Administrative aspects in crisis

management
Dr.Eman Mohamed Gaber
MSc Emergency medicine,Alexandria university
Head of Scientific committee, Alexandria health
affairs Directorate
 ● Crisis overview
● Disaster plan
● Preparedness &
Mitigation
● Response
Outlines ● Recovery
● What pandemic have
changed in our plans
● Open discussion for
hospital emergency plan
 ● Crisis overview
● Disaster plan
● Preparedness &
Mitigation
● Response
Outlines ● Recovery
● What pandemic have
changed in our plans
● Open discussion for
hospital emergency plan
Crisis overview
When the first rain began to fall in On April 19, 1995, did the emergency
Houston, Texas, in June 2001, did department staff arriving for the day shift at 13
hospital staff know they would soon be Oklahoma City hospitals know that a former
providing care for hundreds of patients soldier was driving a rented van filled with
without electrical power or running
water in flooded hospital buildings? 4000 pounds of ammonium nitrate toward the
Murrah Federal Building and that they would
In March 2003, did the 11 Toronto soon be faced with 324 bombing victims?
healthcare workers who were caring
for patients with respiratory
symptoms know they would soon
become infected with severe acute
respiratory syndrome (SARS)?
Crisis overview

We didn’t know all what had happened but we Do Know

some things….
“We know people will pick up firearms, make bombs, and inflict pain and
suffering on others. We know there will be casualties from train accidents,
cars crumpled in chain reactions, building collapses, and explosions. We
know infectious diseases will do what they do best: spread and kill. We know
terrorists have not given up their violent assaults.”

So we are always hope for the best but be prepared for the worst…
Crisis overview

Crisis management, capabilities and preparedness: the case of

public hospitals in Iran, Azad university,Tehran 2010
“Responses from hospital managers and directors show that most of them were not
familiar with crisis management, while majority of them mentioned that they had
crisis management plan and committee in their hospitals. The study also indicates
that having a crisis plan and crisis committee without being familiar with
knowledge of crisis management, do not help managers to cope with crisis.
Moreover, correlations show that older managers were more familiar with crisis
management experiences abroad, and defined responsibilities contributed to
setting up crisis committee, and taking crisis seriously.”
Hospitals vulnerability to stresses

● Complexity of services.
● Dependence on lifelines: water,power,medical
gases,communication, waste collection.
● Hazardous materials
● Receive normal patients flow during crisis
 ● Crisis overview
● Disaster plan
● Preparedness &
Mitigation
● Response
Outlines ● Recovery
● What pandemic have
changed in our plans
● Open discussion for
hospital emergency plan
Disaster cycle
 ● Crisis overview
● Disaster plan
● Preparedness &
Mitigation
● Response
Outlines ● Recovery
● What pandemic have
changed in our plans
● Open discussion for
hospital emergency plan
Preparedness
“Failure to prepare is preparation to failure.”
 Preparedness
“Believing a problem won't happen to you or your hospital is a
significant threat to effective planning and response.”
Leader Integrated roles Continuous, previous
response debriefing
Roles distribution From all hospital operations and discussions

ER
Management management Staff
ER manager Vulnerability analysis
plan committee training

Flexible , applicable Address hazards most

likely affect hospital
Concise, Anticipatory operations
Actual available
Susceptibility to failure
resources

Capacity Capability Vulnerability Surge capacity

Readiness and types of Establish alternate

available services
service areas
Preparedness Imagine unimaginable
Floods, boombing , volcanos…
philosophy Staff protection
Commitment to self protection policies

Build in redundancy
Expect the primary plan to fail and build in
alternatives to every emergency measure.

Rely on standard procedures

People perform best in unusual situations
when they perform activities that closely
mirror what they do under normal conditions.
 Plan to degrade services
Preparedness Maintain normal level of services,
philosophy re-assign resources and personnel
as disasters may be long-lasting in
nature, and multiple disasters may
occur simultaneously.
Emergency operations plan
fits within overall
community plans
pandemic that may simultaneously
impact large geographic areas
 Incident command
Preparedness Training and drilling on the
philosophy activation and implementation of
the incident command system.
Secure telephones should be part of
standard preparedness equipment.

