ASSESSMENT OF PUBLIC HEALTH AND HEALTHCARE PREPAREDNESS CAPABILITIES: ANALYZING CORRECTIVE ACTIONS TO IDENTIFY PRIORITIES Lisa McCormick, DrPH; Jonathan Wilson, RN, MSN, CHEP; Elena Linn, MPH; W. Terry McLeod, RN, BSN, CHEP; Jim Craig, BS, CPM

Initial Detection Initial Response Initial Recovery All Disasters Begin Locally! Local Preparedness Is Essential

Medical & Mental Health Services First Responders Fire/EMS Emergency Management Public Health Law Enforcement Linking Response Systems

Capability Overlap Healthcare Public Health Emergency Management 10 Essential Services of Public Health PHP and HCP Capabilities National Preparedness and Core Capabilities

Public Health Preparedness CapabilitiesHealthcare Preparedness Capabilities 1 Community Preparedness 1 Healthcare System Preparedness 2 Community Recovery 2 Healthcare System Recovery 3 Emergency Operations Coordination 3 4 Emergency Public Information and Warning 4 5 Fatality Management 5 6 Information Sharing 6 7 Mass Care 7 8 Medical Countermeasure Dispensing 8 9 Medical Materiel Management and Distribution 9 10 Medical Surge 10 Medical Surge 11 Non-Pharmaceutical Interventions Public Health Laboratory Testing Public Health Surveillance and Epidemiological Investigation Responder Safety and Health 14 Responder Safety and Health 15 Volunteer Management 15 Volunteer Management Capabilities Overview

National Preparedness Core Capabilities

Capabilities are tested via exercises and real-life events Information and data collected in AARs/IPS are used to identify: strengths areas for improvement capability performance corrective actions Exercises and Real-life events

Need exists for a systematic, rigorous process for examining AARs and IPs Method to examine trends and patterns within areas of improvement across capabilities in order to ensure: Lesson learned are not ignored Lessons learned are incorporated into future planning Mistakes are not repeated Current Need

Purpose: creation of a tool that captures themes within corrective actions overtime Depicts trends in areas of improvement Allows for comparisons (event vs. exercises, exercise type vs. exercise type, year to year) Identifies systemic problem areas that occur over time Goal: enhance preparedness and response by prioritizing resources & strengthening capabilities Introduction to the CAP (corrective action prioritization) process Note: This analysis does NOT look at strengths resulting from exercises/events. It is a way to look at reoccurring themes in areas for improvements.

Data was collected from 12 MSDH after-action reports (AARs) from 2010 to Events (note: two events flood/tornado 2011 combined into one AAR) 9 Exercises A total of 405 Corrective Actions identified 118 from Events 287 from Exercises Created an Excel database and tool for recording, tracking, and analyzing AAR/IPs and CAs Data

Reviewed, coded, and assigned by: 1) Capability: PHP Capabilities & HCP capabilities, function (s), task (s), resource element (s) 2) Theme: Macro-Theme, Needed Action, Unit of Improvement/Focal Point, Mezzo-Theme, Micro Theme, and Agency/Function Responsible Capability and themes for CAs were determined by the context of the CA (i.e. what was trying to be accomplished) Filters and pivot charts are used to analyze results and trends Methods

Staffing: Corrective Actions pertaining to issues regarding staffing (ex. Identifying additional staff, staff assignments, the management of staffing, etc.). Training: Corrective Actions pertaining to the need for additional training (ex. training on roles and responsibilities, policies and procedures, equipment, systems/logistics, ICS, future exercises/drills, etc.). Policies and Procedures: Corrective Actions pertaining to the planning and policies & procedures (ex. operational plans, systems/logistics, equipment, documentation & forms, etc.). External Partners: Corrective Actions pertaining to partnering or communicating with external partners (identifying and developing partnerships/collaborations, MOUs, communication plans, etc.). Internal Partners: Corrective Actions pertaining to communicating, coordinating and partnering with internal partners. Equipment/Resource Need: Corrective Actions pertaining to the need for or standardization of equipment, systems, resources or supplies (ex. communications equipment, documentation & forms, systems/logistics, etc.). Macro Theme Definition

Theme Description Macro Theme Broadest Description of the Corrective Action Unit of Improvement/Focal Point Area that will be improved by CA Needed Action What needs to be done (verb of the CA) Mezzo Theme Provides more detail about the Macro Theme (subject of the CA) Micro Theme Provides more detail about the Mezzo Theme Agency/Function Agency/Function responsible for the CA

CA Description: Provide Additional basic and advanced training opportunities for CORES ESAR-VHP local System Administrators. Example using Themes Macro Theme Training Unit of Improvement/Focal Point Volunteer Management Needed Action Provide Training Mezzo Theme SOP - Policies and Procedures/Roles and Responsibilities Micro Theme Staffing a state created mission and notifying volunteers Agency/Function ViPR

Analysis Examples

Corrective Actions by Macro Themes

Corrective Actions by PHP Capabilities N = 405

Examine Themes within Capabilities N=145

Examine Trends within Agencies/Functions (ex. SMAT)

Monitor quality of evaluation process Realization of the utility of corrective actions/reduce stigma associated with identifying corrective actions Database to track capability improvement over time Conclusion – Tool for Assessments

Assistance in conducting a needs assessment Identify reoccurring & understated areas for improvement Prioritize for future PHEP and HPP work plans Conclusion – Tool for Prioritization

Corrective Actions by Major Themes ( )

Questions? Lisa McCormick, DrPH UAB School of Public Health