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September 21, 2018

Inside Hurricane Florence's wrath: The remarkable story of how CarolinaEast weathered the storm

Daily Briefing

    By Jackie Kimmell, Senior Analyst

    Hurricane Florence may be over as an 'event,' but hospitals in its wake are just now beginning to deal with the storm's flooding, devastation, service disruption, and impact on employees.

    To get a firsthand look into how one hospital prepared to weather the storm, and how it's facing the aftermath, Advisory Board's Chief Nursing Officer Carol Boston-Fleischhauer spoke with Rosanne Leahy, the Chief Nursing Officer and Vice President of CarolinaEast Medical Center. CarolinaEast is a 350-bed hospital in New Bern, North Carolina with over 2,500 employees, and 316 physicians on staff.

    Rosanne Leahy, Chief Nursing Officer and Vice President, CarolinaEast Health System

    Carol Boston-Fleischhauer: Rosanne, thank you so much for speaking with me today. Considering CarolinaEast is located in a hurricane-prone zone, I'm sure you already had some sort of plan in place for Florence in advance. I'm curious as to what the plan’s key elements were, and what was unique this time around.

    Rosanne Leahy: Anytime we see a hurricane heading our way, we activate our incident command center. Our decision to do so this time was made much earlier than we normally do. Hurricanes tend to be fickle storms and they often don't land where predicted. However, this one was so large, landmass-wise, that both our hospital and the whole community felt that no matter where it landed along the East Coast, we were going to be hit, and hit hard.

    Ordinarily we prepare for two to three days of service disruption. In this case, we ordered over a week's worth of supplies and pharmaceuticals during the week prior to the hurricane, and set up a variety of contingency staffing plans.

    We also had to create safe places for staff to board, which was no easy feat.  We not only boarded over 300 employees for almost a week, but we were also asked to board two dozen police officers from our local department because their building was expected to flood (and, in fact, did). Honestly, we were happy to have them, but doing so required some unique logistics, and we ultimately decided to have them board in our rehab hospital conference room. We took in scores of respite patients who couldn't survive on their own and who had medical needs beyond a shelter’s capacity to manage.

    Boston-Fleischhauer: So you evolved into the central repository for any and all types of health care needs in your community?

    Leahy: Well, we certainly were the pointy end of the spear there, I guess. We also kept our cafeteria open round-the-clock to all first responders, visitors, and staff.

    “One of the biggest challenges we faced was continuing to board employees and visitors for such a long period of time.”

    Boston-Fleischhauer: Any challenges with your disaster plan as you went through the hurricane?

    Leahy: You know, frankly one of the biggest challenges we faced was continuing to board employees and visitors for such a long period of time. We needed every cot, air mattress, and recliner we could get our hands on to ensure people could get some decent rest, and of course, the need for clean uniforms and laundry, showers, and other basic hygiene necessities to keep everyone as comfortable as possible.  Mind you, we had hundreds of folks here who weren't prepared to stay for a week, so we had to get pretty creative in meeting everyone's needs as best as we could.

    Another issue was supporting our renal patients. While we have an inpatient dialysis unit, the privately owned outpatient unit closed and the staff evacuated.  We ended up setting up a separate ED triage for dialysis patients and did over 60 treatments on the first day in either our inpatient unit or as portables set up in our ICU. Another big issue was medications. We almost ran out of, of all things, Keflex. So we had to courier some in with help from the closest tertiary care center, but we managed.   Other than that, I don't know what we could have planned for Florence any better than we did.

    Boston-Fleischhauer: You developed staff contingency plans that required staff to work, despite what was happening in the community and to their own homes.  What did you ask of your employees in terms of work?

    Leahy:  Well, we asked our employees to give pretty much anything they could. In these situations, what we say to our staff is: "You have to be at work—at least for the shifts that you have been scheduled for." Now, for some of our staff, this was their first time experiencing this type of crisis situation. I had many young staff say, "Well there's a mandatory evacuation in our community, so how can I come to work?" I had to respond, "Well that doesn't apply to first responders and essential health personnel." Ultimately, we told people, "Look, we need you to be at work for your shift.  If you can go home and get back safely for your next shift, that's great. But if you can't, we'll find a place for you to stay right here because we need you and our patients need you." 

