After Action Report / Improvement Plan

Transcription

1 After Action Report Improvement Plan Outbreak Anarchy A Workplace Influenza Pandemic Tabletop Exercise May 17, 2013 Florida Department of Health in Orange County Orlando Florida 1 Page

2 ADMINISTRATIVE HANDLING INSTRUCTIONS 1. The title of this document is The "Outbreak Anarchy - A Workplace Influenza Pandemic Tabletop Exercise" After Action Report. 2. The information gathered in this AAR/IP is classified as For Official Use Only (FOUO) and should be handled as sensitive information not to be disclosed. This document should be safeguarded, handled, transmitted, and stored in accordance with appropriate security directives. 3. At a minimum, the attached materials will be disseminated only on a need-to-know basis and when unattended, will be stored in a locked container or area offering sufficient protection against theft, compromise, inadvertent access, and unauthorized disclosure. 4. Points of Contact: Health Department: Deborah Collinge Florida Department of Health in Orange County (Office) ( ) deborah_collinge@doh.state.fl.us Exercise Director: Chris Floyd Disaster Resistant Communities Group LLC (Office) ( ) chrisfloyd@drc-group.com 2 Page

3 CONTENTS ADMINISTRATIVE HANDLING INSTRUCTIONS... 2 CONTENTS... 3 EXECUTIVE SUMMARY... 4 SECTION 1: EXERCISE OVERVIEW... 5 Exercise Details... 5 Participant Information... 5 SECTION 2: EXERCISE DESIGN SUMMARY... 7 Exercise Purpose and Design... 7 Exercise Objectives, Capabilities and Activities... 7 Scenario Summary... 7 SECTION 3: ANALYSIS OF CAPABILITIES... 8 SECTION 4: CONCLUSION APPENDIX A: IMPROVEMENT PLAN APPENDIX B: PARTICIPANT FEEDBACK (3 THUMBS UP 3 THUMBS DOWN) APPENDIX C: ACRONYMS Page

4 EXECUTIVE SUMMARY Outbreak Anarchy - A Workplace Influenza Pandemic Tabletop Exercise was designed and conducted to analyze the ability of the department to maintain operations with a reduced workforce due to high employee absenteeism rate due to the influenza pandemic. The purpose of this report is to analyze exercise results, identify strengths to be maintained and built upon, identify potential areas for further improvement, and support development of corrective actions. Incorporated in Section 3: Analysis of Capabilities of this After Action Report is a comprehensive listing of each Target Capability with its associated Major Strengths, Primary Areas for Improvement and Improvement 4 Page

5 Exercise Details SECTION 1: EXERCISE OVERVIEW Exercise Name: Type of Exercise: Exercise Start Date: Duration: Location: Sponsor: Outbreak Anarchy - A Workplace Influenza Pandemic Tabletop Exercise - Orange County Tabletop May 17, 2013 Three Hours Orlando Florida Florida Department of Health in Orange County Purpose: The primary purpose of this exercise was to analyze the ability of the department to maintain operations with a reduced workforce due to a high employee absenteeism rate because of an influenza pandemic. Scenario Type: Influenza Pandemic Participant Information Participant Alelia Munroe Chris Collinge David Overfield Deborah Collinge Debra Amoedo Debra McCray Debra Tucci Derrick Nealey Elizabeth Vazquez Gabriele Bloodworth Location 5 Page

6 Jack Tracy Joan Schendorf Kevin Sherin Lesli Ahonkhai Maria Demas Mary Brett-Blehl Penny Smith Priscilla Faucher Rickey Strong Robin Muhammad Sarah Matthews Scott Fryberger Keila Walker Steven Hale Tara McHugh Yolanda Martinez Number of Participants 26 6 Page

