Hello, everybody, and welcome to our monthly networking and webinar about crisis management. We're excited to have everybody joining us. So today, I would like to welcome our wonderful panelists who will be discussing crisis management. We are joined by Leanne Galligan, Ashkan Niku, Erica Knoll, Ross Frigden, and Leah Stechelte. We are going to go ahead and get started with defining what a crisis is. So Erica, you're going to be kicking us off here. Welcome, everybody. Thanks for having us today. I think this is going to be a great session. I already learned a lot from this group on this call. There's a lot of wisdom in this room and even the folks who aren't presenting. So please do use the chat. We can get to some Q&A, hopefully, at the end. One of the things that I thought was important in our roles is for us to really understand how we define a crisis. I think our phones ring 10, 12 hours a day. We have people who have fabricated crises that are bringing to us, or everything's a crisis, everything's at 11 all the time. And it's important for us here at Peace Your Orthopedics to think about, and for me as a leader, what is this? Is this an 11? Is this a four? What makes this actually something I need to drop everything and focus on? I think it's helpful to have some definitions in your mind. This isn't a routine challenge. This is not a physician upset that someone's copay wasn't collected. This isn't something that you're solving on a day-to-day basis. Typically, in the crises that we in this group have all experienced, it's something that's a little ambiguous. We don't have a clear path. Something has happened, something's about to happen. We are trying to collect information, but we don't always have a clear-cut answer on what the information is even that we need. The other thing I think that's important to keep in mind is that we can't use our routine resources and tools when we're in these situations. So the things we do every day, we can put it into a formula. We can pop things into Excel. We can build a model. We can do some basic calculations. The crisis planning and crisis response, we have to kind of think outside the box a little bit. I think it's also important to understand as we're working with our teams, sometimes as leaders, we feel like maybe we're bringing things to a higher level than maybe our peers or physicians are. We're hardwired as humans to really think that these things aren't going to happen to us. So it happened down the street, it happened in another state, we're fine, we don't need to do any planning. The other thing as humans that we don't do super well is we don't learn from our experiences. I recently heard, and Ross and I were at a meeting in Denver together, our keynote stated that five years after the 1918 Spanish flu, people basically said they forgot it happened. There wasn't a lot of learning that was taken away. So that was a really interesting point for me. The other thing that we do as humans, and we all are kind of guilty as charged, is we're very good at being in the moment. We're not super great about planning out, looking at what might happen. If this happens, how is that going to impact us in our organization? Yeah, so crises, they affect practices of all shapes and sizes. You'll get to hear from that very different shapes and sizes of practice today with this panel. We've already kind of defined what a crisis is, and we hope to kind of dissolve and provide real world examples just proving that that would never happen to me. We're going to look at some implementation. We're going to look at how do you mitigate some of these unexpected events and crises that may come your way. What can we do as leaders in healthcare, not only to protect our patients, but our employees alike? We have a few examples here. Front of mind, looking at natural disasters, you have the Hurricane Adalia that's headed to the Gulf right now. It's a great example of something that we can have processes implemented in our practice and built for, but you never really know what to expect because natural disasters have minds of their own. Cybersecurity, it's not always hackers from other countries that are trying to steal all of your information. Something as small as phishing emails, and I'm sure there's at least one person in this room that's had an employee bring a $500 gift card from Walmart and set it on their desk because they got an email from you. Of course, acts of violence, not always happening in your face, as well as health crises. Of course, we're all very familiar with COVID, so lots of good examples that we're going to get into here and some that I can promise you you would have thought that would never happen to me. It's going to be some fun examples here today. Erica, do you want to go through the phases of crisis? I'll go through a few more just kind of frameworks. When we get to the next slide, there's a book that I just read that I pulled some of this from called The Prepared Leader. Business school professors, they're both organizational leadership professors, Erica James and Lynn Wooten. I had met Erica James when she was at the Emory Business School in Atlanta, and then I saw her book. She wrote it kind of with COVID in mind. They really break it out into how we look at things. We've talked about COVID until we're blue in the face, but I do think we're still learning from it. Some of the examples I use in the book, she talks a lot about the NBA and how they made decisions early COVID. Remember when the NBA finally recognized it, then it actually was happening. The early warning and signal detection. To Ross's point, you can have these weather events. When it's a hurricane, you might have a little time. You're watching things. You're making sure that you've got a communication system. You're staying updated. You can also have a smoldering crisis. You're collecting some information. Maybe you've got some physician behavior. Maybe you've got some employee behavior. You're kind of like, hmm, I need to get a little curious about this. This could lead