Oakland County Health Division
Oakland County’s Emergency Preparedness Best Practices Program for Healthcare Partner Engagement
Oakland County Health Division serves 1.2 million of the 9.9 million Michigan residents. Oakland County is located northwest of the Detroit metropolitan area and is the second largest county in Michigan. As of 2015, the median age in Oakland County is 40.8 years old with roughly 15% (179,188) of the population age 65 years or older. The median income is $67, 465 with 10.1% of individuals living below the poverty level. Oakland County's population consists of 76.3% white, 13.9% black or African American, 6.3% Asian, and 3.7% is Hispanic or Latino individuals. The Oakland County Health Division (OCHD) has developed and maintained partnerships with 43 long term care facilities since 2011. After a needs assessment regarding emergency readiness, it was found that many administrators do not feel completely prepared to protect residents. By utilizing the new Centers for Medicare and Medicaid Services (CMS) emergency preparedness rule as a best practice, the OCHD implemented Oakland County's Emergency Preparedness Best Practices Program for Healthcare Partners with long term care facilities. Objectives included increasing bi- monthly partnership committee meeting attendance from 20% to 40%, improving administrators' level of preparedness to implement the new CMS emergency preparedness guidelines from 23% to 50%, and having 100% of partners understand OCHD emergency communication procedures.
Activities to meet objectives included visiting administrators at their facilities to develop relationships, securing speakers and resources that directly help partners meet CMS requirements, sending formal invitations to meetings, and personal phone calls as meeting reminders. In addition, the OCHD Emergency Preparedness Unit staff provided speaker biographies for meetings, partner recognition for participation in the committee, in person emergency communication education, and conference calls with key public health officials during public health incidents. The OCHD Emergency Preparedness Unit continued conducting exercises and special educational events and seminars to meet the individual needs of group members.
The outcomes from these activities proved to be very positive. The results included increased meeting attendance from average 20% participation to 50% participation, administrators feeling better prepared to meet the new CMS emergency preparedness requirements, and administrators having a better understanding of the OCHD emergency communication procedures. Other outcomes from this program include the development of a maintenance professionals subcommittee, a large increase in POD plan participation by partners, and improved emergency messaging practice scores using the Health Alert Network. These results demonstrate that objectives for this program have been met and exceeded. The primary factors involved in improved emergency preparedness among long term care partners included relationship establishment and maintenance, education, and OCHD staff support.
Long term care administrators in Oakland County have created and practiced emergency plans that improve the safety of their residents and outcomes during an emergency. Administrators feel more confident they are prepared to act in an emergency for the wellbeing of their residents. Pre-established relationships between long term care administrators and the OCHD allow for streamline communication and quicker response during emergencies. This was recently demonstrated during a local water emergency when partners quickly responded to emergency communications and participated in emergency conference calls.
After a needs assessment it was determined that many long term care administrators in Oakland County, Michigan do not feel prepared to meet the new CMS emergency preparedness requirements. Oakland County is home to over 1.2 million residents with 15% of residents 65 years of age or older. The target population for this intervention is individuals over 65 years of age residing in a long term care facility that currently partners with Oakland County as a long term care partnership committee member. This includes approximately 6,000 elderly individuals impacted by the level of preparedness at the facility in which they reside. Oakland County Health Division initiated this committee in 2011 and has kept the primary focus on emergency preparedness topics. This partnership consisted of monthly meetings, emergency messaging, and closed POD planning.
Oakland County's Emergency Preparedness Best Practices Program for Healthcare Partners has utilized the CMS emergency preparedness requirements as best practices and has combined them with partner engagement strategies to encourage and support partners to their improve their level of emergency preparedness. The innovation of this program stems from OCHD's ability to adapt and support federal requirements as best practices for long term care facilities. As OCHD works with these partners and improves their level of preparedness, knowledge is gained about overall community preparedness and capacities, which in turn allows Oakland County to prepare for and react to incidents appropriately in order to best meet the needs of these critical partners who serve high risk populations. This practice is not evidence based however it will be utilized by the OCHD to engage all healthcare facilities in the county.
Oakland County's Emergency Preparedness Best Practices Program for Healthcare Partners was developed to improve the level of preparedness among long term care facilities in Oakland County, and ultimately, to expand this as an improvement measure for all healthcare facilities. An essential component to improving preparedness requires meeting attendance and involvement as educational materials and resources are provided during that time. The actions taken to improve meeting attendance were as follows:
Conducted an initial site visit to each facility within the partnership to conduct a needs assessment and reestablish a relationship with OCHD.
Educated partners about the OCHD emergency communication methods, POD planning and the importance of registering for the Michigan Health Alert Network.
Secured expert speakers to provide input and relevant education to help partners complete their CMS emergency preparedness requirements.
Created formal meeting invite packets that were sent via email and US postal service before every meeting. This packet included a meeting invitation, the previous meeting's minutes, a speaker biography for the upcoming meeting and any printed resources relevant to the upcoming meeting including notification of continuing education credits being offered.
A personal phone call was made to each administrator for a verbal RSVP.
Asked committee members to present their best practices to the group.
Held conference calls specifically for long term care administrators during public health incidents such as outbreaks, ransomware attacks, and infrastructure incidents; allowing OCHD to tailor messaging specifically to the long term care industry.
Sent regular and frequent emails regarding meeting recaps, updates, state sent emergency messaging, and upcoming events.
Held exercises specifically designed to help partners meet their CMS emergency preparedness requirements.
Made personal phone calls to all facilities who have not been actively responding to the Health Alert Network tests to facilitate registration or mitigate technological issues.
