Workbook 8: Resilience Planning
Introduction
“Resilience” means the ability to adapt, recover, and keep going when faced with adversity. An outpatient healthcare practice may face a natural disaster such as a wildfire, neighborhood fire, earthquake, severe storm, flood, or extreme heat event. These natural disasters, including earthquakes in some regions, are more frequent and more severe in the era of climate change. You may experience the loss of electricity, natural gas, or internet to your building. This Workbook is a practical guide to prepare outpatient clinics, practices, and ambulatory centers to minimize losses and to recover quickly from these threats to people, property, and data.
We recommend that practice managers gradually work through the ideas below that are relevant to their building, geography, and climate. For each topic of this workbook, we will first help you to identify your vulnerabilities and then will help you create an emergency plan for each topic. Your plan will give staff members and patients a roadmap to follow in the event of a disaster. This Workbook includes the following topics:
• Patients and Visitors
• Staff
• Your Building
• Electricity and Natural Gas
• Data and Communications
• Supplies: Supply Chain Readiness
• Financial Readiness
• Community Preparation
Resilience Checklist
Patients and Visitors
Ready to evacuate patients and visitors quickly and safely.
Ready to contact patients to reschedule appointments.
Ready to shift to telehealth.
Ready to receive and respond to patient care inquiries during an emergency: clinical questions, medication refills, referrals, billing.
- Contact and activate community partners for assistance if you have agreed to partner with a local pharmacy (Walgreen’s, Costco, etc.) to share medication refrigeration space, bottled water, etc.
Staff Preparedness
Team knows how to shift to their assigned roles to help patients and visitors during a disaster (the tasks listed in the Patients and Visitors section above) such as who is responsible for texting patients, helping evacuate patients and staff, rescheduling appointments, and contacting community partners.
Essential functions such as patient and visitor safety, facility evacuations, and patient and staff communications/text messages, and community partner communications are covered if some staff are unavailable.
Know in advance the safe room or storm shelter to use in the event of an extreme weather event.
Threatening visitor: Make a plan for how staff should respond in the event of a threating visitor (e.g. suspected active shooter).
Annual review of local or regional online emergency preparedness Resources.
Annual staff review of the emergency plans for an event such as a wildfire, flood, hurricane, or tornado, with updates as needed during the year.
Your Building
Annual review of your building’s vulnerabilities. Consider vulnerabilities to extreme storms (roof? doors? windows?); flooding (will staff and patients be able to evacuate?). Consider storing sandbags onsite if your building is highly vulnerable.
Fire: Annual check of alarms and batteries, of fire extinguishers, of evacuation plans.
Create a plan for backup power and water. Consider storing some emergency drinking water on site.
Create a plan for maintaining indoor air quality in the event of an air pollution or wildfire air quality emergency: air filters on HCVAC systems replaced or cleaned regularly according to the manufacturer’s guidelines, PM2.5 masks available on site.
Annual testing of backup plans.
Supplies: Supply Chain Readiness
Identify the supplies you need to keep the practice running for two weeks after an event. Maintain a two-week stock.
Identify your vendors for essential supplies and create a plan for emergency deliveries of essential supplies. Consider backup options.
Data and Communication Plan
Securely back up and store patient data so it can be accessed remotely. Cloud storage is usually the best option.
Create a backup communication system to reach staff and patients before, during, and after an emergency event.
Essential staff and clinicians have each other’s names, email addresses, and cell phone numbers available in the event of a computer system failure.
Annual review of the data and communications plan.
Financial Preparedness
Securely back up and store financial, banking, and billing data so that these can be accessed remotely. Cloud storage is usually the best option.
Annual review of your insurance coverage to know that the practice is protected if an emergency event occurs. Issues to consider are protection of people, building, equipment, data, and revenue stream. Ask the insurance company whether resilience preparedness qualifies the practice for a discount on the insurance premium.
Set aside emergency fund reserves in the bank for one month of operating expenses (salaries, rent, utilities, etc.) should the practice be without income.
Create digital documentation of assets (building, medical equipment, etc.). Take digital photos of the building, medical equipment, office equipment, etc., as proof to show the insurance company if you need to file an insurance claim due to a weather event or other damage. Store these photos in the cloud so you can access them after a weather event.
