High Reliability, The Healthcare FM Podcast is brought to you by Gosselin/Martin Associates. Our show discusses the issues, challenges, and opportunities within the Facilities Management (FM) function. FM professionals keep America's hospitals safe, secure, and functioning.
With COVID-19 impacting all hospitals across the country, regardless of the status of their state's surge, we asked Scott Aronson, Senior Vice President, Security Risk + Emergency Management at Jensen Hughes, to join us. Scott leads the Security Risk + Emergency Management division for Jensen Hughes.
In today's episode, Scott speaks to the key issues related to hospital surge and off-campus sites (2:00); the most important planning considerations for hospitals to consider (8:00); the downstream facility impacts of appropriately loosened CMS regulations (12:30); the top two things non-surged facilities should be doing NOW (17:23); and a look at a post-COVID-19 world (25:10).
Gosselin/Martin Associates is a leading national recruiter and educator in the discipline of healthcare facilities management. The firm works with hospitals and systems across the United States. More information can be found at gosselin-associates.com
Welcome to the High Reliability podcast, the health care facilities management show dedicated to discussing the trends, the issues, the challenges, but most importantly, the people who keep America's hospital safe, secure and functioning.
The high reliability podcast is brought to you by Gosselin Martin Associates, a leading recruiter and educator in the discipline of healthcare facilities management. We work with hospitals and systems across the United States, and my name is Peter Martin, president of Goslin Martin Associates.
Today, I am joined by Scott Aronson, senior vice president Security Risk, an emergency management at Jensen Hughes. Scott leads the security risk, an emergency management division for Jensen Hughes delivering solutions in security, risk management, emergency preparedness, fire and life safety, security design investigations and law enforcement consulting. Scott's clients include healthcare systems and Fortune ranked global enterprises to mount profits, law firms, state and local governments, as well as private clients and their family offices. Previously, Scott was principal Russell Phillips and Associates for more than 17 years before emerging his company into Jenson Hughes, and he has more than 26 years of healthcare specific experience, working with hospitals and systems across the world, Scott. Welcome and thank you. Thank you for having me today.
It's a crazy time. We're in a unique time dealing with the Corona viruses. As we tape this it is Friday, April 10th. So we've got the Corona virus pandemic across the United States and across the world. So let's get right to it. Scott, what do you see as some of the key issues taking place with hospital surge in the use of alternate care sites?
Sure, it definitely is a unique time. So, you know, we kind of look backwards because that's one of our great challenges. History often drives what happens today and in the future. And you know these are not surprises of where we are. You look back and realize you know what? I've worked in health care since 1994 and we've seen different disasters happen from 9/11, through the anthrax scare, to the SAR situation in 2003. We have seen hurricanes and other disasters happening throughout, and I think what we've seen is that our country has has always come together. We deal with these challenges and really focus on how to improve.
And, you know, I'm in and around about 3000 health care facilities around the country. And so what we see is some of these primaries right now is how are we going to address this catastrophic surge? So that is a major challenge to our facilities management, our safety and emergency preparedness professionals. And then where are we going to surge? So is it that we're going to do this within the hospital proper? So we're gonna look at capabilities and how we're gonna address that within, you know, clinical areas, procedural areas or non-traditional space. Is this something that's going to set up where we're going to do it in our medical office buildings? And where are we looking at? The tents, you see tents popping off all over the place. And then the alternate care sites in the field, which would be convention centers, hotels and dormitories, and or large places. In Rhode Island they put up a Lowe's and it is empty, so they are looking at using that entire space. So our challenge is really about how we handle that keys. And then ultimately, where we handle that piece and along with that comes all the resource is and assets and capabilities necessary. Then fully run an alternate care site.
When you begin working with a hospital what is your role and what are they looking at you to do? . Are they looking for your guidance? I guess what I'm asking is, this is such a unique time. Is there a clear road map when you come in? Are you working with clients as you go along, learning is you're going like most of us are
That a unique question, because there's they're a couple parts to that, um, the first pieces we've been doing surge capacity assessment at hospitals and long term care since 2007. So we actually wrote a guide in 2008 on how to surge long term care facility, so that was kind of the nursing home side as we were looking at catastrophic surge for them. But that was more around receiving an influx of patients or residents from another health care facility that been heavily impact. And then we started designing the search capacity plans for hospitals where we would go in and identify what we would call the 4 S's. And now there is a 5th S, which is to assess space staff stuff. So all of our equipment and resource is we need to do it and then the systems. And that was kind of our base of saying, Well, how are we gonna operationalize? This is our systems. Now we really have to put that extra level on top of their of the safety because while we always would do it, that needs to be front and center in these discussions. So we've had that base of doing this where we would go in and we'd say, and only kind of funny discussions when you did it in the past. I go in and talk to the operating rooms and say, OK, we really want to look at how we could serve this and you'd have the chief of surgery. Come up and say you're gonna leave my oh, ours alone. No way Are you touching my operating rooms? And then we would get into that discussion, Will, we would say, Let's book at if your elective surgeries we can't. Well, could we do? Then we start this process with them of helping to engage them in that thought process of saying, Hey, you're assuming you're busy like you are today. You're assuming you're slammed, you've got a case load, the board is loaded up. But in reality, let's take that away and put you into an alternate scenario. And so once you've got the people to that place, they really could think it through and then come up with the strategies for you and with you. Because I'm not a clinician. Our team are there, not clinicians were specialists looking at the disaster scenario and how we could help formulate that into a solution for the client. And so that same type of thing is happening today.
