The healthcare community's reaction to superstorm Sandy offers an example of how usually highly competitive hospital executives cooperate during times of crisis. But the federal government and an increasing number of hospitals and health systems are pushing for more cooperation among competing hospitals and systems before catastrophic events occur.
The chosen vehicle for cooperation is what the industry calls a healthcare coalition, a formal affiliation of healthcare providers and government officials who jointly prepare for and manage a region's healthcare system during a crisis. Some coalitions have been around for years—and they come in many shapes and sizes—but their development has grown this since after HHS' Office of the Assistant Secretary for Preparedness and Response recommended in its National Guidance for Healthcare System Preparedness that coalitions play a central role in regional disaster preparedness.
“The Hospital Preparedness Program is behind coalitions,” said Dr. David Marcozzi, director of National Healthcare Preparedness Programs within the Office of the ASPR. ASPR recognizes that hospitals shouldn't stand in isolation during a crisis, and participation in a coalition facilitates sharing of information and resources during a large-scale event, Marcozzi said.
It's too soon to judge how the existence of healthcare coalitions might have positively or negatively affected healthcare's response to Sandy on the East Coast, but ASPR officials will try to do that once the situation is more stable, he said.
Healthcare executives involved with some of the more established coalitions praised them for the ability to bring competitors and the government together to work toward a common goal. “I have never seen anything work as well as this has,” said Maureen Swick, chairwoman of the Northern Virginia Hospital Alliance and senior vice president and chief nurse executive of Inova Health System, Falls Church, Va. Swick, who has had previous hospital emergency response experience at a prior job in New Jersey, said the NVHA functions with the best interests of the region in mind, not the particular needs of a hospital or system in the alliance.
Cooperation and communication are key to a coalition's success, said J. Kevin Van Renan, NVHA immediate past chairman and senior vice president and administrator of operations for Mary Washington Hospital, Fredericksburg, Va. Without the engagement of the hospital executives, it will not work, he said.
MESH, an Indianapolis-based healthcare coalition, has experienced unusual levels of participation from executives who don't normally cooperate, said Chad Priest, CEO of the organization. “Indiana is a highly competitive environment,” Priest said, but there are some things you can't compete on. Patient safety is probably one and disaster preparedness is another, he said.
The NVHA was created as a response to the Sept. 11, 2001 Pentagon attack and the anthrax attacks that year, said Zachary Corrigan, NVHA executive director. Hospitals were left not knowing what was happening at the Pentagon with patients, while conflicting reports regarding anthrax also led to confusion at area hospitals, he said. “Senior executives realized that in times of crisis, they needed a mechanism that allowed them to respond as if they were part of a single organization,” he said.
Corrigan said the NVHA benefits from its approach of charging equal dues to each of its member hospitals rather than using a bed-count approach, which might give too much power to larger hospitals. “Everyone feels like they have some shared ownership,” Corrigan said.
Funding and dues are growing issues for the coalitions as congressional funding of the Hospital Preparedness Program has been falling and is expected to continue to decline. Hospital Preparedness Program funding stood at $351.6 million in fiscal 2012, which is 15% lower than the $415 million funded in fiscal 2007.
As a result, some coalitions already charge dues from members to pay for operations and are working toward a model in which they don't rely as heavily or at all on federal grant money. Officials for the Northwest Healthcare Response Network, which last week was formed from the merger of coalitions in King and Pierce counties in Washington state, are starting to make transitional plans to be less dependent on grant money, said Dr. David Grossman, chairman of the executive council for the network and medical director for population strategy at Group Health Cooperative, Seattle.
The organization also is considering a conversion to a private not-for-profit structure from its current public affiliation, which would make it easier to function without as much federal funding, said Cynthia Dold, program manager for the new network.
Regardless of their source of funding or their chosen structure, healthcare coalitions are going to continue to be emphasized by the federal government in hospital preparedness, which also is going to face quantitative evaluation by HHS, Marcozzi said. ASPR has laid out 15 preparedness capabilities it expects of the healthcare system and created ways to measure success and failure.
“Before this, preparedness had some vagueness to it,” he said. “These capabilities are the definition of success for preparedness.”