Program Details

Practice Type:	Model
Program Name:	Health/Medical Multi-Agency Coordination Group
Organization:	Multnomah County Health Department
Web site:
Overview:	Health/Medical Multi-Agency Coordination Group
Year Submitted:	2011
Responsiveness and Innovation:	This practice addresses the public health need for coordinated healthcare and public health decision-making and response to health emergencies in a multi-county, multi-jurisdictional area. The Health/Medical Multi-Agency Coordination (MAC) Group practice developed is a decision-making group comprised of hospitals, public health, and other healthcare entities with collective responsibility to: 1) prioritize which decisions must be made in order to support a strained healthcare delivery system; 2) develop ethically-based regional strategies to allocate critical resources; 3) propose altered standards of care and policy approaches; 4) propose community mitigation approaches to limit disease transmission; and 5) support accurate dissemination of information to the public. The use of a MAC Group for public health is an innovative adaptation of a practice used by fire and police. Unique to the practice was the use of community observers' (individuals, non-governmental organizations, and businesses) feedback to refine the practice and measure the likelihood that the community would accept decisions made. Also important was the group’s ability to make decisions that resulted in reasonable operational and financial equity among hospitals/health systems, clinicians, and other providers to protect the health care system’s capacity to provide health care as usual to the community after the event.
Agency and Community Roles:	Since August 2004, the Multnomah County Health Department has served as Regional Lead Agency for Healthcare Preparedness Region 1. This formalized the Health Department’s leadership and support for regional health preparedness that has been ongoing since the fall of 2001. In addition to providing long-term executive-level leadership, advocacy, and support for coordinated healthcare and public health decision-making and response to health emergencies, the Multnomah County Health Department actively participated in the practice development. The Director of the Multnomah County Health Department, and the Deputy to the Director both represented the Multnomah County Health Department on the Health/Medical MAC Group through participation in the Health/Medical MAC Group training, exercises, real-time meetings, and evaluation. The Multnomah County Health Department Health Officer, who serves as a Tri-County Health Officer, served as the principle investigator for the practice as well as technical expert to the Health/Medical MAC Group, attending the training, exercises, and real-time meetings. Deputy Multnomah County Health Department Health Officers also served as technical experts to the Health/Medical MAC Group, attending the training, exercises, and real-time meetings. The Multnomah County Health Department’s Lead Epidemiologist and associated staff developed the epidemiological projections for a 1918-like event for use in the exercise series. Medical Interns to the Multnomah County Health Department’s Health Officer provided technical expertise in describing the current capacity of the healthcare system and strategies to increase capacity to handle the increased demand for care during a severe pandemic, and attended the Health/Medical MAC Group exercise and real-time meetings. The Multnomah County Health Department’s Health Assessment and Evaluation office served as the practice evaluators. The Manager of Health Assessment and Evaluation assisted in the ethics materials development and conducted community discussions to collect information on local values about health and healthcare, which contributed to the development of the ethics framework. Multnomah County Health Department’s HPO Program Managers had primary oversight of the development, implementation, and evaluation of the practice; additional Multnomah County Health Department HPO staff provided practice coordination, technical expertise, administrative assistance, contract tracking, and overall support.
Costs and Expenditures:	Target audience: Healthcare Delivery/Public Health/Emergency Management; 95% of the target population reached. Goal: Develop practical, evidence-based, local health response strategies that are accepted by the community and based on organizational learning principles, increasing the local healthcare system’s ability to respond to rapidly changing situations. Primary Objectives: Develop a Health/Medical Multi-Agency Coordination (MAC) Group comprised of hospitals and public health; develop an operational Health/Medical MAC Group Handbook to guide processes; develop an ethics framework based on community values to facilitate fair and transparent decision-making and reduce unintentional consequences; conduct an iterative exercise series (which became real-time due to H1N1) for the Health/Medical MAC Group to practice decision-making, collaboration, and organizational learning. The practice was implemented from October 2008 to February 2010, with evaluation continuing through May 2010. Project activities were implemented in three phases: Phase One: Developed information for functional exercises, including epidemiological projections for a 1918-like event; description of the current capacity of the healthcare system and strategies to increase capacity to handle the increased demand for care during a severe pandemic, while maintaining essential services not related to influenza; and an ethics framework based on community values on which to run decisions through in order to encourage community acceptance. Phase Two: Identify and train members of the Health/Medical MAC Group, utilizing the Health/Medical MAC Group Handbook as a guide, and conduct an iterative functional exercise series (which became real-time meetings due to H1N1) for the Health/Medical MAC Group to practice decision-making (including the application of the developed ethics framework), collaboration, and organizational learning. Phase Three: Conduct project evaluation activities to inform the refinement of the Health/Medical MAC Group, document what the group accomplished, and measure stakeholder acceptability of utilizing this public health practice for decision-making during a health/medical emergency. A final evaluation report released in June 2010 was developed to be used by other communities wishing to replicate this public health practice. The final evaluation report includes: 1) analytic studies from phase one activities; 2) training materials, recruitment suggestions for effective group members, and an operational Health/Medical MAC Group Handbook with multiple process tools developed during phase two activities; and 3) qualitative data from community observers and Health/Medical MAC Group members on the effectiveness, acceptability, challenges, recommendations and identified next steps from phase three activities. Activities were designed to be easily modified and implemented by communities utilizing the “ordinary” capacities and resources likely to be locally available during a well-established pandemic. Activities started as part of a functional exercise series around a 1918-like pandemic event, but transitioned to a real-time, tested practice due to H1N1. All practice objectives were met. The success of this practice is largely a result of the ongoing work of the HPO, the support of the Multnomah County Health Department, and the partnerships developed across institutions and jurisdictions over the past eight years. In the past five years, the Portland metropolitan region has undertaken significant planning on how best to coordinate the regional health/medical response with jurisdictional level emergency management agencies under the auspices of the HPO. This laid the groundwork for developing the Health/Medical MAC Group, the Health/Medical MAC Group Handbook, its associated ethics framework, and exercise series. The ability to effectively address real-time H1N1 issues was due to this groundwork having been laid, and the long-standing collaboration between the hospital systems and public health.
