P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Implementing
the PREPARE
Approach to
QI in PHEP
Now that we have described an approach for QI in PHEP, we turn in this
chapter to a discussion of how this approach can be implemented.
There are four major parts of the PREPARE approach for implementing
QI in PHEP, shown in Figure 3.1. Although we discuss these parts in
sequence, it is important to keep in mind that QI is an iterative
approach in which the various components build on and inform each
other.
This chapter provides an overview of each part of implementing QI. Chapter Four provides
examples and tools concerning each of the four parts that agencies can use to improve their
preparedness.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Figure 3.1
Implementing
the PREPARE
Approach to
QI in PHEP
A Four-Part Approach for
Implementing QI
A Four-Part Approach
for Implementing QI
1
2
3
4
Identify
the aim
Map
the process
Measure
performance
Make
changes for
improvement
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Part 1: Identify the Aim
Implementing
the PREPARE
Approach to
QI in PHEP
1
Identify
the aim
Once a decision has been made to implement a QI effort, the QI team (with
support from agency leaders) should identify the domain, such as command and
control or risk communication, that will be the initial focus of the agency’s
improvement efforts. While, over time, the agency should make improvements in
each of the six PHEP domains, initial QI efforts should focus on only one or two
domains to ensure that the agency does not overtax its resources (people, time,
and money) for improvement efforts.
Once a domain has been selected, the agency should identify a broad aim for its efforts—i.e., a
statement of what the agency would like to accomplish in the selected domain, including the
expected results of the improvement effort. Initially, this aim will be stated broadly. For
example, during the PREPARE collaborative, the Virginia Department of Health identified its aim
(in the risk communication domain) as: “We will improve the accuracy, effectiveness, and
timeliness of risk communication.” The chosen aim should be consistent with the agency’s
priorities and resources.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
Implementing
the PREPARE
Approach to
QI in PHEP
An agency can usually identify a broad aim for improvement by drawing on its current
understanding of strengths and weaknesses in the agency’s PHEP processes. An aim might be
identified by considering high-priority areas for the agency or areas of known weakness.
Alternatively, the agency might consider priority areas specified in federal or state guidance on
PHEP or review after-action reports for lessons learned from past agency exercises. Formal
assessment tools can also be helpful for identifying weaknesses and areas needing improvement
(e.g., the Center for Disease Control and Prevention’s [CDC’s] Public Health Preparedness and
Response Capacity Inventory [CDC, 2002; Costich and Scutchfield, 2004], or the U.S. Department
of Health and Human Services’ Pandemic Flu State and Local Pandemic Influenza Planning
Checklist [2008]). Another approach is to bring together QI leaders and other stakeholders to
brainstorm about potential improvement aims.6
As the improvement team decides where to focus its improvement efforts, it should refine its aim
to focus on one or more specific activities within the chosen domain that it wants to improve. For
example, an agency might decide that it wants to improve its process for delivering messages to
the public, as shown in the high-level process map for risk communication in Figure 2.2. In
selecting a specific activity for improvement, the agency might seek to improve the way it
performs an existing activity (such as issuing a press release), or it may decide that it would like to
implement a new idea or way of doing things (such as developing a new telephone hotline, i.e., a
call center, for responding to public inquiries).
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
For brainstorming techniques, see The Public Health Memory Jogger II: A Pocket Guide of Tools for Continuous Improvement and Effective
Planning, 2007. Available for purchase at: http://www.goalqpc.com/shop_products_detail.cfm?PID=754
6
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Implementing
the PREPARE
Approach to
QI in PHEP
In QI, a strategy that has the potential to improve a process (whether by improving an existing
activity or implementing a new one) is known as a change idea. During the PREPARE
collaborative, the Virginia Department of Health specified that it wanted to implement a change
idea in the risk communication domain: “Establish a telephone hotline to provide accurate
information to the general public.” The idea for a hotline had been described in the
department’s statewide emergency planning documents, but the hotline had not been set up
until the collaborative.
The team should identify measurable performance targets related to each change idea. To
continue the previous example, Virginia specified that one of its targets was to establish a
telephone hotline within 24 hours of the event or decision to activate the center. Identifying a
specific target is important to establish a level against which current performance can be
measured. Measuring performance will be discussed in Part 3 of this chapter. A table showing all
the aims and related performance targets used in the PREPARE collaborative is found in
Appendix A.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Implementing
the PREPARE
Approach to
QI in PHEP
The team should also specify a timeline for doing the work
(i.e., to successfully implement the change idea). This might
be one or two months in some cases, or a longer period, such
as six or eight months or even longer.
QI teams are most effective when they document the aim of
their work in an aim statement—i.e., a written statement
describing the strategy and expected accomplishments of the
team’s improvement efforts. The main components of an aim
statement, which have already been discussed in this section,
are shown in Figure 3.2. A sample aim statement from the
Virginia Department of Health is shown in Table 3.1.
