The Time is Now Profiting from Hospital Disaster Preparedness: A Process Enhancement Model Contact Info: Maurice A. Ramirez, DO, PhD hire @ mauricearamirez.com www.High-Alert.com 866-231-4755

Contact Info:

Maurice A. Ramirez, DO, PhD hire @ mauricearamirez.com www.High-Alert.com 866-231-4755

Preparedness Balance Sheet Process Enhancement Process Analysis Business Processes Healthcare Processes Income Streams Daily Needs/Resources Inventory Benchmark Triggered Targeted Process Enhancement Event Response Vulnerability Analysis Hazard Based Kaiser Model Income Insensitive Centered on Recognized Events Event Triggered Untargeted Response and Expenditure

Process Enhancement

Process Analysis

Business Processes

Healthcare Processes

Income Streams

Daily Needs/Resources Inventory

Benchmark Triggered

Targeted Process Enhancement

Event Response

Vulnerability Analysis

Hazard Based

Kaiser Model

Income Insensitive

Centered on Recognized Events

Event Triggered

Untargeted Response and Expenditure

Preparedness Balance Sheet Event Response Model Costs Equipment Staff Training Salaries for Training Resource Stockpiles Externally Validated Drills and Exercises Extra Personnel Dollars and Sense $1400/Licensed Bed $3920/Licensed Bed/yr. $1780/Licensed Bed/yr. $1400/Licensed Bed $530/Licensed Bed/drill (2 per year) $1350/Licensed Bed/day Total Cost = $10400/bed/yr

Costs

Equipment

Staff Training

Salaries for Training

Resource Stockpiles

Externally Validated Drills and Exercises

Extra Personnel

Dollars and Sense

$1400/Licensed Bed

$3920/Licensed Bed/yr.

$1780/Licensed Bed/yr.

$1400/Licensed Bed

$530/Licensed Bed/drill (2 per year)

$1350/Licensed Bed/day

Total Cost = $10400/bed/yr

Preparedness Balance Sheet Event Response Model Dollars and Sense $0.00 $0.00 Priceless Total Revenue = $0.00 Business Benefits Joint Commission NIMS Compliance Legal Protection Qui Tam Sarbanes Oxley

Dollars and Sense

$0.00

$0.00

Priceless

Total Revenue = $0.00

Business Benefits

Joint Commission

NIMS Compliance

Legal Protection

Qui Tam

Sarbanes Oxley

Preparedness Balance Sheet Event Response Model Costs Equipment Staff Training Salaries for Training Resource Stockpiles Externally Validated Drills and Exercises Response Personnel NET LOSS = $10400/bed/yr Business Benefits Joint Commission NIMS Compliance Legal Protection Qui Tam Sarbanes Oxley

Costs

Equipment

Staff Training

Salaries for Training

Resource Stockpiles

Externally Validated Drills and Exercises

Response Personnel

NET LOSS = $10400/bed/yr

Business Benefits

Joint Commission

NIMS Compliance

Legal Protection

Qui Tam

Sarbanes Oxley

Preparedness Balance Sheet Process Enhancement Model Costs Equipment Staff Training Salaries for Training Resource Stockpiles Externally Validated Drills and Exercises Extra Personnel Dollars and Sense $1400/Licensed Bed $4920/Licensed Bed/yr. $1800/Licensed Bed/yr. $1400/Licensed Bed $530/Licensed Bed/drill (1 per year) $1350/Licensed Bed/day Total Cost = $11500/bed/yr

Costs

Equipment

Staff Training

Salaries for Training

Resource Stockpiles

Externally Validated Drills and Exercises

Extra Personnel

Dollars and Sense

$1400/Licensed Bed

$4920/Licensed Bed/yr.

$1800/Licensed Bed/yr.

