Reporting - Two of Four: Preparedness

Today I want to discuss what I'm calling "preparedness" reporting: the information collected, primarily at the Federal level, either as part of a grant application or grant monitoring process, or to otherwise assess "compliance" with specific requirements (e.g., NIMSCAST). In my professional career I have been on both sides of grant monitoring - preparing documents and data for a site visit while at a local health department and reading submissions at the Federal level - and in both cases have felt that the system as it stands is unnecessarily burdensome.

At the local level I worked to support our Director while she prepared for a Cities Readiness Initiative (CRI) review, which involved filling the Executive Conference Room with binders and files on any program that had any possible relationship with the CRI program and then sitting through two days of evaluation and discussion with a team from the CDC and the state CRI coordinator. During that time almost all other work in the office ceased since there were only four of us and all were needed to compile all of the information required. While there were undoubtedly some inefficiencies in the way we prepared because the Director was new to her position, the review was so all-encompassing that even an experienced person would have needed the better part of a week to get ready. The reviewers weren't looking for knowledge of the program but specific documentation, so being well-versed in the preparations wouldn't have been enough. The only way to be more prepared would be to base your filing system around the information requirements so that re-sorting wouldn't be needed.

Until the next program came by for a site visit and you had to start all over based on their requirements.

On the other side of things, I've been involved in reviewing monitoring information on a couple of different grant programs, and will use the Regional Catastrophic Preparedness Grant Program (RCPGP) as an example. Details on the RCPGP are available at the link, but it is essentially a program where FEMA gives money to urban areas for regional planning, similar to the UASI program but all-hazards. The RCPGP has a complex monitoring process, which includes quarterly site visits and an on-going program plan (most of the ones I have seen are Microsoft Project charts) which is reviewed on the programmatic and fiscal side at the Regional office, with HQ having the final say on compliance. Our Region has three RCPGP sites (of 11 nationally), all of which submit their materials on the same deadline, and all of which have to be reviewed by our one programmatic person in a week and forwarded on. Each of the three monitoring packets was a folder about three inches thick, and at least one of the sites was far behind where they should be, necessitating extensive documentation of the efforts that have been made to pull them back on track.

And this is one of probably 10 different projects this particular person is responsible for.

Both of these illustrate a common problem; as long as we look at reporting as a discrete event, something that happens once a quarter or once a year, then there will always be a lot of catch up for both the submitter and the recipient. If, instead, we shift the paradigm and make better use of collaborative tools such as SharePoint and Adobe Connect then we can create a system where information is always available for review, where feedback comes realtime, and we can avoid projects getting greatly off track.

Next week I will address similar problems with information collection during an active response, and the following week I'll outline a proposal for a system that would incorporate both sets of reporting.

Reporting - One of Four

I mentioned on Monday that I would be discussing reporting as my first long-form topic. Today I will lay out what I mean by "reporting". Over the next couple of weeks I'll follow with targeted discussions on types of reporting and a proposal for how they can be made more useful for all involved.

Emergency management reporting falls into two separate but related categories: preparedness and response.

• Preparedness reporting includes information required for grant monitoring, tracking training and exercise participation, and the dozens of other requirements laid down, primarily by DHS/FEMA, to determine if a given entity is meeting the requirements for accreditation (e.g., NIMSCAST).
  
• Response reporting refers to the information collected during operations, from field elements to the command element and vice-versa, that is used during the response to assess the effectiveness of a particular strategy and following the response for the After Action Review (AAR) process.

These two types of reports require different sets of data and are collected under different circumstances but there is a clear link between them, or at least there should be. The data collected as part of grant monitoring and accreditation should be linked to operational capabilities; and the data collected during a response should be linked to future grant applications and training/exercise programs. However, the current system of collecting data and preparing reports does not lend itself readily to this sort of cross-purposing. Data is collected in static forms, more often than not using Word templates. That information is then pulled from one static form and plugged into another (e.g., individual comment/evaluation forms are pooled into an AAR) that is distributed as a locked Word file or pdf.