to something. It's really about seeing the signs and reading the board. Phase two is preparation, prevention. In Ross's case, in hurricane country, it's do we need to do anything to our physical structure? What walls do we need to put up on our IT system? Let's be proactive. Once we've looked at the board, let's make sure that we're doing what we can to block and tackle a little bit. Once we are in the situation, it's a lot about damage containment. Leanne and I will talk about a catastrophic flood we had in one of our locations on Christmas Day. Get the water turned off. Stop the bleeding. Make sure that everything is as controlled and contained as possible. Then you can proceed to recovery and rebuilding. Step five, like I mentioned before, we don't do a great job of learning. We don't reflect a lot. We don't go, hey, how could we have done that better? We're going to make mistakes through those first four phases. There are going to be things we learn. There are going to be things, and if our egos get in the way, we are definitely not going to learn. The next time we come and have these kinds of situations, we're not going to be really as prepared as we could be. When we line those up with some of the skills we need as leaders during those different phases, I thought it was interesting how these supporting skills and the crisis levels line up here. In the early warning signal detection phase, when you're getting the information, you have to do perspective taking. You can't just say, well, my perspective, what I know, my education, and my experience is going to be the end-all, be-all here. Someone's had a different experience. Someone's worked in a different setting. We've got people, our attorneys. We've got our risk people. We've got our security folks. We've got lots of people who are going to have opinions and maybe be able to surface us information in a different way. We have to create communication structures to be open to that. When we're preparing, we have to be creative. We can't go, well, we'd always done it like this. That doesn't really work. And when you're trying to fix something, you might have to take some risks, and it's going to feel a little bit uncomfortable. In our day-to-days as healthcare administrators, we use data, we're using algorithms, we're using evidence-based medicine. When you've got a crisis, you've got to think quickly. You've got all this information coming in. You're going to have to take a risk and make the best decision you can. So it is a different skillset for us. The other thing I think we'll talk about at the end is how do you do all that? You get through it. How do you get yourself back to baseline as a leader so that you're not approaching everything as an 11? What are you doing to build your resilience? What are you doing to build your team's resilience so that they can weather some of this stuff a little bit better on a day-to-day basis? And maybe you don't have to be so involved in every minute detail. All right. Next we're going to start getting into some real-world examples from our panelists. So Ross, would you like to get us started here? Yeah. So like Jessica said, we're going to get into the fun part, hearing some of these examples where you're probably going to think at some point, that will never happen to me. Because I can promise you that I thought that as we were prepping for this and hearing some of these examples. So we have some really good people that are going to disprove that for you. So I'll pass this off to Leah because she's got some stuff for you. Yeah. So just like Erica and Ross said, some of these things has happened to us at our practice and we were not expecting it. So I think it's important as we talk about the real-world examples to think about kind of where our mindset was before it happened and how we worked through it and then how we change things for our practice to be prepared for those types of things in the future. One example I have is a cybersecurity concern. It was a phishing email. There was an email that came to our accounts payable department. It looks like it came from our CEO and it was basically asking to pay an invoice and it was about $9,000, I believe. And they did such a good job of making that email look very real like it was from our practice from our CEO that that payment did get sent. And so then we got to talking about it and realized that that was not an email that came from our CEO. And so we already had at the time an invoice approval system in place. But when you get an email from the CEO, you move forward and you kind of do that. And so after that, we implemented more of a strict policy on our invoice approval where those invoices have to come through their proper channel, be approved and signed in the right way. And it was a big learning experience for us. A couple of other examples that we've had were on the acts of violence and physical security that I think Ashkahn can probably talk a little bit more about this. But we've had some patients that come in a little bit aggressively and I'm sure we've all had that. And that's probably the most common when you think of crisis management and physical security. That's probably one of the most common ones that we all see. And so what we did was we implemented a security team because a lot of this happened for us through COVID. We were realizing that we were just we were getting more and more patients that were upset about our policy changes because of the things that we had to change for COVID. And so at the time, we hired a security guard who Ashkahn is. He works with our practice and he's a head of security at the time. But at the time, he was just a security officer that kind of stationed at our office. And he helped us work through a lot of those situations. It was really nice for our staff and our physicians to have a security guard on site so that we could work through those issues in a safe way. And we have grown that over the last couple of years to where now Ashkahn works with our company directly. He's head of security. He's