1. Issel, L. Michele PhD, RN

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Raging fire, drenching hurricanes, flooding flood planes, oozing lava, jolting and jiggling of terra firma, debilitating outbreaks, and leveling winds. These natural disasters, as well as man-made events, have wide ranging effects with implications for health care organizations and the health care system, not the least of which is ethical issues (Leider et al., 2017). The science of managing health care organizations for and during disasters remains underdeveloped, in contrast to the substantial research on managing the disaster itself. Health care management researchers can fill that knowledge gap; here a few examples.

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Both health policy regulations and federal funding influence levels of preparedness and administrative issues faced by health care managers. The Centers' for Medicare and Medicaid regulation now requires all 17 types of providers, whether renal centers, home health agencies, or hospitals and community mental health centers, have emergency preparedness assessments, planning, polices, and training. Furthermore, as of late October 2018, reauthorization of the Hospital Preparedness Program has not yet been acted upon by the U. S. Senate. This delays funding of programs intended to improve and increase capacity and capability to respond to both natural and man-made disasters. Research on the implementation of health policy rarely receives attention from the perspective of how the policy affects organizational structure, human resource management or procedural redundancies needed to have safe and mindful organizations at times of distress.


Most immediately, emergency services and first responders are stressed and stretched, requiring that preplanned coordination, communication, and actions be effectively implemented. The infrastructure through which that occurs might have been damaged, resulting in less coordinated and more ineffective action than necessary to save and preserve lives. Moving patients to safety, transfers under duress with a daunting scale of evacuations would be challenging even in the best of circumstances. The types of medical and psychological care needed varies by the different traumas, whether more infectious or co-morbidities secondary to lack of access to medications. Such factors leads to changes of what is needed to support the providers, given their availability, exhaustion, and anxiety about family.


Undoubtedly, many health care organizations have procedures, may have participated in table-top exercises, or have actual experience. Research emphasis has ignored intra-organizational processes necessary to have successful external inter-organizational network collaboration and communication. Systems and complexity theories, for example, applied at multiple levels, could yield useful insights into what works and what can be replicated.


Given the increasing frequency and severity of severe weather and man-made disasters, a host of questions arise about how to manage the organization at such times. We have much yet to learn about how to make the health care organizations responsive and resilient to disasters. HCMR is a natural (yes, pun intended) outlet for such research.


L. Michele Issel, PhD, RN






Centers for Medicare and Medicaid Services (2018). Quality, Safety & Oversight Group-Emergency Preparedness.


Leider J. P., DeBruin D., Reynolds N., Koch A., & Seaberg J. (2017). Ethical guidance for disaster response, specifically around Crisis of Care Standards: A systematic review. American Journal of Public Health, 107. doi:10.2105/AJPH.2017.303882 [Context Link]