$1400/Licensed Bed

$530/Licensed Bed/drill (1 per year)

$1350/Licensed Bed/day

Total Cost = $11500/bed/yr

Preparedness Balance Sheet Process Enhancement Model Business Benefits Joint Commission NIMS Compliance Legal Protection Qui Tam Sarbanes Oxley Improved Customer Satisfaction Fewer AMA/LWOT Increased Admits Dollars and Sense $0.00 $0.00 Priceless Priceless One Admission per Bed/yr $17374/Licensed Bed/yr Total Revenue = $17374/Bed/yr

Business Benefits

Joint Commission

NIMS Compliance

Legal Protection

Qui Tam

Sarbanes Oxley

Improved Customer Satisfaction

Fewer AMA/LWOT

Increased Admits

Dollars and Sense

$0.00

$0.00

Priceless

Priceless

One Admission per Bed/yr

$17374/Licensed Bed/yr

Total Revenue = $17374/Bed/yr

Preparedness Balance Sheet Process Enhancement Model Costs Equipment Staff Training Salaries for Training Resource Stockpiles Externally Validated Drills and Exercises Extra Personnel Business Benefits Joint Commission NIMS Compliance Legal Protection Qui Tam Sarbanes Oxley Improved Customer Satisfaction Fewer AMA/LWOT Increased Admits Targeted Response reduces cost of response NET PROFIT = $5874/Bed/yr

Costs

Equipment

Staff Training

Salaries for Training

Resource Stockpiles

Externally Validated Drills and Exercises

Extra Personnel

Business Benefits

Joint Commission

NIMS Compliance

Legal Protection

Qui Tam

Sarbanes Oxley

Improved Customer Satisfaction

Fewer AMA/LWOT

Increased Admits

Targeted Response reduces cost of response

NET PROFIT = $5874/Bed/yr

Preparedness Balance Sheet Process Enhancement Process Analysis Business Processes Healthcare Processes Income Streams Daily Needs/Resources Inventory Benchmark Triggered Targeted Process Enhancement Net Profit: $5874/Bed/yr Event Response Vulnerability Analysis Hazard Based Kaiser Model Income Insensitive Centered on Recognized Events Event Triggered Untargeted Response and Expenditure Net Loss: $10400/Bed/yr

Process Enhancement

Process Analysis

Business Processes

Healthcare Processes

Income Streams

Daily Needs/Resources Inventory

Benchmark Triggered

Targeted Process Enhancement

Net Profit: $5874/Bed/yr

Event Response

Vulnerability Analysis

Hazard Based

Kaiser Model

Income Insensitive

Centered on Recognized Events

Event Triggered

Untargeted Response and Expenditure

Net Loss: $10400/Bed/yr

The Return on Investment (ROI) $16274/Licensed Beds/yr $5874/Licensed Bed/yr Profit Improved Customer Satisfaction Fewer AMA’s/LWOT’s More Admissions Shorter Response Phase Quicker Return to Full Operations Greater Surge Capacity Preparedness Balance Sheet

The Return on Investment (ROI)

$16274/Licensed Beds/yr

$5874/Licensed Bed/yr Profit

Improved Customer Satisfaction

Fewer AMA’s/LWOT’s

More Admissions

Shorter Response Phase

Quicker Return to Full Operations

Greater Surge Capacity

Planning In Light of New Realities Healthcare planning traditionally based on “same day last year” and “last time this happened” parameters. Healthcare disaster planning too often looks to change operational procedures. “Practice the way you will play” - Vince Lombardi “ Play the Way You Will Play!” - Maurice A. Ramirez

Healthcare planning traditionally based on “same day last year” and “last time this happened” parameters.

Healthcare disaster planning too often looks to change operational procedures.

“Practice the way you will play” - Vince Lombardi

“ Play the Way You Will Play!” - Maurice A. Ramirez

Learning from the past is rare Planning In Light of New Realities  Lessons Occurred  Lessons Observed  Lessons Learned  Lessons Applied

Learning from the past is rare

Lessons Learned 120 hours of self sufficiency Unified Incident Command System Inter-Facility and Inter-Agency Planning Facility Wide / Community Wide Preparation Unified Multichannel Communications Common Language Communications Externally Validated and Reviewed Community Wide Drills Planning In Light of New Realities

Lessons Learned

120 hours of self sufficiency

Unified Incident Command System

Inter-Facility and Inter-Agency Planning

Facility Wide / Community Wide Preparation

Unified Multichannel Communications

Common Language Communications

Externally Validated and Reviewed Community Wide Drills

Lessons Applied Planning In Light of New Realities ?

