Evolving Role of Healthcare Coalitions

Nothing has more boldly underscored the need for healthcare providers and their public health and emergency management partners to work together to prepare their communities for health emergencies than the Ebola crisis. More than 740 of these stakeholders gathered in Denver, Colorado, for the National Healthcare Coalition Preparedness Conference on 10-12 December 2014.

A National Strategy for Regional Readiness The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR) began promoting healthcare coalitions as part of a national strategy for regional healthcare readiness following Hurricane Katrina in 2005. Currently, there are nearly 500 coalitions nationwide focused on jointly preparing for emergencies that require regional health system response.

This type of cooperation is essential to prepare communities for the increasingly complex disasters they face as a result of growing interaction between the natural and built environments and public participation facilitated by the 24-hour news cycle and social media, according to keynote speaker Admiral Thad Allen (Ret.), the 23rd U.S. Coast Guard commandant. Allen served as the principal federal official for the government response to Hurricane Katrina and the national incident commander for the 2010 Deepwater Horizon oil spill.

To illustrate, Allen compared the strategies of the Ebola response to the management of the Deepwater Horizon spill. In both cases, the objectives involved stopping the threat at its source and preventing it from reaching and spreading on U.S. soil. Success requires coordination across public and private boundaries and multiple layers of government. “The reason what you’re doing is so important is you’ve already got it,” Allen told the conference attendees. “You know what has to be done to address complexity. Be tenacious and keep at it.”

This was the third annual conference hosted by the National Healthcare Coalition Resource Center (NHCRC), a collaboration formed in 2012 by the Northern Virginia Hospital Alliance, the Indianapolis-based MESH Coalition, and the Northwest Healthcare Response Network in the greater Seattle, Washington, area.

Bringing Together Stakeholders “The NHCRC was started in 2012 as an avenue for coalitions to work together to address some of the inherent challenges with convening stakeholders who are used to operating in competitive environments,” said Onora Lien, executive director of the Northwest Healthcare Response Network. “It’s been remarkable to see the program double in attendance since our first event. It is obviously meeting a need.”

Speakers from across the nation conducted sessions in Denver on topics ranging from business continuity planning to pediatric surge capacity to the role of executives in disaster recovery. Many speakers drew on personal experiences with disasters to highlight the benefits of collaboration. Jeffrey Bokser, vice president for safety, security, and emergency services at NewYork-Presbyterian, reflected on his role as incident commander for the hospital’s response to Hurricane Sandy in 2012. “As healthcare workers, it’s in our DNA to rise to the events of the day. But it’s difficult when the day turns into weeks or months,” Bokser said.

Given this reality, many coalitions are built on the premise of sharing information and resources and conducting joint planning, training, and exercises across healthcare facilities. ASPR provides general guidance for coalition structure, but each community, region, or state has flexibility to build a coalition that suits its circumstances.

“Each of the coalitions at this conference represents a unique community with a unique story of healthcare organizations and partners coming together to support one another,” said Sue Snider, executive director of the Northern Virginia Hospital Alliance.

Coalitions in Various States In Boston, Massachusetts, one impetus for bringing coalition partners together was a water-main break in 2010 that forced 2.5 million people under a boil-water order for two days. The relationships built after local healthcare organizations realized the benefits of working together served an important role the day of the Boston Marathon bombings in April 2013, when vascular and amputation kits were in short supply at some facilities and coalition mechanisms helped distribute them.

In New Mexico, where a population of only 2 million is spread across the fifth geographically largest U.S. state and many people drive more than 50 miles to access healthcare, the state’s Department of Health has spent four years developing a regional coalition structure that fits the state’s unique geographic and social context. Contractors visited each hospital in the state, encouraging them to sign memoranda of understanding to assist one another in case of emergencies like winter weather events that can disrupt supply chains.

Alfred Perez of Memorial Medical Center in Las Cruces, New Mexico, who serves as the executive chair of the state’s Region II Healthcare Coalition, said that although some people may have been reluctant to participate at first, the regional coalition structure has shown its value. “There’s that corporate wall that exists between hospitals,” Perez said. “What the coalition has done for us is break that down so we can work together.”

For many coalitions, financial sustainability is among the most daunting challenges. ASPR’s Hospital Preparedness Program is the primary source of funding for many coalition activities, including 84 percent of healthcare exercises, according to a recent survey. However, this funding is decreasing, with a 38-percent cut nationally in fiscal year 2014. Still, ASPR reported a 47 percent increase in healthcare coalition members – defined as healthcare facilities and partner organizations engaged in coalition activities – in 2013. Although applauding the growth, ASPR is encouraging coalitions to reach out to more partners, particularly home health agencies, skilled nursing facilities, and emergency medical services (EMS) providers.

James Robinson, assistant chief of operations for Denver Health EMS, has played an active part in his local coalition since planning for the Democratic National Convention held in his city in 2008. Preparing for an event of that scale required broad partnerships across the city’s law enforcement, EMS, hospital, and public health agencies to ensure the community was prepared in case of an emergency. “One of the benefits of coalitions has been to make people understand that we’re part of a healthcare ecosystem,” Robinson said.

Ongoing Opportunities to Collaborate In addition to the three hosting coalitions, more than a dozen public health, healthcare, and coalition stakeholders from around the country sit on an advisory board that directs the conference program. “Amid the context of Ebola, extreme weather events, targeted violence, and other threats, meetings like this will only become more important,” said Timothy Stephens, chief executive officer of the MESH Coalition. “Our intention is that each year we can give participants the opportunity to collaborate against the most relevant challenges.”

The fourth annual conference will be held in San Diego, California, on 2-4 December 2015. Details will be available soon at www.healthcarecoalitions.org.

Jessica Wambach Brown

Jessica Wambach Brown, M.A., is a freelance writer with years of experience in healthcare emergency preparedness, including positions at the MESH Coalition, the Northwest Healthcare Response Network, and the Department of Defense’s Center for Excellence in Disaster Management and Humanitarian Assistance. Previously, she was a reporter and editor at newspapers in Washington, Montana, and Virginia. She holds an M.A. in diplomacy and military studies from Hawai’i Pacific University and a B.A. in journalism and history from the University of Montana. She resides in the Seattle, Washington, area.



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