Lessons in Leadership: How the BayCare Health System Withstood Hurricane Irma

Article · October 25, 2017

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NEJM Catalyst’s Lessons in Leadership series features how health care leaders creatively guide their teams and organizations to make health care better. See all stories here.


As a large health system with 14 hospitals located in west central Florida, BayCare Health System is no stranger to the threat of hurricanes. As such, we have extensive plans in place to face storms that have the potential to impact us. Once it was confirmed that Hurricane Irma was approaching our region, our chief operating officer assembled our disaster management team and began to operationalize the logistics of a plan that had been established long before, to prepare us for exactly what we were facing.

Nearly a week before Hurricane Irma made landfall, the team initiated the plan and started thrice daily, system-wide calls with nearly 100 cross-functional leaders across the system. Those calls covered a wide range of topics, including the latest weather updates, supplies, facilities, operations, information technology, communications, and ambulatory and physician services. Each area reported their progress and challenges so we could mobilize around those issues. The call frequency increased as the storm neared, until eventually being held every few hours, including midnight updates. These calls set the stage for when to close facilities, how to mobilize materials (medications, sterile supplies, IV tubing, etc.), and where to focus energies and coordinate efforts.

Strategic work efforts included topping off the fuel tanks on the generators, testing communication links, such as ham radios, and securing additional satellite phones with activated minutes. Ultimately, due to being located in a mandatory evacuation zone for one and experiencing water intrusion in another, we closed two hospitals and transported the patients to other in-system hospitals. Payroll was advanced for all employees to provide cash for those individuals preparing to evacuate.

As non-essential operations, including billing, marketing, and insurance, were shut down, the hospitals each implemented local command centers in addition to the virtual system command center. Senior leadership was deployed to local hospitals and braced for the impending impact.

During the height of the storm, we had numerous challenges including power outages, generator needs, and even generator outages requiring onsite support. While we never lost land-based communication, we were prepared with ham operators and satellite phone redundancies.

While mandatorily evacuating the first low-lying hospital, EMS was unable to supply the necessary support to get it done safely before the storm was upon us. Our home care division rallied transport vehicles, and we moved the patients safely and effectively. We also made the decision to close several of our behavioral health inpatient facilities.

As transfers and evacuations continued, our remaining 12 hospitals became both locations of acute care delivery and shelters. We estimate that we sheltered more than 2,000 people and nearly 500 pets. We delivered 80 babies and continued surgeries, heart catheterizations, and other clinical operational needs throughout the storm. Constant, accurate communication to our employees, physicians, and board members was essential through it all. We provided multiple updates each day on the path of the storm and its expected impact for each of the counties in our service area (as the impact of the storm varied across our service area), facilities closing, and letting employees know what to expect at work.

In the aftermath of the storm, deconstructing the shelter location and transferring patients home or back to their places of origin were all challenges. Additionally, many of our physician practices and outpatient resources were without power or unfit for use, and we needed to help them find temporary work spaces. We suffered water intrusion that shut down one hospital, and had to replace and repair generators in two locations. We continue to do additional facility hardening for hurricanes, but Irma brought a few lessons learned:

  • One was the role of the non-clinical senior leadership team during a crisis of this magnitude. We found that most chose to volunteer in our hospitals and provide support as they were able. No job was too large or too small. Having members of the system executive team attend local command center meetings was coupled with cleaning beds, transporting patients, and doing any other jobs that needed to be done. The esprit de corps was palpable as they pitched in to lend a hand.
  • Another was to the extent we were prepared to be a shelter. During Irma, we sheltered thousands of team members who were coming off shifts. We created quiet spaces where they could sleep so they would be fresh to come back for an extended crisis situation. This took priority in terms of shelter operations with families. Food, entertainment, safe accommodations, toileting for pets, and Wi-Fi traffic were all issues that we had to manage. Countless acts of human kindness, heroism, volunteerism, and charity occurred. From employees retrieving platelets after the delivery service ceased operations, to volunteering to provide childcare for those on duty, our team rose to the occasion and did whatever it took to care for the boundless numbers of people we had in our facilities. At one facility, a file cabinet was commandeered and board games were located and placed within as a lending library for families who were sheltering in the building.

While we do not wish any health system the ill fate of having to face such a disaster, we’ve learned that being prepared, having a plan, and remaining calm are essential. Communication within the leadership team and to clinicians and employees is paramount so they know what to expect, and are calmer and better prepared to care for patients. In the end, we sustained damages, but had no adverse patient occurrences and weathered the storm well. Our team demonstrated our culture of humanity at work and became united in the course of this crisis.

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