For many laboratory directors, hazardous emergency safety likely is not at the forefront of everyday operations. Yet when taken for granted, the lack of a comprehensive and clearly communicated action plan detailing an emergency response to an event such as a fire, large chemical spill, or other emergency, can be disastrous. At Mayo Clinic in Rochester, Minnesota, a significant challenge was posed by the need to develop a robust emergency reaction plan and provide fire and emergency safety training to approximately 2,000 occupants of an 11-story laboratory building located within a major downtown medical center. To add to the complexity, the building contains hazardous chemicals, infectious agents and, most important, numerous employees, patients, and visitors.

Creating True Awareness

Prior to initiating this project, fire safety education for laboratory employees consisted of basic videos and organization-wide online training. This was considered sufficient until an emergency event prompted a full evacuation of the building, thereby revealing a significant need for increased education and training. During the emergency, employees reacted in a variety of ways: Some continued to work, while others relocated within the building, or evacuated altogether. Many simply did not know what to do.

As a result of this experience, leadership identified the need to create a comprehensive process for relocation and/or evacuation in the event of a fire or similar emergency. To facilitate this, a multi-disciplinary team within Mayo Clinic’s department of laboratory medicine and pathology (DLMP) was assembled in coordination with representatives from facility emergency management. This team utilized the ADKAR Model1 (see Figure 1) for change management in order to revamp emergency preparedness processes and raise employee awareness. As a first step, work groups were created to address specific aspects of the project, including an education work group to address employee-training needs.

Start with Education

The education team began by evaluating existing fire safety training, which appeared to focus on high-level concepts applicable to the entire organization, but did not provide details for actions in specific work areas. Given this, the team’s first goal was to assess current employee understanding of fire safety in relation to the DLMP and specific work unit procedures. A survey was distributed with a variety of questions regarding basic fire response and work-specific actions, and the results indicated knowledge gaps, which as a result, became the focus of education and training topics. The team then shared the survey data, including question response rates and correct answers with supporting rationale with all staff through a series of e-newsletter articles.

Next, the team created additional education materials to highlight appropriate fire preparedness and response actions such as R.A.C.E. and P.A.S.S. (see Figure 2).

Tailor the Plan to the Facility

In addition to our efforts to raise employee awareness of emergency preparedness and process gaps, the next step was to continue the process of change management by influencing individual desire to change. Employees who were impacted by the real evacuation event realized just how unprepared they and their co-workers were. To emphasize this point to others, the team drew attention to the fact that one of our buildings is a multipurpose, high-rise that contains numerous flammable and hazardous materials, and high-rise buildings pose unique risks in the event of an emergency (eg, congestion in halls and stairwells, risk of injuries during a mass evacuation, varied responsibilities on numerous floors).

The layout of each floor in the high-rise is configured differently and houses a mixture of laboratories, office space, and patient/donor services, so a simple, one-size-fits-all approach to fire and emergency planning was not going to work well. It was determined that the best plan would reflect high-level consistency while allowing for customization at the work-unit level. To encourage individual and unit involvement, staff from each of the 11 floors volunteered to become fire awareness representatives (floor representatives). Each floor representative created their own sub-group consisting of individuals from different work areas on that floor. As a result, 60 additional individuals were given a voice in deciding how their floor would respond within the framework of an overall unified fire emergency plan.

Initially, the floor representatives were responsible for ensuring the training and awareness tools were used properly. They also spoke at laboratory and all-staff meetings, sent reminder emails, placed highly visible action plan posters, and made themselves accessible for any questions or concerns. Monthly meetings were scheduled to allow the floor representatives to share the most effective practices and brainstorm suggestions for improvements. This grassroots effort was key to bringing forth ideas and solutions, while giving employees a sense of project ownership and responsibility.

Supplemental Education Activities

One particularly effective measure was to invite the city’s fire marshal to speak about fire risks, how fires behave, and actions that can be taken in the event of a fire both at home and at work. He emphasized the fact that even though Mayo Clinic has never had a significant fire, the risk remains. He also reinforced the importance of following the R.A.C.E. behaviors with his position and experience lending significant credibility.

