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U.S. Department of Health and Human Services

6.2 Other Healthcare Coalition Preparedness Activities

The remaining preparedness activities for the Coalition focus on evaluation and improvement of the Coalition’s response capabilities.

6.2.1 Exercises

The Healthcare Coalition should use exercises to evaluate the Coalition’s EOP once the EOP has been implemented and personnel have received appropriate education and training. Exercises may evaluate specific elements of a Coalition’s EOP or evaluate the EOP in a broader context. Common elements that may be evaluated during an exercise include SOPs, organizational structure, or the effectiveness of specific technologies used by the Coalition during emergency response. An important consideration in designing an exercise is that the areas to be evaluated are pre-determined and an evaluation plan is established.

The Homeland Security Exercise and Evaluation Program (HSEEP) contains mandatory requirements if Federal emergency preparedness funds are used to develop and conduct the exercise.[7] While a full discussion of exercise preparation is beyond the scope of this handbook, key considerations for healthcare planners are presented in Exhibit 6-4.

Exhibit 6-4. Key considerations for exercise preparation

  • The purpose of the exercise should be clearly stipulated in the Exercise Plan. This drives the scenario to ensure that areas of focus receive proper attention during the exercise. The level of anticipated play by the participating entities should be established. Coalition members that are not able to participate should be kept informed of the exercise development process and the findings from the exercise.
  • The exercise scenario should be selected from hazards identified in the Coalition’s HVA and should not present a “doomsday” event. This will ensure a realistic test of the Coalition’s EOP and avoid a demoralizing “can’t win” situation.
  • Exercise evaluation should focus on the policies, processes, and procedures defined in the EOP and not on the performance of individuals. An evaluation plan should be developed prior to the exercise describing the evaluative process that will be used. Personnel should be designated to specifically evaluate the systems or processes that are objectives for the exercise.
  • The exercise schedule should promote broad participation by Coalition member organizations and any relevant Jurisdictional Agency(s) (Tier 3) or regional Coalitions (Tier 2), if applicable. Representatives from individual healthcare organizations and Jurisdictional Agency(s) should be involved in exercise development and scheduling.
  • A team should be designated to manage the exercise while it is being conducted. The size and complexity of this team will likely vary depending on the specific Coalition. The first priority of the management team should be the safety of exercise participants.

Feedback for the exercise evaluation may be gathered in the form of assessments from the evaluators, role players, and the exercise participants. Two methods that are commonly used to obtain input from exercise participants include the following:

  • Post-exercise “hot wash.” This activity is usually conducted immediately following an exercise to identify key successes or challenges while they are still “fresh” in the minds of the participants. Representatives from all entities that participated in the exercise should be included.
  • After Action Report (AAR) process.[8] The AAR process is a formal and comprehensive process conducted after the exercise to analyze data and observations, positive and negative, related to system performance.

6.2.2 Evaluation and the AAR Process

In addition to exercises, the AAR process is used after an actual incident. This process should go beyond the documentation of “lessons learned” and drives system change through a corrective action process that produces true organizational learning. The AAR process may include the following characteristics:

  • A management team assigned to oversee the AAR process. This team can vary in size depending on the size and complexity of the Coalition and the incident that is being evaluated.
  • Prior to conducting an AAR conference, all exercise-related observations and data should be collected and reviewed to steer the discussion. A short survey from responding organizations that assesses the HCRT performance may also be very beneficial. Incident or exercise-related documents (e.g., ICS forms used during the response, notification messages) should be analyzed to steer the AAR discussion and inform the AAR findings.
  • As part of the AAR conference, participants develop an Improvement Plan (IP) that articulates specific corrective actions by addressing issues identified through the AAR process.[9]
  • The timing of the AAR conference should provide stakeholders with sufficient time to recover from the incident or exercise and allow adequate preparation by the management team. Too long of a delay, however, may allow critical recollections to be lost.
  • The AAR conference should be facilitated in accordance with a pre-established agenda. It may be advisable to have the HCRT Planning Section Chief, or someone trained for that position, facilitate the conference.

A final report should be developed that documents the findings of the AAR process. The report should document both positive and negative findings, with recommendations on how the former might be incorporated permanently into Coalition processes and procedures. Recommendations should be as specific as possible to highlight steps for system improvement.

6.2.3 Organizational Learning

The Healthcare Coalition response organization should be continuously evaluated based on its response to both exercises and realworld emergencies. The goal should be to transform this experience into lasting improvements in Coalition performance.[10] The following concepts are provided for consideration:

  • The AAR and IP are finalized as a combined AAR/IP, and IP corrective action items are tracked to completion as part of a continuous Corrective Action Program.[11]
  • Individuals should be assigned responsibility for implementing recommendations made in the AAR/IP. This commonly would be a Healthcare Coalition EMC subcommittee.
  • Assigned personnel should review proposed changes for clarity and their potential impact on the Coalition. This should include an assessment of the priority of the recommended changes (e.g., life safety issues should be assigned the highest priority).
  • Proposed recommendations may be accepted, accepted with revision, declined (with a reason given), or deferred. The latter option may be preferred if a proposed change is contingent on upcoming funding and should be readdressed if/when the funding is obtained.[12]
  • Changes in Coalition processes and procedures should then be evaluated during follow-on exercises or actual incidents.

  1. FEMA, Homeland Security Exercise and Evaluation Program (HSEEP); Available at: https://hseep.dhs.gov/pages/1001_HSEEP7.aspx.
  2. State of California, Governor’s Office of Emergency Services, Standardized Emergency Management Systems (SEMS) Guidelines, Part III. Supporting Documents (December, 1994); Available at: http://www.oes.ca.gov/Operational/OESHome.nsf/PDF/SEMS Guidelines/$file/AAR.pdf.
  3. U.S. Department of Homeland Security, Homeland Security Exercise and Evaluation Program (HSEEP), Volume 3: Exercise Evaluation and Improvement Planning, (February 2007); Available at: https://hseep.dhs.gov/support/VolumeIII.pdf.
  4. Adapted from Senge P, The Fifth Discipline: The Art and Practice of the Learning Organization; In Ott SJ, Parkes SJ, Simpson RB; Classic Readings in Organizational Behavior. Belmont, CA, Thomson Learning, (1990).
  5. U.S. Department of Homeland Security, Homeland Security Exercise and Evaluation Program (HSEEP), Volume 3: Exercise Evaluation and Improvement Planning; February 2007. Available at: https://hseep.dhs.gov/support/VolumeIII.pdf.
  6. Barbera JA, Macintyre AG, Shaw G, et al, Emergency Management Principles and Practices for Healthcare Systems. Department of Veterans Affairs, Veterans Health Administration (2006); Available at: http://www1.va.gov/emshg/page.cfm?pg=122.

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  • This page last reviewed: February 14, 2012