Bringing Everyone to the Table Building preparedness capacity by inspiring coalition participation

Objectives Define a Coalition List Drivers of Participation Utilize principles in place from a successful Coalition to strengthen your own

What is a Coalition Simple Definition of a Coalition: A group of people, groups, or countries who have joined together for a common purpose 2. The action or process of joining together with another or others for a common purpose

What is a high functioning Coalition? “A state of mindful attention among a group of actors that evolves from common training, intense communication, and a distinct culture derived from shared experience….” “Developing these auto-adaptive systems… depend fundamentally on their access to timely, valid information and their ability to engage in information search, exchange, absorption, and adaptation.” Louise Comfort: Auto-adaptive systems

Motivation Money Mandates Participation

Mandates and Participation

Mandates and Participation Regulatory: Joint Commission Det Norske Veritas (DNV) CMS HPP/PHEP grant requirements Funding Impact: Failure to meet requirements can impact status and funding. Value: Sets minimum standards across board No intrinsic value Burdensome Just meeting the mark

Money & Participation “The future of the 22 mature, well established TX HCCs is currently at risk due to federal NHPP funding cuts.” (NACCHO, 2014)

Money and Participation Sources: CMS rules and reimbursement Hospital Preparedness Program General Fund Memberships Funding Impact: Failure to meet requirements can impact status and funding Continued cuts to HPP grant funding EM NOT a revenue generating department Value: Get new “stuff” Replace expired/out of date equipment/supplies Defrays cost to healthcare facility Training and exercises Decreased funding = decreased coalition staff/activities

Motivation and Participation

What is Motivation A Cycle of Thoughts, Performance and Behavior Three major components to motivation Activation involves the decision to initiate a behavior Persistence is the continued effort toward a goal even though obstacles may exist. Intensity can be seen in the concentration and vigor that goes into pursuing a goal.

Types of Motivation Type /Description Examples Extrinsic Intrinsic -attaining desired outcomes -outside influences -threats of punishment Funding Mandates Requirements Benchmarks Intrinsic -self desire to seek new things and challenges -internal interest or enjoyment -longer lasting, self-sustaining Collaboration Greater Good Impact Trust Commitment

Motivation and Participation Sources: Intrinsic and Extrinsic Shared goals and ideas Rewards Funding Impact: Continuity despite funding loss “What’s in it for me?” Value-added concepts Value: Commitment Shared vision Sustainment

Regional Healthcare Preparedness Coalition 14

Land mass could contain: Coalition Region 25 Counties - 277 cities 9.3 Million* (36%) 877,000/disabilities* (24%) 170+ hospitals 900+ nursing homes 13th Largest State 22nd Largest World Economy Land mass could contain: New Hampshire, New Jersey, Connecticut, Delaware, Rhode Island, and Washington D.C.

Corridor Map

Money and Participation Regional Perspective: Sharing is good Taking advantage of as much free stuff as possible Sustainment is priority Standardization when possible Investment in personnel vs “stuff” Participation = Points 2013 The last year we provided “Hospital Allocations” directly to the facilities.

Mandates and Participation Participation Requirements: Regionally sponsored functional exercises and trainings Monthly drills Staffing of Medical Operations Center Participating Agreements Corridor meetings Everyone has a role Surge, Receiving, Support

Internal Motivators Self-Drive: Value: Collaboration: Best Practices Finding a range of solutions to problems Making a difference “The right thing to do” Value: Size DOESN’T matter Safety Net Collaboration: Neighbors Helping Neighbors Philosophy Becoming Part of a Community Patient is at Center of Actions

External Motivators Preparedness “Report Cards” CEO “Thank You” Letters Excellence in Preparedness Award Points = Opportunity for funding Leadership Opportunities Preparedness Symposium

First Challenge Tropical Storm Allison - June 2001 30-40” rainfall over 5 days All freeways underwater

Healthcare Impact Extensive flooding and subsequent evacuation TMC “off-line” with ripple effect throughout community Hospitals responding individually within systems Loss of 3000 acute care beds and 500 ICU beds overnight No formal coordinating entity*

Our first Coalition was born Regional Bioterrorism Task Force The Regional Emergency and Hospital Preparedness Council (RHPC) Officially formed in 2002 (501c3) Mission: To provide collaborative planning and response to emergencies, in a multi-disciplinary approach, to preserve the medical infrastructure of the region. Continued discussions on need for a coordinating entity

2005 Hurricanes Katrina and Rita Regional coordinating entity for health and medical called into service for first time Leap of Faith No formal plan – concept No formal structure No recognized authority Commitment Commitment to succeed Commitment to mission Commitment to medical community

2006 Evolution of a Concept Catastrophic Medical Operations Center (CMOC) Initial plan put into writing MOUs drafted and signed by hospitals and jurisdictional authorities Formal structure developed Initial training developed and held Infrastructure support from City of Houston Staffing of positions by SETRAC, EMS, and Hospital designees

Additional Opportunities for Growth Hurricane Ike - 2008 Activated by Texas DSHS (Division 1) Coordination of medical response for 28 counties Inclusion of long-term, home health and nursing home component - 2009

CMOC Accomplishments Katrina Rita Transportation and transfer of 1100 patients into healthcare facilities during Hurricane Katrina Rita 29 healthcare facilities evacuated during Hurricane Rita 121 Nursing Home evacuations during Hurricane Rita Coordination of 34 Counties and 2 States Transportation and transfer of an additional 2400+ patients into healthcare settings Hospital diversion rate = 0% Post event QA – 0.08% error rate 27 27

CMOC Accomplishments - IKE Evacuation and repatriation of 56 hospitals Evacuation and repatriation of 220 nursing homes Transportation and transfer of 15,000+ individuals Oxygen Strike Teams Dialysis and Medical Special Needs Transport circuit 4 Forward Coordinating Units

Successful Strategies Ask questions: No one has all the answers All-hazards/capabilities-based planning vs. scenario-driven approach to planning Effectively linking plans: Public Health, SAR, CMOC, MACC, etc. Err on the side of inclusion There will always be a medical component

Regional Coalition Benefits Coordinating entity with SME’s from stakeholders Communication and situational awareness Relationship building Technology adjuncts Common operating picture Shared goals and restrictions Adaptation and innovation Commitment to the cause

“A state of mindful attention among a group of actors that evolves from common training, intense communication, and a distinct culture derived from shared experience….”

Contact Information Lori Upton Lori.Upton@setrac.org 281-822-4450