On Monday, October 24th, Hurricane Wilma made landfall in southern Florida. The most intense tropical cyclone ever recorded in the Atlantic Basin, the storm left behind $6-9 billion in insured damages in the state, hundreds of thousands of customers without power, and 31 people dead.
As hard as it is to believe, the storms effects could have been worse. Without the foresight of the areas hospitals and personal care homes, the states most fragile residents, including the ill and the elderly, might have been exposed to the storms wrath. Instead, they rode out the hurricane in safety and relative comfort as the result of meticulously designed hurricane preparedness plans.
(l-r) Leslie Stephenson, Environmental Services; Bill Hancsak, Director of Security; Gina Melby, CEO; Jean Simpson, Manager, Information Services/ Telecommunications; Robbin Lee, COO
“In May or June, we do drills with the North Carolina Air National Guard, who bring in a C-130 to take our patients to our sister hospitals in Sebring or Alabama, depending on where the storm is heading,” said Fishermens Hospital CEO Kim Bassett. “We practice how to use litters and load patientswe go through all of the motions.”
“Our hurricane preparedness plan details everythingfrom whether we evacuate, to how to deal with our employees and their families when they stay here, to how well take care of our employees pets,” she added.
Securing the facility
Having a facility prepared in advance to meet the high winds and floodwaters of a Category 3 hurricane like Wilma can make a big difference in how a building weathers the storm.
“Many assisted living facilities are not prepared to deal with a hurricane like thisthey dont fund for generators, or have the storage for fresh vegetables and fruits,” said Sallyann Swank, owner and CEO of Swankridge Care Center and a satellite facility in Homestead, Florida. “Some older facilities also have their air-conditioning units on the roof, which is right in harms way.”
In order to stay in touch with the outside world as well as residents family members during a power outage, Swank has equipped their facilities with wireless computers and high-tech televisions that work on a wireless connection. And though the facility did lose power during Hurricane Wilma, its generators kept the 20-bed facility running until electricity could be restored. “There should be a state law mandating that any care facility or gas station have a generator on-hand,” said Swank. “Even banks have them, and thats just to protect your money.”
In addition to having working generators, there are other issues that must be dealt with as well. “The first thing we do is prepare our 20-acre campus, so that any items that can be blown by the wind are removed,” said Fred Stock, chief operating officer of the Miami Jewish Home and Hospital for the Aged at Douglas Gardens. “During a hurricane warning, we also shutter the first-floor windows, because sometimes we need to evacuate people to that floor. We distribute supplies to our different floors, including water, flashlights, and canned goods, so that residents and staff have what they need for the storms duration. In general, we go into siege mode.”
Though the Miami Jewish Home facility came through the storm relatively unharmed, with the loss of about 50 percent of the trees on campus and a damaged roof and duct work, its corporate affiliate, the 46-bed deHoernle Alzheimer’s Pavilion in Deerfield Beach, suffered extensive damage.
“Our residents live in two wings off of a central area, which has a roof made of skylights,” explained Executive Director Barry J. Solomon. “That roof blew off, and so did our front entrance.”
The Pavilions 43 residents were at breakfast when the hurricane started, and were kept in the dining room for their own safety. They later moved into the activity room, where they slept and ate. “We are a locked facility, and because the electricity failed, we had to have staff stand guard at the doors,” said Solomon. “Though we were ready in terms of staffing and procedures, the building itself was the biggest problem.”
Staffing for a storm
No one wants to be in the path of a hurricane, but often medical workers have to take that risk as a part of their jobs. “Normally, our staff stays until our patients are safely evacuated, and then they can leave,” said Meylan Lowe-Watler, assistant administrator, Lower Keys Medical Center. “And I cant praise them enough for how quickly they came back when the evacuation was overby Monday evening, with the help of FEMAs First Strike Team, we had our emergency department back open.”
Though each hospital is different, most of them have a set group of staff members who know they will be on-call if the hospital doesnt evacuate. “We are unique in that we have an A team and a B team specifically for when we declare an event,” said JFKs Hancsak. “The A team comes to the hospital with the appropriate items they need to stay for the duration, and once the storms over and the roads are clear, the B team arrives to relieve them.”
Like JFK Medical Center, the Miami Jewish Home also provides housing for its employees during a storm, as well as a place for their families to take shelter. “We inform the people who may need to stay over, and expect that they will bring their family members,” said Stock. “During the last storm, we had 50 children here for four days.”
Ordered to evacuate
Depending on a healthcare facilitys location, it may be required to evacuate the area, or to help take in evacuees fleeing from the storm. During Hurricane Wilma, between six and eight patients were taken to Miami from Fishermens Hospital, and roughly 38 patients were taken to Miami and Alabama from Lower Keys Medical Center.
“We started evacuating patients by helicopter to Miami on Friday and were done by Saturday at 4 p.m.,” said Bassett. “Because the storm was stalled, there was no big rush. But if we need to, we can use the C-130 and have all of our patients evacuated in 1-1/2 hours.”
Many healthcare facilities have sister facilities that will take their patients in case of a storm, including Swankridge, which works with two nursing homes in northern Florida. Other preparation plans can include hotels or other facilities, though those plans can run into problems.
“We tried to evacuate, but it didnt work,” said Solomon. “The Hilton Hotel was our primary source for evacuation, but they lost electricity and one of their two generators, and they had no room. Because we have a very special population it is hard to find places for our folks, so we decided to ride it out.”
