By Dan Hounsell

Resilience has climbed the priority lists for many healthcare facilities managers in recent years. Rising coastal waters, longer wildfire seasons, and stronger, more frequent and more destructive hurricanes have combined to convince managers that the future of their facilities and organizations depends on the ability to prepare for, respond to and return to operations quickly after a catastrophic event. 

Such crises can be especially challenging for healthcare facilities, given the complexity of facility operations and technology and the presence of patients in need of critical care. 

On the upside, facility managers are hardly alone in facing the resilience challenge. A team of interested parties, from doctors, CEOs and maintenance technicians to local governments and emergency responders, are critical to any organization’s successful efforts to prepare and protect facilities and operations. 

Understanding roles 

The increased attention on resilient facilities has highlighted the important role facility managers play in the success of their organizations. 

“Facilities managers play an integral role in resilience/emergency preparedness for their organizations because they are the keepers of the facility’s critical equipment that is the backbone to a facility’s resilience,” says Karla King, P.E., executive vice president of sustainability and resiliency at AEI Consultants. 

Working with in-house directors responsible for a healthcare organization’s emergency preparedness, facilities managers are crucial to the organization’s coordinated actions in a crisis. 

“Facilities managers play a very key role in terms of making sure that they execute the emergency preparedness plan,” says Aditya Bhagath, P.E., associate with Thornton Tomasetti. “They play the leadership role in making sure everything gets orchestrated correctly.” 

This role on the resilience team can be challenging for some managers, who might not be accustomed to taking a longer-term view of facilities. 

“Facilities managers sometimes have a short-sighted approach to resilience,” Bhagath says. “For example, when we are dealing with flooding, we are looking at what sort of flooding can happen now. But we also have tools to see what sort of reading levels we can expect in the 2100s. Given that we're dealing with healthcare facilities, they're not going to go away anytime soon. They’re going to be there. They will be serving the community. They will be serving patients. 

“Having that foresight to design any new building for flood levels out in the 2100s is critical but is not incorporated as much into the thinking of facilities managers.” 

Building the team 

The process of building the resilience team and establishing relationships requires that managers reach into often unfamiliar territory – the C-suite. 

“We want to go up to the C-level,” says John Friedlander, associate managing director for security risk management with Kroll. “We look to the CFO to endorse the preparedness initiatives, including training. We will also work laterally from the CFO to the executive director and then medical leadership. 

“Whether that's the chief medical officer, the chief nursing officer, the CFO, we want their endorsement. We want their buy-in, and we want them ideally to actually be present in the first planning meeting. Their communication, cascading down and out, indicates they are aware of the initiative, that they are participating in the initiative, and that they are observing other participation levels and to get robust buy in by all constituents.” 

Support from the C-suite also means resilience efforts are more likely to receive crucial financial support. 

“Within the organization, leadership support and buy-in is integral to the emergency preparedness and resilience,” King says. “Leadership needs to provide financial and resource support to the facilities team to be able to not only create the preparedness plan but to test, reinforce and execute the plan. Leadership will be looking to the facilities team during a disaster to keep the property running. Facilities managers need leadership to support them well in advance of that disaster.” 

Next, managers need to turn their attention to the in-house experts in all things facilities. 

“Support staff, from engineering to custodians and possibly food services, maintenance personnel, garage and valet attendants, also have roles as force multipliers in training, planning and preparedness,” Friedlander says. “These people know the back of house better than anyone. The facilities group knows all of the sensitivities — what's out of order and what's in order. Their safety and security measures can bring a world of support and services during emergencies if they're properly trained.” 

Once in-house team members have been identified and relationships established, managers can turn their attention outside the organization. 

“The partnerships with external agencies, starting with public sector, safety agencies, law enforcement, fire and medical response, are critical,” Friedlander says. “Partnerships with county and state officials can reap huge dividends, particularly if the hospital or the facility or the campus is part of a regional or enterprise organization that has far-flung resources. Often, state and county groups can bring additional elements that can be very helpful to the local or specific hospital to complement the jurisdictional efforts.” 

Building strong relationships with outside parties requires that managers discuss hospital operations. 

“Outside of the organization, it is important for leadership and facilities managers to understand the limitations of their facility, when it is no longer able to provide services to the public and how long it will take to resume functionality,” King says. “Community leaders such as the mayor, councilmembers and the local building department should be notified of these limitations and the disaster response plan. They may determine that increased resiliency is necessary and can provide service support (water and power), manpower (first responders) or funding to improve resiliency.” 

To be effective, the discussions of operations need to be specific in terms of the facility’s operations and occupants. 

“It’s not only about awareness of emerging incidents but what we might call threat management on a holistic level, even during live-action exercises, to know where to stage apparatus, to know points of entry and points of exit, and the most sensitive areas of care patient care in the hospital, whether that be obstetrics or behavioral health,” Friedlander says. “This is particularly true for law enforcement. There might be patients who are in custody receiving acute care and other sensitivities. There might be a neuro-psych unit or other inpatient areas with fragile populations — hospice for geriatric care, for example — that difficult to evacuate under the best of circumstances and necessitating prolonged care.” 

Communication is key 

One critical element of resilience team building involves a skill that facility managers might not have had to rely on but that also is critical to their overall success: communication. 

“Communication is a big part of it,” says Randy Braverman, senior consultant with Facility Engineering Associates. “We don't communicate very well at times, and when we're not communicating well, people don't understand the message that we're giving to them. We sometimes move fast as we try to get everything done, and we don't slow down and explain why we're doing things. Managers need to get the message out, and it’s hard when you have a big facility. 

“I'll give an example of myself. When I was overseeing 23 buildings as a director security, we were trying to get the message out and communicate to people, but sometimes, we don't do a great job because we are so busy at our job. We're trying to do everything, and we forget to communicate well to people.” 

Dan Hounsell is senior editor of the facility market. He has more than 25 years of experience writing about facilities maintenance, engineering and management.