Strategic cycling: shaking complacency in healthcare strategic planning

As the conditions affecting business and healthcare organizations in the United States have become more turbulent and uncertain, strategic planning has decreased in popularity. Strategic planning is criticized for stiffling creative responses to the new marketplace and for fostering compartmentalized organizations, adherence to outmoded strategies, tunnel vision in strategy formulation, and overemphasis on planning to the detriment of implementation. However, effective strategic planning can be a force for mobilizing all the constituents of an organization, creating discipline in pursuit of a goal, broadening an organization's perspective, improving communication among disciplines, and motivating the organization's workforce. It is worthwhile for healthcare organizations to preserve these benefits of strategic planning at the same time recognizing the many sources of turbulence and uncertainty in the healthcare environment. A model of "strategic cycling" is presented to address the perceived shortcomings of traditional strategic planning in a dynamic environment. The cycling model facilitates continuous assessment of the organization's mission/values/vision and primary strategies based on feedback from benchmark analysis, shareholder impact, and progress in strategy implementation. Multiple scenarios and contingency plans are developed in recognition of the uncertain future. The model represents a compromise between abandoning strategic planning and the traditional, linear model of planning based on progress through predetermined stages to a masterpiece plan.     

Responding to pandemic influenza: a local perspective

OBJECTIVE: To assess, via a tabletop exercise, the ability of a rural health unit to manage an influenza pandemic. PARTICIPANTS: The exercise brought together community stakeholders including representation from public health, hospitals, long-term care, social services, first responders, morticians, local government and the media. SETTING: Leeds, Grenville and Lanark, a rural region of Ontario. INTERVENTION: In June 2002, exercise participants were presented with a scenario involving the local response to pandemic influenza. Facilitators prepared a framework for the mock emergency in advance. However, the scenario was guided by decisions made by participants and the probable consequences of those decisions. Following the exercise, a debriefing session identified recommendations to be included in future plan development. OUTCOMES: The exercise identified critical issues, including communication, emergency decision-making, vaccination priorization, local surge capacity, and disease containment. Both participants and observers deemed the exercise successful. CONCLUSION: Improvements in the local contingency plan for pandemic influenza were identified. The exercise was an opportunity to familiarize participants with the contingency plan, practice working collectively and identify areas for further planning. The principles and lessons generated from the exercise can be used to guide the response to other large-scale infectious disease outbreaks.     

解析《国际卫生条例(2005)》在应对全球突发公共卫生事件中的首次运用

2009年的甲型流感作为《国际卫生条例(2005)》经修订实施以来世界卫生组织首次宣布的能引起国际关注的突发公共卫生事件,其全球应对措施在《国际卫生条例(2005)》的框架下操作实施。本文主要从预案、通报、事件宣布、联络沟通、口岸监测及控制等方面对《国际卫生条例(2005)》在应对全球突发公共卫生事件中的首次运用进行了探讨。     

"We don't have a back-up plan": an exploration of family contingency planning for emergencies following stroke

Little research has explored emergency preparedness among families coping with stroke. In this longitudinal qualitative study, we explored contingency caregiving planning by interviewing (N?=?18) family caregivers providing care for a stroke survivor at home during the first 6 months post-discharge from the hospital. Emergent themes showed most families did not have a concrete "back-up plan" for a crisis or disaster situation involving the primary caregiver being unable to provide care. Furthermore, they assumed formal respite services or long-term care would be available should the need arise. Despite increased awareness over time, most caregivers had not devised contingency plans at 6 months.     

“We Don't Have a Back-Up Plan”: An Exploration of Family Contingency Planning for Emergencies Following Stroke

Little research has explored emergency preparedness among families coping with stroke. In this longitudinal qualitative study, we explored contingency caregiving planning by interviewing (N?=?18) family caregivers providing care for a stroke survivor at home during the first 6 months post-discharge from the hospital. Emergent themes showed most families did not have a concrete “back-up plan” for a crisis or disaster situation involving the primary caregiver being unable to provide care. Furthermore, they assumed formal respite services or long-term care would be available should the need arise. Despite increased awareness over time, most caregivers had not devised contingency plans at 6 months.     

