A “hiccup” in the essential electrical system could be a sign of a much larger issue within the overall system that could impact patient care if it is not properly communicated.
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It often seems there are more questions than answers when it comes to developing comprehensive utility failure plans. In fact, many facility professionals are in the process of developing their own plans and curious about how their peers are approaching the issue.
This information will help point readers down the pathway to success: how to start developing these plans, common pitfalls along the way and strategies for achieving success.
The partnership between a facilities/engineering staff and the emergency management staff is critical to the success of managing a utility failure event.
A common saying within emergency management is “it’s not if, but when.” It is just a matter of time before an unexpected system failure occurs that will impact the normal operations of a health care facility. The good news is that a team approach can not only greatly improve the resiliency of a facility but also the response of a team when failures do occur.
Those assigned to lead emergency management programs have a vested interest in utility failure plans — this information is a cornerstone of the facility’s continuity plan or continuity of operations plan. They should be involved in the plan development process, and their expertise should be relied upon for the activities needed when responding to a critical system failure.
For example, the emergency manager can assist with the activation of the emergency operations plan and the needed incident command team roles, allowing the facilities/engineering department subject matter experts to focus on repairs.
Critical utility events can have a significant impact on patient, staff, and facility safety and functionality. Activating an incident command early in an event is the best bet to stay ahead of issues and ensure redundancy plans and downtime procedures are being effectively implemented.
The emergency manager also can benefit greatly from working with the facilities/engineering staff to develop related areas of the emergency operations plan.
Writing successful utility failure plans should be a team concept. It seems fairly common for critical details of utility systems to live in the experiential knowledge of staff who have worked in the facilities department the longest. Requesting their time for an afternoon or longer to find out what they know will greatly improve the planning effort. Finding out this sometimes detailed but less accessible information is key to developing a functional and realistic failure plan.
The online business dictionary defines organizational memory as “largely undocumented experience, insights, knowledge and skills acquired over the years, passed on to the newcomers through personal contacts, meetings, training courses and mentor-protégé relationships. Organizational memory (unless pooled and recorded in a readily accessible form such as a database) is destroyed through excessive downsizing, frequent layoffs, unmanaged employee attrition and/or disasters.”
A subset of this concept could be the organizational health care facility memory. This organizational facility memory can be lost due to employee retirement or other attrition causes.
The lack of organizational facility memory can have a negative impact on an organization’s ability to respond to and recover from utility failures effectively, particularly if the specific utility failure cause was not previously included in failure procedures.
Sometimes, organizational facility memory can include temporary measures such as backups or spare equipment that were put into place to facilitate previous planned equipment outages or previous repairs.
In addition to utilities being one of the six critical functions of emergency management, a summary of just a few of The Joint Commission’s (TJC’s) elements of performance (EPs) for emergency management (EM) and environment of care (EC) are listed below to further highlight the relationship between utility failure plans and emergency management (readers should refer to TJC’s standards for exact verbiage):
- EM.02.01.01 EP 3 — Describing the hospital’s capabilities and response procedures to provide for utilities for at least 96 hours in the emergency operations plan.
- EM.02.02.09 EP 07 — Identifying essential utility systems in the emergency operations plan, including the process for maintaining temperatures to protect patient health and safety, and the safe and sanitary storage of provisions.
- EM 03.01.03 EP 11 — Monitoring the management of utility systems during exercises.
- EC 01.01.01 EP 9 — The hospital has a plan for managing utility systems.
- EC 04.01.01 EP 11 — The hospital investigates and reports utility failures.
Making sure to coordinate and manage these EPs in a collaborative effort will help to assure compliance and demonstrate a coordinated leadership effort.
Communication with leadership during a utility failure is critical to a successful response. The failure of a single fixture hardly seems worth the effort of notifying leadership while a “hiccup” in the essential electrical system could happen so quickly and be resolved even before communication can happen. Yet both of these examples could be signs of a much larger issue within the overall system that could impact patient care if they are not properly communicated.
While some minor failure events, such as a plugged water closet, should probably go completely unnoticed by the non-facilities/engineering staff, when considering the impacts to patient care and other critical areas, it is best to consider the worst-case scenario, hope for the best and aim for somewhere in the middle.
Discussing the proper communication efforts with a multidisciplinary team, such as the safety or environment of care committee, regarding when leaders should be notified during various failure event scenarios is an important step in preparing utility failure plans. This multidisciplinary approach will help bring a broader perspective to the communications effort and help to establish guidelines on when and to whom communication should occur.
