Urgent Message: In order for urgent care to meet the on-demand healthcare needs of the community, it must have a plan to continue operations in the face of unpredictable service disruptions due to manmade or natural disaster.
Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine.
From hurricanes to earthquakes to power outages, natural and manmade disasters are on the rise, and in no field is emergency preparedness more critical than in healthcare. For operators of urgent care centers, being down for even 24 hours can result in a financial loss. You have patients who need services, facilities to protect, and critical systems that must be accessible.
While major disasters (such as those listed in Table 1) are a risk, the majority of business interruptions are actually caused by unpredictable events specific to the particular operation, such as a server failure, burst water pipe, or fire. If your center were damaged, how quickly could you replace computers and how would you serve your patients in the interim? Keeping your facility operating with minimal downtime is essential. The eight basic steps described here can help ensure business continuity.
Table 1. Types of Emergencies Potentially Affecting Urgent Care Centers
|· Chemical emergency
· Food safety
· Heat wave
· Highway safety
· Power outage
· Winter storm
Source: American Red Cross
Step 1: Identify Your Team Members
Emergency preparedness starts with having an organized team in which every individual understands their role. Your center’s recovery committee should represent each business function that must stay operable during a disaster, including clinicians, information technology, facilities, human resources, and marketing. Each representative should devise a plan for organizing and engaging their staff in recovery efforts.
People are the most significant asset in an urgent care center, and you can’t recover your operation if you can’t locate and communicate with your staff. Committee members should define expectations for each employee and assure all employees are aware of warning, evacuation, and shelter procedures. In addition, responsibility for meeting employee needs should be delegated so employees can focus on serving patients.
Once your committee is formed, make a contact list covering each area of responsibility and distribute the list to everyone in your organization.
Step 2: Create Your Plan
Because it’s difficult to know the probability of a specific emergency, you should identify and assess the likelihood of all risks associated with your immediate environment and geographic area. Are you located in a Gulf state prone to hurricanes, or in California where earthquakes are more likely? What about tornadoes or ice storms? Many weather risks can be grouped together because they result in a similar effect to your business. And what about nonweather events such as power outages or crime? Your preparedness plan should be all-inclusive and take an “all-hazards” approach.
Determine how you will recover critical business functions and resume operations following a disaster. Often, critical functions are those that are sensitive to downtime, fulfill financial or legal obligations, or protect significant assets. Examples of critical functions might be maintaining the security system, backing up electronic billing records, or setting up temporary facilities to treat patients.
Consider the impact of not having access to the most important components of your business, such as your team, records, telecommunications, computers, equipment, and vendors. Identifying key functions will illuminate what must be included in your preparedness plan:
- Incident management
- Information technology
- Crisis communications
- Resource management
- Employee assistance
- Emergency response
- Business continuity
Establish how long recovery should take from start to finish, and how much data could be potentially lost during a recovery process. Your plan will serve as a guide and how-to manual for keeping your urgent care center up and running, from redundant systems to setting up a new work location to managing repairs.
Step 3: Communicate With Patients
When disaster strikes a community, patients will be in need of services; a delay in resuming the center’s operation will result in patients choosing alternate facilities. Consider incidents that could affect your relationships with patients. What particular situations would cause patients to lose confidence in your services? Your plan should outline how to maintain patient care during an interruption of business operations and procedures to let patients know how they will be impacted by an event. It should also include actions to redirect incoming telephone calls to another urgent care center or a voice message system indicating that your business is experiencing a temporary disruption.
Contact with patients is a top priority, and urgent care centers need to reach out to patients quickly during and after a disruption. Send patients a letter at the start of each season prone to disaster, listing emergency contact information for your facility. Condition patients to visit your center’s website or Facebook page for opening information. When disaster is imminent, use email and automatic callouts to patients. Prepare all messages in advance and reach out after a disaster with website messages, advertising, and physical signage to let people know the center is open. Determine what your patients will need from you and what resources are necessary to meet those needs.