implemented a security system, security policies because of the things that we learned through that time. Yeah. So touching off that, a lot of things, you know, as Leah mentioned, some things come into play, especially I'm going to skip a little bit just to the implementation portion, is you see things from the outside looking in first. You know, when I came on to our orthopedic practice, it was an off-duty officer owned security company where you were paying for someone who was able to detain and arrest if need be. And that was not always the case. Sometimes it was just, hey, can you wear your mask? You don't need a police officer to tell you things like that. So it turned into things like that. And then you have the other kind of security risks that would handle stuff in terms of over the phone is our specific example, which ended up being an active and legitimate threat. We had someone who came on site and wanted to harm people with weapons. Thankfully, our practice made the right steps at the time to notify the correct people. There was no security team, so they notified the police department. We were low and knowledgeable of what we were looking for, which turned into a violent and aggressive patient. And we sought that through. And that's when we implemented a security team and brought me on. Some of this stuff is things that it's inevitable it's going to happen. I had a guy the other day tell me that he was acting out of pocket because his blood sugar was low. And to me, as our head of security, there's nothing you can say to me that's going to excuse that kind of violent, aggressive behavior towards our staff. There's, I'm sure, no practice or anyone that's in here has made your employees sign a waiver. It's like, yeah, I want to be cussed at and berated during their hiring and onboarding. There's nothing to tolerate that and there's nothing in place for that. So that's kind of when you have to address certain policies and procedures. You know, how often do you let that slide? Do you let it slide at all? Documentation is everything. My practice is very aware of what we talked about in the panel. I don't care if I'm writing down the size of your shirt. I'm writing it down. You know, you need to document everything. We notated in the chart. We notated on the security side, the administrative side. Hey, this is what happened last time. Where do we go from here? Kind of what Erica was talking about earlier about learning from it and moving forward. That's going to be one of your biggest steps of implementing things. And when to implement is a question that you have to ask yourself in your practices. Do you wait till it's too late? Or do you put it in place now to prevent and make those preventative measures and policies to keep that from happening? All right. So now we're going to be moving on to natural disaster and unusual and unexpected. So we've already kind of touched on the hurricane that's coming towards the Gulf. I know Peachtree Orthopedics and, you know, our practice here in Raleigh, North Carolina. That's something that's very common. Every year we have to deal with some type of, you know, weather event. You know, we deal with hurricanes, but throughout the country, you know, you have tornadoes that are a lot more frequently that I think, you know, probably affect, you know, Leah Ashkahn a little bit more. And, you know, not always does it have to be something that you can prepare for. Not always is it something that you can prepare for. And, you know, Leanne has a few examples. And I think if there's a practice that can say, if it's happened somewhere, it's happened here, it's Peachtree Orthopedics. So, Leanne. You got to love Atlanta. Good afternoon, everybody. I'm just going to, you know, keeping on this real world examples and sticking with the themes of what have we learned, go through a few of those. So, when you talk about natural disasters, whether that is a weather or a frozen pipe on Christmas Eve, we have learned that, A, it helps to already have your resources lined up. So, for example, when we get a call on Christmas Eve that the pipes in the ceiling of a six floor building have burst and formed a river of water through our clinic, which has also then gone down through the floors. And ironically, it just so happens that our physical therapy is in the same corner on the fifth floor, our surgery center is on the same corner on the second floor, and our MRI magnet is in the same corner on the first floor. So, the entire set of those service lines are all impacted. Knowing and being able to step into that situation with shoes you don't mind ruining is a good way to approach it when you already have your resources and who you need to call. So, having an excellent team like a facilities manager who has his people when you have to start talking about remediation, who are we going to call to help get rid of the water, where are we going to store furniture that isn't damaged. Even though you never think it will happen to you, having those plans and those resources in place and knowing already who you're going to call is a huge time saver and reduces stress immediately off the bat. Some of the things that we learned during COVID, I kind of became our COVID point person, and I realized a few things. One, when you're faced with a disaster or the unusual and unexpected, nobody expected COVID to come our way, identify what are your critical key points. What are the things that if you can't make it happen are going to stop your process. And if you look at COVID, for example, we were suddenly faced with anesthesia groups and hospitals that had testing requirements that we couldn't change and we had to find a way to adhere to. At the time, if we all go back in our minds, we can remember how challenging it was for all of the community resources to, you know, as we call it, try to fly a plane while you're building and learning at the same time. And so we were finding challenges on a daily basis and frustrations, not just for us and our staff and our providers, but for the