7 SECTION 2: EXERCISE DESIGN SUMMARY Exercise Purpose and Design The purpose of this exercise was to analyze the ability of the department to maintain operations with a reduced workforce due to a high employee absenteeism rate because of an influenza pandemic. Exercise Objectives, Capabilities and Activities Capabilities-based planning allows for the exercise planning team to develop exercise objectives and observe exercise outcomes through a framework of specific action items that were derived from the Target Capabilities List (TCL). The capabilities listed below form the foundation for the organization of all objectives and observations in this exercise. Additionally, each capability is linked to several corresponding activities and tasks to provide additional detail. Based upon the identified exercise objectives below, the exercise planning team decided to demonstrate the following capabilities during this exercise: Workforce Influenza Pandemic Planning / Response Activity Target Capability # 1 Implement / Coordinate Preparedness Activities # 2 Coordinate / Manage Operations Scenario Summary An outbreak of unusually severe respiratory illness is identified in a small village in southern China. Over the next 45 to 60 days the outbreak becomes a devastating Phase 6 Influenza Pandemic effecting communities throughout the United States. 7 Page

8 SECTION 3: ANALYSIS OF CAPABILITIES Workforce Influenza Pandemic Planning / Response Performance Adequate Target Capability Activity # 1: Implement / Coordinate Preparedness Activities Associated Critical Tasks Task # 1.1: Provisions and procedures for employees to prepare for an influenza pandemic have been implemented. Adequate Evaluator # 1 Plans have been implemented and updated but familiarization with the plan was not observed by all players. Some of the players were not updated on their assigned positions. Recommend additional review of plans and updates as to roles and responsibilities including the COOP which was referred to on several occasions. Adequate Evaluator # 2 There are provisions and procedures in place for the employees to prepare for an influenza pandemic. However, team members were not as familiar with the details of the plan. Preparedness information would be readily accessible on the SharePoint site, Director's Corner, Daily Pop-Ups and other areas. The type of information that would be posted on the website includes: various links (cdc.gov, who.org, DOH (state and county), F.A.Q's regarding the flu, hotlines (phone numbers), how to prevent transmission, and where to obtain the annual flu shot. Departmental disaster supply kits. Individual team member disaster plans and supply kits for their families / homes. Team members should review and familiarize themselves more with the COOP. 8 Page

9 Task # 1.2: Activate and coordinate workforce reduction plans and procedures. Adequate Evaluator # 1 Players were knowledgeable on staff demographics, skills and needs. Great ideas for planning for phase 6 of influenza pandemic. As the exercise progressed, even though change in clinical practice would be initiated, by the later part of the exercise some players were running their day to day operations. Players identified system for coordinating plans but never defined what "sick" means. Review of knowledge, skills and abilities of staff. Have a thorough understanding that should an influenza pandemic of this magnitude be apparent, daily operations will be curtailed. Definition of "sick" for staff. Adequate Evaluator # 2 There will be a Pan Flu Team established along the lines of an ICS structure (Incident Management Team) to effectively manage the incident / organizations response and operations. As the scope of the incident evolves, there will be a reassessment and triage of priorities and functions within the organization. None Performance Adequate Target Capability Activity # 2: Coordinate / Manage Operations Associated Critical Tasks Task # 2.1: Influenza preventative measures are implemented and enforced for all workplace employees. Adequate Evaluator # 1 Prevention measures for flu transmission was on target but players identified that many staff do not have plan or supplies on hand during the demographic section of the exercise. The prevention measures did not address how to plan for staff 9 Page

10 shortage or to make sure that staff is well supplied before coming to work. Enforcement of flu shots were discussed but no definite decisions made. Recommend that prevention measures also focus on the nonclinical aspects of a pandemic. Recommend research on what is allowable by the state for enforcing prevention measures. Adequate Evaluator # 2 Five preventative measures identified were: Proper hand washing techniques, coughing into the arm, staying home when sick, utilization of PPE and receiving the flu shot. Clearly identify the circumstances in which team members are permitted to report to work after being ill. Task # 2.2: Identify workplace essential and non-essential functions in an effort to set workplace priorities. Adequate Evaluator # 1 Referral made to organization's COOP for workforce reduction. Identification of Essential functions were made but some clinical players advised they would still maintain clinics even though not an essential function. Discussion on plans not being "all hazards", not parallel to this exercise verses a hurricane. Recommend further discussion on essential functions and triggers for non-essential functions. Review of COOP to be detailed with this information. Adequate Evaluator # 2 Business Essential Functions identified were: Environmental, Business Office, WIC, Vitals, IT, Facilities, EPI and, Emergency Operations, additional business essential functions and protocols are detailed in the COOP. Non-essential functions included: Family Planning, pregnancy tests, STD testing, etc. Initiate efforts to start the cross-training process throughout the year for the mission essential departments and the non- 10 Page

