The local health officer was returning from a lunch meeting when an earthquake reaching 6.8 on the Richter scale struck her community. Stopping just as abruptly as it began, the health officer realized that the impacts of this event would be significant enough to demand a response potentially exceeding the resources of the local health department. While exiting her car, the health officer considers a series of actions that her preparedness team could be taking when she is confronted by a number of questions: “The size of preparedness department staff was recently reduced, how do I quickly increase the number of staff to meet the needs of this response? Do we have the proper equipment and resources to handle the present situation? What if we need more due to damage from the earthquake? How do we ensure that we comply with reporting requirements as we deal with this dynamic situation? If an emergency is declared, how could that impact the way we respond? How are we going to pay for all of this in a timely manner?”
Though a hypothetical situation, these questions are frequently posed during public health responses to a number of emergency situations. As staff deploy to address these events, the effectiveness and speed of their response can be greatly impacted by the readiness of what are typically considered to be the support functions of health departments, such as contracting and procurement, human resources, and legally required activities.
The term administrative preparedness is used to describe the efforts of health departments and their partners to identify and leverage strategies aimed at improving the efficiency of organizational operations with the goal of supporting public health emergency response in the field. The following will serve as an introduction to the concept of administrative preparedness. Included in this discussion will be an overview of the administrative preparedness focus areas, discussion on the barriers to administrative preparedness and their solutions, and a description of a newly created tool from the National Association of County and City Health Officials (NACCHO) focused on supporting state and local health departments as they seek to develop formal administrative preparedness plans.
Addressing Emergency Response through Organizational Operations
Administrative Preparedness refers to those coordination and planning activities that are intended to ensure that fiscal and administrative authorities and practices that govern funding, procurement, contracting, hiring, and legal capabilities can be accelerated, modified, streamlined, and accountably managed through all levels of government during emergency responses. Being administratively prepared means that an organization's operations will be more responsive to the needs of preparedness and response professionals as they seek to address emergency situations. In addition, being administratively prepared requires that a health department has a full understanding of its authorities under the law, the various procurement mechanisms at its disposal, the strategies and methods available for addressing emergency staffing needs, and an appreciation of and adherence to reporting requirements both during and outside of a declared emergency.
The concept of public health authorities refers to those legal powers that are available to health departments and health officers. Within the practice of emergency preparedness, public health authorities can refer to the ability of health officials to procure resources, take personnel actions, manage the receipt and use of funding, and impact the speed at which these activities may be conducted through emergency declaration.
The importance of emergency declarations comes from their ability to impact response and recovery. Though laws governing the operations of health departments are written with the intent of ensuring that these entities effectively protect the lives of all members of their communities, the adherence to certain requirements (for example, collective bargaining agreements1) can impede the speed of response and recovery. However, it is possible for many of the requirements codified in the law to be waived or become less stringent through the declaration of an emergency. This loosening of requirements can make a major impact on the speed at which a health department is able to operate and react to a situation where the health of community members is at risk.
Among the operational tasks that can be impacted through the declaration of an emergency, procurement refers to the ability of health departments to acquire goods and services that will enable an effective response to an emergency. Operating under laws that help to prevent financial misuse, the procurement process can be important when dealing with events where the resources needed to respond are not within existing stockpiles. It is also valuable to know of all procurement options that are available to health departments given their situation, as different jurisdictions have different procurement vehicles available to them. These procurement options could include the use of mutual aid agreements, such as the Emergency Management Assistance Compact; term contracts; cooperative purchasing; procurement cards; and emergency procurement provisions that activate following the declaration of certain emergencies.2
Frequently, being administratively prepared in the use of procurement techniques means that a health department has cultivated a strong partnership between it and the jurisdiction's procurement or fiscal agent. It is through this relationship that health departments can gain an understanding of what is and is not possible from a procurement perspective, and procurement/fiscal agents can gain insight regarding the types of resources needed to respond to emergency events.
The identification, deployment, and utilization of a workforce possessing a broad range of skills and knowledge is another critical aspect of administrative preparedness. From finding the right mix of qualifications and experience to ensuring the safety of those who can contribute to a response, the management of people during emergency situations is a critical role for health departments and their human resource staff.
During normal operations it can often take weeks or months to complete the hiring of health department staff due to legal requirements that are intended to ensure a transparent and competitive process. However, those standard hiring mechanisms often do not meet the needs of health departments during emergencies which require immediate, and usually temporary, surges of personnel in areas such as incident command, nursing, epidemiology, and sanitation. To address the surge of workforce needs during a public health event health departments can utilize a number of options which may or may not require the declaration of an emergency, including the use of volunteers (e.g., Medical Reserve Corps or registrants with the Emergency System for Advance Registration of Volunteer Health Professionals), temporary reassignment of staff, collaboration with partner organizations to increase response capacity, and the waiver of hiring and staffing requirements.3
Finally, the reporting of public health and medical data is another essential element of emergency response that an administratively prepared health department can address to facilitate a rapid public health response. Often written into law, health departments are required to report data to various entities, including federal and state agencies, to build situational awareness surrounding public health emergency events. By sharing this information, health departments are helping to build a common operating picture that allows for coordinated efforts to ensure the health of the community.
