Six Lessons QIN-QIOs Learned Supporting Hurricane Recovery Efforts

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In August and September 2017, Hurricanes Harvey, Irma and Maria made landfall in Florida, Puerto Rico, Texas and the U.S. Virgin Islands (USVI), destroying homes and businesses, and causing significant damage to local critical infrastructure. Due to this widespread destruction, accessing health care services was a major challenge, especially for older adults.

In response, two Quality Innovation Network–Quality Improvement Networks (QIN–QIOs)—TMF Quality Innovation Network, the QIN–QIO for Arkansas, Missouri, Oklahoma, Puerto Rico and Texas; and Health Services Advisory Group (HSAG), the QIN-QIO for Arizona, California, Florida, Ohio and the USVI—teamed together with local community organizations, individuals and public health organizations to provide resources to support disaster recovery in affected areas.

Responding to natural disasters like hurricanes often leads to learning opportunities. No two disasters are the same, and unique, unexpected challenges are almost guaranteed.

The following are lessons learned from Russell Kohl, chief medical officer at TMF Quality Innovation Network, and Gwen Williams, HSAG state program director, from their respective QIN-QIOs’ hurricane relief and recovery efforts.

Lessons Learned – TMF Quality Innovation Network

1. QIN-QIOs have a unique ability to support disaster recovery.

While there are a lot of resources available to assist in natural disasters, there are few organizations that have the breadth of relationships across the health care community like QIN-QIOs. Working with physician offices, nursing homes and hospitals, QIN-QIOs already know the local health care communities across the care continuum. Couple these pre-existing relationships with trained quality improvement staff already on the ground in disaster-affected areas and you have an unmatched infrastructure to both gather information and provide assistance to people in need.

2. Distributing medications is often overlooked in disaster planning.

Following the hurricanes in Puerto Rico, pharmacies were unable to verify insurance coverage for patients, forcing them to either demand cash payment or accept potentially high financial risk for lack of payment when systems were restored. In future disasters, affected areas and regions could do well to establish a prescription distribution protocol to provide critical medicine to those in need.

3. Staff members are also victims of the disaster.

It is important to remember that the staff of medical facilities within a disaster area also live nearby, and they may not be available to serve as resources on the ground to respond during a disaster. The destruction of an employee's home, the need to care for family or to evacuate an area prior to a disaster, supersedes an employee’s need to go to work. On paper, there may be three people available to respond, but during a disaster, there may be none. Even remote employees may be severely affected upon learning about the loss of property or life of those on the ground. It is important to make sure that staff members are safe—both physically and mentally—and to connect them to the appropriate resources to improve the health and safety of their families.

Lessons Learned­ – Health Services Advisory Group

4. Facebook is a great communications tool during a disaster.

Following Hurricanes Irma and Maria, many residents lost landline communications and had spotty cell service. Further, with radio and TV stations unable to broadcast due to the destruction of critical infrastructure, Facebook became a primary method of communications for many families and friends to connect with loved ones. Even the local government in the USVI suspended updates to its websites and used its Facebook pages to provide timely information regarding relief distribution and recovery updates, curfews, disaster assistance, power restoration and health services. Facebook was also used to link to transcripts and recordings of the governor’s press briefings. While not everyone had regular access to Facebook, those who did gladly shared with neighbors and reached out to their loved ones on the mainland to let them know they were okay.

5. Partner with public health and safety organizations.

HSAG facilitated communications between Medicare beneficiaries and other organizations such as local health departments, hospitals, nursing homes, home health agencies, volunteer agencies, pharmacies and other stakeholders and partners. Leading up to and after the storms, HSAG shared information about health and other recovery services, as well as the hours of operation for each agency or organization, to provide critical public health and safety information to people in affected areas.

6. Have your plan ready.

It is important for organizations to have a contingency plan in place that is regularly updated. Contingency plans should include what-ifs for every conceivable situation—no communications, no office, displaced workers and others. The plan should go into effect—and staff members should be empowered—prior to the event to ensure that they are safe and operations can resume. Hurricanes Irma and Maria were the first events during which HSAG fully implemented its contingency plan, although the plan had been tested multiple times in recent years. By equipping staff with cell phones and laptops that were taken home prior to the hurricanes, staff members were able to resume operations through virtual private network access to secure servers without having to go to a physical office. Also, fireproofing and waterproofing file cabinets helped safeguard office documents. This was supplemented by HSAG’s established best practice of scanning and storing documents on a centralized server. 

Using the QIO Program’s pre-existing collaboration infrastructure has proven to be an effective method to convene resources in a disaster scenario. By implementing best practices from past experiences, QIN-QIOs can make life-changing differences in the lives of victims and their families.

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