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Darcy Grabenstein: Hello, from SmartLinx Solutions! In today's podcast, we'll discuss not only disaster preparedness but recovering from a disaster as well. Our expert today is Patrick Hardy, President and CEO of Hytropy.com, one of the leading disaster management companies in senior care. A certified emergency manager and certified risk manager, he has extensive experience working with facilities from coast to coast in the public, private, and non-profit sectors in disaster management, from microbusinesses to Fortune 500 companies.
Patrick's background is steeped in emergency preparedness. He was the Senior Consultant to the Chief of Staff at the Governor's Office of Homeland Security in Louisiana, and has also been a visiting disaster instructor to the National EMS Academy, writing the chapters on disaster preparedness, terrorism, and weapons of mass destruction for the new advanced Emergency Medical Technical textbook for use in the U.S. national curriculum. In the summer of 2012, he became the first small business owner ever to be selected as the National Private Sector Representative to the Federal Emergency Management Agency, FEMA, spending three months in Washington, DC. Welcome, Patrick.
Patrick Hardy: Thank you very much for having me today.
DG: Our pleasure. Before we get into today's topics, could you tell us briefly about the services that Hytropy offers? I also see you have many acronyms after your name ― LLC, CEM, CRM, PEM ― what do those represent?
PH: Well, they represent a lot of lost Saturdays and Sundays where I was actually studying for tests and exams and things instead of going out! My company is a full-service disaster management company. We take on disaster programs holistically. We write disaster plans, we train staff, we help run drills, we'd write the reports afterwards, and we have a 24-hour center that can assist them at any time if they actually incur a disaster, and then we actually maintain disaster programs over the long run; we do that on a monthly basis to ensure that everybody's program is taken care of and that it always stays newly minted and up to date.
The different acronyms ― it's interesting because some of them are professional emergency managers certifications, so the CEM is Certified Emergency Manager and the CRM is the Certified Risk Manager that I completed, and then the PM is the Professional Emergency Manager. The LLM is the Master of Laws that I received. I studied law in Great Britain, and so I have a master's degree in law from England.
DG: Oh, interesting. Got it. When I'm thinking about your services, to me it's kind of like an insurance policy. It's something that you know you need but you hope you never have to use it. Would you say that's a fair comparison?
PH: I think on some level that's accurate because a lot of people see insurance as something that they absolutely don't want to have to worry about or think about, but whenever you absolutely need it, then they feel like they're glad to have it. I think that we have to be careful not to place too close of an analogy because when you think about insurance, it's more of a financing of losses. When you have experienced a loss, whether through a disaster or through whatever else, it's one of those things where the financing helps to bring you back to zero. It brings you back; it tries to make you whole as to where you were before. Where emergency preparedness actually says we try to keep you from going below that point.
What we try and do is we actually help to keep you as to where you were at a point of normalcy as before the incident. It's really access to a loss-control mechanism, and it kind of gives people the tools to act if there's an emergency, so they don't have to worry about thinking about who's going to be in charge, what's going to happen, how are these things going to occur, and provide some sort of management and strategy that they can implement if there is an incident of some kind at the facility, whereas insurance simply acts as a financing of losses where that's very predictable.
DG: Patrick, I have to ask you this. I see that you've been involved with the U.S. Chess Federation.
PH: Was, yes.
DG: Chess is all about strategy. How do you apply that strategic thinking that you've developed from chess to helping clients with disaster plans and training?
PH: You know, famed chess master Garry Kasparov once said that he could only think six moves ahead; that was the most he could ever do. He went up against an opponent, it was actually against a computer, Deep Blue, which was the IBM supercomputer, and that computer could think 100 billion ― billion with a b ― moves ahead, and he only lost by one match. All the other ones he tied with the computer, and the computer is able to think so far ahead.
