Title: Health Human Resource Influenza Pandemic Preparedness Planning in Ontario Partnering for Success
1Health Human ResourceInfluenza Pandemic
Preparedness Planningin Ontario Partnering for
Success
Expect the Unexpected Are We Clearly Prepared?
- Health Regulatory Colleges,Delivery Stakeholders
and Government
Council on Licensure, Enforcement and Regulation
2006 Annual Conference
Alexandria, Virginia
2Potential Influenza Pandemic Scenario
- Wont be like
- seasonal influenza epidemics
- SARS
- avian influenza
- But important lessons have been learned from each
- Will likely
- Start at any time during the year
- Happen in waves the first hitting a few weeks
after the pandemic emerges - Have a wave duration of 6 8 weeks with a 2nd
wave occurring 3 9 months after the 1st - Experience the majority of infectious cases in
the 1st wave - Thereafter, settling into a seasonal pattern
- Probable impacts
- Up to 70 of Ontarians infected at some point
throughout the full period - Limited (rationed) antivirals, no effective
vaccine for a minimum of 4 6 months, and
rationed when available, rapid depletion of
personal protective equipment (masks, gowns,
gloves) - Healthcare services particularly acute and
critical care quickly beyond capacity - 20 25 peak workplace absenteeism fear,
added in-home care giving - Intermittent community infrastructure disruption
transportation, food, power, fuel, protective
services, etc.
3Conceptualizing Systemic Impact
4The Approach to Planning for Deployment
- Combines a population needs-based with a provider
capacity and competency-based approach to
planning - This model follows from, and builds on, earlier
pieces of work in Canada on - Health human resource planning in Atlantic
Canada and - A Canadian nurse practitioner initiative which
focussed on primary health care delivery - Provides local planners and care providers with
information to - Describe their anticipated population need, their
provider capacity, and anticipate their unique
gaps or pressure-points most likely to occur at
the time of a pandemic - Understand how the legislative infrastructure for
regulating health professionals (the Regulated
Health Professions Act, 1991 RHPA) organizes
who can do what, under what circumstances - And provides a series of key questions to guide
them toward appropriate preparedness
decision-making now in the pre-pandemic phase
rather than later when we get to WHO-phase 6
(increased and sustained human-to-human
transmission in general population) - The intent of this approach is not to
count-heads, but to cause planners and
providers to re-think traditional, usage and
credential-based health system planning, in
preparation for a time when the normal will not
exist, while making as much use as possible of
familiar and practised processes and
infrastructure supports
5Why This Way?
- No / limited usage-base of information to plan
on 1918, 1957, and 1968 were all distinct, and
occurred in very different times - It will be a public health emergency naturally
lends itself to a population-needs-based analysis - There will be more demand than response-capacity
by a wide margin and a need to
think-outside-the-box - Normal surge response planning will fall short
- The surge will be protracted unlike most
emergencies which tend more toward the episodic - Ontarios health regulatory framework is a
controlled acts model, already featuring
multi-profession access to designated controlled
acts through mechanisms for sharing
responsibilities - The belief that health workers who do not
normally provide influenza care still possess
relevant competencies that would be of great
assistance in the care of flu patients - The approach was intended to identify and create
potential to deploy these competencies, as well
as the competencies of health care workers who
normally provide influenza care, in the most
efficient manner - The experts recommended it
6Composition of the Advisory Group
- Health Services Delivery Sectors
- Acute Care rural, urban
- Community Care
- Long-Term Care
- Health Regulatory Colleges
- Dentists
- Medical Laboratory Technologists
- Nurses
- Pharmacists
- Physicians and Surgeons
- Respiratory Therapists
- Organized Labour
- Professional Associations
- Medicine
- Registered Nurses
- Registered Practical Nurses
- Government
7Anticipated Benefits
- A structured way to prepare in advance based on
local evidence (analysis of need based on
independent measurement of potential demand,
supply) - A way to optimize to the fullest degree possible
all available on-the-ground competencies - A means to identify key areas of expertise
scarce and / or hard to replicate - Potential for tactical deployment of resources
- A way of modeling in advance for alternative
contingency management deployment approaches
before they develop into on-the-ground
emergencies - Opens potential for strategically enhancing
available competencies - Retirees
- Students
- Other volunteers
- And because its happening now
- Hopefully time for preparing for challenges
anticipated in implementation - Needs for training
- What to do about liability
8Components of the Approach
- The analytic framework
- Competencies needed / Competencies available
- The tools for planners and others
- I Competencies to do what?
- II Who can do what, when?
- III What can I (as a health care professional)
do? - IV Volunteer planner resource package
- Planning Activity Considerations for Health
Regulatory Colleges
9Competencies needed / Competencies available
- Considers the spectrum of skills, knowledge and
judgment (competencies) that people will need to
care for those affected by the outbreak - It is about sorting out the competencies that are
required and those competencies available to
deliver the services that people need to meet
their health needs during an influenza pandemic - Questions guide planners in applying the model to
determine their requirements, supply and
potential gaps
10The Tools for Planners and Others
- To give effect to the competency-based approach,
the tools to be described were designed to - Assist planners, health care providers, volunteer
organizations and health regulatory colleges and
their members to better appreciate the various
roles in influenza pandemic planning - Provide opportunities for, and assist in
structuring local planning discussions leading to
better preparedness - Provide a bridge between the planning framework
and the real world of influenza pandemic planning
and care
11I Competencies to do What?