Checklists for each position to

simplify response and define
each task
 Self sustained for 24-72 hour
Preparedness In 2003,major power blackout in the
northeastern United States and Canada
philosophy demonstrated the impact of the loss
electrical services. It is recommended that
every hospital:
●Emergency power generating capacity
●Annual load testing on the generator(s)
●Maintain the water supply and an
alternative water supply in secure areas in
sufficient quantity to support all services
(sanitation, hygiene, laundry)
●Develop a plan for disposal of increased
volumes of contaminated waste
Mitigation
“To lessen impacts,reducing severity and
seriousness.”
 ● Crisis overview
● Disaster plan
● Preparedness &
Mitigation
● Response
Outlines ● Recovery
● What pandemic have
changed in our plans
● Open discussion for
hospital emergency plan
Response
“Healthcare Administrators should Coordinate and integrate
efforts and resources for MULTIDISCIPLINARY response.”
 1. Situation Report (Rapid Needs

Response Assessment):rapidly assess the

impact of a disaster:
● The extent and magnitude of the
disaster and the scope and nature of
casualties
● The status of operations and any
disrupted critical services
● The impact of disruptions on
operations and the ability to sustain
operations
 2.Notifications:
Response
● Timely Staff notifications.
● Receive and send warnings and
notifications from external
agencies.
 3. Triage:
Response
● START (simple triage and rapid
treatment)
● ID-ME (immediate, delayed,
minimal, expectant)
● MASS (move, assess, sort, and send)
● Alternative Triage Area: can be used
at night, weatherproofed, and
temperature-controlled.
 4. Treatment areas:
Response ● Designation should reflect triage
levels.
● An additional triage and
continuous reassessment.
● Close observation for patients
triaged as yellow.
● Victims with no hopes for survival
kept in separate wards.
 5. Ancillary services and
Response supplies
6.Media & publishing
7. Recording
8. Security
9. Role of volunteers (after
Authorities permission)
 ● Crisis overview
● Disaster plan
● Preparedness &
Mitigation
● Response
Outlines ● Recovery
● What pandemic have
changed in our plans
● Open discussion for
hospital emergency plan
Recovery
“To return equal or better than before.”
 ● Resumption of
Recovery normal function.
● Restocking.
● Debriefing.
● Documentation.
● Rehabilitation.
● Preparation.
 ● Crisis overview
● Disaster plan
● Preparedness &
Mitigation
● Response
Outlines ● Recovery
● What pandemic have
changed in our plans?
● Open discussion for
hospital emergency plan
“The Changing Role of Healthcare Administrators
During and After COVID.April 2022”
 1. COVID-19-related financial debt
2. Sustain and improve the quality
of healthcare
How Has the Global 3. Introduce telehealth technology
Pandemic Impacted
4. Staff shortages.
Hospital Administration?
5. Flexibility and reallocation of
resources.
6. Safe services.
7. Following updates and guidelines
 Healthcare management jobs and
hospital administration
implemented the following tactics to
enhance quality of care:
●Use telehealth technology to support
How Has the Global healthcare professionals and patients
Pandemic Impacted ●Follow a framework for providing non-COVID-
Hospital Administration? 19 clinical care during the pandemic
●Statistics
●Follow a comprehensive hospital preparedness
checklist
●Maintain appropriate staffing
●Prepare the clinic, hospital and healthcare
facility ahead of time
 Introduction of Telehealth:
According to the American Medical Association (
AMA), telehealth accounted for less than 1% of
healthcare volume prior to the pandemic and in the
wake of COVID-19, approximately 50% of physicians
How Has the Global
used telehealth for the first time.
Pandemic Impacted Physicians support telehealth due to:
Hospital Administration? ●85% indicated that telehealth increased the
timeliness of care.
●75% said telehealth allowed them to deliver high-
quality care.
●More than 70% were motivated to increase
telehealth use.
 Healthcare staff shortage
●“At Central Christian College of Kansas,
we believe the pandemic has opened the
door to new opportunities into which
How Has the Global healthcare workers can venture... The
Pandemic Impacted main objective is to adapt and be flexible
Hospital Administration? in the ever-changing healthcare industry.”
- Dr. Enrique Barreiro, Chair of the
Master Strategic Leadership
Program, Central Christian College
of Kansas
What Will Healthcare Administrator Jobs Look
Like After the Pandemic?
“According to The Commonwealth Fund, prior to the pandemic, the
United States had the most expensive healthcare system in the world.
Despite high spending, the survey determined that in measures of quality,
efficiency, access to care, equity, and the ability to lead long, healthy, and
productive lives, the U.S. ranked last compared to six similar
industrialized countries (Australia, Canada, Germany, the Netherlands,
New Zealand, and the United Kingdom).”
Amended facility management post Covid-19:
● Focus on emergency management and patient surge planning.
● Pick up the pieces and restart important projects and operations
that fell behind during the public health crisis.
● Prioritize telehealth.
● Employee safety
● Manage employee mental health as a priority.

“In the U.S. a hospital administrator in their mid to late-career

can make as much as $154,000 per year. The salaries for
healthcare administrator jobs are highest in busy cities like Los
Angeles, Chicago, Houston and New York.”
 ● Crisis overview
● Disaster plan
● Preparedness &
Mitigation
● Response
Outlines ● Recovery
● What pandemic have
changed in our plans?
● Open discussion for
hospital emergency plan