Improvement of Employee Drill Response in the Public Health Emergency Response Program

Summary

Impact Statement:

Local health departments play a critical role in responding to public health emergencies and often test their ability to respond during exercises or drills. One local health department in Illinois used the PDCA cycle to improve its ability to assemble staff in a complete and timely manner during call-down drills, enabling the agency to ensure employees will be available to respond in the event of an emergency.

Summary:

The Kane County Health Department (KCHD) observed a low response rate to call-down drills conducted with all employees. These drills are mandated as a part of the Public Health Emergency Response program, and they are designed to ensure that employees will be available to respond in the event of an emergency. The project aim was to increase the rate of response from an average of 69% as of December 2010 (with rates as low as 25%) to 95%, thus ensuring a more effective response to emergencies. Using the Plan-Do-Check-Act (PDCA) process, KCHD identified technical issues with the reverse-911 system, and a lack of staff understanding of the process as root causes. Several PDCA cycles retrained staff, redesigned the system by which staff respond to drills, and ensured regular updates to contact information. These cycles resulted in improvement to 90% between December 2010 and June 2011, a rate that has remained stable since the end of the project.

Organization that conducted the QI initiative:

KCHD

Citation:

Sharp, J. Public Health Quality Improvement Exchange. Improvement of Employee Drill Response in the Public Health Emergency Response Program. Wed, 03/01/2017 - 12:31. Available at http://www.phqix.org/content/improvement-employee-drill-response-public-health-emergency-response-program. Accessed October 10, 2024.

Background and Aim

Aim statement:

By June 30, 2011, the rate of response to reverse-911 drills by KCHD employees will increase from 26% to 95%. Initially, the project intended to improve the rate of acknowledgement (where staff indicated that they would be able to assemble within 2 hours of the call receipt), but after initial investigation of the problem, the team determined that many staff were not even receiving the calls. As a result, the aim of the project changed to focus solely on improving the rate of receipt of calls.

Need For The QI Initiative:

Public health emergency response requires regular drills to ensure that, should the need to assemble staff arise, community needs would be met completely and on time. In reviewing results from drills occurring from January 2009 to October 2010, an average of 69% of staff acknowledged a call placed to them through the CodeRED reverse-911 system, whereas an average of only 29% of staff indicated that they could assemble within 2 hours of the call. At the time of an agency reorganization, dramatic decreases in response to employee drills were indicated. As the organization was much smaller, a low response rate in the event of a true emergency could prove disastrous to implementing a response.

Area for Improvement:

In partnership with the Kane County Office of Emergency Management, KCHD works to ensure public health emergency preparedness and response systems are robust, regularly tested, and will adequately meet the needs of the community and that response efforts, when necessary, are rapid. The ability to rapidly disseminate information to first responders is a critical piece of this process, particularly when public health employees are notified to assemble to provide this response. Regular drills to contact employees are necessary to ensure that in the event of an emergency, all employees can be reached to provide information and instruction.

Root Cause:

• Lack of training or understanding of rationale for employee call-downs. • Employees not receiving feedback on results of previous drills. • Technical issues with system. • Incorrect employee contact information. • Lack of employee motivation or incentive to respond to drills.

Planning and Execution Details

QI Implementation:

This project consisted of several rapid-cycle improvements (RCIs). Following the steps of the PDCA process, the team evaluated the current process using a flowchart and fishbone diagram and further analyzed the baseline data by surveying staff to determine why they were not participating. The results of this process indicated a number of root causes, which included technical issues with the system recording data; and staff issues including a lack of understanding about the process on the part of staff, lack of feedback about results, lack of motivation or incentive to participate, and incorrect contact information for participants. Based on these results, the first intervention was to retrain staff on the employee call down process and provide a rationale for their participation. The intervention indicated a small increase in results, but staff noted that the system was not accurately recording their responses. These results led to another improvement cycle, during which exploration of the system issue led to a decision to test a new data collection process. Staff would respond to drills via a direct call to a dedicated KCHD emergency response phone line, and this intervention led to additional increases in results. A third RCI intervention developed a system to update and regularly maintain contact information, which led to further increases in the response rate. The team completed several PDCA cycles as a part of this process; each cycle was designed to remove or reduce root causes.

Focus activities

Administration:

Communications

Policies / internal procedures and processes

Quality Improvement and Accreditation Readiness

Other QI Focus Activities:

Public health emergency preparedness and response

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Brainstorming

Cause and Effect Diagrams

QI Tool Documentation:

2010-12-02 Fishbone for PDCA - PHER Drill Response.pdf

2011-06-15 Storyboard.doc

Initiative Dates:

12/2/10 to 6/15/11

Initiative Duration:

Between 6-12 months

Methods of evaluation:

Measures to evaluate the initiative's impact included monthly results of employee call-down drills. These results indicated the number of staff that responded to the drill (which varied monthly in both the time of day and the day of the week that drills were completed), and the team compared that rate to the total number of employees that were working (e.g., not on vacation or on medical leave).

Supplemental Files:

Attachment	Size
2011-06-15 Storyboard.doc	621 KB

Improvement of Employee Drill Response in the Public Health Emergency Response Program

Summary

Background and Aim

Planning and Execution Details

Results

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

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Improvement of Employee Drill Response in the Public Health Emergency Response Program

Summary

Background and Aim

Planning and Execution Details

Results

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

QI Spotlight