Competing hospitals must put aside turf issues to create a regional emergency plan. When differences are too great, a third party can help.
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| Gretchen Williams Torres |
Editor's note: This article is based on a report by the Health Research and Educational Trust, "Hospital Response to Public Health Emergencies: A Study of Hospital Collaboration with Community Response Partners" (Summer 2005).
To be well-prepared for an emergency, you need to collaborate with organizations you normally don't work with: your competitors. The response to any emergency is most effective when hospitals share risks and pool available resources.
The crafters of bioterrorism preparedness programs clearly understood this when they made federal and state funding dependent on collaboration with the many organizations--public and private--that respond to emergency events. Still, collaborating is not easy when competition has colored the nature of an interorganizational relationship. Working with competing organizations can be a tough pill to swallow.
Clearly, the brink of disaster is no time to create a solid working relationship. When organizations trust each other, have invested time in building relationships and have little need to protect their respective turf, they are more likely to achieve their shared goals. (See The Collaboration Primer by Gretchen Williams Torres and Frances S. Margolin [Chicago: HRET, 2003].) What is more, the effects of trust, time and turf are multiplicative. More trust, more time and fewer turf battles reinforce the collaborative forces at play and make for better outcomes.
Unfortunately, these goals are difficult to achieve under the most amicable of circumstances. But competing hospital administrators can collaborate successfully if they follow a few basic steps.
Put to rest historical tensions. Until the mandate to become emergency prepared, most organizations were not challenged to work together. Tensions, if they existed, could be ignored. But preparedness is different: Across organizations and sectors, health care leaders recognize that for their institution and their community they must put aside turf battles and competition.
Make preparedness a zone of collaboration. When we talk about preparedness, we mean the processes, equipment and personnel required to prepare, respond and recover from an emergency event. Preparedness can be a "zone of collaboration," or an area in which competition is set aside to solve a shared concern (The Collaboration Primer, 2003). Every organization has a stake in ensuring the other's level of preparedness.
Use third parties as neutral coordinators. In some competitive markets, separate organizations can serve as neutral coordinators for preparedness efforts. These third parties--in some cases private, in some quasi-governmental--have succeeded in joining the relevant parties, raising funds for preparedness efforts, and developing emergency response plans that can be used across organizations. Here are examples of how two different hospital communities have used third parties in their preparedness efforts.
--To overcome hospital competition in its largest cities, the Missouri Hospital Association recommended that the state delegate hospital planning to neutral, regional planning organizations. The St. Louis Metropolitan Medical Response System partnered with the East-West Gateway Coordinating Council of Governments, a regional planning body of elected officials, executives and county officers, to coordinate medical response to emergencies. Together they created a new nonprofit entity, the St. Louis Area Regional Response System (STARRS), to ensure ongoing regional hospital preparedness and response capacity. Its quasi-public designation enables STARRS to receive both government and private grants and contracts to build the level of preparedness and response capacity of all St. Louis-area hospitals.
--In Palm Beach County, Fla., local anthrax exposures in the wake of the Sept. 11 attacks stirred a sense of urgency in its highly competitive hospital community. The Palm Beach Medical Society emerged as a neutral organization with the technical expertise and credibility to work with all of Palm Beach's hospitals. Its separate 501(c)(3) entity, the Healthcare Emergency Response Coalition (HERC), is responsible for interorganizational emergency preparedness planning and represents all area hospitals, the health department, emergency operations center, fire rescue department, sheriff department and Red Cross.
HERC received a grant to create a communitywide mass casualty plan. It developed a memorandum of understanding signed by all hospitals in the county to enable transfer of patients, pharmaceuticals, supplies, staff and equipment between facilities in an emergency. Through this process, interoperable hospital emergency policies and procedures were developed by consensus of the participating institutions. The few contentious issues were resolved through a vote. The collaborative process in a neutral environment fostered a mutual understanding of all players' institutional practices, views and unique constraints.
Ideally, an effective communitywide response strategy is in place before an outbreak or disaster hits. Putting aside historical tensions, making preparedness a zone for collaboration, and using neutral third parties has helped hospitals in some competitive environments develop resources and create plans for emergency preparedness.
Take this opportunity to consider how a neutral third party can help health care organizations in your community ensure emergency preparedness. Look for these key attributes in your third-party arrangement:
Gretchen Williams Torres, M.P.P., is deputy director, research and evaluation, in the Chicago office of the Health Research and Educational Trust.
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This article 1st appeared on August 2, 2005 in HHN Magazine online site.
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