Guide for Incorporating Administrative Preparedness into Exercise

Introducing a tool to assist the integration of administrative preparedness concepts and activities into emergency preparedness drills and exercises

Exercises are valuable tools for testing and improving local capacity to respond to hazards and threats.  Through drills and exercises, public health departments and other response agencies can identify areas for improvement to address for future planning efforts.  Drills and exercises often overlook the important administrative functions in a response: procuring supplies, establishing contracts, identifying and recruiting additional personnel, etc. These vital tasks, and others, fall under the umbrella of administrative preparedness. 

Administrative Preparedness is the process of ensuring that the fiscal, legal, and administrative authorities and practices that govern funding, procurement, contracting, and hiring are appropriately integrated into all stages of emergency preparedness and response. The goal of administrative preparedness is to remove barriers that can prevent the timely occurrence of response activities. A deficiency in administrative preparedness can delay the acquisition of goods and services, the hiring or assignment of response personnel, the disposition of emergency funds, and legal determinations needed to implement protective health measures. 

Following the 2009 H1N1 influenza pandemic, NACCHO developed a number of resources that convey the importance of administrative preparedness to local health departments. These informational tools provide steps that local health departments should take to improve their capacity in this area. NACCHO’s reports related to administrative preparedness have focused on issues related to: procurement, workforce, legal authorities, and emergency reporting practices.  Information on these guides may be found below. 

The Guide for Incorporating Administrative Preparedness into Exercises continues NACCHO’s efforts to provide local health departments with actionable information that can be used to address their capabilities in administrative preparedness.

The Guide for Incorporating Administrative Preparedness into Exercises is organized around the fundamentals and principles of the Homeland Security Exercise and Evaluation Program (HSEEP). HSEEP was developed by the Department of Homeland Security and provides guiding principles for exercise design, development, conduct, evaluation, and improvement planning.  Familiarity with HSEEP concepts, terminology, and methodologies will positively impact the effectiveness of this tool.  If you are using the HSEEP process, the suggested administrative preparedness related activities of this guide should align with the steps you take as you create your activity and proceed through the HSEEP Exercise Cycle.

Additionally, although the action steps of this guide are focused on the integration of administrative preparedness concepts into full-scale exercises, HSEEP is organized in a manner which allows its concepts and principles to be used in drills and exercises of varying complexity. Because this guide is based on HSEEP principles, the following information may also be used in activities beyond full-scale exercises, such as: seminars, workshops, tabletop exercises, games, drills, and functional exercises. 

To see an example of how administrative preparedness has been incorporated into an exercise, please review the section entitled “Administrative Preparedness Best practices and Lessons Learned: Georgia Department of Public Health”.  Additionally, refer to Appendix A if you are seeking additional information on Administrative preparedness or the Homeland Security Exercise and Evaluation Program.  Examples of administrative preparedness objectives and injects that could be modified for use in an exercise may be found below.

In addition to developing familiarity with HSEEP, there are additional considerations that should be made before using this guide. 

Develop and/or Assess the Organization’s Administrative Preparedness Plan

A foundational component of exercising administrative preparedness, and a prerequisite for using this guide, is that the organization has a current administrative preparedness plan, or at a minimum, documented administrative procedures. The administrative preparedness plan and/or procedures should address how the organization will expedite key contracting, procurement, hiring and/or staff reassignment processes during a public health emergency. Similar to other emergency preparedness plans that an organization develops, the administrative preparedness plan will inform exercise planning, design, and evaluation.

Obtain Buy-In from Organizational Leadership.

Another major consideration is the acquisition of buy-in from organization leadership.  Addressing administrative preparedness in exercises and drills requires the incorporation of non-preparedness staff who, otherwise, may not be involved in these activities. Prior to recruiting these staff members for the planned preparedness activity, it would be beneficial to gain the approval of leadership and supervisors. It is highly encouraged that organizations engage leadership to encourage buy-in as soon as the decision is made to incorporate administrative preparedness into preparedness activities. Obtaining leadership approval of exercise objectives that include administrative preparedness may be one way to facilitate buy-in.

Train Non-Preparedness Staff

Many non-preparedness staff are crucial to administrative preparedness (e.g. contracts and accounting staff, human resources) but they may be unfamiliar with preparedness concepts. It may be helpful to provide relevant administrative staff with a basic introduction to emergency preparedness and response, as well as the exercise scenarios.

Exercise Administrative Preparedness Plans

Administrative preparedness concepts to be tested should be methodically and intentionally planned, exercised, and evaluated throughout the exercise process.  Often administrative preparedness activities, such as applying for additional funding or executing a services contact, will be included in the assumptions causing participants to skim over these tasks. By not exercising their administrative preparedness capabilities, the workforce may face unforeseen barriers and challenges during a real-world response, which could have been addressed. Including administrative and fiscal staff in exercise planning, developing one or more exercise objectives related to administrative preparedness, and incorporating administrative preparedness injects into the scenario will help the organization avoid these pitfalls.

