5 emergency communication lessons hospitals learned from COVID-19

The data on COVID-19 doesn't look good. A recent USA Today analysis showed that nearly 80% of the states reported more coronavirus cases than they had in the week before.

Nine states set seven-day records for infections, while Wisconsin and Hawaii reported record numbers of deaths in their states for a seven-day period. We're witnessing more hotspots as states continue to proceed with reopening plans and people experience fatigue with recommended safety measures.

This surge in COVID-19 infections, paired with the flu season, may lead to what some are calling a "nightmare" winter scenario that may further overwhelm hospitals and lead to new shutdowns and restrictions on the delivery of healthcare services. Even a best-case scenario will still result in challenges and increased pressures for hospitals. Before matters get much worse, now is the time for hospitals and health systems to strengthen their emergency communication plan, practices, and processes.

In speaking with our hospital and health system clients, they say one of the reasons their organizations have successfully navigated the health crisis thus far is by prioritizing effective communication with patients, staff, and vendor partners. These clients have done so by leveraging a variety of mechanisms, including text messaging, to get out timely information and updates.

The experiences thus far of hospitals working to manage the health crisis have taught us a great deal about what must happen if hospitals and health systems want to put themselves in the best position to respond effectively to the challenges of the fall, winter, and beyond. Here are five lessons hospitals have learned from the pandemic that can help improve your organization's emergency communication plan.

1. Address vulnerabilities due to reduction of in-person communication
Hospitals are working to reduce the amount of in-person communication occurring in their facilities to the bare minimum to help limit the potential spread of the novel coronavirus. While this is undoubtedly worthwhile from a safety perspective, it can present challenges in coordinating an emergency response, including how to quickly and effective bring the emergency response team together, hold briefings, coordinate efforts, assign staff responsibilities (if any are unclear), and address questions from stakeholders.

For hospitals that struggled with activating and executing elements of emergency operations plans due to restrictions and/or limitations on in-person communication, it is imperative that any such vulnerabilities be addressed. For hospitals with text messaging, key management issues involving situational status, specific incident characteristics, and resource capabilities, among other issues, can be quickly communicated. In addition, text messaging can help support efforts to properly execute the core elements of the emergency operations plan, including activation, assessment, notifications (more on this below), resource requests, and staff and resource tracking.

2. Attend to emergency communication weaknesses
The initial weeks that followed the pandemic declaration put hospital emergency preparedness plans to the test. Some came up short. Hospitals that struggled with their communication often found they lacked an effective and efficient ability to inform staff, patients, vendors, and others about the rapidly changing guidelines and safety protocols. Communication mechanisms typically relied upon to provide timely updates (e.g., phone, email, intranet, website) helped, but they also struggled to either disseminate that information to targeted recipients in a timely fashion or effectively ensure information was read (discussed further below).

When a hospital must get a time-sensitive message out to a significant number of stakeholders fast and with a high degree of confidence that the message will be received and processed, our clients know there's no better means than texting. We say the time to deploy text messaging is before it's needed. If your hospital or health system is not already using a texting platform or has not tapped into it for emergency communication purposes, the time to add or activate this valuable mechanism is now.

3. Never assume an emergency message is received
When hospitals were forced to rapidly scale back their operations, there was a scramble to inform everyone affected. This included patients who had treatments postponed to staff members who were directed to remain home or still come into the facility to vendors whose appointments were canceled. Hospitals and health system lacking text messaging typically relied upon a mix of emails, phone calls, and online posts.

Unfortunately, these mechanisms often left hospitals unsure about whether messaged were received or read. Research shows that phone calls are increasingly ignored, largely due to robocall fatigue. Americans received about 58.5 billion robocalls in 2019, up from about 48 billion in 2018, according to YouMail. There are no assurances of when — or even if — voicemails will be listened to. When stakeholders missed messages providing new instructions, they typically proceeded with original plans of coming to the facility, only to learn departments were closed and appointments and shifts were canceled. This was frustrating and led to an increased risk of exposure to COVID-19.

Two-way text messaging is an effective mechanism for helping hospitals significantly reduce the chance that a message will be missed. This mechanism allows senders to prompt recipients to respond to a message via text. If a hospital wants to confirm that recipients received a message, they can request a simple reply of "yes" and the text messaging platform will record the confirmation. If any recipients fail to respond within a set amount of time (e.g., one hour), hospitals can reach out via phone and/or email. Considering more than 96% of Americans own a mobile phone of some kind, all of which can text, the number of people who will require outreach via another mechanism will be significantly lower.

