warwick business school emergency preparedness and its implications for healthcare : what further...
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Warwick Business School
Emergency preparedness and its implications for healthcare : What further research is needed? Alan Boyd1, Duncan Shaw2, Naomi Chambers1, Simon French2, Russell King3 and Alison Whitehead4 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.
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Aims of this study
Identify research and development needs with regard to emergency management in health care
Large-scale disasters, not smaller emergencies
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National Risk Register (2010 edition)
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London 2005
7/7 attacks 56 deaths >700 injured Injuries not commonly seen Ongoing psychological care
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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)
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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
Vulnerability
Resistance and
resilience
Emergency planning system• Structures• Processes• Resources• Governance
Plans Preparedness
Prevention + mitigation
Warning
Response
Recovery
Implementation
Evaluation and learning
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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
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Context: Scoping studies and systematic reviews
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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 study Systematic 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.
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Our approach
Literature review Researcher survey Debriefs and case studies Interviews Prioritisation workshop and survey Advisory group
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Identified 18 R&D areas
Narrowed to 4 clusters
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18 topic areas1. 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”)
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Peop
le’s
need
sH
igh
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----
----
----
---
Low
Organisations’ needsLow ------------------- High
Potential research topics vary in the extent to which they address the needs of the public and of organisations
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?
?
Warwick Business School
Peop
le’s
need
sH
igh
----
----
----
----
---
Low
Organisations’ needsLow ------------------- High
Potential research topics vary in the extent to which they address the needs of the public and of organisations
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?
?
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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
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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
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Collaborate within the UK and internationallyCompare research prioritiesCoordinate commissioningDevelop commissioning models
Strengthen UK research capacity
Suggested actions for research commissioners
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Further information
More details http://www.netscc.ac.uk/hsdr/projdetails.php?ref=09-1005-01
Executive summary: http://www.netscc.ac.uk/hsdr/files/project/SDO_ES_09-1005-01_V01.pdf
Full report http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_09-1005-01_V01.pdf
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