11 essential functions that can assist with staffing other departments / functions during an influenza pandemic. Task # 2.3: Provisions and procedures for assisting employees with establishing an alternative working environment. Strong Evaluator # 1 Many great ideas on telecommuting, alternative working environments, teleconferencing, etc. Discussion on limitations with state allowance on use of some technologies. Players were knowledgeable on the ability to perform certain job functions from alternative site but noted that some job functions would not be able to. Recommend identification of job functions that cannot be done from alternative worksite and discussion on which staff is responsible for these functions and crossed trained for these functions. Strong Evaluator # 2 All departmental functions were reviewed and it was determined whether certain functions could be executed from home. Departments such as Immunizations, Vital Statistics, Dental, Facilities, etc. could not be done from home. However, there were other departments such as I.S., EPI, etc. where certain functions within the department allowed flexibility to occur off-site. None Task # 2.4: Internal and external communications systems are maintained. Weak Evaluator # 1 Discussion on communication tree with staff but little discussion on communication with clients. Players referred to COOP for communication to clients. Great ideas on innovative communication including, SharePoint, FAQ, director's corner daily pop-up alerts, etc. but all these are for internal communications. The only external was update to website to include State Communication website and County resources. 11 Page

12 Recommend further discussion on communication with clients. While in the beginning of the scenario it might be that clinics would run as normal but later in the exercise the system would be overburdened but some of the players continued to "run" their clinics. There was no identified discussion on how communication with clients would take place. Adequate Evaluator # 2 Communication efforts included: Establishing a Joint Information Center to produce press releases (multiple languages) and notification to the medical community. Also, the DOH will work closely with ESF # 8 at the Orange County Emergency Management Department. None Task # 2.5: An order of succession for the position of workplace leadership has been identified. Adequate Evaluator # 1 Pandemic plan contained order of succession for senior leadership. Discussion on program managers, supervisor and lead succession for operations. Discussion was not delivered with much confidence for pandemic plan but for daily operations. Recommend review of succession planning for loss of senior leadership. Training to second, third and fourth level leadership to understand leadership role in a pandemic should normal senior leadership be unavailable. Adequate Evaluator # 2 This is detailed out further in the COOP. Further consideration should be given to the line of succession for the organization overall, if the leadership identified is no longer able to be present to provide direction for command and control. 12 Page

13 SECTION 4: CONCLUSION Exercises such as this one allow personnel to validate training and practice strategic and tactical prevention, protection, response and recovery capabilities in a risk-reduced environment. Exercises are the primary tool for assessing preparedness and identifying areas for improvement, while demonstrating community resolve to prepare for major incidents. Exercises aim to help entities within the community gain objective assessments of their capabilities so that gaps, deficiencies, and vulnerabilities are addressed prior to a real incident. Exercises are the most effective (and safer) means to: Assess and validate policies, plans, procedures, training, equipment, assumptions, and interagency agreements; Clarify roles and responsibilities; Improve interagency coordination and communications; Identify gaps in resources; Measure performance; and Identify opportunities for improvement. This exercise succeeded in addressing all of the above as it provided examples of good to excellent participant knowledge, teamwork, communication and use of plans and procedures while pointing out areas in need of improvement and clarification. Listed below is a summary of the level of performance the Target Capabilities and Tasks evaluated during the exercise. This summary outlines the areas in which the Florida Department of Health in Orange County is strong as well as identifying areas that the departments should invest future planning, training and exercise funds on. Workforce Influenza Pandemic Planning / Response Activity Target Capability Performance # 1 Implement / Coordinate Preparedness Activities Adequate # 2 Coordinate / Manage Operations Adequate 13 Page