Writing the aim statement brings the team together to work
with a common purpose or goal. The statement can also
help build consensus about the issues and can be used to
guide and focus the improvement team’s efforts over time,
as well as to communicate to others in the agency (and
outside the agency) what the team is trying to do.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
Figure 3.2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
Implementing
the PREPARE
Approach to
QI in PHEP
Components of an
Aim Statement
CHAPTER 4
Strategies and Tools
for Improvement
Measurable
Expected
results of
the effort
numeric target
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Domain
to be
improved
Change
idea to be
implemented
Timeframe
for doing
the work
P R E FA C E
CHAPTER 1
Introduction
Table 3.1
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Virginia Department of Health Aim Statement
from PREPARE Collaborative
Implementing
the PREPARE
Approach to
QI in PHEP
In order to improve the accuracy, effectiveness, and timeliness of risk
communication [domain to be improved and expected results], we will establish a
telephone hotline to provide accurate information to the general public [change
idea to be implemented] in the next nine months [timeframe for doing the work].
Specifically, with this hotline we will be able to:
1.Establish a hotline within 24 hours of the event or decision
to activate call center
2.Ensure that 90% of calls are answered within 5 minutes
3.Ensure that 90% of the callers receive accurate information
[performance targets].
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Part 2. Map the Process
Implementing
the PREPARE
Approach to
QI in PHEP
2
Map the
process
The next part of the PREPARE approach is to identify and map the process used
by the agency to perform the activity it is trying to improve. Mapping the
process to be improved can help diagnose where specific changes might be
needed in an existing activity. In the case of a new activity (such as the telephone
hotline to be implemented by the Virginia Department of Health as part of its QI
effort), mapping can be used to specify the steps that need to be performed to
successfully implement the idea.
Process steps can be documented using a visual flowchart called a process map. A process map is
a fundamental QI tool (Webb, 2003; American Society for Quality, 2007; Damelio, 1996) that
depicts the following components of a process in sequential order:
Inputs, or steps that initiate a process
Outputs, or desired results of a process
Decisions that need to be made
Steps, or the sequence of actions that make up the process.
A sample process map, in Figure 3.3, shows the steps mapped out by the Virginia Department of
Health in setting up its emergency telephone hotline. Tips for creating a process map are found
in Box 3.1.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
Figure 3.3
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
Implementing
the PREPARE
Approach to
QI in PHEP
Sample Process Map for Setting Up a
Telephone Hotline (Virginia Department of Health)
Do
physical
setup
Trigger:
Threat to public
health or emergency
CHAPTER 4
Strategies and Tools
for Improvement
Request
hotline
Authorize
activation
Develop
messages
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Recruit
and train
staff
Activate
hotline
Receive
calls
Citizens
receive
acccurate
information
P R E FA C E
CHAPTER 1
Introduction
Box 3.1
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
Tips for Creating a Process Map
1. Identify the process to be mapped. You might begin by diagramming
a high-level process. This map can then be used to help identify a
specific activity-level process to improve, and a second, more-specific
process map can then be created.
2. Gather the people who best understand the process. These might
include staff involved in carrying out the steps of the process and
those with authority to make changes in the process.
3. Define the input (“trigger” event) and the outcome(s) (i.e., desired
results) of the process.
4. Brainstorma the activities or steps involved from start to finish.
Implementing
the PREPARE
Approach to
QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
5. Arrange steps in proper sequence. Review the order of the steps and
make changes as needed.
6. Identify potential measures of performance for each step of the
process (discussed further under Part 3 of this chapter).
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
For brainstorming techniques, The Public Health Memory Jogger II: A Pocket Guide
of Tools for Continuous Improvement and Effective Planning, 2007. Available for
purchase at: http://www.goalqpc.com/shop_products_detail.cfm?PID=754
a
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Part 3. Measure Performance
Implementing
the PREPARE
Approach to
QI in PHEP
3
Measure
performance
Measuring performance refers to the activity of collecting data to understand
whether and how well a process is working. The best measures of performance
indicate how well a key process is working (e.g., how quickly a message can be
sent to the public) or whether the desired outcomes are being achieved (e.g.,
whether the public received and understood the message). Measures of this type
might include the time needed to issue a critical health message to the public
after an emergency event or the percentage of people who perform an activity
correctly within a particular time frame.
Ideally, QI measures should focus on capabilities—the abilities to perform key preparedness
activities. Public health agencies can draw on some already-established measures (e.g., from the
CDC’s guidance [2002] and the U.S. Department of Homeland Security’s Target Capabilities List
[2007b]) and can also develop their own when no appropriate measures are available.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Implementing
the PREPARE
Approach to
QI in PHEP
In many cases, the agency can make use of data
that are already being collected for other
purposes (e.g., information on completeness of
physician case reporting or public health
lab-specimen turnaround times) in order to
understand and improve performance in PHEP.
