Transcript Document

Expect the Unexpected: Are We Clearly Prepared?
“When the Unexpected Happens:
logistical and technical
challenges”
Carol O’Byrne
Pharmacy Examining Board of Canada
Alison Cooper
Canadian Alliance of Physiotherapy Regulators
Council on Licensure, Enforcement and Regulation
2006 Annual Conference
Alexandria, Virginia
Anatomy of a Disaster
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Stage 1 - Denial
“This morning we had a full dress rehearsal of an
emergency. The alarm bells all rang for ten seconds, then
about 50 doors, all steel, gradually slid down into their
places, so that water could not escape from any one section
into the next.”
"So you see it would be impossible for the ship to sink in
collision with another...."
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Stage 2 - Nonlinear Event
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Stage 3 - Chaos
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Stage 4 – A Few Survivors
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Threatened and Actual Disasters
Threats
• Fire alarm
• Picket line around
exam venue
• Bomb threats
• Pandemics
(S.A.R.S., avian flu)
Disasters
• Power failure
• Hurricane
• Earthquake
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Distractions and Disturbances
• Candidate or
personnel with
medical emergency
• Computer theft alarm
• Candidate’s voice
resonates thru walls
• Administrative errors
and interruptions
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Potential Impact on Exam
•
•
•
•
•
•
Venue becomes inaccessible
Questions or materials are lost
Extra-ordinary measures are imposed
Exam climate becomes more stressful
Candidates and exam personnel react
Candidates appeal, questioning validity of
results
• Exam sitting is cancelled
• Income declines and costs escalate
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
The S.A.R.S. Saga
Chronology
Public health
Nov02 – ‘unusual’
directives
pneumonia cases in
• Quarantine all
China
exposed parties
Feb03 – infected physician
at Metropole Hotel in HK • Isolate patients
Feb03 – tourists in hotel
• Strict screening of
exposed and carry it
travellers and
back home to Canada,
hospital visitors
Singapore, Vietnam
• Close hospitals to
Mar03 – SARS cases
diagnosed in Toronto
visitors/public
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
P.E.B.C.’s Response
• Protocol to protect exam personnel and
candidates
– Screening questionnaire and referral
– Infection control
• Employ staff for screening and medical
consults
• Extra security and support by St. John’s
Ambulance
• Policy to not allow staff to mask or gown
• Temporary policy to allow candidates to
defer exam
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
P.E.B.C.’s Response
• Expand pool of assessors
• Bring in additional exam personnel and
have others on stand-by
• Rent and equip alternate venue for
Toronto site
• Train standardized patients and staff in
private homes
• Reserve alternate exam venues in all
locations
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Extra-ordinary Costs
• Alternate venue rental and equipment
~ $18,000
• Personnel and materials
~ $17,000
• Total
~ $35,000
[6-7 % of exam admin costs, not
including extra PEBC office staff time,
printing and communications]
• Candidate withdrawals/refunds and
deferred revenue
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Lessons Learned
• Maintain information and referral systems
• Budget for extraordinary costs/income loss
• Create disaster/contingency plan
– Reserve funds to cover costs of implementation
– Extra-ordinary measures policies (part scores,
conditional licensure, etc.)