patient who were all here to help guide along this process that, you know, we needed to find a way to control it. So what are those critical points that you need to be able to try to find a way to bring in house so that you can control it. So we ended up implementing our own testing equipment. We researched it, we found one that was economical, that gave us the information that we needed, we put it in place, and we were able to then take some control. In addition, the thing that I learned personally in all of that was about the relationships. Build the relationships before, during, after with those community providers that could possibly be the ones to provide the services you need when you're faced with that crisis. Being able to pick up the phone and call a director of an urgent care and say, listen, I need to get a test done today, they've got to have emergency surgery tomorrow, can you help me? And having them say yes is a key thing to reducing the stresses where you can while you're dealing with all of the rest of the chaos around you in the middle of that crisis. So communication and developing relationships, bring in house those things that are critical that you need to control. We also became an early provider of vaccinations. We realized that getting our staff, our providers vaccinated and putting that line of defense in was going to be critical, and again, that was something that was strained in the community. So we developed our own vaccination program so that we could control that to be able to allow those frontline providers and staff to be back in the trenches and doing what we needed them to do. Another thing that we've learned is that you truly do not ever know what is going to be needed. It's not always water, it's not always power. You might need to think about those things that could never happen. I would pose the question of, what would you do if you suddenly had an absolutely horrific smell invading your clinic and physical therapy space? Do you have somebody that you can call to address that for you? We have had the opportunity to learn that a deceased body of a homeless person with an addiction problem is not as bad as the smell of a freezer illegally put into a loading zone that is broken in a non-temperature controlled area with expired crab meat. The smell of expired crab meat in 90 degree Atlanta summer heat is absolutely the worst smell that you could possibly ever have, I think, invade your space. Having to deal with getting rid of that, bringing in the ozone air treatment, but also realizing how do you manage that with not just, let's get rid of the smell because it is nauseating and people are concerned of what that smell is. Crab meat is absolutely horrific, but also managing the expectations of staff because the power of Google. They can go online and they can research about these ozone machines and think that after they're done, you have to leave the space open and vacated for six to eight hours. Otherwise, there's chemicals that could possibly be dangerous. That's the difference between a commercial grade, which is a super large machine, and a small little desktop machine that needs about 45 minutes. Again, it goes back to communication and making sure that you're managing expectations and guiding people because even though there's not a violent threat of a smell, it still raises the stress level of the people that have to work in that environment. They can build upon each other when they're in downtown Atlanta with all sorts of challenges in their day-to-day environment. The other thing that we have learned as we go back that helps with this unusual and unexpected is you always think that the acts of violence will be somewhere else. Recently in Atlanta, we had one that impacted two of our clinics where we had to go on a lockdown. I personally was looking out of office windows at police officers with AR-15s and we realized that you need to have in place a very easy tool to communicate in a broadcast way. That's not email. That doesn't require people to be at their computer. We would recommend looking into communication services to where you can send out a broadcast message on all sorts of different levels, whether it's weather, power, snow, ice, or something about a lockdown. The one that we ended up choosing that I would share provides the opportunity to do a poll to where the individuals receiving that message can respond with either, I'm safe, I need help, different things so that as administrators, you can get real-time feedback about the current situation for your employees as you go through different situations. It allows you to monitor it. That would be something when you go back to step five on Erica's list of learn, that we've learned ourselves and have made a change. The most important thing I think that the last two things I'll leave this group with is make sure you have identified a leader. You need a team. You need a team of people who bring different skill sets and different tasks that they are going to be responsible for, whether after a flood, did you take inventory of what electronic equipment has been damaged? Supply chains, it can take months to get that. Do you need to get your IT guys going on replacing equipment while you're doing remediation and getting the space back up to? But you need to have somebody who is taking the lead, who holds everybody accountable, and who truly drives that ship forward for you. And we personally are very lucky in that we have that individual on our team here, so we highly recommend that for others elsewhere. And then my final thought is, this has also taught me that you need to be flexible. You need to realize that how your day has started, you may not end in the way that you had planned on your calendar, and that you need to be flexible. And as someone who is no longer with us, who meant a lot to me, she always said, blessed be the flexible, for they shall not get bent out of shape. So I leave that bit of wisdom as we all manage the challenges of the unusual and unexpected and just crisis