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Emergency Management Solutions Oct 2013: The Upside of Disasters

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Hospital death and crisis management

Last week I wrote about the finding at San Francisco General of the body of a patient who had been missing for almost two weeks. Since then, the team at SF General has done an excellent job of managing the crisis. Here are some of the key lessons:

1. Show empathy. Displaying empathy with the victim and her family is crucial and it must be sincere. In this case, the chief medical officer was visibly moved when he said, "What happened at our hospital is horrible. We are here to take care of patients, to heal them, to keep them safe. This has shaken us to our core. Our staff is devastated."
2. Avoid speculation. The hospital has resisted the temptation to guess what might have occurred. Representatives have provided the facts they have available but have not offered explanations or theories based on supposition.
3. Be transparent. The hospital has launched its own internal investigation and is fully cooperating with investigations by the police and sheriff departments, state health authorities, and an independent review ordered by the Mayor's Office. The chief medical officer has stated, "Quality patient care and patient safety is my top responsibility and I am committed to getting to the root cause of this tragedy."
4. Be proactive. The hospital has already made immediate changes to its protocols. The alarm on stairwell doors like the one used by the patient has been changed to require a manual reset. If the alarm sounds near a patient care area, nursing staff take an immediate census of their unit and sheriff's deputies conduct an immediate search of the stairwell. The stairwells are now inspected on a daily basis.

By demonstrating genuine empathy and making immediate changes to prevent a reoccurrence, San Francisco General was successful in changing the story from a front page scandal to one that is reported on in a measured and responsible way. The story is not forgotten and there are still the results of the various investigations to face and no doubt a lawsuit but the hospital has managed to limit the damage to its reputation and preserve the trust of the public.

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Hospital death a case study in crisis management

It's every hospital administrator's nightmare: the unexplained death of a patient under the hospital's care. However, it does provide a good case study in crisis management. Read what is known about the case and then share your thoughts in the comments section.

Over two weeks ago, a patient was admitted to San Francisco General Hospital for treatment of an infection. Later that evening, a nurse checked on the patient at about 10:15. When the nurse returned fifteen minutes later, the patient had disappeared. The hospital implemented its missing patient protocol, which involved a search by hospital staff and sheriff's deputies who provide security at the hospital. As the days went by, family and friends canvassed the surrounding area and posted notices across the city, all to no avail.

Yesterday a hospital employee conducting a quarterly inspection of a little-used fire escape stairwell encountered the body that has tentatively been identified as the missing patient. The door to the stairwell is located a short distance from the patient's bed and is fitted with an alarm and locked from the inside. It's not yet known whether the alarm was working at the time the patient disappeared. 

Those are the bare facts of the case. Put yourself in the place of the hospital administrator. What are your top priorities? What message will you give to the public and the family? How will you regain public trust over this incident?

I'll share some of my thoughts in my next post.

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Who's setting priorities for the government shut down?

One of the hardest things for a manager to do is to set priorities. We face an array of conflicting demands on our limited resources and are often confronted with things that are urgent but not important as opposed to things that are important but not urgent. It becomes almost impossible to set priorities when you're told to shut down non-essential operations. How do you decide which services are essential?

It seems obvious that there are a number of people in our government that haven't figured out the answer to this question. While I am always hesitant to draw conclusions from mainstream media articles without hearing from the agencies concerned, there are a number of issues connected to the government shut down that give me pause:

• California National Guard aircraft repair crews are furloughed. These crews repair the aircraft used to support wildland firefighters throughout the state. At least four major fires are burning in the state as of this morning.
• The Centers for Disease Control have halted disease monitoring, just in time for the start of the flu season. This means our ability to detect outbreaks of disease or incidents of tainted food are curtailed.
• Scientists at the US Geological Survey who monitor earthquakes are on furlough. While a lot of the detection systems are automated, the ability to interpret that data rests with these missing scientists.

A common mistake when deciding on essential services is to look at the obvious without actually doing a path analysis. What this means is we tend to look at the end service and who provides it without considering that many of these end services are the product of multiple hands. I once took a team of unit leaders to help staff a disaster without realizing that none of us knew how to do simple tasks like prepare slide presentations.

I'm not criticizing the decisions noted above. They may have been made for good reasons. But reducing our ability to support vital services by limiting logistical and intelligence capabilities makes no sense. If this shut down continues, as it seems it will, we need to seriously rethink our priorities.

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