Tips for rural hospitals to find their ‘surge gear’

The concept behind Michael Waters’ book The Power of Surge is simple, yet no less powerful for being so.

Surge is the taking of “rapid, robust, and hopefully right-judged action to achieve a task, project or goal.” Such surge actions account for everything from the body’s immune system attacking a virus to community-wide efforts to take care of the victims of a natural disaster. The book makes a case for the practical and moral imperative of organizations to create and develop a “surge gear” to more effectively manage future challenges.

Of course, rural and community access hospitals are more than a little familiar with the idea of stepping up to meet challenges, says Jennifer LeMieux, chief operating officer for HealthTechS3.

“From the annual string of wildfires across the West to the opioid crisis to the ongoing COVID-19 pandemic, hospitals serving rural communities are constantly honing their plans to address emergencies,” she says.

Still, Waters argues, even organizations that are no strangers to surging “can improve what they know and do.”

The Power of Surge offers a checklist of important factors for surge effectiveness. Read on for a few of the more rural healthcare-appropriate highlights:

Surge consciousness. Rural hospital administrators would do well to develop a habit of “thinking surge” as a viable option for accomplishing any project—and instilling that habit in others. Too often, he writes, the idea of taking rapid and robust action to tackle a project often doesn’t occur to people except in a purely reactive way, like when there’s a crisis afoot. But “thinking surge” can and should be considered when it comes to taking on proactive projects, like the organization-wide adoption of new efficiencies.

The ability to shift smoothly into surge gear. Try to ensure that your organization can shift smoothly into surge gear from the more normal gears in which it usually operates. This is enhanced by being clear on what exactly is expected when in surge gear.

Typically, hospitals function in one of three gears, or levels of operation: conventional, or “business as usual”; contingency, which is more intense but includes the maintenance of normal levels of service; and crisis, which sacrifices most attempts at normalcy to address the pressing need. Switching swiftly from one gear to another should feel routine for hospitals, Waters writes, so that the entire operation can adapt to any situation with zero confusion.

Protective diversity. More than just an attitude or way of thinking, the power of surge is also about preparation and the effective channeling of resources. Waters is a big believer in organizations securing resources from a variety of places so as to avoid overreliance on a single source.

“Back-up generators in a hospital, for when normal power supplies fail, is one obvious example,” the author writes. “Others include having more than one team of emergency responders to call on, not relying on a single source of information or a single source of finance or one supplier of resources or one media outlet for communication with the public.”

Contextual awareness. Taking into account local factors like geography, culture, and the local political landscape is essential when in the midst of a surge event. Overlooking or dismissing the beliefs or sensitivities of the local populace can alienate the people necessary for surge success. The same thing goes for a hospital’s employees—trying to install new protocols when one is unfamiliar with the usual way of doing things may negatively affect acceptance of the new protocols.

Collective prioritization. If all those involved in the surge event agree on its priorities, then everyone’s energies are focused and directed towards a common end.

But while collective prioritization might be easy to achieve in sports, where everyone on a team wants to win, what does it look like for a CAH in the throes of an 18-month-long pandemic?

Waters writes that collective prioritization must involve the recognition of an organization’s limitations of energy, attention and financial resources.

“Prioritization works in both directions,” LeMieux says. “Not only must our hospitals and ancillary providers decide the crucial functions that remain ‘business as usual’ in a surge event but they also decide the various levels below, including possible decommissioning of a service or function.”

Rural healthcare looks very different than it did just a few years ago, and it’s safe to say it will look just as different in a few years. Fortunately, books like Michael Waters’ The Power of Surge can help identify the tools and thinking necessary for taking the “rapid, robust, and right-judged” action needed to adapt.