Evergreen staff: building a tree of knowledge for continuous learning

Healthcare institutions breathed a collective sigh of relief on January 1, when efforts made for remediation, testing, and contingency planning for the year 2000 finally paid off. Now that the technology has been improved to ensure compatibility, it is important to keep the momentum going to improve efficiency and increase productivity and patient satisfaction levels. One way to incorporate organizational priorities, goals, and strategy at the departmental level is to develop an education plan that stresses mastering fundamental skills. This article explores the components and role of an education plan and identifies the types of efforts that result in the greatest return. It concludes with a case study.     

Mobilizing Toward Regional Accreditation

In January 1999, the Eastern Regional Health Board began planning for a Regional Accreditation scheduled in November 1999. This would be the first time that our two programs (Addiction Services and Public Health), and two of the nine acute care facilities in our Region would be accredited.This article describes a regional accreditation planning process. It suggests the resources required for such a project, suggests a workable time line, and indicates a communication strategy.Mobilizing over 1000 staE physicians, and the communities toward Regional accreditation was a challenge for the Steering Team. Defining a plan of action with defined time lines proved helpful; defining team chairs who were flexible and positive was vital, and engaging the communities in our review was rewarding. Informing the public was completed using strategies borrowed from our Newfoundland counterparts (an accreditation mural and a regular newsletter), and our own creative strategies such as “;Sharing Day”; and engaging community health board involvement on accreditation teams.The project development was initiated by a steering committee, and spanned 21 teams. Both a communication and education plan were important in keeping the board, stan physicians and residents of the Region informed.     

我国政府甲型H1N1流感风险沟通策略研究

本文通过观察法、内容分析等研究方法,对卫生系统应对2009年甲型H1N1流感疫情中的沟通活动进行研究,剖析了风险沟通的逻辑模型、沟通对象、沟通预案及立体发布网络,并总结出注重倾听公众舆情、赢得公众信任、视公众为合作伙伴、明确告知政策变化缘由、明确承认不确定性、信息发布适度、提前预警宣传教育、主动设置议程、发挥意见领袖作用、创意活动应对心理疲倦等十大风险沟通策略。作者对风险沟通效果进行了综合评价,给出了政府部门风险沟通的定义,并指出今后风险沟通研究方向:应更注重常态视角、研究适合我国的评价指标、强调"民主范式"、开展风险认知机制及影响因素研究等。此次甲型H1N1流感疫情的应对是"非典"以来大型疫情事件中风险沟通理论应用的成功案例,其经验可供今后突发公共卫生事件的新闻信息发布及风险沟通工作参考。     

Preparedness planning for an influenza pandemic: regional efforts

Failure to establish a contingency plan prior to a public health emergency can have catastrophic consequences. The threat of a new influenza pandemic has prompted countries to draft national strategic preparedness plans to prevent, mitigate, and recover from a potential influenza pandemic. This paper examines these preparations in Latin America and the Caribbean and describes potential scenarios of pandemic impact on the burden of mortality and on health services in the Region. In particular, the paper reports on the progress made by Member States in developing national influenza pandemic preparedness plans and implementation mechanisms at both the national and local levels. These achievements were facilitated through a series of planning workshops and self-assessment exercises conducted by PAHO for intersectoral country teams and guided by the WHO global influenza preparedness plan. Although significant progress has been made in plan completeness, intercountry preparedness planning and local level implementation remain key challenges. Multisectoral partnerships are clearly paramount to securing the commitment and resources needed to reach and sustain effective pandemic preparedness in the Americas.     

突发公共卫生事件与综合性医院重症监护超负荷扩容

医院是社会应对突发公共卫生事件的主要机构。在超出正常负荷的情况下,合理有序地进行基础卫生设施扩容是保证医院成功应对突发事件的关键。医院必须能够通过增加重症监护单元（Intensive Care Unit,ICU）容量或通过改造其他区域增加实际ICU收治能力;有次序地将相关区域改造为临时重症监护单元;储备充足的病床和相关监护设施,在应对偶发事件时必须能得到政府协助以获取额外的呼吸机;制定ICU阶段性扩容人员工作计划,保证在应对偶发事件或危机时重症监护的仍可有效执行;抽调临床专业人员参与应急管理组,共同制定和执行扩容计划;为重症监护活动提供充足的基础设施支持。     