Implementation:	This practice addresses the public health need for coordinated healthcare and public health decision-making and response to health emergencies in a multi-county, multi-jurisdictional area. The Health/Medical Multi-Agency Coordination (MAC) Group practice developed is a decision-making group comprised of hospitals, public health, and other healthcare entities with collective responsibility to: 1) prioritize which decisions must be made in order to support a strained healthcare delivery system; 2) develop ethically-based regional strategies to allocate critical resources; 3) propose altered standards of care and policy approaches; 4) propose community mitigation approaches to limit disease transmission; and 5) support accurate dissemination of information to the public. The use of a MAC Group for public health is an innovative adaptation of a practice used by fire and police. Unique to the practice was the use of community observers' (individuals, non-governmental organizations, and businesses) feedback to refine the practice and measure the likelihood that the community would accept decisions made. Also important was the group’s ability to make decisions that resulted in reasonable operational and financial equity among hospitals/health systems, clinicians, and other providers to protect the health care system’s capacity to provide health care as usual to the community after the event.
Sustainability:	There is sufficient stakeholder commitment to perpetuate the practice at three levels: 1) the NW Oregon Healthcare Preparedness Organization (HPO) Steering Committee; 2) the H/M MAC Group; 3) HPO partners and stakeholders. 1) The HPO is a regional health emergency planning collaboration of regional hospitals and health systems, local and state public health, county emergency management, emergency medical services, medical societies, safety net clinics, and behavioral health. A steering committee guides the HPO’s health preparedness activities. In January 2010, the HPO steering committee assigned the refinement and solidification of regional coordination as its number one priority for 2010-2011. The committee further identified specific activities to ensure this: 1) continuation of H/M MAC Group development in the areas of relationships and processes; 2) continuation of H/M MAC Group development in the area of Incident Support Organizations and expanded resource ordering. Their identification of these priorities ensures the HPO’s commitment to the H/M MAC Group. 2) During the H/M MAC Group’s last formal meeting during the H1N1 influenza pandemic, members requested meeting quarterly to continue the development of relationships and processes. Nearly one-half of H/M MAC Group members participated in either a focus group or key stakeholder interview as part of the project’s evaluation, even in the light of competing priorities. Their willingness to participate in evaluation activities and their request to continue meeting demonstrates strong support for their continuing involvement in the H/M MAC Group. 3) HPO partners and stakeholders now rely on the activation of the H/M MAC Group in a real-time regional health emergency that warrants policy recommendations and scarce resource allocations. This includes hospitals/health systems, public health, private and safety net clinics, and emergency management. The Office of Multnomah County Emergency Management is committed to continuing serving in a regional capacity to provide regional situation status and regional resource ordering, which are crucial to the support and functioning of the H/M MAC Group. Regional Emergency Managers are supportive of the H/M MAC Group and its role in health emergencies. They are working towards developing Intergovernmental Agreements to support a County ECC serving this role. We held quarterly H/M MAC Group meetings, beginning on February 3, 2010. We are finalizing additional process components to the H/M MAC Group Handbook that were developed since then including: working guidelines; processes for bringing in new H/M MAC Group members; procedures to respond when there is less than 100% consensus during initial decision-making, when the overall situation changes, and when one or more organizations dissent after decision has been made; process for how issues go to the H/M MAC Group and how issues are prioritized; how technical specialists will be utilized by the H/M MAC Group; how member alternates are utilized and trained; the relationship between and perspectives of the Public Health MAC Group and the H/M MAC Group; and level of public transparency, how and when to inform the public of decisions, and obtain public feedback. These additional processes will aid in sustaining the practice over time. The H/M MAC Group has requested to meet tri-quarterly during FY11. They have identified alternates. FY11 meetings will focus primarily on H/M MAC Group trainings, exercises, and bringing in new and alternate H/M MAC Group members. HPO activities are funded by the federal Hospital Preparedness Program (HPP) via the State of Oregon Public Health Emergency Preparedness Program. The HPO steering committee allocates the annual federal HPP grant to hospitals, health systems and other related entities in Oregon Healthcare Preparedness Region 1 (Clatsop, Clackamas, Columbia, Multnomah, Washington, and Tillamook counties). Public and private partners from Clark County, Washington also actively participate. Initially, and gratefully, this practice was funded by a CDC Pan Flu Essential Health Care Service grant. When the grant ended in September 2010, the HPO directed HPP funding to support the ongoing H/M MAC Group and supportive functions. Because of the HPO’s commitment to regional coordination, it will continue to direct HPP funds towards the H/M MAC Group as long as HPP funding continues.
Lessons Learned:

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