- Provide / support patient care of flu victims
- Identifies the Influenza Care Competencies
(ICCs), under categories - Administrative / support (staffing, health
records, pharmacy, medical imaging, labs,
nutrition ) - Transportation
- Education staff / public
- Infection control / occupational health and
safety / surveillance - Care for well persons (immunization, antiviral
prophylaxis) - Care for ill persons
- Gives suggestions to planners on applying
competency approach to pandemic preparations - Competencies in assessment / diagnosis most
difficult to assess and supply - Single technical skill capacity generally not
useful - Team approach to care likely to be most effective
ideas on structuring teams for greatest
effectiveness - Will be influenced by externalalities such as
care setting (physician office, clinic, emergency
department, alternate care sites)
12II Who Can Do What, When?
- Gives planners an overview of who can do what
influenza care competencies (ICCs) in terms of
controlled / authorized acts in the Regulated
Health Professions Act, 1991 (RHPA) - Identifies those ICCs that are among the 13
controlled acts scope of the Act, and those which
are not i.e. those within the public domain,
and - for the former, identifies which of the regulated
health professions (and paramedics), are
authorized to perform those ICCs and - if they are authorized to perform them, whether
they can self-initiate, or only perform by order
or regulation - Profiles additional factors to consider regarding
an individual professionals competence to
perform ICCs, despite them being within scope of
practice - specific education / training / experience to
perform controlled, and public domain acts - practice restrictions established by other
legislation (i.e. Public Hospitals Act, etc.) - Many of the ICCs are in the public domain
category. Despite this, most require some degree
of education, training and judgement to be done
effectively - Just because an ICC that is also a controlled act
may be in an individual professionals scope of
practice, does not necessarily mean that
individual is competent to perform the ICC
their own professional judgement of
self-competence must be considered
13III What Professionals Can Do
- An approach to self-assessment to get health care
providers thinking in advance of an influenza
pandemic about how they might contribute within
the context of influenza care competencies (ICCs) - Two components
- A three-fold assessment of personal abilities as
they relate to the ICCs and key questions for
individuals to consider regarding their
professional / personal circumstances with
respect to involvement in responding to a
pandemic and - an RHPA controlled acts / ICCs decision tree (the
graphic) that places the ICCs within the
regulatory context for individuals and provides
an accessible overview of certain key questions
and consequences in assessing personal abilities
to assist in an influenza pandemic
14IV Volunteer Planner Resource Package
- For health planners, leaders and managers within
health care facilities and senior leaders of
volunteer agencies and organizations on helping
to support a volunteer response in an influenza
pandemic - Volunteers are defined as those who have not
completed formal health professional training,
who receive no direct monetary compensation, and
who are available to provide assistance during a
pandemic in a formal or informal health care
setting - Content
- A synthesis of and rationale for the needs-
competency-based approach - Advice on determining which ICCs will be required
/ supplied by each voluntary group developing
job descriptions and recruiting screening
orienting training and retaining volunteers - Uses a key questions format, similar to the
analytic framework - Draws heavily on the rich international voluntary
sector library, incorporating lessons learned
from diverse previous emergency management
experiences (e.g. previous influenza pandemics,
SARS, the Sumatran tsunami, hurricanes Katrina,
Rita and Wilma) - Appendices containing resource information, such
as - Sample volunteer position descriptions, request
for volunteers form, volunteer application form,
volunteer screening procedures - List of Ontario volunteer centres
- Canadian Code for Volunteer Involvement
15Health Regulatory College Planning Considerations
- Planning Activity Considerations to support
health regulatory colleges, individually and
collectively, in their creating action plans to
support a consistent, co-ordinated provincial
response - Three themes
- Communications
- e.g. consideration of appropriate communications
strategies with college staff, councils and
members with accompanying infrastructure(s) - Regulatory
- e.g. consideration of the establishment of
complementary guidelines and / or policies for
influenza care during a pandemic as between
regulatory colleges - e.g. consideration of the development of
coordinated policies on the delegation of
controlled acts during an influenza pandemic - Corporate
- e.g. consideration of ability to provide and
maintain critical college operations during a
pandemic
16Lessons to This Point
- Partnership has been essential
- To ground planning in realities of care
delivery - To provide support for order and leadership in
what needs doing to get ready - To champion conceptual approach
- The normal can guide planning for the unusual
- It is the accepted standard for quality and safe
practice - Qualities that still need to be uppermost despite
extreme pressures - It is (somewhat) familiar to all concerned
- Not a slam-dunk
- Real purposeful differences in perspective
- Potential of the scenario unifies
- Listening accommodating have been Important
- Its (been) worth the effort
17Challenges for the Future
- Assumptions will change with new information
- supply will be the problem (lt 2004)
- absenteeism will be the problem (2006 gt)
- Ethical choices
- Finding the right balance quality and safety
in extreme practice conditions - Additional supports needed to land it
- Recognize that this approach is new and not the
way people think now in a day-to-day practice
context - The best approach may be to identify roles
where capacity will be drained first, and plan
first-level replacement providers who could move
into those roles with supports, then identify who
could replace the roles of the first-level
replacement providers, etc. - Advance preparation
- Training, supervision, care plans
- just-in-time but how much time?