situations. Thanks for that, Leanne. I'm going to step in. Thanks, Leanne, for that. And I think, you know, you can see from this group, the presenters, and, you know, just from some of the stories we've told, we've got a lot of stories. The leader thing is really important. So I think, you know, if you've played sports, if you've been in any kind of organization, there's a person that needs to be in charge, because if there's nobody in charge, everyone tries to be in charge. You know, we've learned that we recently had a, we had an MH crisis at one of our surgery centers a while ago. One of our managers, we've got some managers on the phone today. You got to have somebody in charge to run that code, right? If everyone's trying to run the code, somebody is going to forget what's next. And so, you know, anytime I think that you're in these situations, you've got to have that point person. They're not actually doing individual contributor work. They can, but that's not their role, right? So in our OR crisis, it was a young patient, had never had surgery before, had a reaction to anesthesia, you know, stopped breathing. Somebody's got to be in charge of that, right? And so anything that we do, you know, whether it's life-threatening in that kind of situation, whether it's, you know, there's a hurricane coming, there's a core team, but somebody is going to be kind of having to take in all this information and make some quick decisions. Thanks for that. Thanks so much. All right, so we're going to be moving on now to looking at business applications. So what do you need to be doing to implement these types of practices into your own practice? Yeah, so we've talked a little bit about, you know, some of the, you know, you can call them crazy events that have happened and how, you know, the panelists here today have reacted in those situations. You know, one of the things that we often deal with is the aftermath. But, you know, it's just as important to prepare as well. So not all of us, and obviously an active shooter and acts of violence are, you know, more and more common these days and front of mind in a lot of situations. And, you know, certainly some of these practices are not in a position to have a full security team, you know, like Ashkahn, for instance. So I'd love for you, you know, Ashkahn to kind of provide us some, not only, you know, implementation that you guys have enacted, but, you know, provide some advice to those that may not, you know, have a security team on staff. You know, what resources locally can they utilize to be as effective? Yeah, so it's a sad reality is the way we have to put it nowadays is this is almost an everyday occurrence somewhere in the country, in the world that we see, unfortunately, an active shooting, some targeted, some with malicious intent, some are just off the top and immediately just go do something with, they feel like no repercussions or anything like that. And there's no true way to prepare for that in the preventative terms. The only way you can prepare for it is to react based upon proper training, proper practice, things like that. And one of the things as I go through this, that we implement is one, you need to talk about it. You need to address, you know, with your staff, your admins, your leadership is hopefully this never happens, but you need to prepare for the worst and pray for the best in that situation, you know. And so one of the things right there is making the plan, the run, hide, fight method. There's two that the United States promotes, which is RHF, which is that and the ALICE method. And you need to implement which one of those works best for your practice based on layout, based off of accessibility, things that you can look at in terms of how can we get out? How can we hide? How can we make sure everyone's alert? You know, Leanne talked about a communication system. That is probably one of your biggest things, because again, you're not going to be like, hey, pause, let me send out an email that there's an active shooter or things like that. You know, implementation of panic buttons, one of the resources that we use, and I'm almost certain, don't hold me to it, but you can contact any of your local police department, sheriff's office, any kind of law enforcement agency that's around you, and request for their SWAT team or the emergency response unit, whatever they have, their TAC team, to at least come look at your facility. A lot of them will, one, love to, two, will ask you if they can practice there. If not that, you can ask them to practice there. We do it with our local police department. Unfortunately, right now, there's just no good time for us to do it with our staff, but they come in after hours. They go through every nook and cranny. They put a dummy in, I think the last time I shadowed them, they put one in the janitor's closet. And they will run through different scenarios and how to prevent this and how to prevent that, and then certainly provide you with some details. Obviously, a lot of them will provide you with like the FBI and Homeland Security offers a booklet, and it's your active shooter plan. That's not something I would share with you all, obviously, and that's not something once you were to get that implemented, that's not something you share with anyone outside of your organization, but there's things like that in place. Then, again, in terms of having a security team, you don't always necessarily need a team. You could have a security guard. You could have a security officer, and the difference in that is merely depending on the training and depending on what state and municipality you're with. Like me personally, I'm a security officer. I can detain you. I can make an arrest. I can ask questions, whatever I need to do in that form. We're a guard, but I always say you pay for what you get, but before we even get to that part, I always say ask them what they know. What experience do they have? What have they seen? You want somebody who has a little bit of experience and has seen something or knows how