Integrate Post-Emergency Evaluation Findings with Preparedness and Planning

Each phase of the disaster cycle — planning, response, and recovery — is connected. Identifying and applying lessons learned from each phase are vital to the functioning of the preparedness cycle. This will contribute to the goal of improving future responses.

Lessons Learned

Rural communities should evaluate the impact of an emergency or disaster event by completing a post-disaster assessment. Evaluation, such as an After Action Report, can help rural communities identify successes and challenges. It is important to incorporate and address successes and challenges in future emergency planning. The knowledge gained from past experiences is referred to as lessons learned.

Lessons learned in rural emergency preparedness and response may be identified through findings from evaluations and assessments of previous disasters. They may also come from other communities that experienced an emergency that can influence the planning process.

Lessons Learned from Rural Case Studies

The rural preparedness case studies identify a range of lessons learned from specific emergency and disaster events. Rural communities have used these lessons learned to strengthen planning efforts and community resilience. Some examples include:

• The rural community of North Bend, Nebraska, learned the importance of centralized support services and messaging to streamline communication and keep the community informed during their response. The National Incident Management System (NIMS) can be a useful tool when thinking about centralizing services as outlined in Module 2: Rural Community Planning, Response, and Recovery.
• Preparedness planning is essential, as is involving all levels of the community. In the case of the Liberty Medical Center in Montana, where their planning and trainings focused on different types of disasters, the existing infrastructure was able to respond to the train derailment because of the disaster plans in place.
• Identifying hazards and vulnerabilities in the jurisdiction can help rural communities to prepare for them more effectively. In the August Complex Wildfire in California and the Derecho windstorm in Wisconsin, there were questions regarding the jurisdiction and identifying who was responsible for serving particular areas. Those in Mead, Nebraska, also learned the importance of identifying community-specific vulnerabilities and how they affect disaster response.
• Identify supplies and resources needed in the event of an emergency. The Pottsboro Area Library in Texas learned the importance of keeping water on hand as well as the importance of solar-powered batteries to keep the lines of communication open with cell phones and laptops.
• Partnerships, networks, and coalitions are vital for the success of a response effort. Those that responded to the Sitka, Alaska, landslide or the lithium battery fire in Grundy County, Illinois, recommended building community coalitions and advocated for a community-first approach.
• Engaging the community to increase personal preparedness helps improve the resilience of the community. The Pottsboro community expressed frustration with the lack of emergency preparation and education at the individual and community level when faced with a power crisis.

Quality Improvement

Quality improvement (QI) is a framework for establishing processes and activities to be implemented systematically to achieve desired outcomes. As described by the Centers for Medicare and Medicaid Services (CMS), QI “seeks to standardize processes and structure to reduce variation, achieve predictable results, and improve outcomes for patients, healthcare systems, and organizations.”

QI concepts can be applied to emergency preparedness and response to improve capacity, performance, and outcomes. QI processes use measures from assessments and other data to make decisions and promote improvement across the disaster cycle, including the planning, response, and recovery phases.

One common tool that rural communities can use to apply QI to preparedness and response is the Plan-Do-Study-Act (PDSA) cycle.

• Plan – establish baselines or priorities and set improvement goals. These priorities may come from post-emergency assessments as gaps in the response efforts.
• Do – implement the plans designed to achieve the desired goals.
• Study – review the actions to ensure they are implemented effectively and monitor, measure, and document results.
• Act – apply lessons learned and modify the plan as necessary.

The PDSA cycle can be used for response exercises in the planning phase or during an actual emergency response. Incorporating PDSA and other tools into the planning phase will ensure that QI will be more successful.

QI is most effective if integrated into daily or routine work to offer ongoing improvement to preparedness systems and to create a learning organization.

Plan Maintenance

Having a clear and current emergency response plan is critical for successful response. It is important to update and maintain the emergency response and recovery plan. Plan maintenance should occur routinely, as planning and preparedness is a continuous process. Plan maintenance is a part of the QI process for integrating gained knowledge into future response efforts. The emergency response and recovery plan must reflect current priorities, new information, and lessons learned.

Emergency response plans should evolve as rural communities gather lessons learned and consider evaluation findings. Each community should outline the specific timeline and procedures for updating the plan. Plans may be updated following:

• Annual review
• Training exercises
• Disasters
• Changes in jurisdiction or resource availability
• Changes in leadership and staff
• Formal updates in guidance

Within an organization, it is important to identify who will be conducting and responsible for the maintenance of the plan. Clear expectations should be detailed so that it becomes routine for the organization. This step closes the loop in emergency preparedness. By consistently updating the plan, lessons learned are more likely to be integrated to create a more robust response.

Resources to Learn More

Quality Improvement
Website
Outlines the importance of quality improvement in public health and provides a QI Roadmap toolkit, QI Self-Assessment, and several other tools based on the stage of the QI process.
Organization(s): National Association of County and City Health Officials (NACCHO)