One of the things that was interesting was in the beginning they thought he was going to lose these matches 8-0 because the computer could think so far ahead, but what he told people afterwards was he said it can think ahead just because it's doing it by brute force. It literally is looking at every conceivable move and counter move; logically or illogically, it would look at them all. He looked at patterns.
What I try to tell people is when you're in a disaster, you need to have a unified program from top to bottom. Your plans need to flow neatly into your training. They need to flow neatly from your training to your drills, and your drills to what you maintain and what you update. Those are patterns that will allow you to create a measure of predictability if an incident were to occur because there's a lot of instances where the senior administrators will not be on site.
What I tell facilities is I say, in your disaster plans don't try to look at it blow by blow ― first we're going to turn the water off, and then we're going to move Mrs. Jones in the hallway. No. I say to them, “Look at patterns holistically. Who do you have to move? What do you have to do? Have you drilled that out? Has everyone been trained to do that?” If you haven't, then people are not going to see the patterns. People are not going to be able to see far enough ahead to be effective in an emergency.
I think chess is very instructive because there's so many possibilities in real life for anything to happen, even something as simple as that, which is why you have to give people the management, the tools, the unifying procedures from planning, to training, to drills. If you line those all the way up, you give people a very clear path and a very clear pattern that they can follow regardless of whatever the emergency is, whether it's an active shooter, a hurricane, or something else. That's really what I try to hammer into people, is that if you have a unified program, that's what's going to allow you to move forward.
DG: That makes sense. I know that Hytropy serves a wide range of industries, from healthcare, to sports venues, and everything in between. How would you say your approach for long-term care differs from other industries, or does it?
PH: It does because the regulations for healthcare are really heavy. You have to really be able to recognize all the regulations in place, be able to accurately interpret them, and then accurately implement them, accurately have people trained on them, and then accurately have people drill on those things. That's what's really different.
When I'm writing a disaster program ― I don't say the word “plan,” I mean “program,” meaning planning, training, drills, all that. When you put all those together, they not only have to be operationally ready ― in other words, they not only actually have to work in a real disaster, but they have to meet strict regulatory compliance. When I write a disaster plan, for let's say a restaurant ― I do a lot of work with restaurants all over the country ― as I do those disaster plans, there are things that we know are best practices. There's things that we know based on patterns, things that we've seen over time with restaurants, things that we know are going to work well, things we know are not going to work so well, and we implement them. It's always a trial and error, so you're just going to put it out there.
With healthcare, it's very different because not only is there a predictability problem, because every facility seems to be very different, but the other problem, too, is every state has its own regulations. The federal government has regulations. If you're in certain large municipalities, they have regulations. There are counties that have different regulations. All these things have to line up. Sometimes they're with the VA. Sometimes there's OSHA issues. All those things have to line up, so we have to be very careful.
The main difference, I would say, is this. We have to constantly be looking at the regulations because not only could the letter of the regulation change, but actually the interpretation of the regulation can change over time. Disaster is one of the reasons ― when people say, “Well, wherever there's a disaster there must be increased interest” ― there is increased interest because what the compliance officers see is they see what didn't work well. They say, “Well, then, clearly we need to reinterpret the regulations so that they actually work.” That's why they get stricter or they get looser based upon whatever disaster and whatever experiences that they've seen.
DG: I'd like to expand a little bit about regulatory compliance. Are there certain components that healthcare facilities must have in place, maybe in terms from a federal level, in terms of disaster preparedness, in order to maintain compliance?
PH: Unequivocally so, yes. I really put it into three boxes: plans, training, and drills. Plans-wise, plans are interesting because when I go to a lot of facilities who say, "Hey, I've got a wonderful disaster plan.; it's beautiful; it's in place," I look at it and a lot of times it has really similar elements to it, which is it covers the emergency preparedness portion of it. It says if we have a hurricane, pull out the weather radio, stick the batteries in it, start to listen, and then take people to nurses’ stations, yada, yada, yada. What the regulations have now said is that your emergency preparedness plan, that part of it, has to be much more sophisticated and rich. It has to be all hazards, which means that your plan can't just be a "hurricane plan," or a "tornado plan," or an "earthquake plan." It has to be a holistic plan. That's the first thing.