    And like I said, we did find places for them—on air mattresses, cots, recliners, even patient beds. We condensed two units to better utilize the staff that were here. We've allowed staff to leave when they were able to, but we still have staff here today and others who don't even have homes to go to. I don't really foresee moving them out in the near future. How can I?

    Boston-Fleischhauer: In the moment, how did you support the staff members who were working, while at the same time their homes were in danger and their families were displaced?

    “In the middle of the storm you're not doing your normal "executive" job.”

    Leahy: Well, that was our job as the senior leadership team.  We were out there with everyone constantly. Honestly, in the middle of the storm you're not doing your normal "executive" job. You're not holding meetings; you aren't participating in quality improvement projects, nor discussing strategy. Instead, you're just rounding constantly and seeing what the staff need (not only in supporting patient care, but also personally). I'm talking hugs, lots of pats on the backs, and drying a lot of tears.

    Boston-Fleischhauer: Roseanne, you paint a picture of incredible challenges during the height of the storm. Any bright moments to offset the dark ones?

    Leahy: Too many to count. At some point, I will need to gather all of these moments of heroism for everyone to celebrate.

    One example: I was at dinner one night and I had a visitor from out of town sitting next to me in the cafeteria. When we were getting food, I was asked what I wanted to eat—by the manager of our rehab hospital of all people! I thanked her for doing what she was doing, serving in the cafeteria, and she said "Oh gosh, we're having a blast." And the visitor said, "You're a manager, and you're serving food?" At which point I smiled and said "Ma'am, let me introduce you, this is the manager of our rehab hospital, this is the director of health information systems, and this is, and this is…." None of these people worked in the dining department, but were all working together to ensure that the staff, visitors, and everyone were being fed.

    “We had physicians, educators, managers and imaging techs delivering food trays to patients.”

    It goes on. We had physicians, educators, managers and imaging techs delivering food trays to patients. We had members of our leadership team doing laundry in our Rehab Hospital and Behavioral Health Unit. There were a million of these kind of stories. That's what incredible human kindness is all about.

    Boston-Fleischhauer: I'm sure you could, if you haven't already, create a hero board to showcase all of those examples.

    Leahy: Oh yeah, we have to do that just to capture all of them. It was phenomenal to watch.

    Boston-Fleischhauer: During the height of the storm, how were patients and patient's families responding to all of this?

    Leahy: I would say that 99% were wonderful. Everyone knew we were doing whatever we could.  For example, there was a wing where we had water seeping in around the windows—not blowing in, mind you—but nonetheless, the windows and sills were getting wet. We were trying to find places to move those patients. Most of the patients said, "If I was home, I would be dealing with this too. Just put a towel over it, we're fine." You know, there's always the exception, but most of them were great. And remember, we also had scores of patients' visitors that were with us for almost a week as well.

    Boston-Fleischhauer: Is that right? The family members and visitors of patients couldn't go out either?

    Leahy: That's right. They were all camped out in patient rooms and waiting rooms and we did the best we could to board them, just like everyone else.  

    Boston-Fleischhauer: What's your take on how staff were able to balance the needs of their jobs with everything going on personally with them?

    Leahy: I think that when staff are working, especially through an experience like this, it's just really hard, tiring work. It's especially hard without the infrastructure and support systems we're typically used to (including things as basic as transporters, housekeepers, and the like). While it sounds great to say that everyone on staff should stay, you don't really have the resources to house and feed all 2,500 hospital employees, so everyone can't stay. As a result, those that are here are working really hard, because they are supporting the work of those that aren't there as well. Job descriptions go out the window—available personnel just have to do whatever is needed to get the job done.

    I believe our staff got through the pressure of the actual hurricane because they really trust the people they work with. I know a lot is said about the power of teamwork, but I have to tell you, the teamwork our leadership team observed was absolutely amazing. People working very hard together, under extraordinary circumstances, and still finding time to think of something fun and silly to say to break the tension. Everyone had different hashtags to lighten the moment like, '#Go CarolinaEast' or '#CarolinaEast Goes with the ‘Flo'—little things like that to ease the stress.