- Acceptance the reality will be different from
the scenarios, the modelling, the imaginings and
the press - Health Human Resources will be stretched beyond
capacity across all sectors and jurisdictions
mutual aid across jurisdictions will be minimal
if any - WE STILL NEED TO PREPARE
18References
- The Ontario Health Plan for an Influenza Pandemic
(OHPIP) 2006 - www.health.gov.on.ca/pandemic
- The Canadian Pandemic Influenza Plan (the Public
Health Agency of Canada) - http//www.phac-aspc.gc.ca/cpip-pclcpi/index.html
19Speaker Contact Information
- Frank Schmidt
- Ministry of Health and Long-Term Care
- 80 Grosvenor St., Toronto, ON M7A 1R3
- 416 326-0224 phone, 416 314-2339 fax
- frank.schmidt_at_moh.gov.on.ca
20Appendix
Presented at the 2006 CLEAR Annual
Conference September 14-16 Alexandria,
Virginia
21Ontario some facts
- Canadas 2nd largest and most populous province
(12¼ million) (see note 1 below) - Larger in area than France and Spain combined
(see note 2 below) - 90 of the population live on lt 15 of the land
within 100 miles of the St. Lawrence River, and
along the north and north west shores of Lake
Ontario - Ontario is Canadas industrial heartland,
contributing gt 40 of GDP - Major industries are auto manufacturing, mining,
and forestry - The St. Lawrence Seaway gives direct continental
access to the Atlantic, and is one of the worlds
busiest shipping lanes - Capital city is Toronto (pop 2.5 million)
- Toronto is the countrys main entry-point for
immigration, and its communications, commercial
and financial centre - http//plasma.nationalgeographic.com/places/provin
ces/province_ontario.html?sourceG1223 - Toronto was also the continents epicenter for
the 2003 SARS outbreak - Note 1. slightly less than the population of
Pennsylvania - 2. In more familiar terms, 55 larger than
Texas or a bit more than ? the size of Alaska
22Ontario location
23Pandemic Preparedness Planning in Ontario
- Occurring at federal, provincial and local levels
of government linked to the WHO influenza
pandemic planning effort through Health Canada - Ontarios provincial plan is modelled on the
Canadian plan - It has been renewed annually since 2004 the
2006 version viewable at www.health.gov.on.ca/pand
emic - Its objectives
- Minimize serious illness and overall deaths
through appropriate management of Ontarios
health care system - Minimize societal disruption in Ontario as a
result of influenza pandemic - Uses a strategic approach
- Be ready establish comprehensive contingency
plans at provincial and local levels - Be watchful practice active screening and
monitor emerging epidemiological and clinical
information - Be decisive act quickly and effectively to
manage the pandemic - Be transparent communicate with health care
providers and Ontarians
24Planning Structure (fall 2005)
25Planning Structure (2006)
26Highlights 2006 Version of the OHPIP
- Organized into 3 parts with stand-alone chapters
on - Planning context background, roles,
assumptions, phase activities, references - Systemic issues/activities/tools surveillance,
PH measures, the workforce, antivirals/vaccines,
procurement, communications - Context-specific issues/activities/tools PH,
labs, communities, hospitals, paediatric, LTC - Chapters
- Sector-specific Pandemic Lab Manual (tests
available recommended tests) Pandemic Plan for
Long-Term Care Homes Paediatric chapter Acute
Services (triage and critical care) Community
strategy Public Health (public health measures,
surveillance, infection control) - System-wide Surveillance, Public Health
Measures, Infection Control and Occupational
Health and Safety, Communications, Equipment and
Supplies, Antivirals and Vaccines - Identification of work to be done
- Tools
- Highlighting of significant changes for 2005
version - Heath human resource-related sections of interest
in the overall plan - Ethical framework
- Occupational health and safety
- Approach to planning for deployment
- OHPIP Ontario Health Plan for an Influenza
Pandemic
27Planning Process / Milestones
- Process
- An engagement of experts and community-based
stakeholders - Led and supported by government
- Over an 18 month development cycle
- Invaluable, fundamentals-based seen by most
as an opportunity to significantly influence and
guide operational policy development - Milestones
- Advisory Group concept development November
2004 to April 2005 - Steering Committee / stakeholder acceptance
April 2005 - Identifying / developing deliverables April
2005 to September 2005 - Steering Committee acceptance September /
October 2005 - Request for proposal development October /
November 2005 - Consultant acquisition / engagement December
2005 / January 2006 - Product drafting / clinical verification
February / March 2006 - Stakeholder consultations / verification March
to May 2006 - Steering Committee acceptance May / June 2006