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  1. What leadership principles should be followed by hospitalists and key leaders of the organization during a disaster?

  2. How should an emergency command center be designed and operated while conveying an environment of safety for your staff and other essential personnel?

  3. What are some significant considerations for hospitalist and organizational staffing and planning models during a disaster?

Despite the best preparations and planning, many aspects of managing an organization and a hospitalist practice change rapidly, and many new, often unanticipated, problems arise during the peridisaster and recovery period. We present our management learnings as a large hospitalist program within a tertiary-care referral center during an unprecedented disaster in Hurricane Katrina and extend preparedness principles to other types of man-made, natural, planned, and unplanned emergencies.


The ability to lead others through change and adversity and to sustain an effective team with a unified purpose is required during a disaster, not only within the hospitalist program level, but also at an organizational level.

All top leaders in an organization need to be present during and/or in the aftermath of a disaster. This includes not only the CEO and COO, but also the CFO, VP for human resources, and so on. In a severe disaster, issues like how to pay employees if major electronic systems are down, how to prepare an insurance claim for business interruption insurance (documentation needs to start during the actual disaster), access to significant cash reserves in order to function, and how to manage employees who have neglected their responsibilities will be among the multitude of issues for which leaders will be needed. A leadership structure with the appropriate scope of responsibilities and number of direct reports needs to be functional, and on-field promotions will likely be required. Assigning responsibility for conducting every detail of your plan is essential. It will be necessary to ask unofficial leaders to step up and help manage particular functions or groups of individuals and they must be given the authority to do so with appropriate levels of support. They need to have the traits of selfless dedication, courage, decisiveness, compassion, and optimism. The failure to quickly create new leadership structures to fill in for leaders who cannot be present will lead to an unmanageable situation.

A Few Key Leadership Principles

A strong sense of purpose with optimism: “We will make a difference in this disaster. We will care for our patients who depend on us to manage through this difficult time. Here are our challenges and we'll face them together and get through this fine.” Employees (or at least all key managers) need to hear this and be updated with the status of the organization and challenges twice a day with the expectation that they drive it down into the institution. A sense of unaffordable failure can be a self-fulfilling prophecy.

Stopping rumors is one ...

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