Carrie Finley (Host): Welcome to the Superior HealthCast: Quick Takes for Quality Care. Here, we explore practical, forward-thinking ways to improve healthcare quality with one quick, meaningful conversation at a time.

In this episode, we take a deep dive into emergency preparedness and the critical role it plays in healthcare settings. We explore how organizations can strengthen their readiness for unexpected events, protect patients and staff, and maintain continuity of care. You will be able to find this and future episodes on the Superior Health Quality Alliance website or your favorite podcast streaming platform.

I am your host today, and my name is Carrie Finley, and I'm a registered nurse and a quality improvement advisor with Superior Health Quality Alliance. And I'm very excited to be here with my guest, Katie Pisciotta from Superior Health, who will be sharing her expertise. Katie is a certified professional in healthcare quality and a Lean Six Sigma Black Belt who serves as a Director of Emergency Preparedness.

With more than 20 years of experience across public health and clinical settings, Katie specializes in helping nursing homes, hospitals, and clinics strengthen emergency readiness. Her expertise spans infection prevention, quality improvement, and healthcare system resilience, all with a focus on turning lessons learned into lasting improvements and empowering teams to respond with confidence when it matters most.

So, thank you, Katie, for joining us today. So to start off this conversation, can you walk us through what being truly prepared looks like in practice for healthcare organizations such as nursing homes, hospitals, and clinics?

Katie Pisciotta: Yeah. So, being truly prepared really isn't about having a perfect plan sitting in a binder somewhere. It's about what actually happens in the moment. When a team's prepared, you can feel it. People don't freeze or look around waiting for direction. They know their role and they just step into it. There's a sense of calm even when things are moving fast. The organizations that do this really well don't treat preparedness as a once-a-year task. It's part of how they operate every day through quick check-ins, team huddles, and just keeping it top of mind. At the end of the day, preparedness shows up in behavior, not paperwork.

Host: Yeah, that is really helpful context, and I think it leads nicely into something many organizations struggle with. So, let's talk about what you're seeing in the field. What are some of the most common gaps you see when reviewing emergency preparedness plans across healthcare settings?

Katie Pisciotta: Yeah. Honestly, one of the biggest things we see is that plans just do not reflect real life. They are often a little too generic, a little too long, and not always easy to use when you actually need them. And in a stressful situation, nobody has time to flip through pages and pages trying to figure out what to do.

Another big gap is alignment. Different departments may all think they're on the same page. But when something actually happens, that's when you see the disconnect. The strongest plans are simple, clear, and something people actually recognize when they see it in action.

Host: Okay. Well, building on that, how often should facilities be updating their emergency preparedness plans? And like what typically gets overlooked during those updates?

Katie Pisciotta: At a minimum, updating your plan should happen once a year. But realistically, it should be any time something changes. And let's face it, in healthcare, things change all the time. Staffing shifts, residents' needs evolve, equipment or infrastructure changes. A really common example we see is when a facility's resident population becomes more complex. Maybe more individuals on oxygen or dependent on medical equipment, but the plan has not caught up to reflect that reality.

The other big thing that gets missed, lessons learned. Teams will go through a drill or even a real event, have great conversation afterward. And then, those insights don't always make it back into the plan or future training. So, keeping plans alive is what really makes a big difference.

Host: So, updating plans is one thing, but I know learning from real events is another. So, how can organizations better capture those lessons learned that you mentioned after an event and turn them into real improvements?

Katie Pisciotta: This is where a lot of organizations have the right idea but don't quite go far enough. It's easy to sit down with leadership after an event and talk through what happened. But if that's the only perspective you're getting, you're missing a big part of the story. The real insight's going to come from your frontline.

Those are the people who can tell you what felt confusing, what slowed them down, what actually worked really well. That's why creating space through things like micro-huddles is so, so important. And just as important is making sure people feel comfortable being honest. Not everything went perfectly, it's never all going to go perfectly, and that's okay.

Then, it's about follow-through, picking a few key improvements that you heard, assigning ownership, and actually coming back to test those changes once you make them. And that's how you build real progress over time.

Host: Great. Let's shift gears just a bit and talk about preparation in action. Can you talk about the importance of exercises and drills, and what differentiates a meaningful exercise from one that's just checking the box?