Lessons Applied

Strategic Thinking L4  Interstate, Regional and/or Federal L3  Intrastate, Multi-County L2  County L1  City, Township, Interfacility L0  Facility

L4  Interstate, Regional and/or Federal

L3  Intrastate, Multi-County

L2  County

L1  City, Township, Interfacility

L0  Facility

Strategic Thinking L4 aka Macro-Strategic “ 10,000 foot view” Functionally analogous to the Leadership Role of a CEO Planning, Logistics and Operations at a Federal, Interstate and/or Regional Level NDMS – MRC – FEMA – DoD Red Cross – Faith Based National Organizations Insurance Companies – Corporate COOP’s

L4 aka Macro-Strategic

“ 10,000 foot view”

Functionally analogous to the Leadership Role of a CEO

Planning, Logistics and Operations at a Federal, Interstate and/or Regional Level

NDMS – MRC – FEMA – DoD

Red Cross – Faith Based National Organizations

Insurance Companies – Corporate COOP’s

Strategic Thinking L3 aka Strategic “ 1,000 foot view” Functionally analogous to the Leadership Role of a COO, CTO, CFO Planning, Logistics and Operations at a State, and/or Intercounty Level SMRT – MRC – State EOC’s – State Guard Red Cross – Faith Based State Organizations Insurance Companies – Corporate COOP’s

L3 aka Strategic

“ 1,000 foot view”

Functionally analogous to the Leadership Role of a COO, CTO, CFO

Planning, Logistics and Operations at a State, and/or Intercounty Level

SMRT – MRC – State EOC’s – State Guard

Red Cross – Faith Based State Organizations

Insurance Companies – Corporate COOP’s

Strategic Thinking L2 aka Microstrategic / Macrotactical “ 100 foot view” Functionally analogous to the Leadership Role of a Departmental Director Planning, Logistics and Operations at a County and/or Intercity Level SMRT – County Medical Association County EOC’s – County EMS Local Red Cross – Local Faith Based Organizations Insurance Companies – Corporate COOP’s

L2 aka Microstrategic / Macrotactical

“ 100 foot view”

Functionally analogous to the Leadership Role of a Departmental Director

Planning, Logistics and Operations at a County and/or Intercity Level

SMRT – County Medical Association

County EOC’s – County EMS

Local Red Cross – Local Faith Based Organizations

Insurance Companies – Corporate COOP’s

Strategic Thinking L1 aka Tactical “ 10 foot view” Functionally analogous to the Leadership Role of a Shift Supervisor Planning, Logistics and Operations at a City and/or Interfacility Level SMRT – County Medical Association – Local Providers City EOC’s – City EMS Local Red Cross – Local Faith Based Organizations Insurance Companies – Corporate COOP’s

L1 aka Tactical

“ 10 foot view”

Functionally analogous to the Leadership Role of a Shift Supervisor

Planning, Logistics and Operations at a City and/or Interfacility Level

SMRT – County Medical Association – Local Providers

City EOC’s – City EMS

Local Red Cross – Local Faith Based Organizations

Insurance Companies – Corporate COOP’s

Strategic Thinking L0 aka Microtactical “ 1 foot view” Functionally analogous to the Operational Role of a Nurse Interacting with a Patient Planning, Logistics and Operations at a Facility and/or Interdepartmental Level Local Providers Facility Employees Facility Volunteers Facility COOP’s

L0 aka Microtactical

“ 1 foot view”

Functionally analogous to the Operational Role of a Nurse Interacting with a Patient

Planning, Logistics and Operations at a Facility and/or Interdepartmental Level

Local Providers

Facility Employees

Facility Volunteers

Facility COOP’s

Concentric Ring Concept Network – Centric Approach Concentric Ring Approach to Care Concentric Ring Approach to Management L1 L2 L3 L4

Network – Centric Approach

Concentric Ring Approach to Care

Concentric Ring Approach to Management

Concentric Ring Concept Global Approach to Planning L1 L2 L3 L4 Macrostrategic  L4 aka: Regional Strategic  L3 aka: State Macrotactical  L2 aka: County Tactical  L1 aka: City Microtactical  L0 aka: Facility

Global Approach to Planning

Macrostrategic  L4 aka: Regional

Strategic  L3 aka: State

Macrotactical  L2 aka: County

Tactical  L1 aka: City

Microtactical  L0 aka: Facility

Concentric Ring Concept Planning becomes progressive and “Bottom-Up” Facility  City  County  State  Regional Planning also becomes “Top Down” Regional  State  County  City  Facility L1 L2 L3 L4 Macrostrategic  L4 aka: Regional Strategic  L3 aka: State Macrotactical  L2 aka: County Tactical  L1 aka: City Microtactical  L0 aka: Facility

