Measuring Hospital Readiness
Numerous emergency management guidelines, regulations, and accreditation standards have been established to improve hospital disaster response capabilities. However, these standards often lack sufficient detail to guide practitioners. Moreover, no scientifically rigorous standards exist for assessing hospital preparedness. To address this gap, VEMEC is working with key stakeholders within the VA to develop scientifically valid and reliable measures of all-hazard hospital preparedness and to provide emergency managers with a more effective road map to improve the preparedness of their facilities.
Starting in 2004, a panel of subject matter experts was convened with the goal of creating a comprehensive measurement tool for assessing VA hospitals across the nation. From 2008-2010 (Phase I), 140 hospitals were evaluated using an initial tool that assessed 69 emergency preparedness capabilities in six domains: Program Level (development, implementation and maintenance of emergency management programs); Incident Management (processes and procedures for incident recognition, mobilization of critical staff and equipment); Safety & Security (processes and procedures for evacuation and shelter-in-place, and managing hazardous substance incident); Continuity & Resilience (resiliency in personnel, critical systems, health care service, and communications); Surge (processes and procedures for expansion of staff for response and recovery); and Support to External Mission (response and interface with state and community emergency management authorities). From 2011-2013 (Phase II), the measurement tool was modified and expanded to include 71 capabilities, which were then used to evaluate preparedness of the same 140 VA hospitals. Minor modifications were made to the assessment tool to reduce subjectivity in scoring. Researchers at VEMEC used mixed methods to analyze data from both Phases, focusing on evaluating the assessment and scoring process, identifying capabilities with low scores, comparing findings between the two Phases, and addressing challenges in measuring the validity and reliability of hospital assessment criteria and the various domains.
As part of Phase III (2014-2016), VEMEC is working to further improve the evaluation methodology, strengthen data collection activities, and incorporate sophisticated quantitative and qualitative methods to more fully understand the level of preparedness of each assessed facility. Phase III includes changes to the scoring rubric, and the checklist of assessment criteria and capabilities. Much of the work in this phase focuses on creating an assessment tool that can be used by local hospital emergency managers to improve the preparedness of their facilities.