the greatest risks our hospital and community face and what can we do about them?” The methodology used to help answer these questions is the preliminary risk analysis called the Hazard Vulnerability Analysis (HVA).
The HVA can be defined as the identification of hazards and the direct and indirect effects these hazards may have on the hospital. While the American Society for Healthcare Engineering (ASHE) of the American Hospital Association offered the first standard methodology in 2001 for performing a hospital HVA, a wide array of other tools and methods are available for hospitals to utilize for risk and vulnerability assessment such as the Kaiser Permanente HVA Tool
(link: http://www.calhospitalprepare.org/hazard-vulnerability-analysis ).
At its most basic level, the HVA asks the following questions.
In an ideal situation, these questions are answered with input from diverse experts, including facility management, public health, city emergency management agencies, administration, nursing, and medical care. Based on the answers a prioritized list of risks and vulnerabilities can be created, which will then guide EM on what is most important to address. Moreover, the HVA can be utilized to determine mitigation strategies to prevent or reduce undesired effects.
A HVA determines the framework for the entire emergency planning cycle: what to plan for, what will be drilled next, what is the time frame for preparing and recovery, and what plans need improvement after each drill or actual event. A well-done HVA also places the hospital well within the context of the community it serves. Additionally, a HVA is never a one-and-done assessment. The world we live in is constantly changing and new threats, for example cyber attacks and emerging diseases, are always arising. For this reason, the HVA should be reviewed every two-three years at a minimum or if there are significant changes that have occurred.
After my many years of working in emergency response and planning, I have seen that during disasters hospitals’ reveal their true commitment to the communities they serve and to their core values. In the much less exciting phases of mitigation and planning for disasters, emergency management professionals reveal their commitment to the benefits of risk-based thinking. This is the silver lining for hospitals transitioning to ISO 9001:2015 and questioning, “What is an example of risk-based thinking?” The answer is right in your own hospital emergency management team.
Kate Uraneck, MD is an emergency physician with over 13 years of experience in hospital emergency preparedness with the New York City Department of Health and Mental Hygiene. She assisted in the development of the NYC response plans after 9/11. Kate travels the globe giving lectures on Hospital Emergency Preparedness and consults with emergency preparedness and hospital quality improvement. Kate currently lives in Philadelphia, PA.
Emergency management (EM) professionals understand that it is impossible to manage and plan for every conceivable disaster that a hospital might face. What has to be decided is “What are the greatest risks our hospital and community face and what can we do about them?” The methodology used to help answer these questions is the preliminary risk analysis called the Hazard Vulnerability Analysis (HVA).
The HVA can be defined as the identification of hazards and the direct and indirect effects these hazards may have on the hospital. While the American Society for Healthcare Engineering (ASHE) of the American Hospital Association offered the first standard methodology in 2001 for performing a hospital HVA, a wide array of other tools and methods are available for hospitals to utilize for risk and vulnerability assessment such as the Kaiser Permanente HVA Tool
(link: http://www.calhospitalprepare.org/hazard-vulnerability-analysis ).
At its most basic level, the HVA asks the following questions.
- What events can occur?
- What is the likelihood of these events?
- What are the consequences of the event?
- What are the overall risks (likelihood x consequence)?
In an ideal situation, these questions are answered with input from diverse experts, including facility management, public health, city emergency management agencies, administration, nursing, and medical care. Based on the answers a prioritized list of risks and vulnerabilities can be created, which will then guide EM on what is most important to address. Moreover, the HVA can be utilized to determine mitigation strategies to prevent or reduce undesired effects.
A HVA determines the framework for the entire emergency planning cycle: what to plan for, what will be drilled next, what is the time frame for preparing and recovery, and what plans need improvement after each drill or actual event. A well-done HVA also places the hospital well within the context of the community it serves. Additionally, a HVA is never a one-and-done assessment. The world we live in is constantly changing and new threats, for example cyber attacks and emerging diseases, are always arising. For this reason, the HVA should be reviewed every two-three years at a minimum or if there are significant changes that have occurred.
After my many years of working in emergency response and planning, I have seen that during disasters hospitals’ reveal their true commitment to the communities they serve and to their core values. In the much less exciting phases of mitigation and planning for disasters, emergency management professionals reveal their commitment to the benefits of risk-based thinking. This is the silver lining for hospitals transitioning to ISO 9001:2015 and questioning, “What is an example of risk-based thinking?” The answer is right in your own hospital emergency management team.
Kate Uraneck, MD is an emergency physician with over 13 years of experience in hospital emergency preparedness with the New York City Department of Health and Mental Hygiene. She assisted in the development of the NYC response plans after 9/11. Kate travels the globe giving lectures on Hospital Emergency Preparedness and consults with emergency preparedness and hospital quality improvement. Kate currently lives in Philadelphia, PA.