Planning becomes progressive and “Bottom-Up” Facility  City  County  State  Regional

Planning also becomes “Top Down” Regional  State  County  City  Facility

Macrostrategic  L4 aka: Regional

Strategic  L3 aka: State

Macrotactical  L2 aka: County

Tactical  L1 aka: City

Microtactical  L0 aka: Facility

Concentric Ring Concept L1 L2 L3 L4 INCIDENT

Concentric Ring Concept After the Event L1 & L2 Facilities Absorb Immediate Surge L3 & L4 Facilities Provide Supplemental Capacity All L1, L2, L3 & L4 Support Requires MSA’s L1 L2 L3 L4 Macrostrategic  L4 aka: Regional Strategic  L3 aka: State Macrotactical  L2 aka: County Tactical  L1 aka: City Microtactical  L0 aka: Facility

After the Event

L1 & L2 Facilities Absorb Immediate Surge

L3 & L4 Facilities Provide Supplemental Capacity

All L1, L2, L3 & L4 Support Requires MSA’s

Macrostrategic  L4 aka: Regional

Strategic  L3 aka: State

Macrotactical  L2 aka: County

Tactical  L1 aka: City

Microtactical  L0 aka: Facility

Steps to Preparedness Vulnerability Analysis All Hazards Review Didactic Education All Hazards Preparedness All Hazards Planning Immersion Simulation Institute of Medicine Standard ( To Err is Human ) All Hazards Exercises (Disaster Drills) Continuous Plan Review and Revision

Vulnerability Analysis

All Hazards Review

Didactic Education

All Hazards Preparedness

All Hazards Planning

Immersion Simulation

Institute of Medicine Standard ( To Err is Human )

All Hazards Exercises (Disaster Drills)

Continuous Plan Review and Revision

The Mathematics of Public Opinion ( Impact + Vulnerability ) Hazard

The Mathematics of Public Opinion [ Probability x ( Impact + Vulnerability ) ] Hazard Risk Fear is Risk Raised to the Power of Outrage

The Mathematics of Public Opinion [ Probability x ( Impact + Vulnerability ) ] Outrage = Fear Hazard Risk Risk Doubles  Fear Only Doubles Outrage Doubles  Fear Increases Exponentially

The Mathematics of Public Opinion Hazard Risk Outrage = Zero  Fear Abates  People Don’t Care [ Probability x ( Impact + Vulnerability ) ] Outrage = Fear

The Mathematics of Public Opinion Hazard Risk The Secret  Control OUTRAGE !! [ Probability x ( Impact + Vulnerability ) ] Outrage = Fear

The Mathematics of Public Opinion Hazard Risk The Secret  Control OUTRAGE !! Outrage = Enthusiasm – Reality [ Probability x ( Impact + Vulnerability ) ] Outrage = Fear

The Mathematics of Public Opinion Hazard Risk Control Public Opinion = Control OUTRAGE !! [ Probability x ( Impact + Vulnerability ) ] Outrage = Fear

The Flood of Humanity 7 Patients by EMS 28 Self Transport 140 Psychological Casualties 175 Patients in the First Hour

The Flood of Humanity 175 Patients in the First Hour But Wait There’s More!

The Flood of Humanity 175 Patients in the First Hour 350 Family, Friends & Bystanders 525 Searching for the Missing

The Flood of Humanity Total Surge: 1050 From Only 7 EMS Patients

Characteristics of a Mass Triage System It Must Be Fast Improved Survival through Early Care It Must Be Scalable Cannot Slow Due to Surge It Must Be Recurring Cannot Miss Evolving Conditions It Must Include Medical and Behavioral Improved Recovery through Early Intervention It Must Anticipate Exclusion From Care Continuous Integrated Triage

Characteristics of a Mass Triage System

It Must Be Fast

Improved Survival through Early Care

It Must Be Scalable

Cannot Slow Due to Surge

It Must Be Recurring

Cannot Miss Evolving Conditions

It Must Include Medical and Behavioral

Improved Recovery through Early Intervention

It Must Anticipate Exclusion From Care

Continuous Integrated Triage Triaging 5387 Patients Emergency Severity Index (ESI) 1 – 5 Resource and Complaint Balanced System Developed by AHRQ 8 minutes per patient Simple Triage and Rapid Treatment (START) Color Coded Triage based on RPM’s Developed by Fire Rescue – Modified by Military 1 minute per casualty x 5387 = 2 months x 5387 = 1 week 540 per hr. x 8 mins. = 5 months behind per day 540 per hr. x 1 mins. = 2 weeks behind per day