Another benefit of using texting: If the information that needs to reach recipients is too long for a text or must be provided in a format other than text, hospitals can include a hyperlink to this information in the text message.

4. Prepare for before, during, and after the emergency
Significant attention around emergency preparedness is paid to executing the initial response. What often receives less attention is what must happen next, both during and following the emergency. Hospitals focused heavily on responding to the announcement of the pandemic and subsequent guidelines and recommendations, including halting non-essential services and developing ways to safely reduce the number of in-house staff.

Once this work was accomplished, some hospitals took a "wait-and-see approach" to developments. Unfortunately, this was lost time that could have helped organizations prepare for those efforts that would be required for a successful reopening and resumption of operations. As states announced easing of restrictions and hospitals began receiving information about when they could expect to begin resuming services, some found themselves rushing to get messaging and updates out to affected stakeholders. This is an essential component of a business continuity plan.

For patients whose treatments were affected, these details covered everything from the date when the department would reopen/services would resume and how that would affect their appointments, what they needed to do to reschedule appointments, and changes to policies and procedures that patients and visitors would need to follow. Hospitals with telehealth programs also worked to spread the word about the availability of such services.

For staff, information disseminated covered everything from scheduling of shifts, new policies and procedures, steps management was taking to better ensure facility-wide safety, and availability of services to help staff during the challenging time, including COVID-19 testing and mental health support (discussed below). For vendors, messages spoke to rescheduling of appointments and changes to policies and procedures representatives would need to follow during on-site visits.

In the days and weeks that followed the initial reopening phase, what was understood about COVID-19 evolved, affecting how hospitals adjusted their rules and guidelines. As this language changed, affected stakeholders needed to be informed. This often meant significant time spent on phone calls — sometimes multiple calls, if initial calls were missed — and emails that may or may not have been read.

For those hospitals using text messaging, providing frequently changing updates to a majority of affected stakeholders proved simpler and effective. The process: open the texting platform, write the message, select targeted stakeholders, click send. Recipients learned about how to reschedule appointments, masking requirements, new pre-screening policies, and more. The texting platforms could confirm the delivery of the messages, with two-way texting helping document when recipients acknowledged the message. Staff tasked with relying this information — already stressed and often at reduced capacity — had their responsibility workload greatly reduced, permitting more time to focus on other urgent matters. Hospitals were able to ramp back up their operations more easily and begin capturing needed revenue.

As a second wave, coupled with the flu season, looms large, hospitals must strengthen the plan for how they will respond to a potential return of operational restrictions and identify what they can do to simplify and streamline reopening and resuming operations. Text messaging should be an essential part of this planning.

5. Don't overlook the value of staff support
The final emergency communication lesson learned from COVID-19 that will be highlighted in this column is the importance of providing emotional support to staff during times of great stress. As essential as it is for hospitals and health systems to keep staff educated about specific changes to their work schedule, policies, and procedures as well as other developments that affect daily operations, it is perhaps just as important for leaders and manages to remind staff that their hard work and dedication to patient care during such a difficult time is noticed and appreciated.

A growing number of our hospital and health systems clients are sending emotional and inspirational support text messages to personnel to provide a lift to staff members' mental health. For example, New Mexico's Lovelace Health System sent more than 46,000 text messages to staff over a two-week stretch in March. These messages covered a range of topics, including changes to protocols, reminders about safety practices, and information concerning the employee assistance program as well as many uplifting messages and inspirational quotes.

Serena Pettes, vice president of marketing and business development for the health system, stated, "Sending texts to our employees … during COVID-19 has been an easy, quick, and effective way to provide support, encouragement, and guidance during a challenging time."

The benefits of a simple message of appreciation can make a significant difference in morale while also boosting productivity.

Enhance Emergency Communication With Text Messaging
Communication is one of the most important aspects of emergency preparedness and business continuity. When a hospital or health system can communicate effectively and in a timely manner about what staff, patients, and vendors must do in response to rapidly changing developments, execution of an emergency plan becomes easier and more successful. Text messaging helps make this happen.

Brandon Daniell is president and co-founder of Diaog Health, a cloud-based, two-way texting platform that enables vital information to be pushed to and pulled from patients and caregivers.

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