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Health Human Resource Influenza Pandemic Preparedness Planning in Ontario Partnering for Success


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Title: Health Human Resource Influenza Pandemic Preparedness Planning in Ontario Partnering for Success

Health Human ResourceInfluenza Pandemic
Preparedness Planningin Ontario Partnering for
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
Potential 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,
  • 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.

Conceptualizing Systemic Impact
The Approach to Planning for Deployment
  • Combines a population needs-based with a provider
    capacity and competency-based approach to
  • 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

Why 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
  • 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
  • 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

Composition 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

Anticipated Benefits
  • A structured way to prepare in advance based on
    local evidence (analysis of need based on
    independent measurement of potential demand,
  • 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
  • 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

Components 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)
  • IV Volunteer planner resource package
  • Planning Activity Considerations for Health
    Regulatory Colleges

Competencies 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

The 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

I 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
  • 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
  • Team approach to care likely to be most effective
    ideas on structuring teams for greatest
  • Will be influenced by externalalities such as
    care setting (physician office, clinic, emergency
    department, alternate care sites)

II 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,
  • 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
  • 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
  • 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

III 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

IV 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
  • 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
  • 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
  • Sample volunteer position descriptions, request
    for volunteers form, volunteer application form,
    volunteer screening procedures
  • List of Ontario volunteer centres
  • Canadian Code for Volunteer Involvement

Health 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
  • 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

Lessons to This Point
  • Partnership has been essential
  • To ground planning in realities of care
  • 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
  • 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

Challenges 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
  • 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

  • The Ontario Health Plan for an Influenza Pandemic
    (OHPIP) 2006
  • The Canadian Pandemic Influenza Plan (the Public
    Health Agency of Canada)
  • http//

Speaker 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

Presented at the 2006 CLEAR Annual
Conference September 14-16 Alexandria,
Ontario 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 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//
  • Toronto was also the continents epicenter for
    the 2003 SARS outbreak
  • Note 1. slightly less than the population of
  • 2. In more familiar terms, 55 larger than
    Texas or a bit more than ? the size of Alaska

Ontario location
Pandemic 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
  • 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
  • Be decisive act quickly and effectively to
    manage the pandemic
  • Be transparent communicate with health care
    providers and Ontarians

Planning Structure (fall 2005)
Planning Structure (2006)
Highlights 2006 Version of the OHPIP
  • Organized into 3 parts with stand-alone chapters
  • 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
  • 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

Planning Process / Milestones
  • Process
  • An engagement of experts and community-based
  • 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