Guidance for Planning for an Operational Response to Public Health Emergencies

GUIDANCE FOR PLANNING FOR AN OPERATIONAL RESPONSE TO PUBLIC HEALTH EMERGENCIES

Purpose

The following guidance has been developed to assist those charged with developing operational plans for a response to public health emergencies eg, disease outbreaks.

Characteristics of sound operational planning

Planning is about bringing a future event into the present so something can be done now to prepare for it. Good planning:

Is time sensitive
Is continuous
Builds situational awareness
Assists critical thinking about a situation
Assists decision-making
Helps leaders to anticipate
Simplifies complexity
Helps allocate the necessary resources to tasks
Identifies the controls and coordination required for an effective response
Guides preparation, and
Seeks to ensure that plans simple (but contain all the necessary information) and flexible.

A good plan must be:

Detailed
Able to be implemented, and
Tested.

Good planning requires good decision-making. Decision-making can be analytic, intuitive or a combination of both.

Analytic decision-making approaches a problem systematically. It identifies the problem, generates possible solutions to it, considers the ramifications of each, and selects the best solution.
Intuitive decision-making recognises patterns in problems, and identifies solutions to them based on experience, knowledge, and judgement.

Both types of decision-making are rarely exclusive. The selection of a course of action may be intuitive even though the data for the selection was derived analytically.

Summary of Guidance

Good operational planning follows a cycle of logical steps designed to ensure an effective response. A summary of some of the key steps in the planning cycle are shown in the diagram below.

Key steps in the planning cycle

Further guidance on the steps in the operational planning cycle

Assess the current situation

To plan a response to a current or future situation means gaining all available information about it. There are many sources for information including; surveillance, intelligence analysis, libraries, the internet, or seeking expert advice. This information must be analysed once collated in order to identify key issues that contribute to the response to a public health emergency.

Identify and define the problem

A problem occurs when there is a difference between the desired outcome and the current situation. Look for the root cause of the problem rather than merely the symptoms. It is important to properly identify the problem before starting the subsequent stages in the planning cycle. Time invested now will avoid a waste in time and resources later.

Define the aim(s) of the response to the problem

The most important part of planning is the selection and maintenance of the Aim –the desired outcome for the response to the problem. Ideally, there will be some guidance from a higher authority or written material to assist in the selection of the aim. In summary, the aim:

Is the desired outcome for a response to a public health emergency
Should be achievable, simple and likely to ensure a favourable conclusion, and
Must be selected carefully and expressed clearly in order to enable sufficient planning to achieve it.

The plan that will achieve the Aim can be expressed as follows:

“I, (or we) must complete the following tasks {in order to} achieve our Aim”.

A simple example follows:

‘The Aim for our response team is to screen all inbound passengers from areas of concern during our eight hour shift at Auckland International Airport to identify people who are unwell in order to delay the arrival of an infectious disease in the community’.

This statement makes clear what must be done and why, where it needs to be done, who needs to do it, and the duration of the activity. More detailed planning now begins to define the task of each team member during the eight hour shift to achieve the Aim.

Knowledge of the Aim of the response should be enough to guide team members if the situation changes rapidly.

All efforts should be directed to the achievement of the aim once it is determined. This means planning that does not contribute to the maintenance of the aim can be discarded.

Developing a concept for a response

Develop a concept for a response once the problem is defined and the aim decided upon. A concept is what you think you might do in response to a situation. A concept will usually offer a number of courses of action that achieve the aim but which need to be refined before being translated into a plan.

A concept is more flexible than a plan, which is the final product. The term “concept” should be used until the plan is ready to be drafted.

Two useful approaches to help develop a concept include:

The Quick Appreciation approach, or
The Mission Analysis approach.

The Quick Appreciation approach

The Quick Appreciation is easily remembered as four parts: Aim, Factors, Courses Open, and Concept.

Aim: define the problem and select what must be done to achieve the desired outcome.

Factors: vary but generally include:

assumptions
time
location
environment
resources
constraints, and
freedoms.

Courses Open: there are often a number of options available for the response to a public health emergency. The key is to think BIG and record all the options for further consideration. Then test each option against the factors and decide if it will achieve the aim. List the options that achieve the Aim as Courses of Action and compare them with each other to consider their suitability, and

Concept: select the Course of Action most likely to achieve the Aim and develop it through to a plan.

The Mission Analysis approach

This approach takes more time and can be written down. It comprises answering ten questions and analysis of the data gained:

What must be done?
What guidance is available?
What is the most likely scenario?
What is the greatest threat?
What are the superior intentions (i.e. what does the head office want as a result)?
What are the critical tasks required to achieve the outcome?
What tasks are given?
What tasks are implied?
Are there any constraints or freedoms that affect the planning?
What assumptions can be made from the outset?

An example of a written Mission Analysis is provided at Attachment 1.

Definition of the critical tasks is one of the key steps in Mission Analysis. Tasks should be collated into groups that can be assigned to one of the key command and control components in accordance with the ‘The New Zealand Coordinated Incident Management System’ (CIMS). These are; Incident Control, Operations, Planning/Intelligence, and Logistics.

