PUBLI C
HEALTH 128 (2OI4) 703-708
Available online at www.sciencedirect.com
Public H ealth ELSEVIER
jo u rn a l hom epage: w w w .e ls e v ie r.c o m /p u h e
Original Research
Factors affecting preparedness and capacity to manage pandemic influenza: perceptions of healthcare managers
CrossMark
B. Adini a’b,c’*, D. Laor a,b, L. Aharonson-Daniel b,c a Emergency and Disaster Management Division, Ministry of Health, Tel Auiu, Israel b PREPARED Centre for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel c Department of Emergency Medicine, Recanati School of Community Health Professions, Faculty 0/ Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
ART I CL E I NFO
ABSTRACT
Article history: Received 6 April 2013 Received in revised form 2 April 2014 Accepted 3 June 2014 Available online 14 August 2014
Objectives: Numerous interventions seeking to increase preparedness for pandemic influ enza have been implemented, but low compliance of healthcare providers has been re ported in many instances. The aim of this study was to identify factors that affect preparedness for pandemic influenza by examining: hospital managers' perceptions of measures implemented to promote preparedness for pandemic influenza; hospital man agers' assessments of the readiness and capability of their hospitals to manage pandemic influenza; and the effectiveness of a national pandemic preparedness programme in Israel over time. Study design: A quasi-experiment was conducted following implementation of a national pandemic preparedness programme in Israel. A survey assessed hospital managers' per ceptions of the effectiveness of the programme, and the preparedness and capacity of their hospitals to manage pandemic influenza. Two independent evaluations of preparedness for biological threats were conducted, based on a validated tool that included 60 objective parameters. Methods: Correlations between perceived preparedness and capacity and components of the preparedness programme were analysed using Statistical Package for the Social Sci ences Version 17. Stepwise logistic regression was used to determine the components that influence preparedness and capability to manage pandemic influenza. Results: All general hospital managers in Israel were approached twice (first and second evaluations). Ninety-one percent rated themselves as highly/very highly prepared for pandemic influenza, and 87% rated themselves as highly/very highly capable of dealing with pandemic influenza. Strong correlation was found between hospital managers' perceived preparedness and capacity to manage pandemic influenza (rho = 0.761, P = 0.000), and between perceived preparedness and familiarity with the disease (rho = 0.605, P = 0.003). Familiarity with guidelines accounted for 35% of the variance in perceived capability (adjusted R2 = 0.346, P = 0.002). Inclusion of preparedness evaluations
Keywords: Pandemic influenza Evaluation Guidelines Public health Emergency preparedness Emergency response Emergency management
* Corresponding author. Emergency Medicine Department and PREPARED Research Centre, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B 653, Beer Sheva 84105, Israel. Tel.: +972 54 8045700; fax: +972 77 9101882. E-mail address: [email protected] (B. Adini). http://dx.doi.Org/10.1016/j.puhe.2014.06.002 0033-3506/© 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
704
P U B L I C H E A L T H 1 2 8 ( 2 OI 4 ) 7 0 3 - 7 0 8
explained an additional 15% of the variance (R2 change = 0.146, P = 0.026). An increase in mean total score for emergency preparedness was found in the second evaluation compared with the first evaluation. Conclusions: Familiarity with guidelines and preparedness evaluations affect the percep tions of healthcare managers regarding preparedness and capability to manage pandemic influenza. © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Introduction Pandemic influenza poses a major threat to global public health.1 It can quickly cause high morbidity and mortality, overwhelm healthcare facilities, affect the economy, and lead to widespread public anxiety.2 Hospitals are therefore required to develop and sustain capability to respond to such pandemics.3,4 Studying the effectiveness of various in terventions is essential in order to assure preparedness for future pandemics.5 Key elements identified as enhancing pandemic pre paredness and improving staff compliance include assimila tion of national plans,1,5-7 risk communication,8 public health education,9,10 establishment of personal protective gear stockpiles, coordination and information sharing between relevant stakeholders,11 and implementation of training and exercise programmes.12 During a pandemic, healthcare workers are an essential component of the response.13 It is crucial to understand their perceptions about the effectiveness of implemented m ea sures, and the degree to which these measures protect them and enhance the preparedness of the healthcare system.13 Achieving trust increases staff motivation and willingness