to handle a situation. We do scenario-based training. Personally, I do quarterly in-services where I go in. I don't know what I'm walking into. They say, hey, you're going into room seven, and it's just a scenario, and you don't know if it's real or fake. You go in, and they want to see how you handle it. Things like that are things to look at and put into place about how do I address it? How do I think about what comes after, what comes before? How do I address the who's, the what's, the where's, the why's, the when's? And that not only applies to patients. It applies to your own staff. If there's a time where you need to look at a policy violation or some sort of mishap with your staff, how do you address that with them? Do you take it to their leadership first and work it down, or is it something that you implement a security policy? Is that something I have to nip in the butt and deal with it later? So it's all things to think about, but training and practice is pivotal in that situation. Whether it's, like I said, an active shooter event, it's a threat, it's an unusual event, because as I was saying earlier in one of our panel meetings was there's two types of brains that will exist when it comes to this. One, that every person on here is going to retain every piece of this information, and God forbid that situation happens, you're not going to remember any of this, or none of you are going to remember this until that situation comes and you remember A through Z. I think another thing that I'll add to this, because Ashkahn does a really good job of taking care of our security team and implementing our security systems, but there's other things that you can do in your office outside of a security team, such as updating your policies and procedures. One thing that we did here at our practice is our termination policy. Anytime you have to let go of an employee, that can always be a tricky situation, and you never know how those things are going to react. So even if you don't have a security team in place, there are things that you can do as a management team to prepare yourself in certain scenarios and making sure that your policies and procedures are up to date and that your team is educated on those policies and procedures and just making sure you're communicating to staff on how those things will go. Great. So now what we're going to do is go around and each of the panelists is going to be able to provide some tips and takeaways that they have learned through their experiences that they want to impart on to you. Yeah, I'll start. You never really know what's going to happen but you always have to be prepared. There's always going to be some type of situation whether it's expected or not and we're the ones that have to remain clear and level-headed because being who we are and being part of AOE, we are those leaders that Erika alluded to. We are the ones that have to make those decisions and have to be calm to not only benefit our patients but our employees as well. I think another thing that I've learned and that I try to share with my staff is just over-communicate. I think communication is the biggest key, making sure that your teams are trained on processes and that you have, if you have a process and a policy in place, just make sure you communicate that all the way down to everybody in your practice including the physicians and I think you know we're a private practice so each practice is set up but we get our providers input and we make sure they're communicated with and we communicate that all the way down the chain. I want to address, I've got your message Carol, so she mentioned that they had reached out to a local agency and they came and gave them recommendations but some of the stuff went against code such as bolts on the doors. So there are various consultants, there's things that you won't think of that it's not normal for you to think of that can help you in situations like that. There are things that you can look up and say what's an alternative for bolts on top of the doors. There's a new thing that literally slides through the hinge of a door and prevents it from opening. A lot of the fire code stuff I take care of as well on our end and our state and local stuff. If it's an egress door which means it someone has to come in or out of it whether it's a fire if it's an emergency that door has to be able to be accessed. Yeah you can't do that like the bolts on the doors but the hinge, I believe it's called a hinge slip, you put that over the hinge in the active shooter situation that door is not coming off. There's nothing they can do it to is a 18 gauge steel piece of metal that will go over a hinge and lock onto that and it's simple stuff like that. I know we're on the tips and takeaways things just look at look around. One of the biggest things again like Leanne said it's communication. You have to talk about it whether you're going up the chain or down the chain and talk about it. Comfortability is the big thing. A lot of people just want to know hey am I safe? Is my vehicle safe? Things that you don't think of you know you're just coming in clocking in doing your work and going home but in that meantime what's going on what's going on inside and outside so just be aware you know we always say just if you I always tell the people when they come to our practice it's like the airport if you see something say something I don't care if it's too big or too little let us know we'll look at it we'll take it up the chain. Just earlier today we had a little puppy left in the car and we take care of stuff like that like there's nothing too big or too small you know if somebody wants to address something you come in you evaluate hey is this something we can we can deal with or do we need to bring in somebody further out or as a consultant team. The tip and trick that I would for a takeaway is it's not always the obvious that's the answer. You know we have learned recently that we do have panic buttons and they're at the front desk because of course all of the events are