Note: These functions are a guide only and should be amended to fit the situation at hand. New components should be established to deal with new situations.

A Task Matrix is useful tool to ensure all tasks are listed and that no resource is overlooked or over tasked. The Task Matrix lists all resources (including people) down the side of a piece of paper and Tasks across the top. A simple cross or tick in each corresponding box will confirm that each task is addressed and each resource is utilised. The Concept must be reviewed in the event of overtasking. An example of a Task Matrix is provided at attachment 2

The aim becomes the basis for developing the concept. In its simplest form the concept will comprise:

The Aim (developed in the previous step)
The tasks to achieve the Aim
The allocation of resources to achieve the tasks, and
Command, control and communication arrangements.

Brief the Concept to stakeholders to seek improvement

It is now important to identify the draft concept to all stakeholders to:

Ensure there is no duplication of effort from work that may already be in progress
Ensure common protocols are used to assist understanding for command, control and communication arrangements, and
Gain assent and enlist co-operation.

Experience has shown more efficient outcomes can be achieved between individuals and groups who have met before. Liaison should be established early with other stakeholders and maintained through active contact. Active contact means physically visiting people rather than using passive means such as e-mail. E-mail is deemed passive because receipt and response are not guaranteed. Communication by video conference or telephone is active but should only be used after the initial meeting.

A good way to make contact is to attend routine meetings when they are already scheduled. Otherwise, a meeting should be convened. Care must be taken to invite all stakeholders to a first meeting to avoid offending anyone or potentially losing some key expertise. Amendments to the draft concept should be discussed with the stakeholders.

A suggested format for informally briefing a concept is provided at Attachment 3.

Translate the concept into a written plan

The concept is ready to develop into a plan once approved by the stakeholders. Draft the Plan simply using some simple rules:

Think about what is to be said and then how to express it
Use one idea per sentence
Each sentence must be succinct but comprehensive
A sentence should generally be no longer than twenty words
Make each sentence precise and do not use unnecessary words, for example, ‘very’, ‘nearly’, ‘almost’, and ‘that’
Avoid ambiguity
Introduce acronyms before using them, for instance, ‘A Big Concept’ (ABC)
There is no need to introduce an acronym if the term is not used again in the text
Write impersonally, for example, “the following is to happen’, rather than ‘this is what I want to happen’, and
Do not use slang or colloquialisms.

A written plan will comprise:

A purpose and introduction
Background (a brief summary of the situation)
The aim
The Tasks and who is to perform them
Administrative resourcing and logistic arrangements, and
Command, control and communication arrangements.

The introduction introduces the Plan, NOT the problem. Remember that the Plan may be read by someone who is in a hurry and unfamiliar with the background documents. You have only one chance to capture their attention so the introduction should be self explanatory to attract further reading. A good introduction lists:

The intent of the plan
Its status compared with other references in circulation, and in particular its relationship with the prime reference
Key assumptions from either the Quick Appreciation or Mission Analysis
Publication date to indicate how current it is.

The rest of the plan will incorporate all available information for the achievement of the aim and finish with a comprehensive distribution list. It should address primary tasks, with contingency plans for secondary tasks added as Annexes.

The format of the plan is also important. Remember that a plan is a tool for conveying how to achieve a desired outcome to a public health emergency and therefore visual communication is more effective than lots of words. Use check lists, flowcharts, diagrams and pictures wherever possible. A checklist of points the Plan should address is provided at Attachment 4.

Implement the plan

Briefing the plan

The plan is now ready for implementation. The best way to brief the plan to people is through a meeting convened for that purpose. Face to face communication is best. Other forms of communication such as teleconferencing or video conferencing can also be used but have limitations. A good idea is to circulate the plan electronically beforehand so stakeholders have prior knowledge of the expectations of them.

The briefing should be rehearsed wherever possible to ensure a professional presentation.

Before briefing, it is good to develop a seating plan to:

Arrange attendees according to importance of their role, bringing those with bigger roles closer for better engagement
Confirm attendance
Look professional.

The briefing should be introduced with emphasis on the desired outcome, followed by the body of the brief and a summary. Summed up as ‘Tell ‘em what you’re going to tell ‘em, then tell ‘em, then tell’em what you told ‘em.´ Take questions and then ask some questions to confirm everyone at the meeting has a clear idea of their role in the plan.

Training

There may be a training package required to support the concept where special or new skills are introduced. The concept should include who is to conduct the training, timings, and a venue. It is a good idea to appoint a dedicated training team to plan and conduct the training, and then audit it. This creates a training continuum:

Assess need - plan – conduct – audit – revise – plan – …

Rehearsal

A plan involving stakeholders who have not worked together before should be rehearsed. A simple rehearsal is a guided tour of the venue or simulated venue for the plan, with each step in the plan explained chronologically by designated speakers. A more complex rehearsal involves stakeholders simulating their role in the concept.