Those facilities in safer areas that could take in patients willingly did, including the Miami Jewish Home, which doubles as the receiving facility for Dade County Emergency Management. During Hurricane Wilma, they took in 40 residents and staff from the Bay Oaks Assisted Living Facility, as well as 10 residents from hurricane-ravaged areas that needed medical attention. “We have 492 beds and they were all full,” said Stock. “Our 12 hotel rooms were also full.”
Even after the hurricane, some facilities offer on-going help to those who cannot yet return home. “Some of our doctors had significant damage done to their offices, so we are housing their practices in our space until they can make repairs,” said Lowe-Watler. “We are also still housing the patients of an assisted living facility that was damaged.”
Overcoming obstacles
Even with all of the planning in the world, no facility can be completely ready for a hurricane like Wilma. “With every storm that comes, the plan is just an outline,” said Hancsak. “Each storm throws you a few curves, and you need to improvise.”
In the case of Hurricane Wilma, one of the biggest headaches was the lack of gas on the Gulf Coast and the electricity to pump it. Some facilities, like deHoernle, siphoned gas from their own vehicles to keep the generators running. Others, like JFK Medical Center, provided a generator to a local gas station to keep the pumps going. “We talked to a local vendor and asked him if we could hook up our generator,” said Hancsak. “Soon he was pumping fuel for JFK staff, emergency healthcare workers, the fire department, and other medics.”
Hancsak also worked with the local water plant when the power outage impaired their ability to provide the hospital with the water it needed for dialysis and other medical procedures. “We secured a generator from our parent company, Hospital Corporation of America, escorted it to the plant, and then powered it up with the help of an electrician to provide water for our hospital and the community,” he said.
The silver lining
Though no health care facility wants to go through a hurricane, especially one as intense as Wilma, there is a bright side to having survived it. “The only great thing, if there is one, is that you go through these drills all year so that the staff does what theyre supposed to when they need to,” said Stock. “I am so proud of themthey took great care of our residents, who were safe, well-fed, and well cared for. It was an unfortunate experience, but we weathered it as best we could.”
“Our staff was simply fantasticeveryone stayed in good spirits, and pitched in where we needed help,” agreed Solomon. “There was just a wonderful spirit of camaraderie, goodwill and support.”
“There will be numerous career opportunities in 2007, especially in areas where we are seeing shortages, such as nursing, radiology, and pharmacy,” said J. Don Haney, principal and senior partner of Haney/Lowderman, which provides career transition services to healthcare executives. “There are always opportunities at the senior executive level, whether its a CEO moving into another CEO role at a different facility, or a COO moving into a CEO position.”
“Individuals in acute healthcare administration are now finding more positions outside traditional hospitals, including in rehabilitation hospitals and LTAC (long-term acute care) facilities,” added Haney/Lowderman principal, Bill Lowderman. “Were also seeing a real proliferation of jobs for consultants in interim or turnaround management companiesnot just for the CEO, COO and CFO, but in emergency, surgery, and other departments as well.”
According to Haney and Lowderman, while there may be a proliferation of healthcare jobs available, candidates are undergoing a more thorough selection process than ever before. “Especially in upper level positions, employers are relying less on chemistry during the interview, and are spending more time scrutinizing potential employees track records and references,” said Lowderman. “They are using behavioral-based interviewing (BBI) related to the issues, projects and challenges the management position requires based on the belief that the best indicator of an applicant’s future performance is his or her past performance.” Behavioral-based interviewing is also a way of discovering an applicant’s values, temperament, decision-making processes, conflict resolution style and personality.
“Employers who use to consider three candidates for a position now often look at six,” added Haney. “They also conduct more thorough reference checking and even second-generation reference checking, so candidates really need to have their acts together.”
In order to help healthcare executives succeed in their employment quest, Haney/Lowderman, formerly known as Haney & Associates, provides comprehensive career transition services, which include outplacement training techniques designed to help executives minimize mistakes during the job search. Two- to three-day workshops help individuals learn how to build a powerful resume, prepare for interviews, manage references and learn to network. “We believe that its not what you know or who you know, but who knows what you know that determines future career success,” said Lowderman.
With more than 45-plus years of experience between them, Haney and Lowderman understand what skills employers require. “A candidate must have strong leadership skills, as well as strong technology skills and financial skills,” said Haney. “Even non IT-mangers must be more technologically savvy. And if a candidate doesnt have a thorough understanding of the financial aspects of their organization, they are at a definite disadvantage.”
“Executives must have the ability to improve clinical quality ratings and customer service ratings,” added Lowderman, who says that with more of this data available on the Internet, customers who are making the purchasing decision are increasingly focusing on these statistics. “The federal government and customers who are making healthcare decisions are looking for increased transparency in quality and in pricing.”
Being able to work with a myriad of people is also an important skill. “An executives physician-relationship skills must be outstanding,” said Lowderman. “Physicians expect a hospital administrator to be attentive, responsive and honest. And anyone who takes this position needs to realize what a complex relationship it isa physician can be a hospitals competitor, partner, collaborator, customer, and employee, all at the same time.”
“Physicians have more power now than ever before,” added Haney. “They can develop outpatient projects on their own, and there is also a trend toward more physician equity positions. To succeed as an executive requires political astuteness and savvynot only in physician relationships, but with the hospital board, medical staff, employees, consumers and the community.”
Though jobs in healthcare can be extremely rigorous, finding the right position can make it all worthwhile. “Hospital management is one of the most labor-intensive jobs in the world, and one of the most difficult industries for management due to multiple constituencies and the political skills required,” said Lowderman. “Still, for people who relish a challenge, healthcare remains an exciting and dynamic field.”