going to happen at the front desk so the panic button just needs to be at the front desk. Well recently in one of our offices a patient he was on the schedule was pulled over for a routine traffic stop on his way to the appointment and some things took place and he decided to run and so he ran into our office and running behind him came the police with their guns drawn and so everybody then ran to the back. Well once you run to the back there's no panic button you know that all of those things are only at the front so it has prompted us to kind of do a little bit more of a broad view of like are we covered in different areas if something's happening in different places. It's not always going to occur where you imagine it but thank you. On to you Erica. So kind of closing out a few thoughts as we you know considered this topic and what would be helpful for you guys. You know I do think broadening our perspectives is really important so Ashken thank you for coming you know to this group from a totally different background right like you think about things differently than we do and that's that's the key. Let's look at aviation how do they do things right they they check things every time they you know how does the military handle stuff you know we're fortunate to have quite a few military reservists in our organization and you know the way they think about things is different and we've learned a lot from them so I would encourage you know just because it's not about health care doesn't mean it's not relevant to planning and preparation. The other thing about building our teams I said this earlier your perspective is not enough you're going to have to be humble you got to ask questions you're you're really the person that's supposed to be really reading the tea leaves and getting as much information as you can however if you lean on just the one person who's the expert sometimes that person can lead you down a different path so I don't know how many of you have attorneys and risk managers who can really sweat the details. I know I deal with a few of them and if I only listen to what the kind of worst case scenario is in any given situation I would not be able to move forward with a decision. I've got to be able to take that information keep it in mind but we've got to come up with a plan to move forward so that's important. The other thing is you know you've got to take care of yourself. I wanted to share the Mayo well-being index. I think everyone should put it on their phone. I get a trigger every three months to take a 12 question survey. When we had a crisis on Christmas and I took the next survey my well-being went like this. I had to do some stuff to get it back up to normal right so what are the things in your life that you need outside of the job? Ashkin said on our prep call he works 25-8. I was like I don't know man you might need to work like you know 50-55 so you know what are you doing in your life so you can be the best leader possible for your team and then again debrief, debrief, debrief, debrief. So you know it's funny my dad was was in Vietnam. He's he's marine and you know they he kind of qualified that as like a lot of boredom followed by sheer terror followed by a lot of boredom. They document everything in the military. When they screw up they write a like a novel about it. There's nobody like there's literally no ego involved. You're following your orders. You've you've done what you're supposed to do. That didn't work out. What are we going to learn from that um the next time? So documenting, updating procedures, realizing when things there are gaps. So like Leanne said when we had two clinics shut down and then it's like we how do we communicate this out to everybody? I mean it's great but not people are not using that when there's a crisis situation um and then how do you communicate with yourself when the crisis is over? Ashken I would love to hear your your take on that because what I've found is the crisis has passed but the stress level is still. It's inevitable. You're someone even sometimes myself depending on the situation is going to stress. No like you said no one situation is ever going to be the same. So like you know when you're talking about looking at it from this zoomed out look um like me personally I've got a little bit of military um and law enforcement experience. So I've seen things like that but you know like I take into consideration it's like this is an orthopedic practice. Some some things is like you know the guy with the low blood pressure. I'm like all right buddy like well let's laugh that off. Let's get you a coke and a twinkie and get you in the gym. Let's get you worked out and then the other guys um I one of the last things I like don't like to do and Leah knows this is go hands on. I don't want to do that paperwork one and two you're here already for a bodily injury. My last resort is not I don't want to give you further bodily injury. I don't want you to go to jail. I want you to come get the help you need and we can only do that if you're willing and so it's for me it's a big communication thing because it's like hey um with one of my secondary security officers like you know I'm gonna go hands on and that's probably the more stressful part. I want you to have my you know we call it my six. I want you to have my back make sure you know if there's a family member or if he's got a bag or something with him make sure he doesn't get to that. It's again it's that proper training and just practice and being able to assess the situation for what it is. Like you said no no one is going to be the same every day as a toss-up for me and for our admin team you never know what you're going to get and we just kind of we take it look at it if we have time that's the other thing is if you have time to assess what's going on a lot of it you just have to react react react and you go back and you're like yeah that probably wasn't the best way but at that time you know one of my biggest things when I talk to all of our staff is you're you are my