Drills, exercises, and day-to-day events can also
be used to measure preparedness capabilities.
Measures can be used both to establish the
baseline of current performance and to assess
the effect of changes intended to improve
performance. Chapter Four contains examples
of many measures that agencies can adapt.
It is not always possible to measure the ultimate outcome of a specific process. For example,
regarding Virginia’s process map shown in Figure 3.3, initially the department had set a target of
ensuring that 90 percent of callers received accurate information from the hotline. However, the
agency did not have a means to test this aspect of performance; instead, it focused on two other
measures: (1) the time needed for the physical setup of the hotline and (2) the time from the
initial request of the hotline until its actual activation. These measures are shown on the process
map in Figure 3.4.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
Figure 3.4
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
Process Map for Setting Up a Telephone
Hotline, Including Measures
Implementing
the PREPARE
Approach to
QI in PHEP
Measure 1: Time to set up hotline
Do
physical
setup
Trigger:
Threat to public
health or emergency
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Request
hotline
Authorize
activation
Develop
messages
Activate
hotline
Recruit
and train
staff
Measure 2: Time from initial request of hotline to activation
Receive
calls
Citizens
receive
acccurate
information
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
Implementing
the PREPARE
Approach to
QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
After improvements have been made in one process, the agency can then expand its efforts by
measuring another risk communication process. Over time, multiple measures can be used to
provide a full picture of performance in several areas.
Box 3.2 contains more tips about measurement.
P R E FA C E
CHAPTER 1
Introduction
Box 3.2
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Tips for Measurement
Implementing
the PREPARE
Approach to
QI in PHEP
Keep it simple--focus on a few key measures of performance.
Seek usefulness, not perfection.
Choose measures that:
• are feasible to collect
• are explicitly defined so that accurate information is
collected across observations and over time
• provide information that changes made have led to
improvement in the process.
Plan out the details: Who will collect data? How will it be
collected? How frequently will it be collected?
Set realistic targets for performance. Targets may vary with the
location or type of event.
Collect measures as part of the daily routine, when possible.
Use existing databases whenever possible.
First establish a baseline of performance; then track future
performance against the baseline.
Measure frequently to track the effect of changes made to
improve performance.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Part 4. Make Changes for Improvement
Implementing
the PREPARE
Approach to
QI in PHEP
4
Make
changes for
improvement
Once the agency has determined which process it wants to improve and has
measured performance in specific areas, the next part of the QI approach is to
make changes for improvement—i.e., to implement and test the improvement
strategies or change ideas chosen by the agency in order to address gaps in
performance or to improve the overall efficiency of the process.
Two methods can be especially useful for implementing and testing change ideas.
The first is PDSA cycles, which allow changes to be tested in short, focused
cycles of improvement. The second is the use of day-to-day practices, which
allows agencies to test improvements during the performance of normal public
health activities. We discuss each of these methods in turn.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
PDSA Cycles
Implementing
the PREPARE
Approach to
QI in PHEP
One way to facilitate improvement efforts is to conduct small rapid-cycle tests of change, called
Plan-Do-Study-Act (PDSA) cycles. The PDSA cycle, also known as the Shewhart Cycle (Langley et
al.1996), encourages staff to develop, implement, and test changes in phased, deliberate, short
cycles of improvement. Staff test a new idea or change in the smallest and most focused way
possible, study the effect of the change, and then use these results to inform the next cycle of
improvement. A PDSA cycle can be completed in as little as an hour, and it should take no more
than a few days to complete. If the tested change does not seem to have resulted in
improvement, it is dropped or modified, and a new idea is tested in the next cycle. However, if
the tested change seems promising, the next cycles gradually build on that idea, for example, by
involving more people or testing over a longer period.
During the PREPARE collaborative, the team from Virginia used PDSA cycles in developing and
improving their emergency telephone hotline. An example is shown in Figure 3.5. A worksheet
describing the steps in a PDSA cycle is included in Appendix B.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
Figure 3.5
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
Implementing
the PREPARE
Approach to
QI in PHEP
Sample PDSA Cycle
(Virginia Department of Health)
ACT
PLAN
Addressed issues;
planned for setup of 4
phones during exercise
CHAPTER 4
Practice setting up phone
line prior to agency-wide
exercise
ACT
PLAN
STUDY
DO
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
STUDY
Process took much longer
than predicted; identified
technical issues
DO
Technician sets
up 2 phones
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Implementing
the PREPARE
Approach to
QI in PHEP
PDSA cycles can facilitate staff openness to new ideas by alleviating concerns that can arise when
large-scale changes are implemented. The use of small improvement cycles allows the result of
any changes made to be more easily isolated and measured. Also, frequent testing of PDSA
cycles reinforces the notion that QI is not a one-time event but, instead, an ongoing effort for
continuous improvement.