So we had the foundation of the surge plans, staffing strategies for emergencies. But now we have to almost unless a plant, but we have to shift gears a little bit because we don't have that planning ramp up time now, so we have to now go in there and and identify with our health care facilities as they're doing the same process internally. Identify with them. How could we most rapidly convert space, utilize that space, staff it, get the stuff necessary for it and keep the patients and the staff safe throughout our number? One thing when we get in there is toe identify. Do not compromise safety that is huge. I'll reiterate that so many times with our clients, it scares me. When I see CMS come out with a waiver that says, Hey, if you're going to these alternate care sites, you can now eliminate the emergency preparedness rule. There's a waiver that says emergency preparedness requirements do not apply in that same way. I understand it, and I totally agree that we cannot hold people to the same standards. But what I don't agree with, I think we need to put that caveat there That says all aspects of mitigating risks, threats and vulnerabilities to patients and staff need to be taken into account.
So I'll give an example of something that we see when we go in, we may be asked to go in and look at an area. Let's take an existing hospital space that will be the 1st 1 to go to a patient unit. And it's being converted to a negative pressure patient, you know? And they've put in all the individualized areas they've got the through the you know, they pushed the individual units for negative pressure through the window. So we're having the right care exchanges and a single room altering probably doesn't change too much. But when you take an entire unit and you do that now, picture a unit that was neutral, pressure going toe all negative pressure and what happens in a fire now, at this time. So in the past, you would be like, Oh, close the door to fire of origin. Close the door to all the other rooms were fine. Well, if we get into a situation where all negative pressure is pulling that air from the corridor, that could be a smoke filled corridor. Now we have a threat to the patients. Now it is true you're dealing with low volumes. I mean, it's not doing with a high poll from the corridor for negative pressure. But when you have every room going at the same time, how do we handle that? So what we have to look at in that situation is to say, I get that we are doing something different. That's fine. Let's look at how we should alter our fire response procedures or something like this. So if I was in a clinical unit in the past, I had a Pitak in the room. So we had a sucking air from the outside for a room. I had that in my room. I would have said in the past. Okay. In a fire procedure, go in, Shut off the Pitak unit. You know, first, obviously they protect the patients, addressed the room of fire origin, address the rooms adjacent to it and all that. But in the other rooms, we need to shut those P tack off because we have a window that what was out on the floor below us, it'll be sucking smoke into a patient room. And so we might not even know that that is going on because we closed all the doors. So in this situation we do something in reverse. We have to actually go in and shut off the negative pressure. I'm unit center there, not something that people are thinking about right now, because that's not the first thing they're going through. They're going through the engineering process of how to convert a unit. Same thing happens where they're putting the ivy pumps in the corridors. So we just have to. It doesn't make that huge difference. We know that we're kind of violating the the C. M s joint commissioner, the rules that say, You know, what could be left in the corridor as a stable I own that's there, not immovable young. And all we need to do is make sure in there just in time training that they're saying Hey, in a fire, get those pumps into the rooms, will get him out of the court. But there's just little things that we're looking at the altar when we get in there, and it's a challenge to take people. They're working so hard to manage the threat of the cove in 19 and the exposure to their staff from a clinical level, but also really integrate some of the poor practices we know for dealing with fires, emergencies, and other threats.
It's an interesting story. I was listening to the CMS administrator a couple of weeks ago now, when they initially started to make regulatory modifications making them less stringent, as you were just discussing everything himself. That's a really good thing they did, but then you're talking about the downstream impacts and almost your you almost need to bring that next level thinking. You're directing your clients. Okay, this is great. But what does it mean in actuality?
