Hurricane Sandy threatened the lives and livelihoods of millions of residents in the New Jersey-New York-Connecticut corridor in October. Hospitals, clinics, and providers of occupational health services were both victims of and responders to the crisis. With two main hospitals down in Manhattan and others in the region hobbled by overcrowding and compromised infrastructure, occupational health professionals and their colleagues rallied to help employers and their employees locate resources they needed to remain safe and on the job. To learn more about preparedness and response in the wake of Sandy, VISIONS spoke with representatives from three leading health systems:
- Lorraine Chambers Lewis, assistant vice president, North Shore-LIJ Health System Employee Health Services, Long Island, NY. North Shore-LIJ operates 16 hospitals and related medical facilities in the New York metropolitan area. The corporate health team Ms. Chambers Lewis oversees is responsible for the health and safety of approximately 44,000 employees.
- Christopher O’Connor, executive vice president and COO, Yale New Haven Health System, CT, formerly an administrator at Ochsner Clinic, New Orleans, where he assisted with Hurricane Katrina response from an operational perspective. The system provides comprehensive healthcare services through Yale-New Haven, Bridgeport, and Greenwich hospitals and the Northeast Medical Group delivery network. The system employs 11,000 people in New Haven and 18,000 in its medical delivery network.
- Nancy Thorne, manager, Meridian Occupational Health, northeastern New Jersey. The Meridian Health System operates six hospitals and related facilities on or near the Jersey Shore, including six occupational health delivery locations. It employs about 15,000 people.
Q: Your health systems are large and diverse. How did your system manage the overall emergency response and ensure patient safety given the complexity of the situation?
Ms. Thorne: The system has a central command center. A lot is decided at that point and then filtered down to all of the appropriate departments. It has been in place for quite for some time. If you are a manager, you have an obligation to contact the command center and receive instructions – whether you have to report somewhere or call your own staff to bring them in.
Ms. Chambers Lewis: We also have a command center structure. We have a designated location our senior leadership reports to for disaster planning. Computers are set up, and key people have defined roles to address all facets of the emergency.
Mr. O’Connor: We have a Center for Emergency Preparedness and Disaster Response and an integrated emergency preparedness plan for the system. Three hospitals become the hub of our response. Because they are open 24/7, they are the first and major element for response in the community.
Q: How did you deal with the need to relocate patients?
Ms. Chambers Lewis: We have had to move patients from one location to another in the past. We had a similar experience with Hurricane Irene last year, so we had processes in place to quickly move patients out of harm’s way when necessary. We were well prepared from that standpoint. We also took in large amounts of patients from neighboring hospitals that closed near to our Manhattan location.
Mr. O’Connor: This is one of those situations where size and scale enable a better response. We were fortunate in that we received patients, not moved them. We took in 40 hospice patients, and we were able to shelter both staff and patients during the storm.
Q: How did your occupational health program respond during and after the storm?
Mr. O’Connor: During the storm, we focused on acute-care needs. The hospitals have connectivity, and we are able to allocate resources where needed and appropriate. We were able to consolidate facilities within our system that were without power with those that did not lose power. For companies, we focused more on what would be needed after the storm passed. One of our clients, the local power company, was at the forefront of the response and also largely responsible for our own success. We worked with them to make sure they accessed services for their crews out in the street. Everyone approached this with a view of safety first.
Ms. Thorne: We were able to help ease overcrowding in the hospital emergency rooms by treating non-emergent patients in our offices, even though we don’t regularly do urgent care in our occupational health clinics. We also were able to help with communication early on because one of our sites is near the main hospital. From that location, we were able to communicate with employers and provide resources if they needed us. We serve a number of utility companies and emergency responders. We wanted to make sure they knew that we were up and running and we could help meet their needs.
Ms. Chambers Lewis: We have a client where we operate an onsite employee health program, and they lost power for a number of days. We were closed there for a period of time, but their workforce really needed help with medical care while they were at work. Even though the computers were not available yet, we were able to reopen the site using our back-up emergency paper health records. Once the power came back on, we just entered all of the information back into our electronic health record.