– Trained back-up personnel
– Trained exam administrative staff
• Communication plan
• Enhanced infection control procedures at exam sites
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
More Potential Threats and Disasters
•
•
•
•
•
•
Avian flu
Chemicals
Biologicals
Fire
Weather (blizzard)
Angry candidates
or family members
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
The Parade
• Rehearsal
– Started after 1 hour
– Intermittent for about 30 minutes then
• The pipes are calling
– Constant cacophony of multiple bands
ongoing for about 45 minutes
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Alliance Response – on site
• Attempts to move the bands were
unsuccessful
• All the other rooms were locked…
• Paused exam and moved candidates
to corridor
• Continued exam after pause plus
allowed an extra 30 minutes of
exam time
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Alliance Response – follow up
• Develop a plan, consult, revise and
communicate
– In consultation with exam experts,
Board of Directors, other resources
– Communication via email, website
• “No standing”, supplemental exam
date, free re-write
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Costs and Benefits
• Free re-write for
14 candidates
• Costs of
supplemental
exam (preparation
and
administration)
• Overall ~$8000.00
• No candidates
missed the Clinical
Component
• Better relationship
with one academic
program
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Lessons Learned
• You can’t stop a parade
• Candidates (mostly) are
understanding of random events
• Candidates appreciate prompt
communication and a concrete plan
• Have emergency numbers available
to site staff
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
More Potential Threats and Disasters
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
The Examiner
• Inappropriate/disruptive examiner
behaviour in clinical stations
– Falling asleep
– Inappropriate comments
– Handing out business cards/recruiting
staff
– Examiner illness
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Alliance Response – on site
• Replace the examiner
– Chief Examiner assigned a spare
examiner to the station
• Incident report
– Complete documentation from SP,
Chief Examiner, site administrator
– Flagged tests sheets of impacted
candidates
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Alliance Response – follow up
• Investigate, communicate
– Talked to SP, Chief Examiner, exam
site staff
• Remove examiner from roster
• Regulator advised of potential
competence to practice issue
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Costs and Benefits
• Unhappy examiner
• Numerous letters
and meetings to
resolved ongoing
dispute
• Reliability of exam
maintained
• Appeals
minimized
• Confidence of
other examiners
and regulators
maintained
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Lessons Learned
• Competence is an ongoing issue
• Practice competence does not
ensure exam competence
– Training, monitoring and feedback on
examiner performance is essential
• You need a pool of “spares”
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
More Potential Threats and Disasters
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Sage Advice from Long Ago
• Don’t put all your eggs in one basket
– Store critical information in more than one
place
– Provide access to information to more than
one person
– Develop operational teams with overlapping
essential skills
– Share responsibility for decision-making
– Develop contingency plans
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
More Sage Advice…
• Save for a rainy day
– Protect sufficient resources to
implements (sometimes costly)
contingencies
– Be prepared for loss of income
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
More Sage Advice…
• A bird in the hand is worth two in the bush
– Develop collegial working relationships
with others who could help in a pinch
– Have ready spare people, equipment
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
More Sage Advice…
• Penny wise is pound foolish
– Invest time and resources in
contingency and disaster planning
– Train back-up personnel
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
More Sage Advice…
• A stitch in time saves nine
– Take action quickly and effectively to
minimize later problems
– Communicate clearly
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
More Sage Advice…
• When the going gets tough, the tough get going
– Hire resourceful people who take
appropriate initiative, and train them
well
– Develop and implement a
communication system for exam day
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
More Sage Advice…
• It’s always darkest before the dawn
– There is a solution, you just haven’t
found it yet
– Sleep on it, dream about it, play the
movie in your mind
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
More Sage Advice…
• Every cloud has a silver lining
– Learn from each situation
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Considerations in Disaster Planning
• Budget
– Staffing, equipment, computers, supplies
• Work arrangements
– Work from home, alternate office
– Refusing work
• Communication
– Call lists
• Emergency response team
• Early preparation
– First aid training, cross training
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
P.E.B.C. Disaster Planning
• System and database back-up stored off site
• Maintain database of information, contacts and
resources
• Maintain budget reserves
• Plan for alternate office and exam sites
– Identify alternate admin space/facilitate work from
home
– Identify alternate exam venues (not subject to closure)
• Train back-up personnel for key roles in office
and at exam sites
– Train and authorize key decision makers – set
parameters
• Identify contingency policies to be developed in
consultation with stakeholders
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Beyond Katrina: improving disaster
response capabilities
• Paper by A.M. Howitt, H.B. Leonard
of Harvard Center for Public
Leadership
www.ksg.harvard.edu/leadership
Working Papers Spring 2006
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Speaker Contact Information
Carol O’Byrne, Examination Manager
Pharmacy Examining Board of Canada
415 Yonge St., Suite 601, Toronto, ON
(w)416.979.2431x226; (f)416.260.5013
[email protected]
www.pebc.ca
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia
Speaker Contact Information
Alison Cooper, Director of Examinations
Canadian Alliance of Physiotherapy
Regulators
1243 Islington Ave, Suite 501, Toronto, ON
(w)416.234.8800x33; (f)416.234.8820
[email protected]
www.alliancept.org
Presented at the 2006 CLEAR Annual Conference
September 14-16 Alexandria, Virginia