Following is a list of actionable steps for incorporating administrative preparedness into exercises.  As previously noted, the steps in this guide are organized in a manner consistent with HSEEP principles.  Please keep this in mind as you navigate this guide and consider how to incorporate its suggestions into the work of your local health department.

Additionally, the activities listed here should not be seen as an exhaustive list.  Use them as a starting point as you consider new ideas that will further assist the integration of administrative preparedness into future preparedness activities.

During this phase the intent and guidance of officials and exercise program priorities are leveraged to shape the key concepts and planning considerations for exercises.

Corresponds with 2013 Homeland Security Exercise and Evaluation Program Chapter 3.


Exercise Foundation

Identify key factors driving the exercise design and development process.

  • Review grant and/or cooperative agreement requirements for exercise funding and determine how to incorporate administrative preparedness into the design of the exercise while working within funding parameters. 
  • Review administrative preparedness plans, organizational plans, and organizational procedures to determine which aspects of administrative preparedness should be incorporated into the design of the exercise.


Exercise Planning Team and Events

Exercise Planning Team Considerations: Factors to consider when building exercise planning team.

  • Include legal, contracting, accounting, procurement, human resources, and any other professionals who may be involved in the aspect of administrative preparedness to be tested through your planned exercise.
  • Incorporate partners noted in relevant Memorandums of Understanding and Mutual Aid Agreements when identifying the team responsible for planning your exercise and identifying administrative preparedness issues to be addressed.
  • Explicitly mention administrative preparedness as you conduct activities for planning your exercise.
  • If needed, introduce the concept of administrative preparedness and share your organizations administrative preparedness plan with the exercise planning team. 
  • Based on your administrative preparedness plans and/or procedures, identify administrative preparedness responsibilities for relevant positions within the planning team.  If using an Incident Command Structure for planning team, ensure that the inclusion of administrative preparedness concepts are reflected in the responsibilities of related sections.

Planning Activities: Actions and meetings, identified by the exercise planning team, enabling the successful planning of an exercise.  

  • Ensure that the desire to test administrative preparedness capabilities is clearly conveyed to all planning team members during planning activities.
  • Continue to include legal, contracting, accounting, procurement, human resources, and any other professionals on the planning team. 

Exercise Scope: Determination of scope allows exercise planners to identify the appropriate size and nature (discussion-based or functional) of the exercise, allowing for objectives to be met while staying within resource limitations.

  • At this moment it is important to consider the extent to which administrative preparedness will be tested within the exercise.  It may be better to focus on evaluating one aspect of your administrative preparedness plan rather than addressing too many areas. 

Exercise Objectives and Core Capabilities: The planning teams selection of priorities on which to focus exercises, resulting in the identification of specific, measurable, achievable, relevant, and time-bound (SMART) objectives.

  • Create objective(s) that are relevant to the aspects of administrative preparedness that you are interested in exercising. As part of the exercise you may developed objectives on a variety of topics including administrative preparedness or choose to focus all objectives on administrative preparedness. See below for examples of administrative preparedness objectives.
  • Align administrative preparedness objectives and activities with core capabilities and capability targets as they are being identified.

Identifying Evaluation Requirements: Clear articulation of what will be evaluated during the exercise and how exercise play will be assessed.

  • Consider collecting information on triggers for activating expedited administrative preparedness processes. 
  • Identify methods for evaluating the flow and efficiency of expedited administrative preparedness processes.

Scenario: The outline/model of simulated events to take place during the exercise.

  • As the scenario is developed, tease out administrative preparedness related issues that are specific to the threat being addressed and the concepts being tested. 
  • Develop injects that are specific to the threat being addressed and the administrative preparedness processes being tested.  

Exercise Documentation: Exercise materials and documentation used to facilitate exercises and ensure a successful exercise.

  • Incorporate administrative preparedness concepts and objectives into exercise documentation.
  • Administrative preparedness related materials (plans, procedures, etc.) should be available for exercise participant reference during the exercise. 
  • Documents intended for evaluators and controllers should include direction on how to incorporate administrative preparedness activity related staff into exercise roles as they may be new to participation in exercises and drills.  Additionally, these documents should also include direction on how administrative preparedness objectives will be measured, documented, and evaluated.


Exercise Development

Planning for exercise logistics, control, and evaluation.

