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

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

3. 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

4. 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

5. Motivation
Money
Mandates
Participation

6. Mandates and Participation

7. 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

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

9. 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Replace expired/out of date equipment/supplies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

10. Motivation and Participation

11. 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.

12. 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

13. 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

14. Regional Healthcare Preparedness Coalition14

15. Land mass could contain:
Coalition Region
25 Counties 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.

16. Corridor Map

17. 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.

18. 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

19. 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

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

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

22. 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*

23. 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

24. 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

25. 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

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

27. 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 patients into healthcare settings
Hospital diversion rate = 0%
Post event QA – 0.08% error rate 27 27

28. 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

29. 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

30. 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

31. “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….”

32. Contact Information Lori Upton