Unfortunately, the reporting of this information to various stakeholders can create a large administrative burden on operations and can play a role in bogging down response speeds. In addition to this additional workload, reporting can often be hampered by duplicative and inconsistent reporting requests, the difficulty of anticipating reporting needs for all hazards, lack of accessibility to computer-based reporting systems resulting from emergency-based power outages or impacted critical infrastructure, and the differing perspectives on data that is considered timely or useful. To address these barriers health departments may be able to gain a waiver of certain reporting requirements through the declaration of an emergency. To decrease response inefficiencies, public health may also: assess their current data-collection processes to uncover and address duplicative efforts prior to an event, establish standard methodologies for providing data to partners, and leverage common and centralized reporting platforms like WebEOC and Epi-X. Additionally leveraging standardized functions, forms, and processes defined in the National Incident Management System and through the implementation of an incident command system during an emergency response can help to standardize and integrate reporting requirements into response operations.
When considering the wide scope of issues that come into play when addressing administrative preparedness and the various regulatory and policy requirements that may impact activities to address those issues, it becomes apparent that the use of formalized administrative preparedness plans can be essential to an effective public health emergency response. Unfortunately, NACCHO recently discovered that nearly half of local health departments do not have, or are unsure whether they have, formal written administrative preparedness plans that could assist in emergency situations.4 Due to this finding, NACCHO set out to create a tool that could facilitate the creation of administrative preparedness plans that take into account jurisdiction-specific law and policy requirements.
When considering the wide scope of issues that come into play when addressing administrative preparedness and the various regulatory and policy requirements that may impact activities to address those issues, it becomes apparent that the use of formalized administrative preparedness plans can be essential to an effective public health emergency response. Unfortunately, NACCHO recently discovered that nearly half of local health departments do not have, or are unsure whether they have, formal written administrative preparedness plans that could assist in emergency situations. Due to this finding, NACCHO set out to create a tool that could facilitate the creation of administrative preparedness plans that take into account jurisdiction-specific law and policy requirements.
A Guide to Navigate Administrative Preparedness Planning
The NACCHO Administrative Preparedness Legal Guidebook was developed to assist public health professionals to improve their department's administrative preparedness capabilities and ensure that its administrative operations support response activities by encouraging collaborative preparatory work among preparedness, legal, human resources, procurement, and other staff.5 This guidebook contains four sets of stand-alone tools that assist public health professionals as they attempt to incorporate their jurisdiction's individual laws, policies, and procedures into a formal written administrative preparedness plan. The Emergency Declaration Toolset supports health department decision-making processes for considering, implementing, or reviewing the use of state/local emergency declarations. The Emergency Procurement Toolset assists efforts to quickly procure resources during public health emergency response and recovery. The Expedited Staffing Toolset provides guidance for determining if and when an agency should expedite hiring, organize volunteer responders, or reassign personnel. Finally, the Mutual Aid Agreement and Memorandum of Understanding Toolset outlines steps for requesting aid from collaborating jurisdictions or entities participating in mutual aid agreements or memoranda of understanding. Each toolset within the NACCHO Administrative Preparedness Legal Guidebook contains decision-aids, which have been structured to allow for customization based on a jurisdiction's legal and policy requirements. These aids help people think through the options that may confront a health department as it considers different aspects of administrative preparedness. In addition, the toolsets include visual pathways that provide an illustrated overview of the steps outlined within the decision-aid tools.
The Guidebook encourages the participation of operational staff members, including legal counsel, in the completion of each of the tools to both ensure that laws and policies are properly accounted for and that individuals from the different operational areas of health departments gain an awareness of and appreciation for the activities of their counterparts during an emergency response. Each toolset may be utilized independently.
Supporting Administrative Preparedness for Health Departments and Their Partners
While there are many facets to consider when addressing administrative preparedness, there are a great number of resources available to health departments that want to ensure that their operations are ready to respond to any situation. By using tools like the NACCHO Administrative Preparedness Legal Guidebook and other resources that may be found within the NACCHO Toolbox, NACCHO's online collection of public health tools containing materials developed and shared by the larger public health community to address a number of issues including administrative preparedness, health departments can begin to address the many questions that can arise regarding their operations during an emergency response.6 By leveraging the knowledge of NACCHO and its nearly 3,000 member health departments, local and state health departments and their partners can be more administratively prepared to handle the next public health emergency when it arrives.
