Learning the lessons of Ebola as events continue to unfold
In years to come, Ebola’s impact on Texas Health Presbyterian Hospital Dallas will likely become a riskmanagement classic. Business cases will be written and studied at universities akin to how a pathologist performs an autopsy to learn what went wrong and the pathway through which the destruction occurred.
However, we are still in the early stages of these events and many other hospitals could find themselves dealing with similar circumstances. We cannot wait for historians to do their analysis. We need to learn all we can as it unfolds.
Everyone recognizes that Ebola represents a global human tragedy. The only reason that the financial implications on healthcare institutions are important is that they have a critical role in helping people and they are vital economic engines in their communities.
Much has been written about how the Ebola virus kills a previously healthy person. The virus produces proteins that block immune cells from signaling antibodies to attack as well as preventing development of adaptive immunity. Infected individuals experience multiorgan failure, terminal bleeding and ultimately death. Understanding this process is important in learning how to treat it and also how to prevent it.
We have learned in the past few weeks that Ebola not only infects patients, it can infect the corpus of hospitals as well. While the first U.S. manifestation of this infection emerged at Texas Health Presbyterian Hospital Dallas, it could have happened anywhere. This corporate version of the Ebola infection can, in a matter of days, bring healthy hospitals to the verge of business mortality as well. Examining the damage one case of Ebola is having on Texas Health Presbyterian Hospital Dallas can help hospital managers inoculate themselves from a similar misfortune.
When I was HHS secretary, I devoted a significant amount of time to learning how to prepare for pandemics. From my studies, I concluded that there are four critical categories of risk that must be contemplated: reputational risk, staffing risk, clinical volume risk and financial risk. In the current Ebola crisis, and specifically the Texas Health Pres- byterian Hospital Dallas case, we learn that that these risks exponentially multiply, each one compounding the other.
Reputational risk: Brand is a fragile thing. It is the essence of a hospital’s reputation. It is earned over many years, yet it can be seriously damaged with one high-profile incident—fairly or unfairly. The only way to mitigate reputational risk in a crisis is preparation. More reputational damage is done in the early stages of a crisis than at any other time. A fundamental tenet of crisis communication is ensuring that the first public expressions are accurate. In the confusion of the first chaotic moments, there is no substitute for training and practice.
Two important lessons can be drawn from the Dallas experience: Infectiousdisease episodes should be added to the list of emergency preparedness drills, and public relations teams should be organized in advance with protocols and training.
Staffing risk: My previous study of pandemics indicates that with infectious-disease emergencies, hospitals always suffer an erosion of staff resources. It is evident with Ebola in West Africa as health workers without adequate resources or protection either become ill themselves or refuse to appear at work out of fear. There have been numerous media reports of con-
flicts between Texas Health Presbyterian Hospital Dallas and its nursing staff. Again, the way to minimize this risk is training and advanced preparation.
Clinical volume risk: In the recent outbreak in Texas, clinical volumes at the institution where Ebola patients presented have severely declined both for emergency and elective visits. The longer-term consequences remain to be seen.
Financial risk: The financial implications of these events cannot be underestimated. Global stock markets have seen significant declines in response to the current events. Dallas County authorities have already estimated the high costs to their community. Hospitals in Dallas are certainly facing multimilliondollar or potentially significantly more unbudgeted costs.
If the average hospital has 100 days of cash on hand, a shutdown of its emergency department and severe disruption of normal admissions and revenue streams can drain those funds very quickly, placing the institution in immediate financial crisis. Businesses plan for disaster recovery, but it is unlikely that pandemic situations are included in their scenario analysis. They need to be.
The current situation is a critical reminder that pandemics happen regularly. We have experienced at least three worldwide in the past 100 years (HIV, influenza in 1918 and H1N1 in 2009) as well as other outbreaks.
These infectious-disease episodes often reshape geopolitics and economic wealth. They profoundly affect culture, economics, scientific thought and medical care. I recommend that hospital executives read The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry to gain a full appreciation for the importance of pandemic readiness.