1. Genesee County Health Department PREPARE for Pandemic Influenza Learning Session Two September 25-26, 2006

2. Genesee County Health Department Aim Statement 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 component(s): Clear Command Control and Communication (CCC) Accurate & Effective Risk Communication (RC)

3. 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

4. GCHD Sites Burton Health Center McCree North Health Center Floyd J. McCree Courts & Human Services Center

5. 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)

6. PDSA Highlight #1 : Statewide Communications Drill Plan  Rapidly disseminate information to 4 key stakeholder groups (hospitals, long term care facilities, local emergency management coordinators, and local physicians) as requested by the drill. Do  3 of the 4 groups were easily reached through sending a MIHAN alert.  Local physicians do not use the MIHAN, an email was sent to contacts at the management organizations for the 3 hospital networks in the county. Study  It was observed that there is a passive/weak relationship between local providers and the local public health department.  Frequent, up-to-date communication must take place with the 3 hospital organizations to rely on their communication methods during an emergency. Act  Ask the contacts at the hospital networks to perform another test using their preferred method of communication with their physicians.  A questionnaire will be developed and given to the 3 contacts to distribute to their network.  We can look at the response rate to the request and how quickly the questionnaire was dispersed and returned.

7. PDSA Highlight #2 : Provider Communications Test Plan  What is the best way to communicate with local providers/physicians in the event of an emergency?  How long does it take to deliver audience specific message to local providers/physicians in the event of an emergency? Do  On August 30, 2006, an email was sent to all 3 hospital mgmt. organization contacts. It had the provider questionnaire attached. They were asked to let us know when they sent them out and what method they chose (fax, email, etc). Study  As of September 7, 2006, 8 days after the questionnaire was asked to be distributed, 44 have been returned. 40 from Hurley, 4 from McLaren, 0 from Genesys.  As of September 20, 2006, 72 have been returned. 67 from Hurley, 5 from McLaren, 0 from Genesys. Act  The contact info received will be entered into a database.  Future publications/reports may be sent by email to providers if requested.  Consistent communication and testing with the hospital mgmt. organizations will take place to confirm key contact, test capacity, and test response rates.  Follow up will take place with Genesys and McLaren on their rate of return.

8. PDSA Highlight #3 : GCHD Internal Communication Test Plan  Will giving additional instructions in the email communication test increase the % of staff that will respond immediately (< 90 minutes)?  There will be a 10% increase in staff responding immediately (< 90 minutes) to email with additional instructions. Do  An all-staff email was sent requesting an immediate email response with additional instructions to alert co-workers after response was made.  As email responses arrived, names and response times were recorded into a spreadsheet.  Response percentages were calculated for both immediate response and change in response rate from first test. Study  72% of GCHD staff responded to the email test within 90 minutes or less.  83% of available (non-absent) GCHD staff responded to the email test within 90 minutes or less.  There was a 33% increase in immediate GCHD staff response as compared to Email test #1 (without additional instructions). Act  With the significant increase in response rate between the 2 email cycles, we are satisfied with a 83% immediate response rate by email.

9. Results to Date – by AIM measures Reducing by half the time it takes to prepare risk communication messages. Communication checklist was developed and it has decreased the time required to execute the communication plan Emergency Press Release Approval Form has been developed (not tested) Distributing important, audience-specific messages to targeted audiences within 3 hours of preparation of the information to be released. Using the MIHAN - we were able to reach 3 of the 4 groups requested of us in a communications drill Used key contacts at the hospital organizations to communicate with the local physicians Staff person was able to successfully participate in the regional communications test with approximately 3 minutes of instruction on the 800 MHz radio Communicating critical messages to each Genesee County household within 18 hours. Emergency Preparedness Presentations are consistently being made Reaching all staff within 90 minutes of an identified event to relay information. 83% of non-absent staff responded in < 90 minutes to email test 100% of GCHD incident command staff confirmed receipt within 90 minutes 64% of fax stations confirmed receipt of fax in < 90 minutes If an email is sent out by the Health Officer, it will receive more attention and response If adequate instruction and rationale is given to staff ahead of time, a better response can be expected Assuring that 100% of staff has access to and ability to use pre-prepared messages to communicate with the general public. Draft and past messages have been moved to a central location for all team members to access

10. Key Learning in Action Period 1  GCHD staff respond better to emails with specific instructions  If an email is sent out by the Health Officer, it will receive more attention and response  If adequate instruction and rationale are given to staff ahead of time, a better response can be expected  100% of GCHD incident command structure responded immediately to email & HAN communications  RightFax software is not user friendly. Also, it is difficult to get the software to interface with Outlook  86% of GCHD fax stations responded to RightFax test  Having a communications checklist helps make response more comprehensive and reduces time needed to get message out  Draft messages are stored in different places in the GCHD computer file structure, making retrieval inefficient  Networking and GCHD involvement with local community groups has produced most of the Pandemic Preparedness presentation requests

11. Key Learning in Action Period 1  Local media are interested in having an active partnership with local public health  GCHD staff need to be formerly trained on use of the 800 MHz radio  Use of 800 MHz radio needs to be inserted into communications plan  Local physicians are not able to be reached through the MIHAN  It is important to cultivate a relationship regularly with the hospital mgmt. orgs to help facilitate emergency communications  McLaren Mgmt. uses email to communicate with their physicians  Hurley and Genesys use a blast fax method to communicate with their physicians  McLaren communicates with ALL doctors that have “rights” to their hospitals, the others do not  GCHD can use the hospital mgmt. orgs to get emergency messages out, however, cannot guarantee response time, receipt, etc.

12. Next Steps RightFax: Form and populate more recipient groups; train all GCHD staff on using it; complete an external test with Genesee County Department heads 800 MHz Radio: Additional staff (15) are being trained on the 800 MHz radio in November 2006; try to improve hospital 800 MHz radio response Reverse 9-1-1: Test with key groups Preparedness Presentations: Use evaluation findings to set up more engagements; send canvas letter to Genesee County groups to solicit requests Target Audience Communications: Create comprehensive database with physician contact information we have gathered. Continue to communicate with the hospital networks to have a better relationship so that we may work with them more efficiently during an emergency GCHD Call-Downs: Refine and practice GCHD call-down lists from home residences GCHD File Structure: Test reorganization of EP file structure with communications team GCHD Intercomm: Once phones installed, test Emergency Press Release Approval Form: Once approved, test Communications Checklist: Convene the whole communications team to refine and practice the checklist