Rescuing Your Practice (continued)
Technical difficulties
Cure MD’s Hashmat believes that in
Mother Nature’s ballpark, physicians are beating the
odds. So far, few have wrestled with picking up the pieces. But
when it comes to technology, something as innocuous as a system
crash, virus attack, or talented hacker can wreak the same
havoc as a tornado.
“There was no
habit,” Beaton says of his pre-September 11 back-ups.
“I never thought in terms of natural disasters. Now
everyone here thinks about it every time we do something:
‘What happens if we lost that? How would we recover
it?’ That’s critical.”
Physicians enjoy two
main options for computer backups: buy your own server and take
responsibility for this daily routine or farm out the task to
an application service provider or ASP. An ASP is basically a
third-party entity that manages and distributes software-based
services across a wide area from a central data center. The
former fits hospitals with a large IT department, the latter
works best for individual practices, says Hashmat. This takes
one burden off your back during a stressful time—and you
can still access your database from remote locations in a safe
environment. “If you can do on-line banking, you know
software solutions have made security concerns a thing of the
past,” he adds.
If you want direct
control, then make sure to handle your back-up tape or disk
properly—which means avoiding dust and not throwing it in
your vehicle’s trunk where heat can corrupt the data,
says Iron Mountain’s Malis. Even passing by the wrong
building can demagnetize disks, which are also prone to viruses
that eat away your important files in the middle of the night.
If you choose the ASP route, select a system that backs up byte
level changes every night so that you only update that
day’s changes as opposed to wasting time and space
re-recording static patient records.
The costs for either
route are similar, according to Malis; tapes cost between $75
and $100 each while ASPs typically charge a couple hundred
dollars a month to take responsibility for up to seven
gigabytes of information, which will handle the scheduling and
billing for approximately 20,000 patient records. Offices using
electronic medical records would need hundreds of gigabytes to
back up their charts.
Beaton would now
factor where his IT providers are located into his decision;
the greater the distance, the more desirable. In his case, the
hospital billing company that handles those details was located
next door—on the same power grid and battling the same
clean-up and security issues. The computer mainframe sat across
the street from the World Trade Center. “They actually
had to send somebody in with the Marines to pull out the tapes
to reload them elsewhere about a week or so later,” he
says.
Finally, take a
practical pause and stash a few laptops away in an off-site
storage location. You’ll need these to access the saved
data, and computers represent one of the harder items to order
quickly after a disaster, Malis says, due to the sheer demand.
The human touch
Good disaster recovery plans include
employee input—even if you build it topic by topic
throughout several months of routine staff meetings.
Identifying a potential new practice spot and spelling out who
covers which responsibilities should be high on the list.
It’s also crucial to establish a communication
chain—as in you will call the office manager, who will
call the head nurse, who will call her staff and so forth. Make
sure everyone has an updated list of personal contact phone
numbers at their residences, including cell phones and pagers,
for this purpose.
When Malis worked as a
nurse in Miami, the clinic had a standing rule for hurricane
threats: half the crew went home, half stayed at the facility
and both sides understood they’d switch places—no
phone calls necessary—when the all-clear signal sounded.
But don’t’
leave your people contingencies at this paper level. Step back
quietly and evaluate your situation: If your staff
consists of young, single employees without many personal
responsibilities, chances are better they’ll stick to the
script, she says. A more mature staff with myriad family
commitments likely means you’re hearing a lot of
well-intentioned lip service in these calm times. One of
Blythe’s clients even surveyed its employees for
agreement with a business continuity plan that outlined moving
30 miles down the road. A whopping 90 percent backed the idea.
But when an emergency sparked the plans, less than 20 percent
went. “They had baby-sitting problems and school drop-off
woes,” he says.
Nor is it enough to
assure these dedicated staff members that you’ve covered
their salaries via insurance. If you can’t write a check,
that’s an empty guarantee. That’s why Malis advises
squirreling away a wad of payroll checks right next to the
extra laptops in your safe location.
You can’t
realistically expect to reach every patient with news of your
new location, hours, or procedures during the
clean-up—and frankly, whether you need to depends on your
specialty. As Malis points out, a cardiologist who treats an
older population with chronic heart problems will likely have
their symptoms exacerbated during a disaster and need care.
Plastic surgeons aren’t as much in demand. Allergists can
expect their wheezing patients to seek out an emergency care
center. “You need to be concerned with your ongoing daily
practice, how to handle the non-emergency care,” she
notes.
