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High Reliability in Healthcare

Updated: May 31

The overwhelming task of preparing hospitals for climate-related disasters


High Reliability in Healthcare is becoming a priority for healthcare administrators. According to a study published by Cambridge University, during the eight-year period from 2010 to 2017, 89 hospital evacuations in the United States were precipitated by “external causes” – specifically: 60 hurricanes, 21 wildfires, and 8 severe storms. Will your hospital be next? If only you could know that. While knowing is not possible, planning for such eventualities and developing high reliability in healthcare can certainly be a strategy that you can implement. There has never been a more relevant time to ask if your institution is ready for the increasing number of natural disasters.


COVID has created a focus on reliability that was hardly necessary before.


The height of the COVID pandemic put extraordinary pressure on hospitals across the country. Hospitals were required to setup extra beds when overwhelmed with patients (sometimes even in hospital cafeterias), and meet demands for ventilators (of which there were often not enough, or not the right kind). This means hospital staff experienced enormous stress in a myriad of ways.


Naturally, most of the attention over the past 3 years has been on new imperatives and precautions that COVID has forced on healthcare providers and hospitals. However, when climate catastrophe strikes, such as wildfires, floods, and hurricanes, hospitals are hit just as hard, if not even harder. Medical supply chains can be disrupted, transportation routes blocked, patient records lost or destroyed. And the hospital facilities themselves may suffer significant damage.


Providing adequate care, never mind high reliability in healthcare services during a disaster can be challenging. Maintaining the basic physical safety for patients and staff, can become an overwhelming challenge. To cope requires what is called high reliability in healthcare, or more precisely that the organization plan and act in such a manner that they become a High Reliability Organization (HBO).


In many cases, hospitals will need to be evacuated due to climate-related disasters. Evacuating a hospital is an enormously disruptive and potentially hazardous procedure. For example, in the aftermath of Hurricane Harvey in 2017, hospitals in the Dallas-Ft. Worth metropolitan area saw patient increases of 600%. This was the result of the influx from Houston-area evacuees. During Hurricane Sandy in New York in 2012, patients in critical condition couldn’t be moved. And doctors were put into the position of having to decide who is likely to live or die.


The case for creating high reliability in healthcare


As global climate continues to warm, extreme weather and the destruction it wreaks will only grow more frequent in years to come. According to the World Health Organization, “A warmer and more variable climate threatens to lead to higher levels of some air pollutants, increase transmission of diseases through unclean water and through contaminated food … [and] floods and droughts will have a dramatic impact on health.”


There will be a greater need for hospital services, even as hospitals’ capacities are critically compromised and stretched perilously thin. And as the National Resources Defense Council points out, when disaster comes, the hospital may be the only place for miles around where survivors can get a meal or a place to sleep.


People generally know there is shelter, blankets, food, water, medicine, power and other resources at a hospital. This observation underscores why food security is a crucial element of disaster preparedness for hospitals. What happens if these (hopefully) high-reliability organizations become further overwhelmed by the local population? People will simply be seeking safety, and a little bit of food and water until the storm has passed. Items earmarked specifically for patients, their doctors, and support staff will suddenly be at-risk because of general desperation.


The Hospital Preparedness Program


In order to ensure high reliability in healthcare The Hospital Preparedness Program (HPP), which is administered under the U.S. Department of Health and Human Services, is the only source of federal funding designed to help the nation’s healthcare delivery systems prepare for and respond to emergencies. Sadly, HPP’s funding has been cut by over 60% since 2003, adjusting for inflation. The grim reality is that, to a large extent, hospitals and other healthcare facilities are on their own for emergency planning. However, will for-profit organizations struggle to create a budget to advance this form of organizational security?


It would only take a small amount of quarterly profits from shareholders to form a literal rainy-day fund of critical back-up food and supplies. Or, will those in the expanding at-risk areas of the country, have to plan on ensuring that they have their own food and supplies?


Learn more about high reliability organizations.

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