Yeah, Absolutely. Absolutely. And I plugged CMS. I mean, really, you applaud what they're doing. They are working incredibly well with healthcare partners. But everybody's trying to make the right accommodations. But when we think of a command center and you think of that command center structure in a hospital, there's a reason why we break it down. We've got safety, security role that's in there. So we have all those different functions and we need to make sure that in the health care facilities that he's is still critical. What's happening? They have to protect the patients and staff from a clinical standpoint, from an infectious disease standpoint. But we also have to be making sure that all of those other components are there. So you really break that down. I mean, think about what we're talking to people about doing. We're talking to people about taking clinical units and altering their use. We're talking about procedural space surgical and interventional radiology areas that have holdings pack use that can be converted to inpatient units. We're looking at non traditional space, such as our clinics are even in some cases, cafeterias, rehab gym's, conference rooms at altering those spaces as well. And then we go outside the building and we take into account all of the things that may be owned by our health system. The M O Bs, Ambulatory Surgery Center, endoscopy centers everything else. Then we go to the tents that are outside of our hospitals that are being set up. I was at Connecticut and there's the 4- 25 bed Mobile Field Hospital is deployed. You'll see it right outside of ST Francis. You'll see this in a lot of areas. You see New York City, Central Park and all the tents set her up and then you go to the big boys. You know, those convention centers, all of that, Every one of these of the different level we need to take when we're thinking about how to deal with the rapid infusion of patients, the protection of the patients from a clinical level and what we need to do for safety. Security. Emergency response situation happened That was in the Midwest, where there was a person that wanted to blow up the hospital, and he was actually killed by law enforcement. Wanted to blow the hospital because of COVID 19 patients. He's blaming the health care infrastructure for this. If we think that's not going to happen in all of these alternate care sites that they don't need to think about the physical technical security necessary to protect the patients and staff that they're putting in there, then we have another thing coming that is a big challenge in society. People are scared. A lot of unique people are out there and some can become bad actors. They tend to think of other things. So we're now thinking off our structure, our patients, all the things going on. And we also have to add an element of additional security perspective to it to be able to identify. How are we gonna do this? We now have meds. We've got pharmaceutical. We've got on a PPE, which we know is in high demand. We've got ventilators out there. The black market would love to have this. That's where all the dollars are coming through. So we have to protect those assets. Then we look at our staff that are coming into work that need to be protected because we now have a patient population that's rapidly coming into our hospitals, our alternate care sites that are not being monitored for what else were they coming from? What is that? A person that's now in our structure? And then we moved to that next level identifying those other bad actors out there, ones that may want to do harm to the facility and How do we establish appropriate perimeters? And this is where engagement with our community partners emergency responders are so critical. While enforcement needs to be part of the solution, there also attacks, though they're also having challenges, but we have to engage them to be part of the solution. I know that we've been doing a tremendous number of security risk assessment and security master plans because people have not been able to think to that level yet. They really have picking into all the access points, all the alterations going on. We're seeing, you know, closed hospital shuttered. Hospitals reopen. And you know, there are so many changes happening in this industry. Those pieces need to be in place for that emergency planning, security, risk planning and the fire, our traditional fire threats.
Great answer and great practical example. Scott, you've talked a number quite a bit about the areas of the country that right now are undergoing major surge, talked about D. C. Before our conversation, you mentioned Connecticut, Rhode Island, the Midwest, what about for somebody who's in a part of the country where right now they're not experiencing a huge surge. Maybe you know those sections of the Midwest that we know about outside of Chicago in the major cities. Is
there anything one or two things that you would recommend a director or a hospital should be doing now in anticipation of the surge? Or what should they be doing? If they're sitting there saying it's coming, what should I do? When's it coming?
Yeah, so good question there because I think that in each different space, they have to have that evaluation done. So my number one thing that I would have them doing is not go off of their past surge plan. Don't just look at that and say "That's what we agreed to" - go assess their entire hospital and reviewing the space and reviewing the concept of how they can use space. That would be number one, because so much of it people. You've got some really bright people in health care institutions. They know what they're hospitals build like in the structure of it, but they really need to go out and walk it and look at those areas to determine. Is it a viable use of that space? And how could we do that? You have to take into account your patients, have to take into account your staff, sleeping aspects of what needs to happen. So what are we going to do to utilize the space? Well, and then the other part is, the resource is an asset. Do it.
So again, if you're gonna be converting an area to negative pressure, having the plan already in place of how you're gonna do that is so critical, you know, putting out really good information. So there's good data to help you determine how to accomplish that. But yet those resources and assets is extremely challenging. And if you wait to the time when the emergency is upon you, you're in trouble. And this is one of those dicey ones because you don't want people to go out and spend massive amounts of money to prepare them for something that that still may not hit their area. But at the same time, we know it's hitting in most spaces and we know it's gonna escalate. Soto really do a practical investment of handling the capability to serve and having the right resources and assets is gonna be vital I'm also understanding your staff. So when we talk about the facilities management, the environmental service is all the team members. The security team is making sure that your staff have their own plan. So are they okay if they've done the right things? Because so many times we're ready to go push the button we activate and that we'll start our own staff can't come in. We've seen that through hurricane planning. We know that's a big issue that's always going on in major hurricanes, and the health systems had advanced strategies. How to accomplish that have come out of it in fantastic shape. I don't want to say that they haven't been damaged by it, but if they worked with their staff to better prepare, they were in much better shape than those that didn't have a true management strategy for how to work together with their team.