Community Preparation
Contact and activate community partners for assistance if you have agreed to partner with a local pharmacy (Walgreen’s, Costco, etc.) to share medication refrigeration space, bottled water, etc.
Provide patients and staff with resources so they are prepared to protect themselves and their families in the event of a disaster. My Green Doctor offers some of the best!
Resilience Planning Action Steps
Patients and Visitors
a. Vulnerabilities: Can you quickly notify patients? Can you quickly shift to telehealth? Can you fulfill patient care needs during or after an emergency: answering patient inquiries, prescription refills, transportation for elderly/vulnerable patients?
b. Emergency Plan:
8.01: Create backup communication systems for staff and patients in case the practice’s building is not suitable for use after an extreme weather event or disaster. Essential staff and clinicians should have each other’s names, email addresses, and cell phone numbers available in the event of a computer system failure. Consider adopting a text messaging system to inform patients regarding an extreme weather event or other disaster.
8.02: In advance of an event, provide patients and staff with extreme weather and emergency preparedness resources. Offer local governmental resources and consider providing My Green Doctor’s free resources such as brochures that can be printed for your patients, or purchased from My Green Doctor, or accessed through a URL or QR code provided to patients (https://www.mygreendoctor.org/waiting-room-brochures/).
8.03: Plan to shift to telehealth appointments using telephones or HIPAA-secure video conferencing software if the practice’s building is not suitable for use after an extreme weather event or disaster. Telehealth visits may be preferred by your patients and staff if transportation systems are disrupted, as is often the case following a flood event. For more guidance on telehealth, see My Green Doctor’s Workbook 6: Transportation and Commuting.
8.04: Use an Electronic Health Records system (EHRs) to maintain digital patient records digitally, store records remotely, and allow access remotely in the event of a disaster.
Staff Preparedness
a. Vulnerabilities: Does your team know their roles in an emergency? Can essential functions continue if some staff are unavailable?
b. Emergency Plan:
8.05: Create a resilience plan that contains each staff member’s name and their assigned tasks during and after an extreme weather event or disaster.
8.06: Assign clear ownership to each task or responsibility.
8.07: Practice emergency preparedness situations such as a fire, flood, wildfire evacuation, tornado warnings, extreme heat, wildfire smoke events, or threatening visitor.
8.08: Update the Plan and review it with the staff and clinicians annually.
Your Building
a. Vulnerabilities: Can your clinic function without power or water? Are backup systems in place and tested? Do you have an evacuation plan in case of a building fire?
b. Emergency Plan:
8.09: Make a list of critical functions that require water, including drinking water. Brainstorm alternative ways to access water and/or undertake critical functions. Consider storing bottled water in another location away from your practice’s building so it will be available to you after an extreme weather event or natural disaster. Consider partnering with another facility near your location to share water resources.
8.10: Consider installing upgraded air filters (MERV-13 or higher) in your HVAC system to keep inside air clean from wildfire smoke particles (PM 2.5) and other air pollution. Have your system inspected and the air filters cleaned or replaced regularly as recommended by the manufacturer or your installer. Consider having PM2.5 masks available in the building.
8.11: Share air quality website information with your staff and patients so they know where to find that information during wildfires or other air quality events. (Share this link with staff and patients: https://www.iqair.com)
8.12: Encourage patients and staff to go to the Watch Duty website (or get the app) and sign up for notifications about wildfires in your area. (Share this link with staff and patients: https://app.watchduty.org)
Building Fire Preparedness Steps (choose 1-2 steps to work on per month):
8.13: Check with your building manager, organization, or local government to learn what fire safety preparations are required for your business.
8.14: Verify that you have smoke detectors installed in hallways and rooms in your facility. Test these regularly according to the manufacturer’s or local government instructions.
8.15: Conduct a staff teaching session on your emergency evacuation plan at least once a year. This should include teaching each staff member where the fire extinguishers are located and how to use them, testing the alarm system, and conducting a fire drill and emergency evacuation exercise.
