Preparing for the next hurricane isn’t enough

As South Carolina recovers from the tremendous flooding and damage from Hurricane Joaquin, one of the considerations will be how we could have been more prepared. Studies show that despite popular public awareness months, individuals don’t adequately prepare for a very human reason – they don’t want to think in personal terms about what horrors may befall them. This is exactly why we must place more importance on ensuring the readiness of our healthcare system at local, state and national levels.

As a nation, do we even know how ready we are? We know that public health preparedness funding has been gutted over the past 5 years, and private sector healthcare has focused the preparedness conversation primarily on hospital readiness. While I certainly want my local hospital ready whenever they are needed (for most events, they are prepared and used to dealing with the unknown), what about the rest of our healthcare system?  

{mosads}Public health officials have recognized that to be truly prepared, we need to move past focusing on hospitals and look at the broader system. If we can keep patients in their assisted living and dialysis centers they won’t have to resort to a hospital to refill their prescriptions or continue their care. This shift in focus is reflected in government funding moving from hospital coalitions to healthcare coalitions. While encouraging, this is not sufficient: these coalitions should be bringing in all types of healthcare from primary care to pharmacy and dentistry. Right now, many of these groups are simply not at the table.  

These gaps in healthcare preparedness coordination are partly the result of coalitions focusing too much on hospitals—but it is also happening because public health has never made a great argument for why other parts of healthcare should participate in these groups. And when healthcare is primarily owned by the private sector, as in the United States, we need to provide a return on investment to motivate the private sector to be part of this conversation.  

This is much easier said than done. How do you demonstrate a return on preparedness investment for events that may never happen? Recently David Marcozzi, with the Centers for Medicare and Medicaid Services, and his team took the first steps at proving a tangible return in his paper published in Disaster Medicine and Public Health Preparedness.  It successfully demonstrated financial return for a regional emergency response team

The difficulty here, and one that Marcozzi saw in his report, is that even when you can find a return on investment for preparedness it tends to be low. Marcozzi cited a 5 percent positive return for the $1.3 million invested in the program.  It’s hard to use a 5 percent return as a reason for a company to invest in preparedness.  As this is one of the first reports examining return on investment in preparedness, it’s possible that other organizations will be able to demonstrate higher results, but that argument has not yet been successfully made. 

But what’s the alternative?  Not preparing and creating risk for communities?  Crossing our fingers and hoping for the best? Perhaps the conversation needs to turn away from calling it ‘preparedness’ and think of it as simply needing to provide continuous care no matter what happens. Patients should expect continuity in their healthcare delivery as the norm.  Then preparedness stops being about singular catastrophic events and starts to become day-to-day action and practice, with systems that are sufficiently elastic to absorb disruptive events without a break in care.  This change in perspective may sound simplistic, but shifting how we as a society think about continuity of care could make all of the difference in the world. 

A major way to achieve this is by finding a way to effectively include all of health, public and private, in coalitions and in coordination, and changing the way coalitions think of their work. We can work to make healthcare more effective by focusing on strengthening day-to-day operations and creating resiliency throughout the healthcare system. Making healthcare coalition efforts focused on day to day continuity of care is reason enough to participate, at least until the economic argument is successfully made.  We know it’s only a matter of time until we have another hurricane, snowstorm or flood so let’s work to stop our self-imposed silos and better protect communities.

Lord is executive director of Healthcare Ready, a nonprofit dedicated to building healthcare resilience by strengthening healthcare supply chains through collaboration with public health and private sectors to address pressing issues before, during, and after disasters.



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