Triaging 5387 Patients

Emergency Severity Index (ESI)

1 – 5 Resource and Complaint Balanced System

Developed by AHRQ

8 minutes per patient

Simple Triage and Rapid Treatment (START)

Color Coded Triage based on RPM’s

Developed by Fire Rescue – Modified by Military

1 minute per casualty

540 per hr. x 8 mins. = 5 months behind per day

540 per hr. x 1 mins. = 2 weeks behind per day

Continuous Integrated Triage Move (5387) If you can hear the sound of my voice... 80% Rise and Walk (4310) Green Conscious – Alert - Oriented Ambulatory - Following Commands NYHC = 1 GOLD Pulmonary = 1 NIHSS = 0 GCS = 15 STABLE for Transport First!!!

Move (5387)

If you can hear the sound of my voice...

80% Rise and Walk (4310)

Green

Conscious – Alert - Oriented

Ambulatory - Following Commands

NYHC = 1

GOLD Pulmonary = 1

NIHSS = 0

GCS = 15

STABLE for Transport First!!!

Continuous Integrated Triage Move (1077) If you can hear the sound of my voice... 16% Wave an Arm or Leg (862) Yellow Conscious – Alert - Oriented NON-Ambulatory - Following Commands NYHC = 1 or 2 GOLD Pulmonary = 1 or 2 NIHSS < 2 GCS = 15 STABLE to Wait for Care!!!

Move (1077)

If you can hear the sound of my voice...

16% Wave an Arm or Leg (862)

Yellow

Conscious – Alert - Oriented

NON-Ambulatory - Following Commands

NYHC = 1 or 2

GOLD Pulmonary = 1 or 2

NIHSS < 2

GCS = 15

STABLE to Wait for Care!!!

Continuous Integrated Triage START (215) 4% Who Did Not Move Respirations No Respirations = DEAD CPR Contra-Indicated in Mass Casualty Abnormal (<12 or >20 in an Adult) Red or Black (We’ll come back to this...) Normal (12 to 20 in an Adult) Check Pulse

START (215)

4% Who Did Not Move

Respirations

No Respirations = DEAD

CPR Contra-Indicated in Mass Casualty

Abnormal (<12 or >20 in an Adult)

Red or Black (We’ll come back to this...)

Normal (12 to 20 in an Adult)

Check Pulse

Continuous Integrated Triage START (215) 4% Who Did Not Move Pulse No Pulse = DEAD CPR Contra-Indicated in Mass Casualty Abnormal (<60 or >100 in an Adult) Red or Black (We’ll come back to this...) Normal (60 to 100 in an Adult) Check Mentation

START (215)

4% Who Did Not Move

Pulse

No Pulse = DEAD

CPR Contra-Indicated in Mass Casualty

Abnormal (<60 or >100 in an Adult)

Red or Black (We’ll come back to this...)

Normal (60 to 100 in an Adult)

Check Mentation

Continuous Integrated Triage START (215) 4% Who Did Not Move Mentation Conscious, Alert, Oriented, Ambulatory Follows Commands, but not Paying Attention Green Conscious, Alert, Oriented, Non-Ambulatory, Follows Commands Yellow (Includes Special Needs) Unconscious, Disoriented, Unresponsive Red or Black

START (215)

4% Who Did Not Move

Mentation

Conscious, Alert, Oriented, Ambulatory Follows Commands, but not Paying Attention

Green

Conscious, Alert, Oriented, Non-Ambulatory, Follows Commands

Yellow (Includes Special Needs)

Unconscious, Disoriented, Unresponsive

Red or Black

Continuous Integrated Triage Psych-Triage (5387) All Triage is Continuous and Repeated Expands to Include Behavioral Health Exposures Witnessed Death or Serious Injury  PsyRED vs. PsyBLACK Family Member Died  PsyRED vs. PsyBLACK Entrapment or Delayed Rescue  PsyRED vs. PsyBLACK HAZMAT Exposure  PsyYELLOW Decontamination  PsyYELLOW

