Emergency preparedness and its implications for healthcare
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Aims of this study

Emergency preparedness and its implications for healthcare : What further research is needed?Alan Boyd1, Duncan Shaw2, Naomi Chambers1, Simon French2, Russell King3 andAlison Whitehead41 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.


Aims of this study

Aims of this study

Identify research and development needs with regard to emergency management in health care

Large-scale disasters, not smaller emergencies


National risk register 2010 edition

National Risk Register (2010 edition)


London 2005

London 2005

7/7 attacks

56 deaths

>700 injured

Injuries not commonly seen

Ongoing psychological care


Health emergency planning

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 (Nelsonet al, 2007)

UK NHS definition of a major incident (DoH, 2005)


Aims of this study

A picture of healthcare emergency planning:Balancing supply & demand through resistance & resilience of systems

Implementation

Major incident

  • Emergency planning system

    • Structures

    • Processes

    • Resources

    • Governance

  • Resistance and resilience

  • Vulnerability

  • Prevention + mitigation

  • Vulnerability

  • Resistance and resilience

  • Warning

  • Demand for healthcare

  • Supply of healthcare

  • Plans

  • Preparedness

  • Response

  • Incidence + prevalence of illness

  • Service user expectations

  • Structures

  • Processes

  • Resources

  • Governance

  • Recovery

Evaluation and learning


Scoping studies what are they

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


Context scoping studies and systematic reviews

Scoping study

Systematic review

Context: Scoping studies and systematic reviews

For a methodological framework see:

ArkseyH, O’Malley L (2005) Scoping studies: Towards a Methodological Framework. Int J Soc Res Methodol, 8:19-32.

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


Our approach

Our approach

Identified 18 R&D areas

Narrowed to 4 clusters

Literature review

Researcher survey

Debriefs and case studies

Interviews

Prioritisation workshop and survey

Advisory group


18 topic areas

18 topic areas

Learning (systems, measuring preparedness, quality improvement systems)

Incident Level (Definitions, factors determining escalation/declaration, business continuity)

Public Recovery (Early response, social support networks, vulnerable groups)

Re-organisation (Minimise adverse effects, wide area emergency, long-running emergency)

Risk communication (Public perception and communication, good practice, communicating expectations)

Priority (Characteristics of effective planning, investment in preparedness)

Training (Effective exercises, impact, developing emergency planners)

International research (Transferability, multi-nation research)

Strategic modelling (Criteria, good practice, local NHS good practice)

Social networking (Public communication, intelligence gathering, trust)

Surveillance (Lab capacity, enviro data, usefulness to decision makers)

Community Groups (vulnerable groups, Access if infrastructure disrupted, involvement in processes)

Willingness to work (Factors, increasing it)

Infectious diseases (Predicting impact, assessing cross-species transmission risk, bioterrorism)

ICT Resilience (Systems at risk, NHS-Net, National Resilience Extranet)

ICT developments (Planning for ICT innovation, training and education, smart phones)

System Recovery (Systems, prevention and recovery of responders)

Collaboration (“mixed economy”, external “navigation”)


Aims of this study

Potential research topics vary in the extent to which they address the needs of the public and of organisations

?

People’s needs

High ------------------- Low

?

Organisations’ needs

Low ------------------- High


Aims of this study

Potential research topics vary in the extent to which they address the needs of the public and of organisations

?

People’s needs

High ------------------- Low

?

Organisations’ needs

Low ------------------- High


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

Suggested research topics to be commissioned


Aims of this study

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


Suggested actions for research commissioners

Suggested actions for research commissioners

Collaborate within the UK and internationally

  • Compare research priorities

  • Coordinate commissioning

  • Develop commissioning models

    Strengthen UK research capacity


Further information

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


Thank you for listening

Thank you for listening

Prof Duncan Shaw

[email protected]


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