Curbside Consult with Dr. Jayne 8/3/20

I’ve written about business continuity planning previously. It seems like every year it becomes a germane topic as we experience tropical storms, hurricanes, wildfires, and floods across the US and around the world. Throw in a global pandemic that shuts down medical offices and curtails hospital services and you’ve created a situation where continuity planning is an absolute necessity. Did I mention cyberattacks and ransomware? These are a couple of other good reasons to go through a planning exercise if you haven’t done so already.

Business continuity planning is part of the consulting work I do, so I’m no stranger to helping organizations walk through some of the circumstances their practices might encounter. As a CMIO, people expect me to be versed in the IT side of things, and many clients are concerned with the obvious things like EHR outages, power outages, etc. Clients living in coastal areas typically have a decent hurricane / storm plan, but many organizations haven’t thought about the natural disaster aspect. One summer my little corner of the world experienced floods, tornadoes, an earthquake, and locusts, so it was a bit of a sign that we all need to think about these things.

As I’ve worked with clients on this the past couple of years, we’ve spent more time discussing cyberattacks and ransomware, as numerous healthcare organizations have been hit by this. As of the last couple of weeks I have a great new case study for this with Garmin. They were hit by an attack that disabled their services for more than a week. They claim they didn’t lose any client data from their sites, but the reality is that clients lost data because they couldn’t sync their devices with the Garmin services. Understanding the anger in the client community about exercise data from wearables should make physicians think twice about how patients would feel if their actual medical information were lost or held for ransom.

When I go through a business continuity planning exercise with a client, I usually include a discussion of what it would look like if key human resources became unavailable. For example, what would happen if the CEO or COO departed the organization? Do others have signatory or contracting authority, and how would day-to-day operations run? For smaller practices, what is their plan if they lose a key biller or scheduler? Most of the time we’re focused on the operational and financial side of the house, with a brief but general discussion on the clinical side.

The clinical side of business continuity planning certainly came into focus earlier this year with COVID-19, as practices shifted to a telemedicine models and looked for new technologies to be able to safely reopen their patient care operations. I added a couple of different dimensions to my client-facing materials based on those experiences and they’ve been well received by organizations I’ve worked with. Still, I was thinking in more broad strokes about how organizations might be impacted if they can’t see patients and looking at it from a macro level.

Unfortunately, this week I had to think about it from a micro level, as my practice suddenly lost one of our full-time providers. Since I’m just a worker bee at my brick-and-mortar practice, I’ve never been privy to their business continuity planning and didn’t worry about it too much since my clinical work isn’t my main source of support. One would think that in the event of the loss of a provider, they could use the same checklists they might use when a provider quits or retires. It quickly became apparently, however, that they either didn’t have such checklists or were so overwhelmed by grief that they hadn’t worked through the process.

My involvement started when one of the nurse practitioners called me, as the most senior physician working at the time, asking what to do about the fact that the EHR was still putting my late partner’s DEA number on her prescriptions. Pharmacies in our area have an issue with NPs who write controlled substances and often ask for the supervising provider’s information as well, so we’ve added that to our prescriptions. I’m not sure if it’s custom code with our EHR vendor or a feature that they offer, but it’s how we roll. This was three days after his passing, so I can only guess that the other midlevel providers for whom he was the collaborating physician either didn’t write any controlled substances prescriptions in those days or didn’t think about what went out on the script since it hadn’t yet been addressed. In the short term, I supervised the NP for the prescription in question so the patient could be managed, but it made me wonder about the plan.

I also had the unique experience of staffing my late partner’s primary practice location, where our staffers had created a temporary memorial with flowers, photos, candles, and other tokens representing his personality. I’m not sure the organization had thought about how that would impact patients or the staff working at the location, since many patients had questions about the memorial and what had happened that our employees were unprepared to field. I was surprised by one particular patient who hounded me for details. I learned later that she had already posed the same questions to the receptionist and the nurse, but wasn’t deterred by their comments about the situation. Having to constantly respond to questions certainly weighed on the staff throughout the day.

As someone who has led other organizations, part of me wanted to go ahead and raise the question to leadership about the handling of the memorial and potential word tracks for staff, but didn’t want any inquiry to be seen as interfering with our practice’s collective grief. Knowing there are often no good answers to these issues, I opted to say nothing and let the organization figure it out. It felt like a bit of a cop out since usually I’m one to tackle problems head on, but maybe it was part of my own grief reaction. It was hard enough to get through the day with his presence all around us, and after a long day of COVID patients, I was ready to let it go.

It also served to illustrate something I’ve acutely questioned this year, the idea of “who cares for the caregivers?” Most of us are getting burned out and certainly all of us are tired, and the worst part is we know that there is no end in sight. My colleagues who have been in military operations have had the best advice for coping, but I’m concerned that this recent loss will put some of our team over the edge.

I hope sharing this story encourages organizations who may not have thought about these issues to add them to your to-do list, because it’s only a matter of time before a similar loss might impact them. If you haven’t done business continuity planning, you need to do it now. If you’ve already done it, take a moment to look at your plan to see how your organization plans to handle the loss of key staffers and consider how co-workers and the community might be impacted by such a loss. Having a plan and implementing it during stressful times certainly beats feeling like everything is swirling around you.

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