Psych-Triage (5387)

All Triage is Continuous and Repeated

Expands to Include Behavioral Health

Exposures

Witnessed Death or Serious Injury  PsyRED vs. PsyBLACK

Family Member Died  PsyRED vs. PsyBLACK

Entrapment or Delayed Rescue  PsyRED vs. PsyBLACK

HAZMAT Exposure  PsyYELLOW

Decontamination  PsyYELLOW

Continuous Integrated Triage Psych-Triage (5387) All Triage is Continuous and Repeated Expands to Include Behavioral Health Observations Family Member Died  PsyRED vs. PsyBLACK Injury / Illness of Self or Family  PsyRED vs. PsyBLACK Unaccompanied Minor  PsyYELLOW Missing Family Member  PsyYELLOW Separated from Immediate Family  PsyYELLOW Home Uninhabitable  PsyYELLOW Displaced from Home  PsyYELLOW Parent of Child Under 18 years  PsyYELLOW

Psych-Triage (5387)

All Triage is Continuous and Repeated

Expands to Include Behavioral Health

Observations

Family Member Died  PsyRED vs. PsyBLACK

Injury / Illness of Self or Family  PsyRED vs. PsyBLACK

Unaccompanied Minor  PsyYELLOW

Missing Family Member  PsyYELLOW

Separated from Immediate Family  PsyYELLOW

Home Uninhabitable  PsyYELLOW

Displaced from Home  PsyYELLOW

Parent of Child Under 18 years  PsyYELLOW

Continuous Integrated Triage Psych-Triage (5387) All Triage is Continuous and Repeated Expands to Include Behavioral Health Reactions Felt / Expressed Extreme Fear or Panic  PsyRED vs. PsyBLACK Felt Direct Threat to Life (Self / Family)  PsyRED vs. PsyBLACK Thought or Intent of Self Harm  PsyRED vs. PsyBLACK Concerns of HAZMAT Exposure  PsyYELLOW

Psych-Triage (5387)

All Triage is Continuous and Repeated

Expands to Include Behavioral Health

Reactions

Felt / Expressed Extreme Fear or Panic  PsyRED vs. PsyBLACK

Felt Direct Threat to Life (Self / Family)  PsyRED vs. PsyBLACK

Thought or Intent of Self Harm  PsyRED vs. PsyBLACK

Concerns of HAZMAT Exposure  PsyYELLOW

Continuous Integrated Triage Red vs. Black Resource Based Ethical Decision Resources Available to Treat WITHOUT Endangering Two or More Other Patients Red Treatment Areas Red (Critical) Medical Treatment Area PsyRED (Critical) Behavioral Health Treatment Area Resources NOT Available to Treat WITHOUT Endangering Two or More Other Patients Black Treatment Areas Black (Expectant) Medical Treatment Area PsyBLACK Behavioral Health Treatment Area

Red vs. Black

Resource Based Ethical Decision

Resources Available to Treat WITHOUT Endangering Two or More Other Patients

Red Treatment Areas

Red (Critical) Medical Treatment Area

PsyRED (Critical) Behavioral Health Treatment Area

Resources NOT Available to Treat WITHOUT Endangering Two or More Other Patients

Black Treatment Areas

Black (Expectant) Medical Treatment Area

PsyBLACK Behavioral Health Treatment Area

Expanding the Healthcare Highway HOSPITAL

Expanding the Healthcare Highway HOSPITAL

Expanding the Healthcare Highway HOSPITAL FAMILY CENTER

Expanding the Healthcare Highway PRE-DECON TRIAGE

Expanding the Healthcare Highway DECONTAMINATION AMBULATORY NON-AMBULATORY

Expanding the Healthcare Highway DECON DECON START TRIAGE AMBULATORY NON-AMBULATORY

Expanding the Healthcare Highway REPEAT TRIAGE EMERGENCY ROOM GREEN TREATMENT AREA GREEN RED RED YELLOW BLACK EXPECTANT TREATMENT AREA

Expanding the Healthcare Highway ADMISSION FAST TRACK EMERGENCY ROOM GREEN TREATMENT AREA

Expanding the Healthcare Highway DECON DECON BEHAVIORAL TRIAGE MEDICALLY CLEARED - STABLE

