Planning for disaster.

Handling unforeseen -- and unwanted -- events effectively starts with thinking about what would happen if the earth caved in next door.

LUXURY HOTELS, PHARMACEUTICAL COMPANIES AND MORE REcently, fast food chains have all suffered consequences from responding to a crisis without a workable crisis plan. The middle of a crisis is not the time or place to make thoughtful, well-planned responses to unexpected events. With forethought and prior delegation of responsibilities and evaluation of courses of action, however, any crisis can be handled effectively.

Effective crisis management by long-term care facilities is getting increased attention because of the exposure health care providers face. Health care providers are particularly vulnerable when crises strike, because regulatory agencies may take punitive action if they deem a provider's response to the crisis inappropriate. Patient exposure to risk is a patient rights issue; also, when a crisis strikes, providers may be affected by jurisdiction battles among regulators.

The long-term care facility manager's role is essential in developing and implementing a crisis plan. It's imperative that sufficient quality information be obtained during the plan development process. Once the plan is designed, managers must ensure that employees are properly trained to respond and sufficiently motivated to follow the plan. A type of contingency plan, the crisis management plan anticipates the occurrence of undesirable events that have minimum to low probability. Crisis planning presumes that leadership can foresee potential adverse events and employ strategies that will secure the most favorable outcome. The primary objectives of the crisis plan are containing the crisis; reducing the risks; and utilizing "impression management" tactics.

Recently, a California nursing home facility was able to manage an overwhelming crisis safely and effectively by adapting its crisis management plan to fit the situation. A retaining wall separating the facility from an underground parking construction site collapsed. The cavity in the ground was large enough to swallow the entire facility, and part of the facility appeared to be sliding towards the hole. State and local building and safety and licensing agencies appeared on the scene simultaneously. While these agencies debated who had jurisdiction, management and staff began accomplishing their crisis duties according to the plan. Management evaluated the situation and available options, and tailored its crisis plan to fit. The facility's operating contingency plan was approved by the licensing agency and residents were permitted to remain in the facility.

The licensing agency was particularly interested in provisions to protect residents' rights. The facility had designed a procedure for interviewing each resident and documenting each person's decision to remain in the facility or to be transferred out. All of the residents chose to remain in the facility and were moved to common areas that were not in danger of structural damage. The dining and activities rooms were converted to wards, and contingency plans for meal service and the activities program went into effect. One challenge for the facility was obtaining room dividers for resident privacy in these temporary wards. Another problem was inadequate supplies of camera film and hand cranks for electric beds that could not be plugged in. The staffing plan needed to be adjusted in the interim and hand bells were provided to residents who relied heavily on call bells to acknowledge their needs. The facility also had pre-arranged transfer agreements in effect with other local nursing homes. They did not need to utilize these agreements, but the other facilities did provide supplies and staff assistance to help carry out the crisis plan.

The media did not cover this event, but administration was prepared with a current listing of FAX numbers for local television, radio and newspaper offices to transmit accurate, detailed information if the media picked up the story.

The California facility had a well-thought-out plan that helped the staff swing into smooth, effective action. A good plan deals with specific types of crises and identifies resources available for dealing with them. Written procedures provide step-by-step instruction for assessing the crisis and adapting the plan to fit the situation. Individual tasks and responsibilities are clearly described and roles are defined for all levels of personnel. A crisis official is designated for each functional unit within the organization. Documents are developed for recording information from the onset of the crisis to its conclusion. A schedule is established for testing the plan and responses are evaluated after each test.

The facility in our example used two documents, the Emergency Response Checklist and the Crisis Log, which proved to be very valuable both during and after the crisis. The checklist identified each task to be completed, from locating residents and staff to shutting off utilities and barricading danger zones. The crisis log recorded all actions taken and all communication with individuals and agencies involved in responding to the crisis. Each entry included the date, time and signature, which proved to be beneficial in settling the case after the crisis was over.

Most crises have a high potential for distortion, rumor, stress, lack of control, and increased scrutiny by the external environment. A comprehensive plan mitigates the negative consequences in those situations. Crisis planning identifies possible future threats and designs strategies with the greatest potential to deal with them. Through the planning process, managers define problematic relationships within and outside the organization and determine possible courses of action to cope with those relationships.

A key component of a comprehensive plan is the delegation of responsibilities for communication. Some basic communication guidelines are vital to managing crises effectively. Communication may do little more than cover up what has transpired if a crisis is not handled responsibly. But if the responses are appropriate and communication is not effective, the outcome may still be perceived as negative. When both the responses and communication are effective, a negative situation can be turned into a positive one.

Good communication procedures describe how inquiries are to be handled by all levels of personnel. One spokesperson is designated to represent the organization to the media and the public. When crisis strikes, that spokesperson must provide thoughtful responses -- not nervous reactions. Questions from the media and the public should be anticipated and responses should be made available in writing, using non-technical language. Throughout the crisis, a media log should be maintained, which records all information provided to the media. The information must be timely, factual and as complete as possible. If any information is being withheld to protect the personal rights of an individual, that should be acknowledged without apologies.

One trap that the spokesperson can fall into is the attempt to compare the current crisis with other incidents. The current incident should be confined to the locale where it occurred and any comparisons should be avoided. It's important to continue assessing the situation by confirming the facts, investigating rumors and analyzing expert information.

The effective management of any crisis has obvious benefits for the organization, and for the managers who successfully implement the crisis plan.

Steve Paterson is an Executive Director with Southern California Presbyterian Homes. He holds a MS degree in Health Care Management from California State University, Los Angeles.