Managing Without Measuring: Why Healthcare Emergency Management Needs Performance Measures
Nicholas V. Cagliuso, Sr., PhD (c), MPH
Coordinator, Emergency Preparedness
NewYork-Presbyterian Healthcare System
New York, NY
---------------------------------------
Being an emergency preparedness coordinator for a health care system that spans four states, I am frequently asked hypothetical “what if…” questions about our ability to handle disasters. What if we have another 9/11? Are we ready? What if there is a storm more devastating than Katrina? Are we better prepared? These scenarios are always a challenge for me to answer with complete candor.
Fundamentally, we are more than ready to handle anything that comes our way. America’s 21st century medical infrastructure remains one of the best in the world, with first class clinicians and staff, top-notch institutions and billions of dollars in resources. And with the support and attention, we continue to see from the spectrum of stakeholders now involved in emergency management after two unprecedented national emergencies in the last seven years, it is safe to say that hospitals everywhere continue to improve their abilities.
But stepping back and looking at the enormity of our health care system, the reality of gauging our emergency preparedness becomes much more complex. What concerns me the most is the larger issue of what do we truly know about how we perform before, during and after emergencies? What assumptions are we making about the quality of our response? Will all of our resources and training be enough? Have we tested ourselves to be sure that we can deliver the best emergency care when it matters most? These are issues that loom large.
After years of working on these issues with members of the health care community, I believe that an essential part of our solution depends on the development of uniform, nationwide health care emergency preparedness performance measures. This effort begins with an examination of key stakeholders’ perspectives on what they believe constitutes emergency preparedness. As so many others have said, “You can’t manage what you don’t measure.” Just as other clinical and administrative health care efforts are assessed using specific metrics, we must implement a way to measure our state of preparedness. Currently there exists no way to objectively compare and analyze where we stand, leaving us in the position of relying on subjective analyses that often assume capabilities. While subjectivity drives all decisions, employing it in policy decisions requires that we measure it to define areas of agreement and disagreement. Without doing so, we’re left in an extremely dangerous position.
Emergency department (ED) professionals and quality improvement experts should strongly support emergency preparedness performance measures. Recent health care trends have gauged improvement efforts against metrics that can only be met with maximized ED operations and high quality care. We all know first-hand the value of such measures helping us identify problems, find solutions and quantify progress. As the lynchpin of emergency operations, the planning and preparation insights that can be gained from these metrics should be of particular importance to EDs.
For hospital governance boards, CEOs and senior leaders, the current inability to assess how well prepared their institutions really are to deal with disasters should cause them to take pause. In essence, they are managing without measuring. Without the tools that emergency preparedness performance measures can provide, hospitals risk failing to sustain core services when their communities need them the most. The costs of recovering from such failures are tremendous, not only financially but also reputationally and ethically.
At the end of the day, whenever and wherever the next major emergency occurs, what unfolds in EDs across the country will be a testament to our hospitals’ emergency preparedness efforts. We have the resources and the dedication to deliver the necessary help, but what remains to be seen is if this can be managed effectively and efficiently enough to provide the highest quality care to our patients. Without the help of uniform performance measures, we might never know until it’s too late.
