When the Unexpected Happens: logistical and technical challenges

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When the Unexpected Happens logistical and
technical challenges
Expect the Unexpected Are We Clearly Prepared?

• Carol OByrne
• Pharmacy Examining Board of Canada
• Alison Cooper
• Canadian Alliance of Physiotherapy Regulators

Council on Licensure, Enforcement and Regulation
2006 Annual Conference
Alexandria, Virginia
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Anatomy of a Disaster
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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...."
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Stage 2 - Nonlinear Event
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Stage 3 - Chaos
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Stage 4 A Few Survivors
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(No Transcript)
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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

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Distractions and Disturbances

• Candidate or personnel with medical emergency
• Computer theft alarm
• Candidates voice resonates thru walls
• Administrative errors and interruptions

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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

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The S.A.R.S. Saga

• Chronology
• Nov02 unusual pneumonia cases in China
• Feb03 infected physician at Metropole Hotel in
  HK
• Feb03 tourists in hotel exposed and carry it
  back home to Canada, Singapore, Vietnam
• Mar03 SARS cases diagnosed in Toronto

• Public health directives
• Quarantine all exposed parties
• Isolate patients
• Strict screening of travellers and hospital
  visitors
• Close hospitals to visitors/public

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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. Johns
  Ambulance
• Policy to not allow staff to mask or gown
• Temporary policy to allow candidates to defer exam

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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

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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

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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

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More Potential Threats and Disasters

• Avian flu
• Chemicals
• Biologicals
• Fire
• Weather (blizzard)
• Angry candidates or family members

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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

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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

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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

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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

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Lessons Learned

• You cant 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

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More Potential Threats and Disasters
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The Examiner

• Inappropriate/disruptive examiner behaviour in
  clinical stations
• Falling asleep
• Inappropriate comments
• Handing out business cards/recruiting staff
• Examiner illness

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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

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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

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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

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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

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More Potential Threats and Disasters
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Sage Advice from Long Ago

• Dont 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

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More Sage Advice

• Save for a rainy day
• Protect sufficient resources to implements
  (sometimes costly) contingencies
• Be prepared for loss of income

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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

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More Sage Advice

• Penny wise is pound foolish
• Invest time and resources in contingency and
  disaster planning
• Train back-up personnel

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More Sage Advice

• A stitch in time saves nine
• Take action quickly and effectively to minimize
  later problems
• Communicate clearly

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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

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More Sage Advice

• Its always darkest before the dawn
• There is a solution, you just havent found it
  yet
• Sleep on it, dream about it, play the movie in
  your mind

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More Sage Advice

• Every cloud has a silver lining
• Learn from each situation

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(No Transcript)
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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

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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

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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

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Speaker Contact Information

• Carol OByrne, Examination Manager
• Pharmacy Examining Board of Canada
• 415 Yonge St., Suite 601, Toronto, ON
• (w)416.979.2431x226 (f)416.260.5013
• obyrnec_at_pebc.ca
• www.pebc.ca

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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
• acooper_at_alliancept.org
• www.alliancept.org