8.16: Plan and post your escape route(s). Walk through your office and identify at least two ways out of every room and hallway (a window and a door, or two separate doors in the hallway). Create a map that shows how to exit the building in case of a fire and post it near stairwells, entry and exit doors, and inside patient exam rooms.
8.17: Use Stairs: Remind everyone to use the stairs, not the elevator, in case of a fire. Help create a plan for anyone who might need extra assistance walking down the stairs. Post this reminder to use stairs on your evacuation maps.
8.18: Designate a meeting place outside of your medical facility for all staff and patients to meet. Be sure that it is a reasonable distance away from your building, such as across the parking lot, across the street, etc., not right next to the front door. If the building is on fire, you do not want to be standing right next to it for safety and you will also want to stay out of the path of the firefighters.
Electricity and Natural Gas
a. Vulnerabilities: Can your clinic function without power? Are backup systems in place and tested?
b. Emergency Plan:
8.19: Consider installing rooftop solar panels (or a solar microgrid on the ground) with a battery for solar storage, or a solar backup generator, for a backup power supply in case of an extreme weather event or other disaster. A propane gas-powered generator is a more expensive and polluting option.
Data and Communications
a. Vulnerabilities: Are patient records securely backed up and accessible remotely? Can your team communicate if systems go down?
b. Emergency Plan:
8.20: Create a backup communication system for staff and patients in case the practice’s building is not suitable for use after an extreme weather event or disaster. Some ways to communicate in this situation would be two-way radios for staff, and/or creating a What’s App group or a Signal group for staff and patients. Ask patients if they would like to opt in to a message group so they can receive updates and information.
Supplies (Supply Chain Readiness)
a. Vulnerabilities: Do you know your critical suppliers? Do you have backup options if deliveries are disrupted?
b. Emergency Plan:
8.21: Identify and make a list of the most important medications and medical supplies for your patients and staff. What items would be critical in the event of an extreme weather event or a disaster?
8.22: Talk to your medical supply distributers and ask how you can collaborate to ensure you can still receive vital supplies after a disaster. Consider working with an additional supplier so that you have a backup way to get supplies.
Financial Readiness
a. Vulnerabilities: Is your practice prepared to manage temporary closures, insurance claims, or cash flow interruptions?
b. Emergency Plan:
8.23: Check your insurance coverage and see if your practice is covered in the event of an extreme weather event or disaster.
8.24: Set aside emergency accessible funds or bank deposits for one month of operating expenses.
8.25: Create digital documentation of assets (building, medical equipment, etc.) to show your insurance company as proof of the assets/ items that were damaged during a weather event if you need to file an insurance claim due to a weather event or other damage. Store these photos in the cloud so you can access them after a weather event.
Community Preparation
a. Vulnerabilities: Are you connected to nearby clinics, pharmacies, or local health systems for mutual support?
b. Emergency Plan:
8.26: Reach out to nearby pharmacies like Walgreen’s or stores like Costco and ask if they are interested in partnering for disasters or extreme weather emergencies. Can they offer bottled water or access to medications for patients/ extra refrigeration space for your practice’s cold medications? Can you offer to share something similar if your location is not damaged, but their location is damaged?
8.27: Offer to help your community create a community solar-powered space, like a Community Lighthouse (https://www.togethernola.org) for community members to use during disasters or extreme weather events.
8.28: Provide patients and staff with resources so they are prepared to protect themselves and their families in the event of a disaster. My Green Doctor offers some of the best! See below.
Online Resources
My Green Doctor: Free patient brochures in several languages that can be printed for your patients, purchased in bulk from My Green Doctor, or accessed by patients and staff using a URL or QR code: https://www.mygreendoctor.org/waiting-room-brochures/. Topics include extreme heat, wildfires, air pollution, and other climate-related threats.
Red Cross: The Red Cross provides active disaster alerts on their website: Red Cross Weather Page and free app: Red Cross Weather App Download Page.
Watch Duty: Local active wildfire information and alerts for the United States, available from the app or website: https://app.watchduty.org.
IQ Air: Local daily air quality information for more than 80,000 locations worldwide: https://www.iqair.com.