What we need is a system that allows for searching and cross-referencing of data, covering both preparedness activities (e.g., projects funded with grant money) and response activities (e.g., daily situation reports from a command post at a wildfire) so that it is possible to identify the links between the two. With this sort of linked system it would be possible to, let's say, evaluate the effectiveness of a jurisdiction's use of FEMA's Assistance to Firefighters grant program by evaluating the performance in the response of the assets funded by the grant, and not based solely on the information in the grant monitoring paperwork. It is possible to do this sort of cross-referenced evaluation now, but it requires an investment of human capital to review:

• Grant monitoring paperwork - both fiscal and programmatic;
• Operations logs to determine when the assets funded through the grant were activated;
• Situation reports to determine the types of missions those assets were used for;
• AAR (if they exist) to determine the effectiveness of those assets.

Since each of the above listed reports will be in different formats, including what may be hand-written operational logs, and none of them are likely to be context-searchable, tracking a single asset from purchase with grant funding to deployment and evaluation will require one or more persons to hunt through piles of reports looking for some kind of specific identifier. Once the asset of interest has been found it might be possible to track it through all of the different reports, but only if it is listed in the same way in all of them.

Over the next two weeks I will look more closely at the two identified types of reporting, and I will then end the month with a specific proposal to link them. I look forward to what I hope will be an active discussion of this issue, which I know greatly impacts emergency managers at all levels.

Returning

I've been away from this for far longer than I thought I would when I wrote my last post. I won't go in to details, suffice to say that work got a little more crazy than I expected. Either way, I plan to start writing again and wanted to take this opportunity to talk a little about how I see the blog shifting focus.

When I first started writing it was primarily out of frustration. I was working for a local health department and was very pigeon-holed. All I was working on was pandemic preparedness, and despite numerous other opportunities and projects that needed doing, my assignment never wavered. That was a management decision and even a change of supervisor didn't change my workload. So I started the blog to explore other areas of preparedness/response that I was interested in. Then I changed jobs, moved across the country, and shifted from local government to Federal/regional work in general emergency management. I shifted to try and rotate through topic areas to cover local, state, and Federal issues. To be honest, after a while it felt forced, and that was when I suspended writing.

I've decided to shift focus a little, back to one of my original idea, and use this space to explore areas of the field that I want to delve into a little more. I will be posting only a one or two times a week, and hopefully the posts will be deeper than before.

The first area I will be looking at is information collection and dissemination within an organization. Not crisis communications, but how reporting does and should flow. This will be drawn from my experiences working in the Regional office during the early days of a dual deployment of field personnel, as well as the on-going H1N1 incident.

My hope is to use the blog to develop these topics and potentially identify areas for writing more complete white papers or policy suggestions, and look forward to discussion on them after posting.

Thanks for your patience through the months of silence.

Hiatus

I will be taking a (hopefully) short hiatus from writing this blog. I've hit a point where most political debate, which is at the heart of many of the issues I like to discuss here, has me tearing out my hair. I'm going to take a little bit of time away from these issues (well, except for work where I don't have a choice) and see if I can get over the annoyance. Keep watching the feed, and I'll be back at it as soon as I can.

Joel

Pandemic - What now? (Public Health)

Yesterday I threw out a sampling of the stories I've read in the last day or so about the WHO decision to declare a pandemic. Today I will be more editorial and get into what it means, from my point of view.

In a post a couple of weeks back I gave my thoughts on some of the controversy the WHO was dealing with at the time, the "will they or won't they" declare the H1N1 outbreak officially a pandemic. At the time the main problem the WHO was faced with was the fact that they had crafted a pandemic alert system that was based solely on the spread of illness. Their system didn't take severity into account. My take was that the people developing the system had done so either consciously or subconsciously based on H5N1, with its high case fatality ratio. The pieces I have read that are critical of the decision to declare a pandemic have focused in on this point. They have pointed to the 145 deaths and argued that we can't be in a pandemic because pandemics come with so many dead and dying that the social order will break down.

This is a beast of our own making.

I have been in public health, working on pandemic preparedness, so I know just how hard it was to get people who weren't epidemiologists or other public health professionals to take the potential impact of a pandemic seriously. I also know how much easier it is to make the point that preparedness is important by focusing on the worst case scenarios - not only in pandemics but in everything (the category 5 hurricane, the 9.5 earthquake). Add these two together and you have the common impression that a PANDEMIC (the catastrophic type we talked about as opposed to the textbook definition) is an illness on such a massive scale that society itself will fall apart.