The impact of clinical crisis management on trauma team outcomes following a prolonged strike by nursing,technical, and support staff

There is a paucity of literature describing the preparation of hospital institutions prior to a nursing strike and the quality outcomes during and after a prolonged nursing strike. No published study was found describing the effects of a prolonged strike on quality outcomes specific to trauma patients. The American College of Surgeons (ACS) suggests specific critiques and complications data that each trauma program may choose to track as quality indicators, and those metrics are submitted to regional, state and national databanks and closely examined during site accreditations. This research study analyzed data from three equal time periods following a multiservices strike involving both nurses and service/technical staff lasting 63 days. The purposes of this study were to (1) evaluate the effects of prestrike organizational leadership and crisis management planning on organizational staffing and emergency management to reduce health care risk during the strike, (2) describe outcomes data from three equal time periods: prestrike, strike, and poststrike, and (3) specifically compare the trauma program's selected ACS trauma metrics for critiques and complication rates for our high‐risk/high‐volume population as a level 1 trauma center.     

Fukushima nuclear incident: the challenges of risk communication

On March 11, 2011, a magnitude 9.0 earthquake occurred off the Sanriku coast of Japan, which resulted in multiple tsunamis. The earthquake and tsunami damaged several nuclear power stations, with the Fukushima Dai-ichi Nuclear Power Plant being the worst affected, which led Japan to declare a State of Nuclear Emergency. As of November 9, 2011, the National Police Agency of Japan reported a death toll of 15 836 people, with 3664 people still reported missing, following the earthquake and tsunami. Australian radiation health advisers were deployed to Tokyo early in the nuclear emergency to assist the Australian Embassy in assessing the radiological threat, to provide risk advice to Embassy staff and Australian citizens in Japan, and to plan for any further deterioration in the nuclear situation. This article explores the challenges of risk assessment, risk communication, and contingency planning for expatriate staff in the worst nuclear incident since Chernobyl, outlines what measures were successful in addressing heightened perceived risks, and identifies areas where further research is required, particularly in a radiological context.     

Perspectives on aquatic animal disease contingency planning in the Asia-Pacific region

The movement of live aquatic animals is one of the principal reasons for the rising number of disease emergencies in Asia and the Pacific. Contingency planning is crucial in the effective management of such emergencies. Within Asia, the Asia Regional Technical Guidelines on Health Management and the Responsible Movement of Live Aquatic Animals provide the basic framework for national and regional efforts to reduce the risk of introducing disease across borders. However, in following these guidelines, the progress made by countries on contingency planning has, to date, been rather limited. In this paper, the authors broadly examine the implementation of health management programmes, highlight some regional initiatives that support contingency planning and describe the present status of contingency planning in the Asia-Pacific region.     

北京市“7·21”特大暴雨灾害后卫生防疫应急工作评估与思考

目的为全面总结2012年"7.21"特大暴雨灾害后北京市疾控中心开展的抗灾防疫卫生应急工作经验,发现工作不足,为将来更好地开展自然灾害卫生应急工作积累经验。方法参照国家自然灾害卫生应急预案和相关技术文件,从卫生应急的反应速度、规范化程度、措施针对性、有效性及防疫效果等方面,按照好、中、差三级对此次灾后卫生应急工作进行矩阵评估。结果此次灾后卫生应急工作,反应迅速、步骤合理、措施得当、效果显著,尤其是与各级政府密切合作,充分发挥了疾控机构在灾后卫生应急工作中的技术指导和权威地位,但是在应急工作有序性和规范性上还有所欠缺,也暴露出北京市基层疾控部门在开展自然灾害后抗灾防疫应急工作能力和准备上的不足。结论应提高抗灾防疫意识,积极开展自然灾害前的应急准备工作,编制预案,培训技术,进行物资储备,并找准职能定位,不断规范、强化灾后卫生防疫应对措施与程序,持续提升抗灾防疫工作能力。     