And the last thing we need to do is not see our entire maintenance staff show up at the building because I just even they're scared. They may be scared to come in, in some situations, and you just need to provide the right education, work hard to make sure you have the right PPE. They don't need a lot, but they do need the basics and making sure that that's understood by them. Because if they haven't been involved directly in the education and education is just the director has been involved or the manager, they're missing out on what this means them. And then they're just reading the news media. And we know that the media can be all over the place. Depends what you listening to risk areas that what happened?
That's a great point, your last one just talking about educating the staff and making sure they know and that that source of information is you and not the media. As you know, you wrote your 4-S plan in 2007. We talked about surge and your first person piece of advice is Don't go off your past. Is there a thing that you've noticed that hospitals have done really well to prepare for COVID, kind of like an ah ha moment. We've done this well, this is a good thing.
Yeah, I would say the ah ha moment are the ones that have exercised and done it under real conditions that they actually did it. They went through and they ran these disaster exercises and random break points at their hospital. When leadership has been that committed, those plans will work because at any time you can take an existing plan that's strong and make alterations to it. It's much easier to modify an existing plan than it is to create it on the spot. Because you haven't tested it. You don't know where your failure points are on it, and so that's always the point that we come back to us when we walk in there and they actually take out that plan. It's amazing to see what they can do with it. I did at one time. I went to a health care system that we had done a surge plan for dealing with again another hospital evacuating into them or internal relocation of patients. They took that surge plan, and the trauma team sat down and applied it to a mass casualty incident they had had many years before of that completely overwhelmed them and they stopped and said, You know what? If I just had these beasts 15 to 20 surge areas in front of me sitting here, I would have altered my entire thinking that night at 9:30 p.m. I would have used my space differently.
And so to me, that's always the moment that we see that they put it together. They see the work that they've done on planning for space management and staffing strategies and equipment strategies, and they get to apply in an alternate way, almost like when I wrote a full building evacuation plan for someone where we go through and we identify. Okay, Stairwell three a and stairwell three B will be for vertical moves going down, and then we show that stairwell three C and D are going to be for emergency responders coming up well, the simplicity of that is, when the actual event happens, Stairwell three and three b may be out of action, so they may be gone. That may not be feasible, So at that time they do an alternate strategy and they reverse it. And they say, Let's use 3 C and 3 B and one is up and one is down. And so because the plans are already there, it enables them to work through that when you kind of think of the impact of the future, like we think of where is this going to go post COVID 19?
If there was one thing that we should see the industry do, it is to set structures in these hospitals. These nursing homes every day are same. Team is in there every day. We know them inside and out to take the planning that we're doing and turn it into reality to know what are my true redundant failures on water, my true redundant failures on medical gases and have a backup strategy that's tried, tested and proven For each of these, that will be the piece that should come out of this, and we're so scared that after this is over, we're gonna watch the health care facilities and they're gonna be exhausted. They're gonna be tired. There's gonna be a lot of people that leave the industry because they're burned out. What we don't want to see happen is the stop. They take their foot off the gas pedal. We want to see him, maybe pull it back, You know, slow down a little bit, but continue their planning efforts because they've learned a tremendous amount.
And this learning, if they don't follow it through, will go for not and that it that is not where we need to be. This is our time to advance. My firm always talks about advancing the science of safety. You know, that's a big thing. I think this is where they advance where their projections will be for the future and make sure the appropriate investments are done to support that planet.
it's interesting you say that because we've been trying to think this through as well, what's going to result from this? We agree people will leave -with the population of baby boomers with the the great amount of director level people being at a baby boomer, We think coming out of this you will see an increase of people leaving in the industry because they're just going to be exhausted. And this if you were thinking of retirement prior, this may be the catapult for you because you're gonna have been going 24X 7 for months and months at a time. So I agree with you on that. I think that's a really ll risk. Obviously, you're trying to get through this now, So you're not thinking about the back end, But that atrophy from existing director level, I think could become a real issue coming out of this.
Yeah, it really could. And we we know what's gonna happen. But as long as the team's really do document what they're going through in this event and document it well, even though they're tired, make sure they're they're putting down what worked? What didn't They will end up being okay and then bring those facility director's back as consultants to help and to provide guidance to the team members that are growing up through. But yeah, I I really agree. But it's also kind of opportunity or health care systems to really invest in their infrastructure and in their capabilities to handle threats like this.
Thanks. Scott Aaronson, senior vice president. Security risk in emergency management at Jensen Hughes. Thank you for your time this morning. Stay safe. And we really appreciate your insight and your knowledge.
Peter. Thank you so much and be safe.
Thank you, Scott. Have a good day.