Katie Pisciotta: Something I love to talk about. A meaningful exercise really starts before the exercise itself. If you walk into it without thinking about your own environment, it is going to feel like checking a box, and you will not get much out of it. The best exercises are grounded in your reality. Who are you caring for? What are their needs? That being mobility, memory care, medical equipment. Where are your biggest challenges or vulnerabilities? Because every facility is different. That's why preparation matters so, so much. We actually provide a preparedness packet to help teams think through all of those details ahead of time and come in ready. When you approach it that way, the exercise becomes much more meaningful and much more useful. At the end of the day, you really do get out of it what you put into it

Host: And with that, what role does leadership play in shaping a culture of preparedness in healthcare facilities?

Katie Pisciotta: Just like everything else, you know, leadership definitely sets the tone. But what's really powerful, to see during an emergency is what we call emerging leadership. That's when someone who might not have a formal leadership title steps up and just takes ownership in the moment. And you can't force that.

But what you can do is create an environment where it's more likely to happen. And that comes from building confidence, encouraging critical thinking, and letting people know that we trust their judgment. That's where staff empowerment and judgment training becomes really, really important. Because in real situations, people don't always have time to ask for permission, nor should they stop and try to ask for permission sometimes. They need to be able to act. And when they do, that's what keeps everything moving and creates continuity even in really challenging moments.

Host: So for organizations that may not have tested their plans recently, this can feel a bit overwhelming. If a facility hasn't recently tested their emergency plan, like what risks might they be facing, and how can they get back on track?

Katie Pisciotta: Yeah. Unfortunately, I've seen this happen time and time again. If a plan hasn't been tested, the biggest risk, of course, is that you really don't know how it's going to hold up. Everything can look solid on paper. But until you try to use it, you don't see where communication breaks down, where your roles are not clear or what takes longer than expected. And in scenarios, like a tornado, that could happen in seconds. Something taking longer than expected is a big issue. Those are things you want to learn in a practice setting, not a real event.

But the good news is that getting back on track doesn't have to feel overwhelming. You can start small, even with something like a micro-huddle drill. These are things I love to encourage facilities to do. these are quick 5, 10, 15-minute no-prep scenarios where teams walk through a realistic scenario. They make decisions in real time, and then debrief what worked and what didn't. It's a simple way to build instinct, build confidence, and build that team alignment without a lot of lift.

So for example, you could put a small team together and say, "It's 10:00 PM. We've just lost power. Our generator is delayed. Who's doing what in the first 15 minutes?" And then, you just talk it through. So, who's checking on residents that are on oxygen? Who's communicating with leadership or families? What's the backup plan if something doesn't go as expected? And you can do all that in just a few minutes. And it gets people thinking in a really practical way. And the goal is to just get people thinking. And then from there, you can build into a tabletop or larger exercise. Preparedness builds over time. It's about starting small and building confidence as you go.

Host: Yeah. Great. Well, before we wrap it up, can you share how your team works with facilities to assess preparedness and provide support?

Katie Pisciotta: Our goal is to support facilities in a way that feels practical, approachable, and most of all, genuinely helpful. So, we work alongside teams to identify real risks, things like staffing, utilities, communication, and transfers, while also offering guidance during events, especially when quick decisions are needed. And when things are moving fast, we help with documentation and communication in the moment, so teams can stay focused on what matters, which of course is your staff, your residents, and your patients.

We also support facilities proactively by connecting them to existing exercises and opportunities to practice. We provide resources like our regional exercise preparedness packet and our Get in the Mindset and Hotwash Workbook. This is to help teams prepare and get the most value out of those exercises. Again, you get what you give. And we support staff training to build confidence and decision-making skills. We review and update emergency preparedness plans to keep them current, again, realistic and usable, and help teams stay aware of emerging risks and evolving threats.

And then, our involvement doesn't end when the event is over. We know that sometimes that can be one of the most difficult times. We stay engaged afterward, talking through what happened, helping teams prioritize improvements, watching for any impacts on quality and safety. And at the end of the day, it's about supporting facilities across the full continuum before, during, and after an event, so that they feel more confident and more prepared, and better equipped each time something might occur. Because in reality, we can't stop these events from happening, whether they're big or small. But what we can do is we can make sure teams are prepared, coordinated and, in our situation as a QIN-QIO, supported as much as possible every single time

Host: Wonderful. Well, thank you, Katie, for your time and insights. And thank you listeners for listening. This has been a very informative and wonderful conversation about emergency preparedness. Remember, you can find all episodes of the Superior Health Cast Quick Takes for Quality Care on our website, and that's www.superiorhealthqa.org, and you can subscribe on your favorite podcast platform.

We love hearing from you, so please send any of your comments, thoughts, questions, or suggestions for future episodes. And you can do that at info@superiorhealthqa.org. Your feedback helps shape the conversations that matter most. So until next time, stay inspired and keep striving for quality care.