The second part of your plans that are important are not only the response element, but also the recovery element, so actually making sure, can your pharmacy recover after an incident of some kind? How long is it going to take to bring people back to the facility? What procedures do you have to go through? Can your kitchen be reopened? Under what conditions would your kitchen not be able to be reopened? How long will it take to reopen these things? These are questions that now CMS [Centers for Medicare & Medicaid Services] wants to have answered ― states, too ― which is they want to know, OK, that sounds good; you've taken care of the evacuation portion, but hey, you know you have to come back into business; this is where people live. How long you going to be gone? What do you anticipate? How long is it going to take to fix these things?
You'll get facilities that have great emergency response plans, and then they'll have vendor plans where they'll say things like this: "Well, you know, my local pharmacy, they'll take care of everything, and they'll make sure that we have all the meds that we need. They said that they'll be there with a big ol' truck and bring everything out there." Then you'll call the pharmacy, and the pharmacy will tell you, "Well, we don't plan on doing that at all. There's just only three of us. I'm in the middle of nowhere. If I have an incident, my people evacuate, we're not coming back for a long time. It'll be weeks before we come back." That's an incongruity. Those are the things that we have to solve.
Training-wise, training has to now be within a reasonable period of time after hire and has to be every year. It can't just be simply saying, "Well, we're going to train you on a couple modules" and that's it. No, it has to be kinesthetic; it has to be workable. People have to know what's going on because CMS can now quiz them. CMS will literally walk up to a random employee and ask them questions, and if they cannot answer those questions, that can be considered a deficiency for them.
The last thing is drills and exercises. They have to run a tabletop exercise every year, which is exactly the way it's described, which is you basically game-out a disaster. You actually talk out the procedures, policies, and the way things work over a tabletop with a given scenario. The other one is a large, full-scale exercise, which is actually activation of people, moving people around, pulling equipment out, making sure you practice with the residents, things like that. There's a lot of different elements to it, and it's become much more rigorous. Again, it's about a holistic program. If you have that holistic program in place, then everything seems to line up and you get a level of sophistication that you wouldn't have had previously.
DG: I know we were talking more in general, but I'm going to get a little specific. In the wake of last year's hurricanes, Harvey and Irma, in which, as we know, many long-term care facilities in Texas and Florida were really hard hit. There's a bill on the Florida legislature that would, among other things for instance, require nursing homes to have alternative sources of energy capable of heating, cooling, and venting a building for at least four days in case of an emergency. Given that, have you seen an increase in requests for hurricane preparedness assistance? Could you share, maybe, some tips that long-term care facilities, or any organization for that matter, could implement in order to be ahead of the game when it comes to a hurricane?
PH: Yes, and the one thing that I will say that I see with a lot of programs is that they set up their drills and their exercises, things like that, as if they're these cardboard paragons of normalcy. They really practice these things out time and time and again. It almost becomes theatrical. Everybody knows, OK, you're going to pull everybody to the hallway; then they're going to say "evacuate"; you're going to move into 300 hall; then they're going to place them there; then we wait 5 minutes — we hope maybe it's a little longer so we get a little de facto break — and then that's it. Then we bring everybody back in their rooms and that's done. That doesn't create a layer of predictability that would be effective in a real incident. It's almost like a cardboard cutout of what people think a real incident is going to look like when, in fact, that's not what it looks like at all.
I have seen requests for a lot of different kinds of preparedness equipment because every year, as hurricane season approaches, you start to see public service announcements, and you start to see celebrities starting to talk to people about, OK, go ahead and make sure you have your equipment ready, and you have your flashlights ready. I tell people that's all fine, and that's wonderful and important, but don't get stuck with the wonder weapons because the wonder weapons aren't going to help you. If you don't have effective leadership, if you don't have people who have been trained, if you don't have people who have been through drills — realistic hurricane drills where you have people laying on the ground. When you have big problems, people have to be screaming, lights have to be going off. I mean, you have to do the real thing.