to participate actively in the response,14-16 while inadequate information may lead to non-compliance with the recom mendations of governing authorities, as was seen in the low rates of vaccination against influenza A/H1N1 among medical teams in most countries.17 The national programme for preparing the healthcare system in Israel to manage the influenza A/H1N1 pandemic was instigated and directed in 2009 by the Ministry of Health (MOH). Based on a risk assessment, all hospitals were instructed to prepare for the identification, admission and treatm ent of patients with suspected pandemic influenza. A national doctrine was disseminated to all medical facilities, and each hospital developed organizational standard oper ating procedures (SOPs). Influenza A/H1N1 was declared to be a disease that requires individual reporting, and an epidemi ological investigation was conducted following each identified case. In the initial phases of the pandemic (containment stage), hospitals were instructed to hospitalize each suspected patient in order to facilitate familiarity with the disease. Later, this policy was modified and m ost cases were referred for community care. Specific measures were implemented during the 2009 pandemic by the MOH to promote hospitals' emergency pre paredness, as follows:
• Designated equipment (e.g. ventilation machines and personal protective gear) was procured by the MOH and distributed to all hospitals; • Regional conferences focusing on the disease and the required response model were held, led by senior m an agers of the MOH; • Guidelines delineating risks and countermeasures were disseminated to the hospitals throughout the pandemic period; • Evaluations of emergency preparedness were conducted by the MOH in each facility after the implementation of the 2009 national pandemic programme; these evaluations were repeated in 2011—2012; • Various types of exercises were initiated, including table top and full-scale field drills, and all medical facilities in the region participated; • Ongoing monitoring of suspected and diagnosed patients admitted to the hospitals was undertaken, and policies were modified as required. This study analysed the strengths and weaknesses of the MOH’s pandemic preparedness programme with a view to increasing capacity to manage future pandemics. The spe cific aims of this study were: to examine hospital managers' perceptions of the measures implemented by the national government to promote preparedness for pandemic influ enza; to investigate hospital m anagers’ assessm ents of the level of preparedness and capacity of their hospitals to manage pandemic influenza; and to evaluate the effective ness of the programme in promoting preparedness over time.
M ethods Evaluating the effectiveness of the national pandemic preparedness programme Following the declaration by the World Health Organization in January 2011 that the influenza pandemic had been controlled, a survey was conducted by the MOH among hospital managers in Israel with the aim of assessing perceived effectiveness of the pandemic preparedness pro gramme. The survey covered four main topics: familiarity with the threat; perceived effectiveness of governmental ac tions; clarity of relationships with interface agencies; and perceived assessm ent of readiness and capability. A
PUBLIC HEA LTH 1 2 8 ( 2 0 I 4 ) 7 0 3 - 7 0 8
705
validated questionnaire including 12 questions was dissem inated to the managers of all 28 general hospitals in Israel, asking them to rate their perceived level of preparedness for pandemic influenza, their perceived ability to deal with pandemic influenza, and the effectiveness of each compo nent of the programme. The elements included in the ques tionnaire are presented in Table 1 . Each element was rated on a five-point Likert scale ranging from 1 (very low) to 5 (very high). Following the launch of the national pandemic prepared ness programme, two surveys were conducted in all general hospitals to assess the level of readiness to manage biological threats. The first evaluation was conducted in 2009-2010 following the implementation of the national preparedness programme, and the second evaluation was conducted in 2011—2012. The evaluations were based on a designated tool comprising measurable param eters used routinely by the MOH.18
Twenty-three out of 28 hospital managers in the country (82%) responded to the survey. The mean perceived preparedness score was 4.5 (standard deviation 0.598). Twenty-one hospi tals (91%) rated themselves as highly or very highly prepared to manage pandemic influenza, one hospital rated itself as prepared, and data were not available for one hospital. The mean score for perceived capability to deal with pandemic influenza was 4.35 (standard deviation 0.714). Twenty hospitals (87%) rated themselves as highly or very highly capable of dealing with pandemic influenza, and three hospitals (13%) rated themselves as capable. Mean scores for the 10 preparedness items ranged from 3.73 to 4.75 (Fig. 1).