我国突发公共卫生事件应急预案体系建设中存在的问题及其对策

目的完善我国突发公共卫生事件应急预案体系建设。方法结合卫生应急工作的实践,回顾了我国突发公共卫生事件应急预案体系建设中存在的问题并进行了分析。结果我国突发公共卫生事件应急预案体系已初步形成,但仍需要在今后的工作中进一步发展和完善。结论完善我国相关卫生法律法规,及时更新和修订预案,重视预案的培训和演练,加强预案的宣传教育,加强应急预案体系的管理,是当前发展和完善我国公共卫生事件应急预案体系建设的重要措施。     

军队医院在突发事件中医疗物品储备箱的应急预案

为应对各种突发事件,制定医疗物品储备箱的应急预案显得尤为重要,本文简单讲述了军队医院为应对各种突发事件,制定的应急预案制度及医疗设备箱的准备要求。     

盆腔肿瘤IMRT自动计划与人工计划比较研究

目的:将盆腔肿瘤调强放疗(intensity-modulated radiation therapy,IMRT)的自动计划与人工计划进行剂量学对比,探讨自动计划在盆腔肿瘤IMRT计划设计中是否具有优势.方法:回顾性分析60例盆腔肿瘤放疗患者的临床资料,所有患者的IMRT人工计划均在Eclipse治疗计划系统上完成,再通...     

疾病控制机构自然灾害卫生应急预案初探

通过对疾病控制机构自然灾害卫生应急预案的研究,加强对自然灾害的卫生应急准备,提高卫生应急速度和工作成效.笔者从预案的适用范围、工作原则、启动条件、应急组织、运行机制、现场处置工作规范、应急保障、日常应急工作管理等方面详细地阐述了自然灾害卫生应急预案的主要内容,根据灾区现场工作经验提出自己的看法,认为应加强日常的物资、技术贮备,缩短自然灾害发生时准备的时间,提高灾区疾病控制工作的能力,为实现大灾之后无大疫的目标提供制度和技术保障.     

Pandemic planning in Canada

A Canadian plan for pandemic influenza was completed by the National Advisory Committee on Immunization in 1988. Its development took several years and involved consultation with provincial public health and laboratory authorities, the licensing body, manufacturers of influenza vaccine and antiviral agents, and representatives in the USA and UK. Key decisions in creating the pandemic plan include: (1) aiming for federal-provincial consensus on use of vaccine and antiviral drugs, (2) a selective vaccination approach (high-risk persons plus essential workers), (3) bulk purchasing and distribution of vaccine through the public sector, (4) leaving antiviral drugs on the open market, (5) careful planning of the communications strategy, and (6) increasing inter-pandemic use of flu vaccine in target groups. The plan addresses recognition of a pandemic; activation of a Pandemic Influenza Committee whose membership and responsibilities are spelled out; the federal-provincial decision making process; influenza vaccine considerations; amantadine and other antiviral agents; estimates of target group size, vaccine uptake, manufacturing capabilities and time frames; and communication considerations. Since 1988, influenza vaccine use has increased considerably in Canada and experience has been gained with amantadine. Manufacturing capability within Canada for influenza vaccine has also been enhanced. It is now time to update the plan, especially the targets, and to make sure that everyone involved remains aware of the assigned roles.     

A five-year plan for population research and family planning services. 3. Family planning services

A tentative family planning program plan for 1971-1975 is presented. The estimated need for family planning services by 1975 is projected to be 6.6 million individuals, classified as poor and medically indigent. The author states that more research is needed to project a similar need for higher income groups who have trouble controlling the number and timing of their children. With better research family planning services could help meet their needs too. The plan projects greater expansion of services to non-metropolitan areas to overcome a maldistribution of present programs. It is estimated that 90% of those in need can now be served by existing services, while new delivery agencies would need to be created to serve the remaining need. Manpower development of this plan calls for an expansion in the use and role of paraprofessional personnel. The utilization of operational research, planning and evaluation is needed for objective data, to help programmers determine shape and scope of required program, and to improve its efficiency and effectiveness. To do this a 3 phase 5 year plan is presented. As program services expand the role information, education and communication plays is critical. Development of these functions will help in reaching program goals. Projected estimates by 1975 of direct costs of provision of family planning services will be between 360 and 395 million dollars.