If you make it so that it's almost like Shakespeare, then you're wasting everybody's time because everybody knows now we go to stage left, now we do this, and now we say these things, and then we say, “All clear!” and then we all go back to our rooms and wish we didn't have to do these things. If you lay it out and you actually create an unpredictable environment, that's what real life is going to be like in a real incident. That's what I would tell people, which is if you make it so predictable that everybody knows exactly what to do, you are ill-preparing yourself for the real thing.
DG: I'm going to ask you the same question in terms of earthquakes or fire, or flooding as we've seen recently in California. Again, are there any basic guidelines that facilities should follow to prevent injuries and casualties in those incidences?
PH: Yeah, it's really interesting because fires, and massive flooding and earthquakes — because of what we see in the movies and because of its very visual appeal, it kind of lives as a phobic niche in our psyche, where it's this great fear that we're going to have this massive flood that's going to destroy everything. That's not terribly realistic. What you do see, though, is you see moderate incidents where people are ill-prepared to handle them, and it's because people have not been trained in one critical element of a disaster program, and that is leadership.
In a real disaster, in a real incident where life and death is at stake, ordinary employees are going to be trusted to resolve these complex, operational and strategic questions that are going to be done in the absence of normal leadership. The administrator may not be there. The Don may not be there. The head of maintenance may not be there. They may be gone; they may be injured. That has happened many times. If they're gone, somebody has to not only fill the leadership vacuum, but has to ensure that the facility continues running in their absence as the way it's supposed to be done and, on top of it, has to activate this big binder of a disaster plan. They have to know where to open it, what to do with it, and do all that stuff. If you don't train people in how to lead and do those things, then everything you've done, that beautiful big disaster plan you have, is going to go now to waste because you haven't trained people on the abstract things that represent what a real disaster is going to look and feel like. If you haven't done that, then people are just going to be ill-prepared.
DG: Those are really good points. I mean, if you don't have the training, you could be out of luck because your disaster plan could be ruined in whatever the natural disaster is. You may not have access to it.
PH: That's absolutely right. On top of it, if you have a massive fire, people aren't going to say, "Well, gee, let's go ahead and find the binder. I wonder what I should do first." If you have an active shooter, people aren't going to say, "Well, gee, I wonder where that big white binder is. Let's go and look at that, and figure out what we need to do." Everybody knows you're going to have to run, hide, fight, and then you call 911, and then you start moving, but then there's a lot of complex tasks that are going to take place over the next hours and days, things that may seem unimportant and may seem subtle, but in the long run will have a massive impact on your workforce and on the ability of your facility to reopen. It's just really incredible to me.
DG: Sure, and when you were talking about fire it reminds me of – it's like taking it to the next level, but in the workplace you have a fire captain for each department. It's that leadership; you're right. It's all about the leadership.
PH: What I've done a few times is in offices where people were the fire captains and they said, "OK, we want to show you our fire drill." I say, "OK, that sounds good." Then they set up their fire drill and I say, "Who's your fire captain?" Then they say, "It's so-and-so," and I say, "OK, sounds good." Then in the middle of the fire drill, I turn to that person and say, "By the way, you've now been injured by the fire, and you can't tell anybody, but you've been burned." I do that on a couple of different floors, and I see how people react because people are like, "Where's so-and-so? They're the fire captain!" and they don't know what to do because they were so used to that.
DG: Right, so you need a Plan B.
PH: Right because the usual person who is playing that Shakespearean role all of a sudden isn't there, so now we have to have an understudy — to sort of keep the analogy up — so it's kind of an interesting leadership flux where you have to keep throwing wrenches into your gears. If you keep doing that, you're going to be in a position where people are going to realize, OK, we clearly have to do more training; we clearly have to train people on different elements of this program. Otherwise, you're just relying on a small handful of people to do everything, and that's just not realistic.