Expanding the Healthcare Highway DISCHARGE HOME HOSPITAL BASED SUPPORT CENTER “ PSYCH-RED” “ PSYCH - GREEN”

Expanding the Healthcare Highway DECON DECON BEHAVIORAL TRIAGE HOSPITAL BASED SUPPORT CENTER

Expanding the Healthcare Highway DISCHARGE HOME BEHAVIORAL HEALTH ADMISSION “ PSYCH-RED” “ PSYCH - GREEN”

Preparedness Balance Sheet

Preparedness Balance Sheet Sticks NIMS-IC for Hospitals Joint Commission Medicare/Medicaid CMS Attestations Willful Blindness Qui Tam Sarbanes-Oxley Carrots Public Relations Community Relations Employee Relations Customer Service Preferential Billing Rapid Recovery

Sticks

NIMS-IC for Hospitals

Joint Commission

Medicare/Medicaid

CMS Attestations

Willful Blindness

Qui Tam

Sarbanes-Oxley

Carrots

Public Relations

Community Relations

Employee Relations

Customer Service

Preferential Billing

Rapid Recovery

Preparedness Balance Sheet Process Enhancement Process Analysis Business Processes Healthcare Processes Income Streams Daily Needs/Resources Inventory Benchmark Triggered Targeted Process Enhancement Event Response Vulnerability Analysis Hazard Based Kaiser Model Income Insensitive Centered on Recognized Events Event Triggered Untargeted Response and Expenditure

Process Enhancement

Process Analysis

Business Processes

Healthcare Processes

Income Streams

Daily Needs/Resources Inventory

Benchmark Triggered

Targeted Process Enhancement

Event Response

Vulnerability Analysis

Hazard Based

Kaiser Model

Income Insensitive

Centered on Recognized Events

Event Triggered

Untargeted Response and Expenditure

Preparedness Balance Sheet Process Enhancement Process Analysis Business Processes Healthcare Processes Income Streams Daily Needs/Resources Inventory Benchmark Triggered Targeted Process Enhancement Net Profit: $5874/Bed/yr Event Response Vulnerability Analysis Hazard Based Kaiser Model Income Insensitive Centered on Recognized Events Event Triggered Untargeted Response and Expenditure Net Loss: $10400/Bed/yr

Process Enhancement

Process Analysis

Business Processes

Healthcare Processes

Income Streams

Daily Needs/Resources Inventory

Benchmark Triggered

Targeted Process Enhancement

Net Profit: $5874/Bed/yr

Event Response

Vulnerability Analysis

Hazard Based

Kaiser Model

Income Insensitive

Centered on Recognized Events

Event Triggered

Untargeted Response and Expenditure

Net Loss: $10400/Bed/yr

From Preparedness to Profitability Given that the investment is required NIMS Compliance Joint Commission Medicare/Medicaid CMS Attestation Qui Tam Sarbanes-Oxley Given that the investment is the same Process Enhancement / Process Analysis Model Event Response Model

Given that the investment is required

NIMS Compliance

Joint Commission

Medicare/Medicaid

CMS Attestation

Qui Tam

Sarbanes-Oxley

Given that the investment is the same

Process Enhancement / Process Analysis Model

Event Response Model

From Preparedness to Profitability The Return on Investment (ROI) $16274/Licensed Bed/yr Savings $5874/Licensed Bed/yr Profit Improved Customer Satisfaction Fewer AMA’s/LWOT’s More Admissions Shorter Response Phase Quicker Return to Full Operations Greater Surge Capacity

The Return on Investment (ROI)

$16274/Licensed Bed/yr Savings

$5874/Licensed Bed/yr Profit

Improved Customer Satisfaction

Fewer AMA’s/LWOT’s

More Admissions

Shorter Response Phase

Quicker Return to Full Operations

Greater Surge Capacity

Learn more about using a Process Enhancement Model Compatible with LEAN and Six Sigma to meet your Disaster Preparedness Benchmarks by contacting: Dr. Maurice A. Ramirez email: hire@mauricearamirez.com phone: 866-231-4755 From Preparedness to Profitability

Learn more about using a Process Enhancement Model Compatible with LEAN and Six Sigma to meet your Disaster Preparedness Benchmarks by contacting:

Dr. Maurice A. Ramirez email: hire@mauricearamirez.com phone: 866-231-4755