    Boston-Fleischhauer: As I'm listening to this, I'm recalling that I recently (back in August) worked with your management team to discuss how to rebuild the resiliency of your workforce. In that research, we emphasize how important it is to support staff after a major event to avoid long-term consequences. Here, you have a 2,500 employees and physicians that are reeling. So now, in the aftermath of the storm, what does staff recovery look like?

    “Okay the emergency is now behind us. What must we do now to help our people?”

    Leahy: Well that's most of the work the admin team has been preparing for over the last two days. We've been saying, "Okay the emergency is now behind us. What must we do now to help our people?"

    There are some steps we've immediately taken. We decided, for instance, that we will pay employees from their first shift of the storm through Monday at 7a.m. Our usual practice is that we don't pay employees while they sleep, but we recognized that this one was going to be an unprecedented event, and we anticipate we'll have many employees who are going to be hurting financially (in particular, with the loss of their homes or substantial damage to them). So that was an immediate way to put some money in their pockets, and to help to mitigate that understandable stress.

    We have other strategies that we are contemplating as well—that we'll soon be announcing—which are all are intended to signal to staff, "We know you are hurting, and we are going to do whatever we can to help you through this."

    Boston-Fleischhauer: So, you are helping your employees be strong as employees, while also recognizing that they are hurricane victims as well.

    Leahy: That's right. We are treating staff that way, but we are also treating ourselves, as leaders, that way. We had one member of our senior leadership team who, even the day after the storm, had to be evacuated from their home, and two other executives who have had substantial damage to their homes, making them inhabitable.

    The damage isn't about rank or income. I mean, we have several physicians who lost their homes as well. The difficulty is that it's economically more profound for people with fewer resources and those are the ones we are particularly trying to help.

    Boston-Fleischhauer: I was going to ask, "I wonder when you'll get back to normal," but maybe the question is, "what will your new normal look like?"

    Leahy: I would liken this experience to what Eastern North Carolina went through with Hurricane Floyd a few years ago. That wasn't a very impressive hurricane, but it caused catastrophic flooding and we had staff who were dealing with the aftermath for months. Hurricane Florence, as I'm sure you've seen on the news, is a whole different animal.  We continue to get rain days after the storm, intensifying current and future flooding concerns. I’m afraid this will take years to return to 'normal’.

    Boston-Fleischhauer: How is the ED holding up?

    Leahy: Well, after a hurricane, we always have things like chain saw accidents. You know, someone is up on a ladder and they only use their chain saw once every few years. We've had broken backs from falling off ladders and roofs. And we've had some infections; I anticipate we will see more. Unfortunately, we've also seen some drownings, which I fear may continue until the flooding is under control. On a rather somber note, just this morning we had to discuss as a leadership team whether we needed to expand our morgue capacity. Certainly, when you're worried about finding enough morgue space, it's been a bad week.

    “I slept at home for the first time [in a week] last night”

    Boston-Fleischhauer:   To clarify, your leadership team has been here all week?

    Leahy: Yes, I slept at home for the first time last night. We've had two people in our leadership team who haven't been able to go home at all yet, because the roads to their homes aren't passable.  

    Boston-Fleischhauer:  You know, there's an old adage that suggests 'leadership' is all about being visible and physically present. It sounds like your team has had a full-out effort to do just that.

    Leahy:  You know, so many people have said to me, to Ray Leggett (our CEO), and to all of our executives, "Thank you for being here." It's funny—it's not like we haven't been "there" in the past, but I think we upped our visibility. I think that leadership is not just about being in the building but also visibly present with the staff—and wearing jeans and flip flops and sleeping on an air mattress too. It makes a real difference; not just for crises like what we are going through with Hurricane Florence, but as we continue moving forward as well.

    Boston-Fleischhauer: What a lesson to take away from all of this.

    Leahy: Yes, along with lots of other lessons that I will need to take stock of down the line. I'm grateful that our physical facilities remained solid and our staff remained safe during the height of the hurricane. As leaders, our new challenge is to support our community and the resiliency of staff as the phases of recovery and rebuilding begin.

    From hurricanes to shootings: How can hospitals prepare for disasters?

    Hospitals must be prepared for myriad disasters that can stress health care systems to the breaking point and disrupt delivery of vital health care services.

    Advisory Board has compiled step-by-step procedures for various threats your facility may encounter—though we hope you'll never need to use them.

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