priority not even myself first you are my priority then I will go down the line and make sure you know whoever's next is safe and we're able to operate and able to move forward but I think it's just a big thing about being able to recognize what options you have in place you know Leanne was talking about panic but something we just implemented because even though you have them you're not always going to remember to hit that a lot of times you're going to forget to have them in my instance all my girls their knees keep hitting them and I get a whole SWAT response to one of my locations and I'm like what's happening but a new thing this has got to be all across the country is mobile panic buttons you can have them around your neck I've been piloting one that I wear on my duty belt things like that because a lot of times one like Leanne said you're going in the back and now there's not a panic button you start to look at different forms of things like that and that's from us re-evaluating the situation and saying okay yeah you're right we had to run to the back we have nothing back here besides a fire extinguisher and a water fountain what are we going to do you know so it's things of just looking around and one thing I do almost monthly I started to do it every two weeks and it sounds terrible as I go around to all of our locations and I tell them I'm like don't think I'm crazy and don't think I actually want to do this but I have to go around and think how would I want to hurt you or if I wanted to get in here and steal money or if I wanted to get in here and find drugs or well homeless we had a homeless guy living in our basement at one of our sites how would I want to get in here okay now I know what can I do to prevent it what can I put in place you know what we personally did access systems cameras I have a modular speaker for we had roofers a few months back who were trying to beat the heat and we're out there at 5 a.m. and the security company calls me and plays a recording from the speaker of hammers and drills going off at 5 in the morning I'm like and I look at our cameras you're able to bounce back and say okay it's a roofer so we don't we don't need the police things like that it's things to assess and talk to your leadership talk to your your management your providers and things like that because once they see these things being in place and hopefully preventing these things from ever even happening it's so much smoother from there because I can tell you countless times merely a presence alone is enough so we've gone through most of the presentation and I want to give an opportunity for anyone to ask questions and also I wanted to point out Mike made a great point in the chat to it's important to be testing these things on a regular basis too that's so true so if you have questions feel free to drop them in the chat you know we appreciate everybody coming to today's session as I said at the beginning I'll be opening up a breakout room shortly for anybody who wants to stay on and just network with anybody else on the call but in the meantime does anybody on the panel have anything else they want to share or any other you know departing words of wisdom that they want to express I think we talked on our our call when we were preparing about community resources for emergency alerts I think every jurisdiction has something right so whether it's whether Ashken do you have some resources for the group yeah so I don't know I think they're national now because they're they're headquartered out of California so there's various groups we personally we used to use a company called alert com and it will tell you anything and everything you need to know as long as you're so we had it set up for our leadership to be the ones to be able to send out messages and not only was it in reference to a crisis well crisis but if you're not able not everyone has access to the email outside of the office sometimes so we would put out hey ice storm tomorrow you know we are open but delayed or we're closed tomorrow each jurisdiction I think will have a different one that one is a good example there's hundreds of them out there I always tell people I'm not gonna you know sell you on this specific one try three four or five of them you may try one and like the demo and then you get it you're gonna hate it so I always tell people just try them out there's a couple different companies there's consulting groups that you can have just come look at your facility like you could use this you don't really need a through z you just need kind of l through o and take those for what they are and step by step and kind of index off what you want what applies to you because a lot of stuff you know when you're looking at a through d it's not going to apply to you when a lot of stuff is you might need c d e f but you didn't need part b so a lot of some consultant agencies will make you buy the whole alphabet and some won't but that's something like I said we used alert com but I would pilot multiple programs and if they don't let you pilot it I wouldn't go with them all right Eric had dropped the well-being index link into the chat so feel free to look at that as another resource for you I don't see any other questions in the chat if anybody has follow-up questions you can always email us at education at aaoe.net and we can always follow up I'm going to go ahead and open the breakout room for anybody who wants to join feel free to do that and if anybody has other thoughts reach out to us anytime we appreciate you coming thank you so much to all of our panelists who are joined us today and went through this whole presentation it was great the recording will be available afterwards so you'll be able to have an opportunity to access that so thanks everybody so much and have a great day thank you great job Jessica and panel thank you

crisis management

emergency preparedness

effective communication

training

leadership in crisis

security measures

debriefing

flexibility in crisis management

community emergency alerts