Warwick Business School Emergency preparedness and its implications for healthcare : What further research is needed? Alan Boyd 1, Duncan Shaw 2, Naomi Chambers 1, Simon French 2, Russell King 3 and Alison Whitehead 4 1 Manchester Business School, 2 University of Warwick, 3 Royal Free Hampstead NHS, 4 Wrightington, Wigan and Leigh NHS Foundation Trust These projects were commissioned by the NIHR Service Delivery and Organisation (NIHR SDO) programme under the management of the National Institute for Health Research Evaluations, Trials and Studies Coordinating Centre (NETSCC) based at the University of Southampton. From January 2012, the NIHR SDO programme merged with the NIHR Health Services Research (NIHR HSR) programme to establish the new NIHR Health Services and Delivery Research (NIHR HS&DR) programme. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR HS&DR programme, NIHR, NHS or the Department of Health.

Warwick Business School Aims of this study  Identify research and development needs with regard to emergency management in health care  Large-scale disasters, not smaller emergencies

Warwick Business School National Risk Register (2010 edition)

Warwick Business School London 2005  7/7 attacks  56 deaths  >700 injured  Injuries not commonly seen  Ongoing psychological care

Warwick Business School Health emergency planning ‘A coordinated, cyclical process of planning, implementation, evaluation and learning which aims to increase the capability of society to prevent, protect against, respond to, and recover from any occurrence which presents a serious threat to the health of the community, or disrupts the health care system, or causes (or is likely to cause) such numbers or types of casualties as to require special arrangements to be implemented by one or more health care organisations’. Public health preparedness planning (Nelson et al, 2007) UK NHS definition of a major incident (DoH, 2005)

Warwick Business School A picture of healthcare emergency planning: Balancing supply & demand through resistance & resilience of systems Major incident Demand for healthcare Incidence + prevalence of illness Service user expectations Supply of healthcare Structures Processes Resources Governance Resistance and resilience Vulnerability Resistance and resilience Emergency planning system Structures Processes Resources Governance PlansPreparedness Prevention + mitigation Warning Response Recovery Implementation Evaluation and learning

Warwick Business School Scoping studies: What are they?  A research tool for when it is beyond the capacity of specialists to read/synthesise all relevant papers  Aim to create a broad map of research potential size/scope (Grant et al, 2009), key concepts (Arksey and O’Malley, 2005) conceptual clarity (Davis et al, 2009) setting this within policy/practice (Anderson et al, 2008)  Quickly getting a sense for ‘what’s already out there’ – dimensions of interest

Warwick Business School Scoping studies: What are they?  A research tool for when it is beyond the capacity of specialists to read/synthesise all relevant papers  Aim to create a broad map of research potential size/scope (Grant et al, 2009), key concepts (Arksey and O’Malley, 2005) conceptual clarity (Davis et al, 2009) setting this within policy/practice (Anderson et al, 2008)  Quickly getting a sense for ‘what’s already out there’ – dimensions of interest

Warwick Business School Context: Scoping studies and systematic reviews 9  Broader topic; range of study designs relevant  No quality assessment  For researchers and research funders  Well-defined question; determines relevant study designs  Narrow range of quality assessed studies  For practitioners and policy makers Scoping studySystematic review For a methodological framework see: Arksey H, O’Malley L (2005) Scoping studies: Towards a Methodological Framework. Int J Soc Res Methodol, 8:19-32.

Warwick Business School Our approach  Literature review  Researcher survey  Debriefs and case studies  Interviews  Prioritisation workshop and survey  Advisory group 10 Identified 18 R&D areas Narrowed to 4 clusters

Warwick Business School 20/12/201211

Warwick Business School 20/12/201212

Warwick Business School 18 topic areas 1. Learning (systems, measuring preparedness, quality improvement systems) 2. Incident Level (Definitions, factors determining escalation/declaration, business continuity) 3. Public Recovery (Early response, social support networks, vulnerable groups) 4. Re-organisation (Minimise adverse effects, wide area emergency, long-running emergency) 5. Risk communication (Public perception and communication, good practice, communicating expectations) 6. Priority (Characteristics of effective planning, investment in preparedness) 7. Training (Effective exercises, impact, developing emergency planners) 8. International research (Transferability, multi-nation research) 9. Strategic modelling (Criteria, good practice, local NHS good practice) 10. Social networking (Public communication, intelligence gathering, trust) 11. Surveillance (Lab capacity, enviro data, usefulness to decision makers) 12. Community Groups (vulnerable groups, Access if infrastructure disrupted, involvement in processes) 13. Willingness to work (Factors, increasing it) 14. Infectious diseases (Predicting impact, assessing cross-species transmission risk, bioterrorism) 15. ICT Resilience (Systems at risk, NHS-Net, National Resilience Extranet) 16. ICT developments (Planning for ICT innovation, training and education, smart phones) 17. System Recovery (Systems, prevention and recovery of responders) 18. Collaboration (“mixed economy”, external “navigation”)

Warwick Business School People’s needs High   Low Organisations’ needs Low   High Potential research topics vary in the extent to which they address the needs of the public and of organisations 03/09/   ? ?

Warwick Business School People’s needs High   Low Organisations’ needs Low   High Potential research topics vary in the extent to which they address the needs of the public and of organisations 20/12/   ? ?

Warwick Business School Suggested research topics to be commissioned  Affected public Recovery and long-term health impacts Engagement with community groups and vulnerable populations Public risk communication and information dissemination Use of social networking  Inter- and intra- organisational collaboration Factors affecting multi-agency working Linking emergency planning with other planning 03/09/201216

Warwick Business School  Preparing responders and their organisations Learning and quality improvement Exercises and training  Prioritisation and decision making Priority and resourcing given to emergency planning and management Issues relating to organisational change Social, administrative and political contexts Leadership and decision support systems during crises 03/09/201217

Warwick Business School  Collaborate within the UK and internationally Compare research priorities Coordinate commissioning Develop commissioning models  Strengthen UK research capacity Suggested actions for research commissioners 14/09/201218

Warwick Business School Further information More details  Executive summary:  Full report  /09/201219

Warwick Business School Thank you for listening Prof Duncan Shaw