Using PDSA cycles can also help maximize the value of larger public health preparedness
exercises. Staff who are planning the exercise can identify one or more PDSA cycles that could be
carried out during the exercise (see Box 3.3 for detailed guidance). The improvement team might
want to run a series of cycles prior to the exercise, especially if the team is using a new process in
the exercise. For example, during the PREPARE collaborative, the team from Virginia had a large
agency exercise planned toward the end of the collaborative period. The department tested and
developed each of the processes required for their new hotline through a series of PDSA cycles
before the exercise.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
Implementing
the PREPARE
Approach to
QI in PHEP
During the agency-wide exercise, the department used PDSA cycles to test a number of
components of the hotline, including using a hotline-activation form, setting up the phones,
conducting just-in-time training for volunteers, and putting out a press release announcing the
opening of the hotline. After the exercise was over, Virginia planned another series of PDSA
cycles to improve areas needing
ongoing work. In the words of one
team member, the PDSA cycles “really
did move things along, instead of
waiting for one big way to test [the
hotline]. It was a way of seeing you
could make progress in shorter
periods of time.”
Tips for using PDSA cycles to improve
exercises are found in Box 3.3.
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
James Gathany, CDC/ Judy Schmidt, 2006
P R E FA C E
CHAPTER 1
Introduction
Box 3.3
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Getting the Most Out of Exercises
Implementing
the PREPARE
Approach to
QI in PHEP
Before the Exercise (PLAN):
Clearly identify which processes you are testing in the exercise.
Identify a few specific processes you can reliably and feasibly
measure during the exercise (i.e., for which valid measures are
available and for which data collection processes would not be
too burdensome).
Identify performance targets (desired and predicted).
Develop a plan for data collection. Note that data collection
does not need to continue for the entire exercise period (e.g.,
you could test and gather data from a telephone hotline for
only two hours, even though the larger exercise will continue
for two days).
Develop a process for debriefing and data analysis to be used
after the exercise.
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
During the Exercise (DO):
Implementing
the PREPARE
Approach to
QI in PHEP
Systematically collect performance data on the processes you
are testing (this step might require observers who are not
actively participating in the drill).
Systematically collect feedback from exercise participants,
soliciting their ideas for ways to improve the processes you
have tested.
After the Exercise (STUDY AND ACT):
Implement the process for debriefing and data analysis.
Compare actual performance on the processes of interest to
target/predicted performance. If you have achieved the desired
targets in some areas, what actions are needed to facilitate
continuing improvement? If you have failed to achieve targets
in some areas, which areas need improvement?
Identify QI teams for the specific areas needing improvement.
Identify opportunities to test/drill each potential process
improvement prior to the next large-scale exercise. Are there
analogous day-to-day processes that can be used to test
potential improvements? Include data measurement where
possible (these are the PDSA cycles leading up to the next
exercises).
P R E FA C E
CHAPTER 1
Introduction
CHAPTER 2
The PREPARE
Approach for QI
in PHEP
CHAPTER 3
Implementing the
PREPARE Approach
to QI in PHEP
CHAPTER 4
Strategies and Tools
for Improvement
CHAPTER 5
Support from
Leadership for
QI in PHEP
APPENDIXES
REFERENCES
G L O S S A RY
R E S O U RC E S
ACKNOWLEDGMENTS
Day-to-Day Events
Implementing
the PREPARE
Approach to
QI in PHEP
Another key strategy is to use day-to-day events to test and improve emergency response
capabilities and processes. Many of the capabilities required for emergency preparedness—e.g.,
risk communication, disease surveillance— are also required in day-to-day activities. For example,
the annual flu season requires many of the same activities that would need to be performed
during a pandemic, such as performing surveillance for disease activity, communicating with the
public about disease-prevention measures and availability of vaccines, and providing vaccines to
the public. During the PREPARE collaborative, Virginia realized that it could adapt an existing
resource—a telephone hotline for sexually transmitted disease (STD)—to handle calls during a
public health emergency. After talking with the manager from the STD division, the team was
able to recruit staff from that division to help develop, manage, and answer calls for their
emergency hotline.
There are a number of benefits to using day-to-day activities to improve preparedness. It can
allow an agency to improve both day-to-day and emergency planning activities at the same time,
which helps address the agency’s general needs. Also, the more frequently staff practice
emergency skills during regularly occurring events, the more familiar they become with their
emergency roles, and the more likely they are to perform them well. In some cases, the use of
day-to-day activities to test agency preparedness can help gain the buy-in of non–emergency
planning staff, because they are less likely to feel that they are being pulled away from their
“regular duties” to perform separate preparedness functions.