However, you can reach
masses via an Internet site refreshed daily. Malis suggests you
increase the odds your patients will be caught in this net by
posting a small line in your Yellow Pages ad asking people to
refer to your Web site in an emergency. Just be sure to
establish an e-mail account also where patients can leave
messages for your office. The Kentucky Medical Association adds
newspaper ads, radio spots, and direct mailings assembled from
that mailing list back-up as effective communication methods,
too. Make arrangements ahead of time to reroute physical mail
to a post office box, putting someone in charge of collecting
it once a day.
Finally, bounce your
business recovery arrangements off other physician practices
for input. Benchmark your strategies against those of large
medical facilities, and, as Blythe can attest, establish a
buddy in another part of the country willing to contact you
during a crisis to walk you through these written steps.
In the aftermath
“During the interruption, there was
a lot of denial,” says Beaton of the atmosphere after his
crisis. “It was a very isolating event—nobody
thought about the physicians who were just devastated by all
this. It’s awful to build something and have it vanish in
an instant.
“Nobody
appreciated just what a disaster this would be financially, and
even those who did said, ‘Well, it will turn around next
week, and next week.’ That’s probably true with a
lot of disasters—you don’t just turn it on and
off,” he says quietly.
But he wasn’t
alone, despite the emotions. According to Chicago-based
psychologist and organizational consultant Laurie Anderson, no
matter the cause, reactions to emergency situations typically
display five stages:
Shock:
Don’t be surprised if employees reject company
overtures at the onset. Most can’t and won’t
confront their feelings at first.
Anxiety:
Guilt, depression, and anxiety sets in, with obsessive
thinking common. Expect sleep disturbances, inertia, lethargy,
short attention spans, crying at the drop of a hat. It’s
also normal to feel detached from events, watching life as if
it’s a television show.
Anger:
Employees snap at co-workers, and sometimes pick a fight
over imagined slights.
Denial:
Staff refuses responsibility for anything connected to
the tragedy. In this stage, some employees file lawsuits and
become hostile at motivational or pep talks.
Acceptance:
Employees eventually want to get on with a normal life,
although they never forget the event.
Recognize that it’s natural for your
crew to probe deep, life-affirming questions at this time,
warns Paul Ofman, a consultant with RHR
International in New York
who serves as a leadership volunteer with the American Red
Cross. The most common: How much and where should I work to
achieve the best balance in my life? “People will and
probably should be asking themselves about their values and
priorities,” he says, “but it doesn’t
necessarily mean they will completely revise their
lifestyle.” This group, of course, includes physicians.
It’s yet another
reason, Blythe says, that “the best crisis
management program is more proactive than reactive. The
practices that have good systems in place to deal with bad
things happening are the ones that will be much more resilient
and survive.” g
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Myth Understandings
Want a real shock? Try rebuilding
after a disaster operating on these common myths about the
process:
Assume the government will cover
everything.
No doubt you can hear Adjusters
International’s vice president of sales John Marini
laughing from his office in Utica, New York. The Federal Emergency
Management Agency doesn’t
dole out dough to private businesses. Its cash stockpile goes
to get the roads open, bridges in place, and utilities back up.
The exception to the rule: bona fide 501c (3) non-profit
agencies. And even clinics that qualify still need to find 25
percent of the restoration cost as Uncle Sam caps his
involvement at 75 percent.
To add insult to
injury, even this assistance isn’t what you expect. Most
insurance policies replace something in its entirety. So if the
roof sustains hail damage, your policy buys
a entire new roof since you don’t want part of it to stand out. FEMA would only replace the damaged shingles. “FEMA isn’t
a bail-out operation; it’s a last resort to get you to the bare minimum standards,” says Marini. “No fancies.”
a entire new roof since you don’t want part of it to stand out. FEMA would only replace the damaged shingles. “FEMA isn’t
a bail-out operation; it’s a last resort to get you to the bare minimum standards,” says Marini. “No fancies.”
Yes, the government
has been known to extend low-cost loans to disaster victims,
but they’re just that: money you must return with
interest. And like any loan, you need to prove viability.
“The government has absolutely no obligation nor
inclination to clean up your property,” says Bruce
Blythe, the president and CEO of Adjusters International in
Atlanta. “If you don’t have insurance when an
earthquake hits, you’re out of luck. No one will bail you
out.”
Consider insurance companies your ally.
“We’ve all been told
we’re in good hands. Sorry my friend, we’re
not,” he says. “Their job is not to come out and
give you money—their job is to audit the claim you
present.” If this scares you, seek out an insurance
adjuster who represents the policy holder to walk you through
the process. They typically charge on a sliding scale based on
the amount you eventually claim from the insurance policy.
Besides, as Blythe chimes
in, insurance money doesn’t actually solve the problem.
It’s cash—not the actual hand-written patient
medical records scattered across the county. g
Julie
Sturgeon is a regular
contributor to UO.
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