Genesee County Health Department PREPARE for Pandemic Influenza Learning Session 3 February 1-2, 2006

Genesee County Health Department gchd team members Ward Lindsay –Development, Planning & Grants Supervisor –GCHD PIO April Carpenter –Public Health Program Coordinator Carrie Chanter –Health Educator Kathy DeSnyder –Epidemiologist –Emergency Preparedness Coordinator

Genesee County Health Department gchd sites Burton Health Center McCree North Health Center Floyd J. McCree Courts & Human Services Center

Genesee County Health Department genesee county health department Location: Genesee County, Michigan (with office/clinic locations in Flint and Burton) Population of Genesee County: 439,000* Mission: to improve the quality of life in Genesee County by preventing disease, promoting health and protecting the environment through activities consistent with our assessment, policy development and assurance responsibilities. Staff size: 160 Government: governed by a nine-member Board of Commissioners each of whom is elected from a unique district within the County. In addition, the Department reports to a five- member advisory Board of Health. The GCHD is governed by the State’s Public Health Code and other rules, regulations and procedures adopted locally. *U.S. Census Bureau, 2004 American Community Survey)

Genesee County Health Department applying quality improvement to public health preparedness Quality varies widely in public health preparedness Making lasting improvements to preparedness capabilities is difficult Quality improvement methods from other sectors offer promise as a systematic way to improve performance –The PREPARE for PI learning collaborative was designed to develop a model for QI in PHP

Genesee County Health Department improvements in these 5 domains can improve outcomes Inputs Alerts Clinic/ Office Visits Hospital Visits Morbidity, Pharmacy Data Sick Days Outcomes Mortality, and Social Disruption Surveillance Case Investigations Public Health Emergency Preparedness Activities Risk Communication Disease Control and Treatment Decision-making Command and Control Minimized

Genesee County Health Department PREPARE for PI as a pilot learning collaborative It was organized by RAND and the Center for Health Care Quality at Cincinnati Children’s Medical Center Funding came from HHS and RWJF We participated in the pilot learning collaborative from May 2006 through February 2007 We worked with 4 other health department teams from across the country

Genesee County Health Department our AIM for improvement The Genesee County Health Department will minimize the health and social impact of pandemic influenza in its jurisdiction by improving the accuracy, effectiveness, and timeliness of its command and control and risk communication. By October 2006 we will develop the tools and implement the technology to provide quick and clear communication to our staff and to the public. We will also cultivate a readiness among both the staff and the public to receive essential information and directives from the health department in the event of a pandemic flu or similar public health emergency. We plan to do this by: –Reducing by half the time it takes to prepare risk communication messages. –Distributing important, audience-specific messages to targeted audiences within 3 hours of preparation of the information to be released. –Communicating critical messages to each Genesee County household within 18 hours. –Reaching all staff within 90 minutes of an identified event to relay information. –Assuring that 100% of staff has access to and ability to use pre-prepared messages to communicate with the general public. Our aim addresses the following PREPARE domain(s): –Clear Command Control and Communication (CCC) –Accurate & Effective Risk Communication (RC)

Genesee County Health Department changes tested: ccc –How long does it takes GCHD staff to confirm receipt of an emergency ? –How long does it takes GCHD staff to confirm receipt of an emergency that contains additional instructions for the reader to alert co-workers to read and respond? –How long does it takes for GCHD incident command staff to confirm receipt of a MI-HAN alert? –How long does it take for staff monitoring 14 GCHD internal fax machines to confirm receipt of an emergency fax? –Would an from the Health Officer requesting completion of a task, increase response rate? –Would training a staff member “just in time” allow her to properly participate in a region wide communications drill utilizing a 800 MHz. radio? Reaching all staff within 90 minutes of an identified event to relay information.

Genesee County Health Department changes tested: rc Reducing by half the time it takes to prepare risk communication messages. Would using a communications checklist reduce the amount of time needed to develop and release messages to the public? Can pre-prepared message maps on pandemic influenza be used by any GCHD staff to create an educational, health related column for the local newspaper more effectively than just writing the column from scratch? Communicating critical messages to each Genesee County household within 18 hours. Would the GCHD be able to efficiently communicate with 4 identified stakeholder groups as requested by a State wide communications drill? What is the most efficient method to alert local physicians during an emergency? Would the hospital management organizations be willing to help with this process? Would sending out a press release regarding GCHD’s Pan Flu educational campaign increase requests for presentations? What communication method will be most effective with the general public during an emergency? (TV, radio, flyers, press releases, contacts, etc)

Genesee County Health Department lessons learned If adequate instruction and rationale are given to staff, a better and more timely response can be expected. If an is sent out by the Health Officer, it will receive more attention and response. While striving to improve response time and response percentages, we recognize that we will never reach 100% of GCHD staff in a timely manner, nor have 100% of staff available to respond during an emergency. We must plan ahead for that. Not all staff know how to properly respond to test communications, expecting that someone else will “take care of it.”

Genesee County Health Department lessons learned Having a communications checklist helps make response more comprehensive and reduces time needed to get message out Draft communications need to be stored in a common folder with a logical file structure, enabling all staff to access and use prepared messages GCHD staff need to be formerly trained on use of the 800 MHz radio and use of 800 MHz radio needs to be inserted into communications plan Local media are interested in having an active partnership with local public health

Genesee County Health Department lessons learned Local physicians do not have access to all available methods of communication It is important to cultivate a relationship regularly with the hospital management oranizations to help facilitate emergency communications GCHD can use the hospital mgmt. orgs to get emergency messages out, however, cannot guarantee response time, receipt, etc. Hospital systems primary method of communicating with their physicians are different and we must plan for that Creating and updating a stakeholder list is very time consuming Networking and GCHD involvement with local community groups is key to educating the public about preparedness

Genesee County Health Department overcoming barriers to change There will always competing interests - change must be made a priority Requires diligent planning & commitment to improve Requires buy-in from management team first before approaching front-line staff with change strategies Requires convincing staff that improvement is possible Requires cross divisional communication and collaboration Difficult to accurately predict time projects will take Requires knowledge of using data collection devices/reporting

Genesee County Health Department Implement desktop faxing 800 MHz Radio training and tests Testing Reverse Community Preparedness Presentations Target Audience Communications GCHD File Structure Reorganization GCHD Call-Down Tests GCHD Intercom Tests Emergency Press Release Approval Form Communications Checklist looking forward for continuous improvement ……next steps

Genesee County Health Department next steps for QI in the gchd 1. Present RAND lessons to Management Team 2. Collectively select another area to practice CQI 3. Train area staff on process, get started 4. Tell the story of the RAND and other GCHD CQI projects to the staff at large 5. Continue training GCHD staff as new CQI projects are identified 6. Incorporate CQI measurements into everyday operations and CQI content into management team meetings and monthly reports