DG: I know you were saying that you have to make the training as unpredictable as possible, I guess, because you don't know how you're going to react in the situation until you're in it. I guess if you can just closely mimic that, you'll definitely have more success.
DG: Your website is called ReverseDisaster.com. Would you say that the bulk of your services are focused on helping organizations before disaster strikes? How do you also help them recover? Because I think that's a big issue.
PH: It's a huge issue, and because of the nature of disaster preparedness, it's all about preparing people. That's all about prior to the emergency, but we do give a lot of help during the disaster and afterwards because what we've told people, because we're full-service — we're not consultants; we don't get paid by the hour or anything like that. We turn to people and say, "If you have an emergency, you can call us 24 hours a day, 7 days a week. You can speak to a real person, and they will help walk you through the emergency. You can say, 'We're doing this, we're doing this, but frankly we're stumped. We don't know what to do next.'"
What the people who answer those phones are instructed to do is not to give answers, actually. They've been told not to give them any answers. Instead, they're told to ask really critical questions, things that will get them to think through their own answers. We're not there; we're not standing there; we don't know what's really going on. They say, "Well, we've been flooded." Well, how? There's no way for us to physically see it, so we'll turn to them and say instead, "Have you thought about this? Have you thought about that? Have you thought about trying these things?" And that helps to jog their memory a little bit as they walk them through the plan. We actually make sure that we do that; that's part of our service commitment, is making sure that people understand that we're not just there when everything is fine and we have to prepare. We're there if you have an emergency and you need somebody, we are your partners, and we're going to be there, and we're committed to you over the long run.
We had a call once. It was about 5:30 in the morning or so, and it came from a school. We do a lot of charter schools and other types of public schools around the country. They called in the middle of the night and said, "We have a massive emergency. We're activating our disaster plan." We thought, well, maybe it's a tornado, or maybe it's a flood or something. The principal gets on the line and says, "We've had this massive disaster and we can't do anything about it." We said, "What was it? What happened?" They said, "The entire school is covered in grasshoppers." The entire school.
DG: What?! It sounds like a plague!
PH: It did! It sounded like a plague, and I couldn't believe it. What they basically had was one of those weird — sometimes it happens where there's these weird insect migrations, and what happened was the grasshoppers basically swarmed, and the entire school was covered in these insects, just covered with them. They said, "Obviously there's nothing in our disaster plan that talks about this! What do we do?!"
DG: What did you tell them?
PH: I don't remember exactly what we said. I read the report a little bit where we basically gave them ideas: Have you thought about calling these people? Have you thought about calling the Department of Agriculture, because the Department of Agriculture has Insect Response Teams, and they'll give you answers. Have you thought about calling this phone number? This is a hotline that they have to help you. They're trying to get this whole thing done because they want to get the school day done.
They said if you can't come to school, then — if the other thing you need to be activating at the same time, which is why planning is so important because you can't just do this off the top of your head. You need to think through. If you can't open the school, you have to call another school and say, if the kids can't come to this school, then they got to be bused somewhere else because you clearly don't want kids busing directly to your school. You don't want people showing up. This was early enough in the morning where the kids hadn't shown up yet. They were trying to figure it all out. It's interesting because it's all about solutions; it's all about the unpredictability of it. It's nice for us because it gives us a chance to say, "Yeah, we haven't heard of that either, but I'll tell you what, if it ever happens again, we certainly know what to do from here."
DG: Thank you so much, Patrick, for sharing your expertise with us today. To all our listeners, thank you for tuning in. For more information on Hytropy and its services, visit ReverseDisaster.com. If you'd like to learn more about SmartLinx Solutions and our fully integrated suite of workforce management solutions, visit us online at SmartLinxSolutions.com.