Data analysis
Relationship between implemented measures and perceived preparedness and capability
Data were analysed using Statistical Package for the Social Sciences Version 17 (SPSS Inc., Chicago, IL, USA). The re lationships between the different components of the pre paredness programme and perceived preparedness and capability levels were analysed using Spearman's rho (twotailed Spearman's rank correlation coefficient). Strong, moderate and weak correlation were defined as >0.60, 0.30—0.59 and
HEALTH 128 (2OI4) 703-708
Available online at www.sciencedirect.com
Public H ealth ELSEVIER
jo u rn a l hom epage: w w w .e ls e v ie r.c o m /p u h e
Original Research
Factors affecting preparedness and capacity to manage pandemic influenza: perceptions of healthcare managers
CrossMark
B. Adini a’b,c’*, D. Laor a,b, L. Aharonson-Daniel b,c a Emergency and Disaster Management Division, Ministry of Health, Tel Auiu, Israel b PREPARED Centre for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel c Department of Emergency Medicine, Recanati School of Community Health Professions, Faculty 0/ Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
ART I CL E I NFO
ABSTRACT
Article history: Received 6 April 2013 Received in revised form 2 April 2014 Accepted 3 June 2014 Available online 14 August 2014
Objectives: Numerous interventions seeking to increase preparedness for pandemic influ enza have been implemented, but low compliance of healthcare providers has been re ported in many instances. The aim of this study was to identify factors that affect preparedness for pandemic influenza by examining: hospital managers' perceptions of measures implemented to promote preparedness for pandemic influenza; hospital man agers' assessments of the readiness and capability of their hospitals to manage pandemic influenza; and the effectiveness of a national pandemic preparedness programme in Israel over time. Study design: A quasi-experiment was conducted following implementation of a national pandemic preparedness programme in Israel. A survey assessed hospital managers' per ceptions of the effectiveness of the programme, and the preparedness and capacity of their hospitals to manage pandemic influenza. Two independent evaluations of preparedness for biological threats were conducted, based on a validated tool that included 60 objective parameters. Methods: Correlations between perceived preparedness and capacity and components of the preparedness programme were analysed using Statistical Package for the Social Sci ences Version 17. Stepwise logistic regression was used to determine the components that influence preparedness and capability to manage pandemic influenza. Results: All general hospital managers in Israel were approached twice (first and second evaluations). Ninety-one percent rated themselves as highly/very highly prepared for pandemic influenza, and 87% rated themselves as highly/very highly capable of dealing with pandemic influenza. Strong correlation was found between hospital managers' perceived preparedness and capacity to manage pandemic influenza (rho = 0.761, P = 0.000), and between perceived preparedness and familiarity with the disease (rho = 0.605, P = 0.003). Familiarity with guidelines accounted for 35% of the variance in perceived capability (adjusted R2 = 0.346, P = 0.002). Inclusion of preparedness evaluations
Keywords: Pandemic influenza Evaluation Guidelines Public health Emergency preparedness Emergency response Emergency management
* Corresponding author. Emergency Medicine Department and PREPARED Research Centre, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B 653, Beer Sheva 84105, Israel. Tel.: +972 54 8045700; fax: +972 77 9101882. E-mail address: [email protected] (B. Adini). http://dx.doi.Org/10.1016/j.puhe.2014.06.002 0033-3506/© 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
704
P U B L I C H E A L T H 1 2 8 ( 2 OI 4 ) 7 0 3 - 7 0 8
explained an additional 15% of the variance (R2 change = 0.146, P = 0.026). An increase in mean total score for emergency preparedness was found in the second evaluation compared with the first evaluation. Conclusions: Familiarity with guidelines and preparedness evaluations affect the percep tions of healthcare managers regarding preparedness and capability to manage pandemic influenza. © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Introduction Pandemic influenza poses a major threat to global public health.1 It can quickly cause high morbidity and mortality, overwhelm healthcare facilities, affect the economy, and lead to widespread public anxiety.2 Hospitals are therefore required to develop and sustain capability to respond to such pandemics.3,4 Studying the effectiveness of various in terventions is essential in order to assure preparedness for future pandemics.5 Key elements identified as enhancing pandemic pre paredness and improving staff compliance include assimila tion of national plans,1,5-7 risk communication,8 public health education,9,10 establishment of personal protective gear stockpiles, coordination and information sharing between relevant stakeholders,11 and implementation of training and exercise programmes.12 During a pandemic, healthcare workers are an essential component of the response.13 It is crucial to understand their perceptions about the effectiveness of implemented m ea sures, and the degree to which these measures protect them and enhance the preparedness of the healthcare system.13 Achieving trust increases staff motivation and willingness