Emergency Preparedness Is Changing Public Health Practice
Since 2001, the federal government has spent approximately $5 billion to upgrade the public health system's capacity to respond to large-scale emergencies, such as bioterror attacks, pandemic disease outbreaks, and other disasters. This infusion of funds represents a massive resource increase for a system that had been neglected and underfunded for decades. What effect has the new emphasis on emergency preparedness had on public health practice? To answer this question, RAND researchers have conducted several interrelated projects over the past three years to examine the public health infrastructure. All told, these projects involved visits to 44 communities in 17 states.
The studies showed that public health emergency preparedness is transforming public health agencies in several ways. Key signs of change include new partnerships between public health and other agencies, such as law enforcement; new workforce initiatives, such as agency-wide staff training in emergency preparedness and the hiring of bioterrorism experts; new technologies that facilitate communication between public health officials and other emergency responders; and evolving organizational structures. But while each of these developments has had a positive effect on public health, integration of preparedness with other public health functions continues to pose a challenge. The preparedness mission has also raised challenges in the areas of leadership, governance, quality, and accountability. For example, during preparedness exercises, strong leadership from public health officials outweighed all other factors in determining how well jurisdictions fared when presented with a wide range of scenarios related to infectious disease outbreaks.
While emergency preparedness is clearly stimulating change in public health practice, important barriers remain, including inadequate accountability systems, a lack of evidence-based performance measures, and an ongoing need to integrate public health functions into other public health activities, such as disease prevention and control, health promotion, public safety, and workforce training. Sustained funding for public health preparedness will be critical for overcoming these barriers. Also needed is a uniform definition of public health, which would clarify roles and responsibilities and help government agencies and the public understand what to expect from public health departments during an emergency.
Quality Improvement Methods Can Improve Public Health Preparedness
The term quality improvement (QI) refers to a range of strategies and techniques designed to set goals, measure performance, and enhance the quality of products, processes, and services. To understand how quality improvement methods might enhance public health emergency preparedness, a RAND research team examined QI practices currently used among a small group of public health departments.
The research found that, although none of the agencies had comprehensive QI processes for public health emergency preparedness, all had developed some performance goals and measures for emergency preparedness. Sites had difficulty prioritizing goals, however, and few had implemented systematic QI approaches to understand processes, identify needed changes, and implement improvements. Systematic feedback mechanisms for QI were also lacking. The main barriers to implementing QI were a lack of resources—especially time and staff—and incentives.
Based on these findings, the study team made several recommendations. A key step is investing in QI capabilities and building organizational and leadership capacity. Public health organizations need to develop performance goals and measures that are specific, measurable, relevant, and time-bound. Documenting key processes is also important. State efforts should focus on facilitating QI for public health emergency preparedness at the local level, while federal grants could be used to incentivize QI at both the state and local levels.
RAND is currently building on this research through a pilot learning collaborative that aims to enable public health departments to apply QI methods to enhance their preparedness for a potential pandemic influenza outbreak. To accomplish this goal, the Promoting Emergency Preparedness and Readiness for Pandemic Influenza (PREPARE for PI) project is fostering a creative partnership between health services researchers, QI experts, and local and state health departments. The project is sponsored by the U.S. Department of Health and Human Services (HHS).
Nicole Lurie, M.D., M.S.P.H. is Co-Director of RAND Center for Domestic and International Health Security and the Paul O'Neill Alcoa Professor of Policy Analyst at RAND. Considered a top authority in strengthening the public health systems, Dr. Lurie also continues to practice clinical medicine in the health care safety net. Dr. Lurie has a long history in the health services research field, primarily in the areas of access to and quality of care, managed care, mental health, prevention, and health disparities.
Read more work by Dr. Lurie »
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