Be Prepared to be Surprised Supporting Your People in a Disaster

1. Be Prepared to be Surprised Supporting Your People in a Disaster 6th Annual Alaska Hospital Preparedness Conference Anchorage January 30 2008 Jamie Campbell, North York General Hospital, Toronto, Canada Mary Yates, York Central Hospital, Richmond Hill, Canada

2. Workshop organization • What happened • What we experienced…as a result of what happened • What we did…as as result of what experienced. • What we learned about people, leadership and processes…as a result of what we did.

3. SARS provided us with a unique, albeit painful opportunity to observe and learn about leadership, people and processes

4. “Though we like to think of it as a clinical issue, it was first and foremost a human resources issue.”

5. What happened?

6. What happenedPre-SARS assumption “Due to advances in the science of disease treatment and control over the last century, health care practitioners generally did not consider that their lives might be at risk while caring for patients with an infectious disease.” Sue Kwolek, Vice-President & Chief Nursing Executive, North York General Hospital, 2006

7. What happenedSARS 2003; Worldwide Worldwide: 8,078 cases - 775 deaths

8. What happenedSARS 2003; Ontario

9. What happenedSARS 2003; Toronto • 375 Cases • 247 probable • 128 suspect • 61% cases in Toronto • 43 deaths • 33 deaths in hospitals • 3 health care workers died • By June 2003, over 7,000 health care workers had been quarantined • 65 Medical Officer of Health Orders • 1 Court Order

10. What happened What if all of your staff, physicians & volunteers were placed in “working” quarantine for 10 days?

11. What happenedSARS I; 42 Days • City Wide Code Orange • Two hospitals completely closed • Widespread media attention • Extra volumes in Emergency and Obstetrics • SARS patients and staff

12. What happenedSARS II ; 86 Days • NYGH outbreak on Orthopedic Unit • Complete closure of entire hospital • 117 SARS patients total; 44 of them were staff, 1 died • Created 2 SARS units (15 and 22 beds) • Opened a 23 bed SARS ICU • Created 47 negative pressure rooms

13. What we experienced

14. What we experienced-As leaders- “SARS changed my job immediately …managing SARS became my job.”

15. What we experiencedSARS 1 March 28 …the roller coaster ride begins • Knowledge changed on a hour to hour basis • Complete absence of protocols…’made things up as we went along’ • A time of ‘high emotionality’…shared by 1700 staff, 300 physicians, 500 volunteers and countless patients

16. What we experienced “You experience some really emotional times when people are working flat out with no breaks. I worked 26 days in a row and there were lots of people who did that.”

17. What we experiencedCoping with change Constant, rapid change!! • Directives

18. What we experiencedThree groups of staff • Those who became ill with SARS • Those who worked on SARS units • Those who continued to come to work during SARS

19. What we experienced “People get so caught up in caring for others, they neglected their own basic needs.”

20. What we experiencedan ever changing crisis • Fear • Exhaustion • Precautions • Work quarantine • Own staff sick • Death

21. What we experiencedAs leaders “People got emotional ; part of my job was to go around hugging people.”

22. What we experiencedIsolation & ostracism • Staff and patients • Media • Staff stigma • Rumour mill • Surreal working environment • Construction strike • Child care • Work at other hospitals • Spouses

23. What we experienced As leaders “You’re making decisions quickly with little information and knowing some decisions will come back to haunt you. But you had to do it.”

24. What we experiencedAs leaders Policies we never even imagined • Work refusals in the event of a Code Orange • Staff Redeployment process for clinical and non clinical areas • Decision making process for staff identified as surplus • Keeping staff “whole”

25. What we experiencedAs leaders “Forget about job titles, job descriptions and your box on the Org Chart …it’s all irrelevant!”

26. What we experienced Making sense of the chaos Maslow’s Hierarchy of Needs self actualization achievement affiliation safety basic needs

27. What we did

28. Extraordinary courage came from ordinary people Staff Support Personal Care

29. What we did Communication • Confusing information from Ministry, Public Health, Disaster Control made effective communication really challenging • Daily SARS staff bulletins • Hospital walk-abouts • Staff/Management Forums 2x per day; all 3 sites by teleconference • Mass telephone call out

30. What we didCommunication

31. What we didCommunication

32. What we didEmotional Support • Emotional support for staff • Staff questions and concerns • Hospital walk-abouts • EAP • Staff/Family Crisis Counselling • Spiritual Care • Staff Centre (with counsellors)

33. What we didStaff support services • Staff who are sick regardless of their symptoms • All staffing issues • Staff who are traveling during the quarantine period • Support for patients who are unable to have visitors

34. What we didStaff support services • On line groceries • On line pharmacies • Dog walking • Medication refills • Child care issues • Request for letters • Employment issues with employers other than YCH/NYGH

35. What we didBending the rules • Parking tickets • Hotel receipts • Taxi chits • Shoes

36. What we didSupport for staff who were ill • In isolation with no TV’s • Pick up newspapers, crossword puzzles, cards • Staff wrote letters • Got them email access

37. What we did; Support for staff who live alone • Grocery shopping • Dog walking • Gasoline • Eldercare support • Contact

38. What we didLearning • Physicians • Staff – clinical and otherwise • PPE • Mask Fit testing • Inform, inform, inform

39. What we didRecognition/Appreciation • Concert tickets • Gum, chocolate • Museum, art gallery, science centre • Tee-shirts • Managing public support • Wall of Appreciation • Ice cream & sandwiches • Parking was free

40. What we didRecognition (Compensation) Compensation for staff who worked in SARS affected areas of the hospital. • Compensation for management • Double the shift premium…not unionized • Violated collective agreements • SARS Compassionate Fund

41. What we didRecognition/Appreciation • All staff and all physicians • All staff who worked during the 21 day period that we were a Category 3 Facility • Staff who worked on the SARS unit during the 21 day period • Staff who missed shifts • Management • Intensivists, infection control and occupational health practitioners • Heroes

42. What we learned

43. What we learnedEmployee contact information • Up to date employee info including cell numbers • Up to date info for the Child Care Centre • Know where else your staff are working

44. What we learnedPeople • Staffing the registration area • Return to regular activity when the hospital re-opened

45. What we learned “The speed at which people found a way to handle the crisis in the absence of procedures.”

46. What we learnedCommunication • Communication is vital; the rumour mill has a life of its own • People perform better and feel less stress if they feel listened to and respected

47. What we learned “People forget to eat and sleep. In a crisis, you have to pay attention to that. It takes its toll.”

48. What we learned Mary’s lessons; people When others are experiencing stress • People perform better and feel more secure when they are well informed • Professionals are better able to do their jobs when they feel safe and well protected • People face challenge more effectively if they feel supported, practically and emotionally

49. What we experienced “During SARS, the ‘dark side’ got magnified.”

50. What we learnedMary’s lessons;people • It’s amazing what people can do in a crisis…the challenge is sustaining the kind of effort required to keep that attention and energy going • Numerous incidents of ‘caring’…restored faith in humanity • Numerous incidents of ‘not caring’; contributed to occasional feelings of cynicism • Pay attention to people’s ‘bottom rung’ needs • And when it comes to recognition, the devil is most certainly in the details