Created binders for all committee members to collect meeting information throughout the year. This binder can be shown to surveyors to demonstrate involvement with community partners as required by the CMS emergency preparedness requirements.
The population selected was long term care facilities within OCHD's Long Term Care Partnership Committee. The committee members were selected due to their existing relationship with the OCHD which enabled the OCHD to communicate with administrators directly via telephone and email.
The timeline for the program was one year, from January 2017 through December 2017. Bi-monthly meetings were scheduled starting in February and continuing throughout the year, with a final meeting in December. The CMS emergency preparedness requirements consisted of four primary areas and each topic was presented individually at a single meeting. The other two committee meetings were relegated to a kick off meeting where all OCHD administrators provided information about their programs and a final meeting focused on water management plans as cases of Legionella increased in southeast Michigan. Also, CMS distributed a new rule in June, 2017 stating that every facility must have a water management plan to reduce growth and spread of Legionella effective immediately which highlighted the need for this specifically tailored meeting.
There were multiple stakeholders involved with implementing the Oakland County's Emergency Preparedness Best Practices Program for Healthcare Partners. The OCHD Emergency Preparedness Unit coordinated with external partners including the Oakland County Homeland Security Division to provide exercises and trainings, state partners from Michigan Department of Health and Human Services provided presentations at meetings, the Oakland County Medical Control Authority provided education and well as updates at meetings, Region 2 North Healthcare Coalition coordinated exercises, and CMS agreed to be a point of reference for questions regarding emergency preparedness requirements. To foster stakeholder relationships, an explanation of the program and the intended goal were described a request for stakeholder involvement. Providing stakeholders with the pertinent information that allowed them to contribute to the committee in a productive way was critical.
Internal partners included the OCHD Communicable Disease Unit who provided updates at all meetings and the OCHD Environmental Health Unit who provided relevant education to the group. Collaboration with internal partners to educate committee members was fostered through personal conversations about the goals of the education requested and meeting reminders. All meeting presenters were given a hand written thank you card after each meeting they contributed to. These relationships were imperative to the success of the program because the program required subject matter experts educate committee members on various emergency preparedness topics. It allowed members to see the collaboration among agencies and develop relationships with other organizations that may be involved in their emergency response. Also, all of the stakeholders now have a direct contact to this partnership committee to disseminate information.
The primary costs involved in initiating this program, primarily were office supplies, printing and mailing. These costs were in kind as the OCHD already had the materials, printer ink and mailing accounts for costs. The OCHD Emergency Preparedness full time staff adopted the program as an additional project thereby negating the need to hire more staff to implement the program. The OCHD Emergency Preparedness Unit is fully funded through Public Health Emergency Preparedness (PHEP) and Cities Readiness Initiative (CRI) grant funding.
Objectives for the Oakland County's Emergency Preparedness Best Practices Program for Healthcare Partners were to increase bi- monthly partnership committee meeting attendance from 20% to 40%, improve administrators' confidence level to implement the new CMS emergency preparedness requirements, and to have 100% of partners understand OCHD emergency communication procedures. Meeting attendance was a quantitative measure and attendance was taken via a sign in sheet at every meeting. The February 2017 meeting demonstrated the highest level of participation at 65% and the year averaged a 50.1% attendance rate. A survey given to long term care partners via Qualtrics indicates that 70% of respondents feel prepared to meet the CMS emergency preparedness requirements and that 87% of respondents understand OCHD's communication procedures. The partner engagement strategies implemented have proven very successful as 94% of survey respondents feel comfortable contacting Oakland County staff for emergency preparedness planning support.
After a county wide water emergency in the last quarter of 2017, partners expressed their appreciation for the partnership committee and their relationship with OCHD which allowed them to respond to the incident effectively and efficiently.
This program has been successful primarily through establishing or renewing relationships with committee members and engaging internal and external partners and stakeholders. Sustainability depends on staff hours available to implement the project as well as office supply availability. Lessons learned include the need to engage and tailor messaging to maintenance professionals as they are knowledgeable in building systems such as heating, cooling, water, electrical, and multiple of facets related to healthcare facilities. This has been implemented and a maintenance professionals subcommittee has been established where these professionals troubleshoot and share ideas. It has been recognized that many maintenance professionals are expected to do the emergency planning at facilities so educational materials and resources must adapt to that population of professionals. Long term care facilities have a very high turnover in administrators so re-engaging and reeducating multiple administrators at one facility is not uncommon. To address this issue we created a PowerPoint which is presented via webinar to orient new administrators to the partnership committee. We also created a POD planning 101 PowerPoint presentation and Incident Command training overview for committee members as these topics were very common conversations pieces and needed resources for committee members and staff training.
The benefits of sustaining this program are that Oakland County as whole becomes a better prepared community and that the population served by Oakland County long term care facilities can recover from incidents quicker with plans in place. As education and resources evolve, committee members learn and collaborate with public health officials for best practices. Long term care residents are more likely to remain safe due to the preparedness planning at their facility in which they reside. Stakeholders and community partners that have relationships with committee members are better able to streamline incident response. Lives saved due to planning and response efficiency are immeasurable.
Stakeholders and committee members agree to sustain this program as the benefit is evident to all involved. The practices put in place through this program that involve emergency preparedness best practices combined with engagement strategies will continue to direct this program. Due to this program's success, the OCHD is reaching out to all healthcare facilities in Oakland County through a Healthcare Preparedness Symposium in the first quarter of 2018 to establish relationships, provide resources for emergency planning, and provide educational presentations.