The benefits of lessons learned: The COVID-19 experience in the Canadian province of Alberta.

The mantra from emergency management professionals is that lessons learned when enacted are beneficial; when they are not, it is a lesson observed. The COVID-19 pandemic has required healthcare organisations to be agile and responsive. This paper describes how Alberta Health Services leveraged the lessons learned from previous incidents in order to provide a flexible response to a rapidly evolving situation.

Decision-making in crisis: Applying a healthcare triage methodology to business continuity management.

The concept of triage in healthcare has been around for centuries and continues to be applied today so that scarce resources are allocated according to need. A business impact analysis (BIA) is a form of triage in that it identifies which processes are most critical, which to address first and how to allocate limited resources. On its own, however, the BIA provides only a roadmap of the impacts and interdependencies of an event. When disaster strikes, organisational decision-makers often face difficult decisions with regard to allocating limited resources between multiple 'mission-critical' functions. Applying the concept of triage to business continuity provides those decision-makers navigating a rapidly evolving and unpredictable event with a path that protects the fundamental priorities of the organisation. A business triage methodology aids decision-makers in times of crisis by providing a simplified framework for decision-making based on objective, evidence-based criteria, which is universally accepted and understood. When disaster strikes, the survival of the organisation depends on critical decision-making and quick actions to stabilise the incident. This paper argues that organisations need to supplement BIA processes with a decision-making triage methodology that can be quickly applied during the chaos of an actual event.

Testing the Assessment of New Radiation Oncology Technology and Treatments framework using the evaluation of post-prostatectomy radiotherapy techniques.

INTRODUCTION: We tested the ability of the Assessment of New Radiation Oncology Technology and Treatments framework to determine the clinical efficacy and safety of intensity-modulated radiation therapy (IMRT) compared with 3-dimensional radiation therapy (3DCRT) for post-prostatectomy radiation therapy (PPRT) to support its timely health economic evaluation. METHODS: Treatment plans produced using FROGG guidelines provided dosimetry parameters for both techniques at 64 Gy and 70 Gy and were also used to model early and late outcome probabilities. Clinical parameters were derived from early toxicity and quality of life patient data, systematic literature review and expert opinion. Dosimetry parameters were correlated with the measures of clinical efficacy and safety. RESULTS: Data from two patient cohorts (29 and 27 respectively) were collected within the project timeframe, providing evidence for acute toxicity and quality of life, and dosimetric comparisons. Relative rates of tumour control probability (TCP) and normal tissue control probability (NTCP) modelling were readily derived from the planning exercise and demonstrated advantages in uncomplicated TCP for IMRT over 3DCRT, predominantly due to normal tissue sparing. The safety of IMRT delivery was demonstrated with TCP uncompromised by IMRT protocol violations, which achieved rectal sparing only by reducing minimum target dose and coverage. CONCLUSION: Sources of desk-top and patient-based evidence were successfully used to demonstrate potential improved clinical efficacy and safety of applying dose escalation using IMRT instead of 3DCRT in PPRT.

Healthcare system resiliency: The case for taking disaster plans further - Part 2.

For the most part, top management is aware of the costs of healthcare downtime. They recognise that minimising downtime while fulfilling risk management standards, namely, 'duty of care' and 'standard of care', are among the most difficult challenges they face, especially when coupled with the increasing pressure for continued service availability with the frequency of incidents. Through continuous operational availability and greater resiliency demands a new, combined approach has emerged, which necessitates that the disciplines of: (1) enterprise risk management; (2) emergency response planning; (3) business continuity management including IT disaster recovery; (4) crisis communications be addressed with strategies and techniques designed and integrated into a singular, seamless approach. It is no longer feasible to separate these disciplines. By integrating them as the gateway for service continuity, the organisation can enhance its ability to run as a business by helping to identify risks and prepare for change, prioritise work efforts, flag problems and pinpoint important areas that underpin the overarching business continuity processes. The driver of change in staying ahead of the risk curve, and the entry point of a true resiliency strategy, begins with identifying the synergies of the aforementioned disciplines and integrating each of them to jointly contribute to service continuance.

Healthcare system resiliency: The case for taking disaster plans further--Part 1.

To establish true healthcare resiliency, and to better position healthcare organisations to provide effective response, continuity, resumption and recovery of fundamental services and operations during serious incidents and disasters, the disaster planning process must evolve into an integrated approach of four contingency planning disciplines that holistically examine the end-to-end, all-hazard response continuum. This process also needs to incorporate and scale multifarious organisational levels and, when required, the health sector. This paper is the first component of two independent, but related, pieces. It will examine the typical state of disaster preparedness and plans in healthcare, examine the worth and value of honing disaster plans, and will introduce two recommended contingency planning disciplines: enterprise risk management and emergency response planning. For each discipline, a case will be made for its inclusion into the overall disaster planning process, including examination of background information, benefits, how it improves disaster planning, and other resources helpful to the reader. The second paper, in afuture issue of the Journal of Business Continuity & Emergency Planning, will introduce business continuity management--including IT disaster recovery--and crisis communications as the third and fourth contingency planning disciplines needed for a fully integrated approach. The opinions expressed in this paper are those of the authors and may not be entirely those of the organisation.

Using community triage centres or non-traditional care facilities during a flu pandemic or other infectious disease outbreak.

One assumption of pandemic planning is that, during an influenza outbreak, acute care facilities may be quickly overrun with patients and as such must prepare in advance. In order to operationalise one component of a pandemic plan, Capital Health in Edmonton, Alberta, piloted a mobile triage centre facility (portable isolation containment systems) and tested pandemic influenza triage and assessment guidelines in the winter of 2006-07. The mobile model provided emergency department surge capacity for communicable disease emergencies with scalable deployment capabilities. The deployable module has several advantages over a fixed structure like a community facility. The triage facility is a location for short-term treatments, such as intravenous therapy, prescriptions, medication distribution, and self-care education, which are needed during a pandemic influenza outbreak. Decanting infectious patients away from the emergency department protects a highly-vulnerable hospitalised group from viral transmission. Based on the pilot, it is found that community triage centres are a viable support option for emergency departments in an urban setting during pandemic influenza.

Taking care of the sick and scared: a local response in pandemic preparedness.

Virtually all health care operations, including public health, are undertaken only at a local or regional level. Large-scale infectious disease emergencies, such as SARS or pandemic influenza, will be recognized and managed at a local level. The creation of the Public Health Agency of Canada (PHAC) was an important step in strengthening public health capacity. However, we need adequate operational capacity in local public health departments to have a strong public health system. Local public health takes an integral role in the preparation for and management of infectious disease emergencies. Local public health departments and regional public health infrastructures must be positioned to both maintain core functions and to lead and support health sector response to emergencies. The local establishment of a flexible and sustainable emergency management system must address the need to: integrate health care and first responders; provide all-hazards tools for managing a crisis at the frontline; rank service priorities and provide surge resources; and provide accurate information on a timely basis. Only the leaders within the local or regional health care facilities and organizations can develop workable plans to deliver health care. PHAC must ensure and support the local public health infrastructure and local emergency preparedness. Without this support, there will be consequences for local response to major public health emergencies.