14 APPENDIX A: IMPROVEMENT PLAN This Improvement Plan has been developed specifically for the Florida Department of Health in Orange County based on the results of Outbreak Anarchy - A Workplace Influenza Pandemic Tabletop Exercise conducted on May 17, These recommendations draw on both the After Action Report and the After Action Conference. Capability Observation Recommendation Responsible Agency Completion Date Implement / Coordinate Preparedness Activities Coordinate / Manage Operations 14 Page

15 Open discussion. APPENDIX B: PARTICIPANT FEEDBACK (3 THUMBS UP 3 THUMBS DOWN) Reevaluated coop plans. Group participation. Thumbs Up The facilitators were excellent, and the inventory of how many staff had which sets of needs, such as transportation, or school age children was very helpful The inventory and discussion surrounding essential roles for staff with COOP planning. Scenarios for staff situations, staff who wanted to work but was sick. Utilization of staff from all different program areas. Facilitation of the exercise. Utilization of the online program to complete the exercise. Format of the exercise. Interaction with other department managers. Facilitator led exercise in a very professional manner. Facilitator ensured we stayed focused and on target. Group participation went well. Exploring a disaster response together in a congenial atmosphere. Reviewing key concepts of the disaster response model and roles at the various alerts and pandemic levels. Renewing the passion for a response through collaboration of key partners. Validating that what we remember to do is best practice. The exercise allowed for the overall review of the agency's pandemic influenza response plan. Exercise allowed for sharing of ideas that were not included in the agency plan. Discussions and input from all players. 15 Page

16 Discussions and input from all players and concluding remarks from facilitator. Instructions and communication re: event and what was expected / needed from staff participating. Open discussion and planning. Use of scenarios if this...then what. Time to practice succession planning for when senior management are too sick to come to work. Player participation. Exercise was realistic and plausible which allowed the use and review of pandemic response plan. Exercise was timely and well organized. Enjoyed the players who got "sick" as some tended to dominate responses. Good size group to have meaningful dialog. Getting new information from EO staff about the change in shelter roles. By having some of the participants become "sick", it required others to think more globally. Engagement of staff. The event was well planned and advertised. Easy to follow module. Good participation from attendees. Thumbs Down Increased participation and input from all staff areas. Use of tools within the health department to provide complete data / answers to questions. More focus on answering of the actual questions with the information provided in the scenario and not going on about what ifs. Have specific data available for usage. Promote conversation from all participants. Need for improved and increase communication. Need to train program staff on importance of having personal emergency plans and "go 16 Page

17 kits". Need to insure that all staff, department, agency and organization are all trained on all aspects of COOP and agency plans. Specific plans for employees out sick during pandemic. Communication regarding specific aspects of COOP. Maybe present training in the morning vs. Friday afternoon when budgets were due. Review and update of plans especially by senior leadership to identify areas for improvement. There were levels of uncertainty in some critical areas of the exercise. Some players continued to dominate response. It would have been good to tell sick players, they could respond but after the non-sick players responded. As a health department, we need to have clear written guidance on the following by program: Who by program determines when a department changes from their primary work to emergency operations? What is the table of organization for both COOP and ICS in an emergency? Are each position 3 levels deep in both COOP and ICS structure within health department? DOH-Orange. Staffing for FOC seems to overlap with staffing for COOP To simplify for staff, develop a table that would describe how operations would change for each type of emergency; storms, disease outbreaks, bioterrorism, etc. Better preparation of the participants with respect to knowledge of the plans and the rationale behind them. We need to have a better grasp on how the chain of command will be passed down from senior leaders as the need arises. It was scary to go through the exercise and realize that there does not seem to be a written disposition as to who is in command if leaders fall ill. I think it needs to be clearly stated. 17 Page

18 APPENDIX C: ACRONYMS Acronym Meaning COMM CONOPS COOP EOC ESF IAP IC ICS IMT JIC LOFR MOA MOU NIMS OPS PIO SitRep SOG SOP UC Communications Concept of Operations Continuity of Operations Plan Emergency Operations Center Emergency Support Function Incident Action Plan Incident Command Incident Command System Incident Management Team Joint Information Center Liaison Officer Memorandum of Agreement Memorandum of Understanding National Incident Management System Operations Public Information Officer Situation Report Standard Operating Guideline Standard Operating Procedure Unified Command 18 Page