In general, leaders are not typically aware of utility system failure points and the details of redundancy strategies. So, even a simple failure event can cause a significant amount of fear and concern, rightly centered around patient and staff safety.
Instead of brushing aside these feelings, addressing them during nonemergency times with a multidisciplinary team will help to better understand expectations for communications. This is an opportunity to educate regarding the details of systems and redundancies.
When notifying administration and other leaders, facility professionals should stick to the facts and be prepared to clearly explain the impacts and mitigation strategies (the incident command team can help develop these strategies).
Usually one of the first questions asked is, “How long is this going to last?” While this may be one of the most difficult things to actually determine as a utility failure unfolds, it is one of the vital pieces of information for the facility’s incident command team.
Understanding the duration of the failure helps the team to properly gauge the magnitude of the needed response. To implement the entire incident command team for a water leak that can be addressed in less than an hour would not be an efficient use of resources.
One of the best resources for estimating utility failure duration is historical information. Taking the time to properly document and track utility failures will help establish baseline information on these failures. Additionally, tracking these events will help trend infrastructure issues and provide data for infrastructure improvements.
However, even with historical data, every failure event is an event unto itself. Being as transparent as possible and communicating as much information that is available is important. Allowing areas to plan ahead for potential impacts will provide for a better and safer response.
A utility failure event also presents an opportunity to educate other leaders on the systems that literally keep the hospital running. When the water is looking murky across the facility, the water system is the key concern for the day. Facility professionals should take time to talk to staff and explain the system and the situation. Even if they do not remember all of the details, they will remember having a knowledgeable and communicative facility leader during a stressful time.
In addition to this information sharing, facility professionals should have a presence across the facility during a failure event. They should round in the impacted departments and hear the issues from the front-line staff. These activities build trust through all staff levels and have a positive impact on future events.
When it comes to facility utility failure plans, one of the most important things to remember is that one size truly does not fit all.
Reviewing multiple plans from various health care facilities clearly demonstrates that differences in utility systems along with specificity for each facility’s infrastructure greatly influences utility failure plans. Still, some key components are evident through the variety. They include:
Purpose. Describing the purpose of the failure plan was prevalent in all of the plans reviewed. While many of these were brief, single sentences, providing the purpose of the plan at the beginning provided a quick reference to assure what was going to be covered in the plan.
Authority. Listing those positions that have the authority to implement the plan is an important part of the plan. It is important to establish the authority for times other than normal working hours. This will help reduce confusion for events that happen during the off hours.
Definitions and parameters. These will help to define when a utility failure occurs. As stated earlier, implementing the incident command for a plugged water closet would be an inefficient use of resources. Providing a matrix of activation levels such as alert, minor impact, moderate impact, major impact against an axis of definitions and parameters, authority to activate, notifications and infection control activation could provide a quick reference plan.
Procedures. Most of the utility failure plans reviewed provided specific step-by-step procedures to follow to restore system services. This is a great opportunity to document the organizational facility knowledge so proper response can be achieved regardless of which staff members are on-site or available.
Emergency clinical interventions. Most of the clinical interventions were fairly universal in scope. Including clinical staff in the development of this portion of the utility failure plan will not only engage the clinical staff but provide for realistic responses when needed.
While there may not be a clear template that fits any and all health care facilities, it is important to use a multidisciplinary approach to develop specific utility failure plans. Some important questions that can be used in this effort include:
- What is the utility’s contact information in the event of a failure?
- Where is the facility located on the utility distribution network?
- How reliable is the utility distribution network where the facility is located?
- Have facility professionals discussed with the local utility whether they consider the hospital facility to be a priority when responding to a failure?
- Have facility leaders considered participating with the local utility when they conduct drills or exercises to respond to a failure?
- Do facility professionals have partnerships in place with other local facilities in case of an extended utility failure?
- Have facility professionals determined utility usage under normal operating conditions?
- Have facility professionals identified essential functions and minimum utility needs?
- Do the utility failure plans include a prioritization for utility allocation to key resources (e.g., HVAC systems, ventilators, patient monitors)?
- How often are utilities inspected and tested to assure reliable operation?
- How long will emergency supplies last, and how can the health care facility be assured of continued delivery during an extended outage?
Kathryn Dudley, MHS, CHSP, is a safety officer for Saint Alphonsus Health System in Boise, Idaho, and Jonathan Flannery, MHSA, CHFM, FASHE, FACHE, is the senior associate director of advocacy for ASHE.