“We had a similar experience with Hurricane Irene last year, so we had processes in place to quickly move patients out of harm’s way when necessary.”
Q: Do you feel as if you had to step outside of your usual “comfort zone?”
Ms. Chambers Lewis: You have to be prepared to provide additional services that are not necessarily customary. Many of our offices were asked to provide minor acute care, which we don’t usually do. This was particularly helpful for employees that just need minor care for a cut or a Tetanus shot. It was also helpful for employees to have somewhere to go for emergency medication refills. Many private physician offices were not open at the time. The convenience of having this service at work is also a plus. We also provided staff to support PAS (Personal Assistance Services) for people with disabilities, which is something we don’t typically do.
Q: It seems that one of the challenges in emergency situations is ensuring the safety of your own employees, who are well trained and motivated to help others, even under risky circumstances. How did you handle that?
Ms. Chambers Lewis: The magnitude of Sandy created some significant challenges with our workforce. Two (non-North Shore-LIJ) hospitals closed in Manhattan—NYU and Bellevue. This put a significant burden on our Manhattan location, Lenox Hill Hospital. The hospital had an extremely high census. We had to bring in extra resources to serve these patients. We had nurses from NYU coming into our hospital to work there. There was a screening process that we had to activate to satisfy regulatory issues.
Mr. O’Connor: We had an incredible response from each of our hospital staffs. We had more people than we probably needed. Those are all good things and the result of prior planning and exceptionally dedicated employees. It’s part of our responsibility as management to protect our employees. Our job is to make sure our staff members know there are limits on what they can and can’t do. They are our most valuable resource; we need them to go forward.
Q: In what ways did your employee health team have a significant, positive impact?
Ms. Chambers Lewis: From my perspective, our quick response and communication were the most important ways in which we were able to support this health system. Our employees were calling and wanting to do something to help. People were still coming to work even though they didn’t have housing and other essentials. We put together an emergency employee resource center and webpage. We posted information on carpooling, medical resources, clinics, financial and housing assistance, paid time off, and other services. By having those resources set up really quickly, we could make sure our workforce was okay.
Q: Was that something you already had in place?
Ms. Chambers Lewis: We had the talent within our system to quickly pull it together. First, we were able to gather our web team and our communication specialist and activate a call center rather quickly. Those phone calls evolved into the identification of high-level needs: people needed housing, financial assistance, reassurance, to feel safe and healthy, and still be able to participate in the workforce as much as they could so they wouldn’t incur additional financial hardship.
Q: How well prepared do you think your organization was for the severe communication challenges you encountered?
Ms. Thorne: Because we had advance notice, we were able to print out paper patient schedules and patient contact information and take that home with us on Friday. Some of us were still able to use our phones; we were calling clients and patients from our homes. We also were able to redirect our staff to the hospitals and ERs that were getting busier and busier. We opened two of our office locations to help with emergency room overflows.
Ms. Chambers Lewis: Similar to Nancy’s situation, we did not want to rely on computer resources during the storm, so we printed out the schedule for the next three days. Key EHS staff members took the list home, and they knew who to call in the event of an emergency situation. This ensured that appointments and services were managed, and that everyone knew what was going on. If you have that connection, it’s not a burden on just one person; it’s shared among your leadership team. Everybody knows who to call to rearrange their schedules and to make sure that you have internal contingency disaster planning.
Mr. O’Connor: Communications is always the hardest thing to maintain, particularly because much of the infrastructure comes under fire – you lose phone and Internet connectivity.
Ms. Thorne: Social media also played a role in our response. Any department that communicated any kind of messaging could send it to the IT folks. They would put it on our Facebook page, and we could direct our client companies to check there for information about service availability.
Q: If you had to go through this all again, what would you do differently next time?
Ms. Chambers Lewis: It didn’t happen in our office, but I did hear there were some instances where refrigerators were not functioning and put medical supplies at risk. I would encourage all clinics to make sure all refrigerators that store vaccines have a generator backup. I also think we could do more to recognize subtle indications from employees who can benefit from a referral to our employee assistance program and counseling. Oftentimes we will be the only folks who see an employee vulnerable. We want our client companies to be aware that stress can have a significant negative impact on their workforce, so increasing awareness and making sure they know we are a resource for behavioral health services is something we want to focus more attention on.
