Pandemic Planning and Response in Academic Pediatric Emergency Departments During the 2009 H1N1 Influenza Pandemic

Abstract

Objectives: The terrorist attacks of September 11, 2001, initiated a shift toward a comprehensive, or "allhazards," framework of emergency preparedness in the United States. Since then, the threat of H5N1 avian influenza, the severe acute respiratory syndrome epidemic, and the 2009 H1N1 influenza pandemic have underscored the importance of considering infectious events within such a framework. Pediatric emergency departments (EDs) were disproportionately burdened by the 2009 H1N1 influenza pandemic and therefore serve as a robust context for evaluation of pandemic preparedness. The objective of this study was to explore pediatric ED leaders' experiences with preparedness, response, and postincident actions related to the H1N1 pandemic to inform future pandemic and all-hazards planning and policy for EDs. Methods:The authors selected a qualitative design, well suited for exploring complex, multifaceted organizational processes such as planning for and responding to a pandemic and learning from institutional experiences. Purposeful sampling was used to recruit medical directors or their designated physician respondents from pediatric emergency medicine training institutions representing a range of geographic regions across the United States, hospital types, and annual ED volumes; snowball sampling identified additional information-rich respondents. Recruitment began in May 2011 and continued until thematic saturation was reached in January 2012 (n = 20). Data were collected through in-depth individual phone interviews that were recorded and professionally transcribed. Using a standard interview guide, respondents were asked open-ended questions about pandemic planning, response, and institutional learning related to the H1N1 pandemic. Data analysis was performed by a multidisciplinary team using a grounded theory approach to generate themes inductively from respondents' expressed perspectives. The constant comparative method was used to identify emerging themes.Results: Five common themes characterized respondents' experiences with pandemic planning and response: 1) national pandemic influenza preparedness guidance has not fully penetrated to the level of pediatric emergency physician (EP) leaders, leading to variable states of preparedness; 2) pediatric EDs that maintained strong relationships with local public health and other health care entities found those relationships to be beneficial to pandemic response; 3) pediatric EP leaders reported difficulty reconciling public health guidance with the reality of ED practice; 4) although many anticipated obstacles did not materialize, in some cases pediatric EP leaders experienced unexpected institutional challenges; and 5) pediatric EP leaders described varied experiences with organizational learning following the H1N1 pandemic experience.

Organizational learning in hospitals: A realist review

“…Any number of individuals on a unit may engage in leadership functions, with or without a formal leadership role (Collin, Valleala, Herranen, & Paloniemi, ). Some leadership functions include setting an example (Chamberlain, ; Crofts, ), engaging with staff (Chamberlain, ; Collin, Paloniemi, & Harranen, ), empowering staff (Chan, ), delegating tasks (Collin et al, ), persevering even when obstacles arise (Filice et al, ), creating connections among potential collaborators (Pappas & Wooldridge, ), forming effective teams (Rangachari, ; van Veen‐Berkx, Bitter, Kazemier, Scheffer, & Gooszen, ), and guiding collective reflection on changes implemented and lessons learned (Collado, ). Overall, leadership engenders a culture of safety that encourages open communication (Chamberlain, ; Souba et al, ) and facilitates change (Ford & Angermeier, ).…”

“…Improved clinical outcomes were identified in 12.2% ( N = 18) of the studies reviewed. Examples of clinical outcomes linked to organizational learning include reductions in surgical site infections (Fan et al, ), mortality (Lees et al, ), medication errors (Drach‐Zahavy & Pud, ), patient pain scores (Lees et al, ), and hospital length of stay (Filice et al, ).…”

Organisational learning in hospitals: A concept analysis

“…Evidence suggests that contextual factors play an important role in translating experiences into organisational learning. Contextual factors conducive to organisational learning include (a) a shared purpose and motivation to improve the organisation's performance (Davis, ; Nes & Moen, ; Olson, Tooman, & Alvarado, ), (b) interpersonal connections among members of the organisation (Filice et al, ; Rangachari et al, ), (c) a sense of psychological safety (Crofts, ; Edmondson, ; Singer et al, ), (d) sufficient time, space and resources for interaction and collective reflection (Ding, ; Gregory, Hopwood, & Boud, ); Singer et al, ), (e) the individual and collective skills necessary for effective reflection and communication (Dückers, Wagner, Vos, & Groenewegen, ; Olson et al, ) and (f) leaders who foster organisational learning (Chamberlain, ; Ford & Angermeier, ). All of these factors may be strengthened as the team members gain more experience working with one another.…”

“…Ford & Angermeier, ; Gagnon et al, ; Gibson & Campbell, ; Thompson, ), (b) collectively reflecting on past experiences (e.g. Edmondson, , Lipshitz & Popper, ), (c) intentionally obtaining, developing, and sharing knowledge and skills (Nembhard & Tucker, ; Vashdi, ), (d) making important information or behaviours resistant to loss by incorporating them into the organisation's policies, processes and/or culture (Davis, ; Nes & Moen, ), and (e) team members demonstrating leadership by initiating, facilitating and/or sustaining improvements (Filice et al, ; Philibert et al, ).…”

Nurses’ preparedness for infectious disease outbreaks: A literature review and narrative synthesis of qualitative evidence

“…In the absence of adequate support and measures from institutes, not only the quality of healthcare service delivery would be hampered, but the incentives and intention to work could also be hindered (Filice et al, 2013;Shih et al, 2007). The reviewed articles maintained that nurses could encounter unanticipated challenges, such as manpower shortages and inadequate facilities, in responding to an infectious disease outbreak, of which only institutional actions could mitigate the adverse impacts to practice.…”