Exercises

An exercise is a repeat of the Rehearsal with conditions created to replicate the actual incident as realistically as possible, and it should follow the rehearsal.

Management and review of the plan

A draft plan is a living document that permits amendment and evolution. A plan should be allocated to a person dedicated to keeping it amended and current. Key questions to ask include: Has the problem or situation changed? If so, do you need to change your aim or planned response?

Attachment 1

AN EXAMAPLE OF A MISSION ANALYSIS OF THE BORDER-QUARANTINE PLANNING REQUIRED FOR A PANDEMIC BIRD FLU EMERGENCY IN THE XXXXX REGION

For:Pandemic Bird Flu Border-Quarantine Planning Project Team

In conjunction with The Ministry of Health (MoH)

By: XXXXXX

Date:December 2010

Intent – What must be done?

The intent of this Mission Analysis is to determine what must be done in order to develop a sound Pandemic Bird Flu Border Management Plan (BMP) for the XXXXX based on the scenario of an aircraft landing at XXXXX Airport after transiting through an area of concern.

Direction and Guidance – what direction and guidance is provided?

The following References were canvassed for direction and guidance and their application to Border-Quarantine Planning is detailed below:

A.New Zealand (NZ) Influenza Pandemic Action Plan dated Sep 2006

This reference states its Specific Objective as: ‘To prevent, or delay to the greatest extent possible, the arrival of the pandemic virus into NZ.’ This Objective implements the ‘keep it out’ strategy of pandemic planning. Appendix F details the Border Management practice and advocates a minimum quarantine period of two days. It states that special powers are required for dealing with uncooperative passengers but does not address what form these should take.

B.MoH – Guidelines for Managing International Travellers during Various Influenza Pre-pandemic and Pandemic Phases dated March 2007

This reference details best practice for the management of travellers arriving in NZ in accordance with the World Health Organisation (WHO) classification of risk. It lists the extant powers and regulations applicable to Border Management of a Pandemic Incident. Further, it advocates the implementation of Ref C for management of the Incident.

C.The NZ Coordinated Incident Management System dated 1998

This reference details roles and responsibilities for key appointments and coordinating headquarters (HQ) for all incident management. It contains guidelines for contingency planning.

D.XXXXX International Airport Pandemic Influenza Action Plan as at 29 Nov 2007

This reference is specific to XXXXX Airport and is not intended to complement the XXXXX BMP but it achieves that effect. It is robust and should be included in the BMP of the XXXXX but it eschews Ref C which indicates the potential for a clash in command and control arrangements.

E.National Health Emergency Plan – Guiding Principles for Emergency Management Planning in the Health and Disability Sector dated June 2005

This reference executes its title and provides guidelines for Emergency Planning but it is not a directive and does not contain any material specific to BMP.

Most Likely Scenario

The Pandemic Bird Flu outbreak is in a foreign country and is recognised and classified on WHO guidelines as WHO Phase III. New Zealand makes a decision on whether or not to close its borders and if it keeps them open then air travellers are processed in accordance with Refs A and D.

Most Dangerous Scenario

An aircraft leaves an area of concern before the outbreak is detected and must land in New Zealand for either safety or operational reasons. The outbreak is classified as a WHO Phase V or VI pandemic.

What are the superior intentions for the Border Management Function of a Pandemic Flu Incident derived from References A to E?

Ref A states the intent is to keep a pandemic out if at all possible and then to contain a pandemic within controlled conditions once it enters New Zealand. Given that a high risk aircraft has landed in New Zealand then planning focus switches to containment.

What critical task must be achieved in order to meet the superior intentions in a Border Management Incident?

Contain the bird flu contagion to people already at risk in order to minimise its release into the New Zealand community.

Given tasks

At risk people are contained on the aircraft at the start of the problem. They are also contained once in quarantine and while in a vehicle travelling between the aircraft and the quarantine facility. The weak points are the exchange points between the areas of containment. This indicates that processing of at risk people can be phased if limited resources mean that processing in one packet is not feasible. Each phase poses its own challenges as shown below:

Implied tasks

a.Conduct a reconnaissance of the ground to establish:

likely response time
capacities for processing people – holding and process areas
time past a point to process people
administration areas for at risk people
need for interpreters
recording personal details, Next of kin
identity photographs
utilities – food & water, toilets, electric supply, lighting, and
first aid stations
ensure minimal interference with routine airport function
VIP and media briefing locations
embussing points
security requirements:
personnel and vehicles
time in location
time to deploy
time for briefing/training/rehearsals
rotation/shifts
briefing areas
utilities – water and food, toilets, first aid, brew/meal areas
rest areas
pre and post duty sanitation areas
staff administration areas
contingency plans
inner and outer cordon
inwards and outwards camera surveillance
possible command and control arrangements
communications options
routes
alternate routes
weak points in the perimeter
points for good observation and monitoring
effects of meteorology
day/night options, and
use of white light.

b.Anticipate the requirement for compulsion by regulation and physical force where necessary.