to participate actively in the response,14-16 while inadequate information may lead to non-compliance with the recom mendations of governing authorities, as was seen in the low rates of vaccination against influenza A/H1N1 among medical teams in most countries.17 The national programme for preparing the healthcare system in Israel to manage the influenza A/H1N1 pandemic was instigated and directed in 2009 by the Ministry of Health (MOH). Based on a risk assessment, all hospitals were instructed to prepare for the identification, admission and treatm ent of patients with suspected pandemic influenza. A national doctrine was disseminated to all medical facilities, and each hospital developed organizational standard oper ating procedures (SOPs). Influenza A/H1N1 was declared to be a disease that requires individual reporting, and an epidemi ological investigation was conducted following each identified case. In the initial phases of the pandemic (containment stage), hospitals were instructed to hospitalize each suspected patient in order to facilitate familiarity with the disease. Later, this policy was modified and m ost cases were referred for community care. Specific measures were implemented during the 2009 pandemic by the MOH to promote hospitals' emergency pre paredness, as follows:
• Designated equipment (e.g. ventilation machines and personal protective gear) was procured by the MOH and distributed to all hospitals; • Regional conferences focusing on the disease and the required response model were held, led by senior m an agers of the MOH; • Guidelines delineating risks and countermeasures were disseminated to the hospitals throughout the pandemic period; • Evaluations of emergency preparedness were conducted by the MOH in each facility after the implementation of the 2009 national pandemic programme; these evaluations were repeated in 2011—2012; • Various types of exercises were initiated, including table top and full-scale field drills, and all medical facilities in the region participated; • Ongoing monitoring of suspected and diagnosed patients admitted to the hospitals was undertaken, and policies were modified as required. This study analysed the strengths and weaknesses of the MOH’s pandemic preparedness programme with a view to increasing capacity to manage future pandemics. The spe cific aims of this study were: to examine hospital managers' perceptions of the measures implemented by the national government to promote preparedness for pandemic influ enza; to investigate hospital m anagers’ assessm ents of the level of preparedness and capacity of their hospitals to manage pandemic influenza; and to evaluate the effective ness of the programme in promoting preparedness over time.
M ethods Evaluating the effectiveness of the national pandemic preparedness programme Following the declaration by the World Health Organization in January 2011 that the influenza pandemic had been controlled, a survey was conducted by the MOH among hospital managers in Israel with the aim of assessing perceived effectiveness of the pandemic preparedness pro gramme. The survey covered four main topics: familiarity with the threat; perceived effectiveness of governmental ac tions; clarity of relationships with interface agencies; and perceived assessm ent of readiness and capability. A
PUBLIC HEA LTH 1 2 8 ( 2 0 I 4 ) 7 0 3 - 7 0 8
705
validated questionnaire including 12 questions was dissem inated to the managers of all 28 general hospitals in Israel, asking them to rate their perceived level of preparedness for pandemic influenza, their perceived ability to deal with pandemic influenza, and the effectiveness of each compo nent of the programme. The elements included in the ques tionnaire are presented in Table 1 . Each element was rated on a five-point Likert scale ranging from 1 (very low) to 5 (very high). Following the launch of the national pandemic prepared ness programme, two surveys were conducted in all general hospitals to assess the level of readiness to manage biological threats. The first evaluation was conducted in 2009-2010 following the implementation of the national preparedness programme, and the second evaluation was conducted in 2011—2012. The evaluations were based on a designated tool comprising measurable param eters used routinely by the MOH.18
Twenty-three out of 28 hospital managers in the country (82%) responded to the survey. The mean perceived preparedness score was 4.5 (standard deviation 0.598). Twenty-one hospi tals (91%) rated themselves as highly or very highly prepared to manage pandemic influenza, one hospital rated itself as prepared, and data were not available for one hospital. The mean score for perceived capability to deal with pandemic influenza was 4.35 (standard deviation 0.714). Twenty hospitals (87%) rated themselves as highly or very highly capable of dealing with pandemic influenza, and three hospitals (13%) rated themselves as capable. Mean scores for the 10 preparedness items ranged from 3.73 to 4.75 (Fig. 1).
Data analysis
Relationship between implemented measures and perceived preparedness and capability
Data were analysed using Statistical Package for the Social Sciences Version 17 (SPSS Inc., Chicago, IL, USA). The re lationships between the different components of the pre paredness programme and perceived preparedness and capability levels were analysed using Spearman's rho (twotailed Spearman's rank correlation coefficient). Strong, moderate and weak correlation were defined as >0.60, 0.30—0.59 and
