Hospitals, sys­tems play crit­i­cal lead­er­ship role in boost­ing our na­tional health se­cu­rity

Modern Healthcare - - COMMENT - By Paul Kuehn­ert In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? mod­ern­health­ View guide­lines at Send drafts to As­sis­tant Man­ag­ing Edi­tor David May dmay@mod­ern­health­ at

Amer­ica’s hospitals and health sys­tems must be pre­pared for any­thing, but as the range of threats to health in our com­mu­ni­ties be­comes broader and the threats hit more quickly and fre­quently— whether it’s the dev­as­ta­tion of nat­u­ral dis­as­ters or emerg­ing threats such as the Zika virus—provider or­ga­ni­za­tions will need to play big­ger roles in head­ing off prob­lems be­fore they spi­ral into crises.

To sup­port re­silient com­mu­ni­ties that can meet and over­come threats to our health se­cu­rity, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion es­tab­lished the Na­tional Health Se­cu­rity Pre­pared­ness Index as a stream­lined tool to bet­ter un­der­stand the na­tion’s ca­pa­bil­i­ties.

It an­nu­ally re­ports a na­tional pre­pared­ness score from 0 to 10, as well as scores for each state, that can be used both as bench­marks and tools for col­lab­o­ra­tion. This work, now handed over to the Robert Wood John­son Foun­da­tion, as­sesses pre­pared­ness across six ar­eas—dis­ease sur­veil­lance, com­mu­nity plan­ning, in­ci­dent man­age­ment, care de­liv­ery, en­vi­ron­men­tal health and coun­ter­mea­sure man­age­ment.

The U.S. earned an over­all score of 6.7 out of 10 for health se­cu­rity pre­pared­ness this year. That’s an im­prove­ment of 3.6% since the index was launched in 2013. It’s a small but nev­er­the­less im­por­tant shift. The index shows par­tic­u­larly strong preparation in in­ci­dent com­mand and con­trol, as well as coun­ter­mea­sure man­age­ment, but there’s a real need for im­prove­ment in en­vi­ron­men­tal and oc­cu­pa­tional health, as well as health­care de­liv­ery.

Na­tional pre­pared­ness has im­proved most in com­mu­nity plan­ning and en­gage­ment, ris­ing 8.4% in three years. These im­prove­ments are mov­ing in the right di­rec­tion, but clearly we must do more.

For hospitals and health sys­tems, no sin­gle do­main is more rel­e­vant than health­care de­liv­ery. When un­der cri­sis con­di­tions, our na­tion’s hospitals must con­tinue to de­liver ef­fi­cient, high-qual­ity care, which not only serves pa­tients but pro­tects com­mu­ni­ties. It’s a test in which the in­dus­try can­not af­ford to earn any­thing but top marks. For the sec­ond con­sec­u­tive year, the U.S. earned a score of 5.1 out of 10. To be clear, that’s a na­tional num­ber. Ca­pac­i­ties in each state, health sys­tem and hos­pi­tal vary. For each, the index of­fers lead­ers a clear frame­work to bet­ter un­der­stand the strengths and gaps in ca­pac­ity within their or­ga­ni­za­tions. Within that frame­work, there are el­e­ments that hospitals can con­trol them­selves or in­flu­ence more di­rectly, e.g., emer­gency room wait times, the num­ber of staffed beds and level of spe­cial­ist staffing. They have lit­tle con­trol over oth­ers, such as the num­ber of nurses in the state or how far peo­ple must travel to ac­cess spe­cial­ized treat­ment fa­cil­i­ties. Those fac­tors must still be un­der­stood as ref­er­ence points to un­der­stand the chal­lenges in meet­ing the needs of the peo­ple and the com­mu­ni­ties those or­ga­ni­za­tions serve.

Hospitals and health sys­tems can also take the point on other el­e­ments, such as bet­ter in­te­gra­tion of health­care and so­cial ser­vices. Through col­lab­o­ra­tion with other stakeholders, we could make sig­nif­i­cant progress to­ward im­prov­ing the level of pre­pared­ness in the com­mu­ni­ties they serve.

Dig­ging deeper into to the data, the index ex­poses a pre­pared­ness gap in stark geo­graphic terms be­tween high­est- and low­est-scor­ing states— amount­ing to a 36% chasm in 2015. Mary­land achieved the na­tion’s high­est over­all pre­pared­ness level of 7.6 in 2015, 14% higher than the na­tional av­er­age. A to­tal of 18 states, many clus­tered along the Eastern Seaboard, Up­per Mid­west and South­west, sig­nif­i­cantly ex­ceeded the na­tional av­er­age. Con­versely, 16 states, es­pe­cially in the Deep South and Moun­tain West, lagged sig­nif­i­cantly below the na­tional av­er­age. Hospitals and health sys­tems need to be will­ing part­ners in clos­ing these chasms.

No sin­gle sec­tor, agency, or­ga­ni­za­tion or pro­gram can be held ac­count­able for all of the mea­sures tracked within the index (or even a sin­gle do­main), but hospitals and health sys­tems can play piv­otal roles with peers in public health and emer­gency man­age­ment to im­prove over­all pre­pared­ness. Keep­ing our neigh­bors safe is a re­spon­si­bil­ity we all share.

Paul Kuehn­ert is an as­sis­tant vice pres­i­dent at the Robert Wood John­son Foun­da­tion and a fel­low of the Amer­i­can Academy of Nurs­ing.

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