Ms. Thorne: We moved all of our vaccines to the hospital on Friday, so we were fairly prepared in that regard. In retrospect, we could have done more to help first responders, utility workers, and clean-up crews be better prepared…their employers were scrambling to get their employees updated with their Hepatitis B, flu shots, and Tdap. In the future, that may be something we can help them with proactively.
Q: Did you apply lessons from your Katrina experience to preparations for Superstorm Sandy?
Mr. O’Connor: It actually goes back farther than that. I have been in hospital administration and operations for 20 years, starting out as an emergency room technician. I subsequently ran two different emergency departments. I experienced the 9/11 attacks (from a distance), preparations for Hurricane Ike, and then went through Katrina in New Orleans. These types of events have helped prompt new and different ways of thinking about preparedness. It has become more of a focus for hospitals. For example, the Joint Commission now requires evacuation drills; that is what benefitted the folks at Bellevue in New York. Those types of drills were not required before Katrina in 2005.
Q: What additional advice do you have for occupational health professionals and healthcare administrators to help them be better prepared for a natural or man-made disaster?
Ms. Chambers Lewis: Make sure that employee health services or the occupational health program have their own disaster plan, including protecting medical records. Some of our offices were affected by floodwaters, and we literally had to move paper charts to higher ground to make sure they were not damaged. Having an IT solution that is accessible and connected through all your locations helps to give you flexibility. It is great to have options regarding when and where you can restore normal services.
Ms. Thorne: Communication to both internal and external clients is the key. Especially now, our system is increasing utilization of social media. I think that’s important because that’s where people working at our command center and our clients sent a lot of the messages—through Facebook. If we can’t physically call our clients on the phone, I want to know we have a place to direct them where they can get information.
Mr. O’Connor: The key is communication, including collaboration with state and local agencies, police, fire, ambulance, all of which are critically important. It’s much easier to establish rapport with these agencies when you are not in crisis mode. The more time you have to work together before an emergency situation arises, the better off you are. There is a tendency to underestimate the time it takes to develop an evacuation plan, a power-loss plan, all of the plans that are necessary to be sure you have a framework for a coordinated response. You are going to have to adapt during a crisis – that’s inevitable – and you will need fluidity in response. But at the end of the day, you need a response plan that puts your staff and your organization at the forefront. If you do that well, you will be in a good position when the time comes.
People on Street
What one thing should an occupational health program do to improve its bottom line?
“WELLNESS. I recently gave a wellness presentation, and I believe we can take advantage of the information, incentive, and interest in wellness by extending our expertise in preventive medicine and making it a profitable undertaking.” —Robert Carlson, Director, West Georgia Worx, LaGrange, GA
“TEAMWORK. Have all of the employees buy in and understand why their jobs are just as important as the physician or the practice manager. The medical assistant, the drug screen tech, the receptionist…we all contribute to our success.” —Charlotte Tharp, BaptistWorx, Louisville, KY
“SERVICE. Customer retention and customer growth are paramount to a successful occupational health program. Being flexible and customer-service oriented is the most important factor. We need to maintain our customer base through great customer service, take what we learn from that experience and leverage it to bring in new customers.” —Douglas Lott, Mercy Occupational Health Services, Toledo, OH
“VOLUME. If you have people sitting around not busy enough, then it is going to be very difficult to be profitable and stay viable. You have got to stay busy, and you can’t keep doing the same thing you were doing 10 or 15 years ago. The world is changing. You have got to stay on the cutting edge.” —Mark Savage, IU Health Occupational Services, Michigan City, IN
“RELATIONSHIPS. If you build relationships with companies, they want to stay with you and they will embrace you as an organization and be loyal to you. It is easier to keep a customer than to go out and get a new one.” —Debbie Acciavatti, DMH Corporate Health Services, Decatur, IL
“INTEGRITY. Be consistent with yourself and your word. As long as you are consistent and you are a department or company that keeps its word, people are going to continue to come back to you.” —Romont Johnson, ProMedica Occupational Health Services, Toledo, OH