Now that we're facing a pandemic that doesn't meet that criteria the skeptics are proven right. Or at least, so they will argue.

As is often the case, if you prepared for the disaster that hits you, your preparations look wasted. The easiest time to judge preparedness efforts is when they fail. If done right, proper preparation can leave you wondering if you overestimated the threat in the first place. Personally, I think that we have mostly done the right things when it comes to pandemic preparedness:

• Education - While this could have been done better, the publicity over pandemic preparedness efforts, the risk, the chaos in the streets stories on the nightly news all served to make the public aware of what a pandemic could be. I doubt that it motivated many to actually prepare their own households to shelter in place, but at least the basic, Pandemic 101 part of things was done before the first outbreak.
• Planning - The Federal government and agencies, states, and localities all have plans in place. Many of them are draft, many have unwarranted assumptions, and most have holes that you could drive an SNS delivery truck through, but they exist. People at all levels have thought about some of the tough questions and while they may not have answered them at least they are aware the questions exist.
  

Was declaring a pandemic the fear-mongering that some have claimed? a political action to justify the money (and there's been a lot of it) invested? I don't believe so. I would argue that many of the people involved would probably be happier if the declaration hadn't been made. We have no higher level to go to, there is no 11 on this amplifier. But the system is what it is, and changing it now would just continue to elicit complaints from other people that the lack of a declaration was politically motivated to avoid embarrassment or other reasons.

So what now? We continue on as we have, monitoring the situation. If it stays as mild as it has been then in a few months time when the WHO determines that the pandemic has passed we sit down and rewrite the guidance to include some sort of severity scale along with the geographic one. If it doesn't remain mild, if it kicks into high gear as the cool weather returns to the northern hemisphere, we batten down the hatches and ride it out.

Either way, there will undoubtedly be plenty of material for reviewing and investigating when it's all said and done.

Pandemic (Public Health)

I was away from last Thursday until Sunday, and without internet access. I wasn't off the grid, just visiting my brother and his wife, but I didn't feel like going through the hassle of tracking down their router key to get online. Sunday night and Monday morning were my first exposure to the pile of "IT'S A PANDEMIC" news. Rather than rehash, since most readers who are interested in pandemic news have already seen it, I figured I'd link to the more compelling stories I encountered when I got back online. If nothing else this post will serve to illustrate some of the places I look for information. Due to the number of links I'm just copying titles and attaching the link to them. Also, these are in the order I found them, which may or may not be related to the initial publication.

• Quickly Noted: It Begins (Continues)
• What a Pandemic Means in U.S.: Keep Doing What We’re Doing
• Swine Flu: Officially a Pandemic
• Health Officials Struggle to Estimate Need for Flu Supplies
• Going to phase 6
• We’ve Only Just Begun
• Chan Declares Level 6, Calls Pandemic `Moderate’ Severity
• WHO declares swine flu a pandemic, warns moderate severity expected
• World now at the start of 2009 influenza pandemic
• WHO counts to six
• Statements by HHS Secretary Kathleen Sebelius and DHS Secretary Janet Napolitano on WHO Decision to Declare Novel H1N1 Virus Outbreak a Pandemic
• WHO declares swine flu pandemic - BBC
• WHO declares swine flu pandemic - Guardian
• WHO: Swine flu pandemic has begun, 1st in 41 years
• World Health Organization Calls Swine Flu Outbreak a Pandemic
• Declaring a pandemic
• Flu Pandemic Is Declared -- First Time in 41 Years
• WHO: Swine flu now a pandemic
• Swine flu is officially a pandemic. But don't worry ... not yet, anyway

Now keep in mind, those are only the ones that dealt mostly with reporting on the declaration (as opposed to fallout, next steps, or editorializing - if I'd included those we'd be here all week). For better or for worse, this is BIG NEWS. Tomorrow I'll add some of my personal thoughts on what this means.

Reccommended article (Public Health)

Effect Measure is a fantastic blog for people interested in all aspects of public health. This piece is an excellent, easy to follow explanation of the process that we are currently in for developing a vaccine for H1N1. I recommend that anyone interested in the vaccine development process, or that just wonders how it all happens, head over and check it out.

Swine flu: why does it take so long to make a vaccine?