An additional work team was tasked with revising the designated meeting locations for each floor in the event of an evacuation. Determining factors included the number of employees per floor, their typical locations on the floor, and the relative locations of exits and stairwells. To assist in this process, a special software simulation program was utilized to determine the best flow of personnel during an evacuation. When the plans were ready, employees were trained to report to new meeting locations and an animated online module was created to encourage a diverse understanding of these locations; the user is able to select a floor and work unit location, and the module provides several relocation options.

Drill the Plan

Once a plan is determined and education is implemented, the next step is to drill the plan. Fire drills were scheduled for one or two floors at a time to minimize congestion in the halls and stairwells. Floor representatives served a critical role in communicating the date and time of the drills and explaining what needed to be done. In addition to the standard staff, everyone on the drill floors was invited to participate, such as physicians, office support employees, and vendors or visitors that happened to be in the area at the time.

During the drills, floor representatives and designated observers were assigned to monitor employee actions and collect data, such as how long it took employees to relocate to their designated location(s). Participants were encouraged to share their impressions and ideas about the drill through a short debriefing session and via an online survey. These data were used to make adjustments to individual plans.

After drilling each floor, a building-wide evacuation drill was conducted. Approximately 1,700 employees evacuated the 11-story building and gathered in their designated meeting locations, impressively, within 15 minutes. During the drill, designated employees performed systematic sweeps of each floor to ensure that no one was left behind and observers again monitored personnel movement, safety, and how the relocations impacted patient services in other work areas. Progression from the building to the meeting locations was orderly and no injuries were reported. Results showed that personnel knew what to do, where to go, and acted in a manner that minimized disruptions to daily operations. Based on these results, the education and training efforts were deemed successful and no further changes were made.

Continual Reinforcement

Through careful planning and execution, the education team identified knowledge gaps, created educational tools that addressed those deficits, and trained employees on new processes for relocation in the event of a fire or other emergency. Maintenance for this program is minimal and provides floor representatives with the flexibility to customize the content to fit the needs of their specific floor. To sustain the gains that have been made, floor representatives continue to meet on a monthly basis and they are responsible for providing periodic awareness and education updates, and coordinating annual drills on their floors. This structure provides a local contact to address any questions or concerns and helps to sustain a floor-wide approach when responding to a fire or evacuation emergency. Fire drill exercises reinforce previous learning, provide initial training to new and transfer employees, and allow for monitoring of the process to determine if modifications are needed.

Conclusion

Over the course of this project, we learned a few valuable lessons long the way:

• Engage local employees (ie, floor representatives and observers) to generate buy-in and create local champions for the project
• Take the time to identify knowledge and ability gaps for all employees
• Incorporate a variety of educational methods to meet different learning preferences and the unique needs of multiple work areas/shifts
• Make learning fun, engaging, and relevant to audience(s) in order to increase retention

It is critical to truly engage with staff members when overseeing any project. Many small steps are needed to build momentum in influencing how employees respond to major change. Ongoing and visible support from leadership is key to these endeavors and providing a safe and responsible work and care environment is paramount to our operations. The floor wide approach to planning and communicating with others locally and building-wide during an emergency has improved significantly and we owe much of the sustained success to the ADKAR model.

Reference

1. Hiatt JM. ADKAR – A model for change in business, government and community, 1st ed. Prosci Research: Loveland. P2, 2006.

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Patricia Hlavka, MS, CSP, is a safety coordinator in the department of laboratory medicine and pathology at Mayo Clinic. She is a certified safety professional (CSP) and a member of the American Society of Safety Engineers. Her responsibilities focus on laboratory safety, including the safety audit program, and developing and maintaining documentation, training, communications, awareness, incident investigation, laboratory safety committees, and emergency management.

Amy Seegmiller Renner, MS, HT(ASCP)^CM, is an education specialist II and an instructor in laboratory medicine and pathology for the College of Medicine at Mayo Clinic. Her job duties include the design, development, delivery, and evaluation of training and educational materials for learners within the department of laboratory medicine and pathology. Amy’s primary responsibilities focus on professional and leadership development.

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The authors would like to thank Aaron Getchell, Stephen Grinnell, Twyla Rickard, and Deborah Teske for their contributions to this article.