Step 4: Assess Your Suppliers
A business disruption scenario might involve downtime of systems for medical records and billing or the failure of a supplier to transport goods. Do an assessment of your vendors and other businesses critical to your daily operations. Do they have a disaster plan in place? Who would be a backup to the important suppliers you work with?
Make a vendor emergency contact list and identify alternate suppliers of components that are vital to your business. Consider partnering with vendors that support business continuity and information technology recovery strategies. These suppliers can provide office space, data centers, replacement machinery, and other equipment. Competition for these resources will occur if a regional disaster affects your geographic area.
Step 5: Determine Resources Necessary to Resume Operations
Determine which resources are required to restore critical functions and how to replicate them in another work location. Purchase safety equipment and emergency supply kits and make sure employees know how to access and use these supplies. Emergency kits should include everything needed to recover from a disaster, including emergency phone numbers, an employee listing, security keys and keycodes, and insurance policy information so you can report claims.
Make sure to include procedures to restore data and telephone connectivity following a disaster. Develop a communication plan that includes a 24-hour phone tree, call-in system, web page, and email alert system. Identify external emergency resources that you will contact and what they will be able to provide, including:
- Local and state law enforcement
- Fire department and emergency medical services
- The local emergency management office
- Your American Red Cross chapter
- Telephone, water, gas, and electric companies
- Businesses in your immediate area
- Repair and cleaning services
Step 6: Create a Facility Recovery Plan
Consider your facility’s physical capacity to withstand damage. Your facility recovery plan should define shelter space, building entrances, exit routes, locations of emergency equipment, locations of controls for utility and protection systems, access roads, and parking areas. Instructions for operating all systems and equipment—including shutting down or resetting the building’s electricity, gas, and water—should be accessible to employees and emergency responders. A room should be designated as an emergency operations space.
Potential damage can be mitigated by inspecting the following building features:
- High-value equipment and fixtures
- Storage, tanks, and equipment
- Antennas and satellite dishes
- Process controllers
- Information technology equipment
- Roof covering and drainage
- Windows and doors
Are there investments you can make to assure your center opens when others are down? For example, a natural gas-powered electric generator can assure your center remains open when everyone else goes days without power.
Identify an alternate location for patient care and procedures to relocate administrative and medical staff. If your urgent care operation doesn’t have a secondary facility, partner with another medical practice that you can share resources with.
Step 7: Protect Your Records
Identify records and documents that must be readily accessible to perform essential functions and backup your patient, employee, and vendor data at an off-site location. You can protect your data and hardware by:
- Backing up data on memory sticks
- Backing up data daily
- Having an additional online backup source
- Using battery-powered laptops
- Contacting your computer automation systems company for detailed catastrophe plans
- Keeping paper forms on hand for “offline procedures”
Step 8: Test Your Plan
Test your plan annually with exercises and drills. Tabletop exercises can be enacted around a conference table to discuss situations or particular scenarios, which employees would handle certain priorities, and procedures to be followed. Simulation exercises allow team members to experience simulated disaster situations and evaluate timed responses from various departments.
A full-scale training situation exercise will utilize system, processes, and staff as would be required in the event of a disaster. Regular emergency drills can assess the readiness of your employees and facility.
Consult with your insurance agent and learn what coverage is available and what precautions to take for disasters that may impact your business. Many general policies do not cover earthquake and flood damage, which may be purchased separately or as an endorsement to an existing policy. Business interruption coverage may also be available to make up for lost profits during a business shutdown or to cover certain continuing expenses resulting from an emergency.
While revenue loss is a significant concern for urgent care operators, ultimately your center exists to serve patients. As a consequence, urgent care centers play an important role in community recovery and should be prepared to deal with whatever comes your way.
(JUCM has covered various aspects of disasters that could affect an urgent care center’s capacity to conduct business and provide care for years. We recommend the following as supplemental reading to this article.)