Implementing Innovations in Public Health Agency Preparedness and Response Programs

Failures in maintaining accurate and robust communication and information flows are often responsible for impeding organizations’ abilities to make informed decisions and work together during emergencies.¹ Numerous tools and trainings have been developed to improve public health preparedness and response (PHPR) communications, but effectively implementation of evidence-based PHPR system improvements is unclear, and systematic uptake and adoption of evidence-based innovations into public health agencies has been limited. Practical factors such as limited resources and time present barriers to implementation, and perceived lack of generalizability and relevance present additional obstacles. Generated evidence is seen as novel to context or, as in the case of “lessons learned,” anecdotal and only relevant to those directly involved in the event.² A goal of implementation research in the population health domain is to identify the factors, processes, and methods that can successfully and broadly embed evidence-based interventions into public health organizations to achieve improved health outcomes and maintain these outcomes through sustainable programs and practices.^3,4 Meeting this goal is never more critical than when a disaster strikes—natural or human-made—and public health agencies, as front-line organizations in emergency and disaster coordination, response and communication,^5,6 must mobilize to coordinate and provide emergency response and recovery assistance.

The PERRCoLate (Preparedness and Emergency Response Research and Learning) Project sought to understand the structural, organizational, and stakeholder engagement factors that influence innovation implementations in public health agencies. Implementation demonstration projects were conducted in which public health agencies selected and implemented an evidence-based PHPR communication product. These agencies were observed and evaluated to describe implementation processes and identify challenges and realities involved with instantiating, adopting, and utilizing an innovation.

IMPLEMENTATION PROJECTS

Three evidence-based PHPR communications products were available for implementation: (1) an interactive tutorial designed to help agencies improve their communication capacity with stakeholders through the use of SMS (short message service) text messaging, (2) a tabletop exercise that uses a “forced decision-making” framework for participants to apply new risk communications research evidence and improve communication protocols as an emergency scenario unfolds, and (3) an online risk communications course that focuses on how to set clear communications protocols and procedures before an emergency begins.

DEMONSTRATION SITES

Six public health agencies in Washington State were enrolled as demonstration sites. Figure 1 illustrates our data collection and analysis protocol. A mixed-methods approach was guided by the following implementation questions:

1. What benefits were derived from the implementation? How might those benefits be sustained over the long-term?

2. What were the most significant barriers and facilitators to implementation?

3. What mechanisms support adoption and use of research findings and evidence-based tools and trainings?

4. What mechanisms detract from adoption and the use of research findings and evidence-based tools and trainings?

FIGURE 1—

Preparedness and Emergency Response Research and Learning (PERRCoLate) Project Data Analysis Protocol

Note. PHA = public health agency; PHPR = public health preparedness and response.

All sites reported the implementation process contributed to improved organizational collaboration and internal communications, stakeholder connections, and overall programming capacity. Five of six public health agencies reported that leadership support or follow-through were the most helpful factors to implementation. Five public health agencies identified competing priorities—for example, time or outbreaks—as the greatest barrier to implementation, with staff turnover (identified by three agencies) contributing most frequently to time constraints.

Project findings suggest that innovations most likely to be implemented are those that present a clear value proposition to agencies and their leaders and can be characterized as those which:

• clearly fit the public health agency’s identified needs and close a capability gap,

• are congruent with the agency’s mission,

• are multipurpose and can support non-PHPR work,

• can help meet external funding requirements,

• provide opportunities for reinforcement, and

• are credible, particularly if associated with an academic partnership.

When rating how likely the benefits or outcomes of the implementation are to be sustained over time, three of six public health agencies selected “between Very and Somewhat Likely” and three selected “Somewhat likely.” Agencies indicated the following as constraints on sustainability: leadership follow-through or commitment, staff turnover, competing priorities, and limited resources to provide opportunities for staff to practice. In particular, the role of leadership emerged as a key factor.

CONCLUSIONS

This paper describes challenges to the translation of research-to-practice in PHPR programs and how to best disseminate, adopt, and use new ideas to benefit public health practice. Implementing innovations with quality and fidelity to the tool or training being implemented requires consideration of the conditions that contribute to the tool or training yielding its intended impact. However, even if all the conditions of an organization’s “readiness” to adopt an innovative tool or product are met (i.e., motivation and capacity to implement, intention to change), successful dissemination and implementation are still not assured. How to sustain the benefits of, or knowledge derived from, implementation of an innovation presents additional challenges.

Several themes specific to increasing the likelihood of success when engaging in translation and dissemination of innovations in public health agencies emerged from our work. First, using a formal, systematic methodology to assess the quality, appropriateness, and feasibility of implementing new tools and trainings can build a foundation for implementation success by prioritizing tools, clarifying potential benefits, and matching new tools to agency needs. Academic institutions that translate evidence into trainings and tools have a responsibility to make these products freely available to public health agencies and should also provide guidance regarding a tool’s context fit to ensure that agencies invest energy in selecting the right tool.

Second, contrary to the commonly held assumption that public health agencies are unable to implement new innovations because of the scarcity of funding, the lack of fiscal resources was not cited as a key constraint. Agencies identified competing priorities (staff time constraints and events such as outbreaks) and leadership support as critical barriers to implementing new tools, trainings, ideas, or innovations. Public health agencies do need funding to support adoption of new technologies, tools, trainings, and ideas, but they also need support to engage in innovative thinking about how to turn use of these products into sustainable learning opportunities.

Third, sustainability was identified as a key challenge for institutionalizing successful outcomes of implementation, with leadership identified as a significant facilitator. Public health agency leaders are change agents, and their decision-making about and support of innovations are key facilitators for implementation success and, potentially, for sustaining new knowledge and practices associated with innovations. Future research should consider how leadership creates the pathway for implementation and diffusion of innovations in public health, as well as contributes to the sustainability of knowledge. In light of the importance of leadership buy-in, training in change management tailored specifically to public health agencies may be a valuable intervention to support the implementation of innovations.

We are only beginning to understand how to effectively implement evidence-based PHPR innovations in public health agencies. Public health has the opportunity to leverage implementation lessons from other sectors (e.g., business and health care) to improve the translation, dissemination, and implementation of new skills, ideas, and technologies in practice. Identifying the greatest barriers to implementation of innovations in practice, and how can they be addressed most effectively, are next steps. Sustaining success in the face of staff turnover and changing public health priorities could be addressed by working toward creation of public health learning organizations that identify and support innovations and improvements. Additional work focused on studying implementation realities in public health is needed so public health can benefit from evidence-based strategies for improving PHPR.