  • The successful incorporation of administrative preparedness into planning should result in the control structure and Simulation Cell (SimCell) having the ability to provide and/or generate administrative preparedness related injects for exercise players.  
  • Ensure that SimCell does not remove administrative preparedness related activity from the exercise. 
  • The defined duties of the following staffing positions should include awareness of administrative preparedness activity and provide an understanding of position responsibilities related to those activities: evaluators, controllers, simulators, observers, and players.

This phase involves those activities surrounding exercise play, including preparation, management, and wrap-up activities.

Corresponds with 2013 HSEEP Chapter 4.


Exercise Play Preparation

Briefings: After setting up the exercise site, briefing of exercise participants on roles (controller, evaluator, actor, etc.) and corresponding responsibilities.  Schedule separate briefings with elected and appointed officials, controllers and evaluators, actors, players, and observers to avoid confusion.

  • There should be player and/or actor roles specific to administrative preparedness (e.g., fiscal, contracts/grants, human resources). 
  • Administrative, fiscal, and/or human resources staff participants may not have exercise experience. Be sure they understand the difference between actors, players, observers, controllers, and evaluators.  Stress the importance of accurate documentation.


Exercise Play

Control: SimCell introduces injects and controls the pace of play, based on feedback from the Controllers.

  • Include administrative preparedness injects that impact play pace, e.g. a contract issue with a trucking company has resulted in delayed delivery of assets to the point of dispensing (POD).
  • Mimic real-world administrative processes as much as possible, e.g. submitting requests to purchase supplies. 
  • See below for examples of administrative preparedness injects. 

Observation and data collection: Throughout the exercise, evaluators use the Exercise Evaluation Guides to record both quantitative and qualitative data on pre-determined measures designated by the exercise lead. Evaluators should be positioned at locations where they can best gather information and track participant actions. 

  • When possible, evaluators monitoring administrative preparedness activities should be experienced in those administrative activities.
  • When possible, record quantitative information on the amount of time (hours, days) a particular process took / would take based on the scenario.   
  • When possible, record qualitative information on the procedures actually used by exercise players, adherence to document procedures, modifications made (if any), issues experienced, and other relevant strengths and areas for improvement.


Wrap-Up Activities

Player Hot Wash: Sessions held immediately after the exercise with all players, led by experienced facilitators. Actors/players should submit Participant Feedback Forms at this time.

  • Include questions that evaluate the flow and efficiency of administrative preparedness tasks. 
  • Identify additional observations that can be included as strengths and areas for improvements related to each objective tested in the exercise.

Controller/Evaluator Debriefing: Separate hot washes for each functional area with the relevant controller(s) and evaluator(s). At this time, controllers and evaluators will complete their Participant Feedback Forms and submit those forms, in addition to their Exercise Evaluation Guides.

  • Consider treating “Administrative Preparedness” as its own function with its own debriefing. At the minimum, ask evaluators for qualitative data on the execution of administrative processes during game play.

The assessment of those capabilities needed to accomplish a mission, function, or objective based on the performance of critical tasks to capability target levels.

Corresponds with 2013 HSEEP Chapter 5.


Evaluation Planning

Evaluation Team: Team identified by exercise planning team to oversee all facets of the evaluation process.

  • Administrative staff should be incorporated in evaluation team to provide ideas and perspective on how to evaluate administrative preparedness activities during exercise play. These persons should be assigned to evaluate identified administrative preparedness objective(s). 
  • Evaluators should be identified prior to the exercise as part of the exercise planning process.

Exercise Evaluation Guide Development: Creation of tool to guide exercise observation and data collection.

  • Exercise evaluation guides should be created for each of the administrative preparedness objective(s). 
  • Critical tasks and elements that were identified during exercise design and development should be incorporated into these guides to focus evaluator observations.

Recruit, Assign, and Train Evaluators: Process of recruiting, assigning, and training evaluators for exercise play.

  • Incorporate administrative preparedness elements into just-in-time training for exercise evaluators. 
  • Consider experience and administrative preparedness expertise when identifying and assigning evaluators.

Evaluation Documentation:  Finalization of evaluation information to be documented in the C/E Handbook or an Evaluation Plan.

  • Administrative preparedness details, instructions, and evaluation tools should be explicitly identified within documentation created for evaluators.


Observation & Data Collection

The collection and recording of information related to exercise conduct, including: participant actions, discussions, etc.

  • Ensure the accurate recording of administrative preparedness related activities and discussions within evaluator notes and records of the exercise. 
  • Creation of additional forms (beyond the exercise evaluation guides) and provision of additional resources may be needed to facilitate the capturing of needed information. 


Data Analysis

The evaluation of exercise participants’ ability to perform core capabilities and determine if exercise objectives were met.

  • Using notes and exercise records, identify the administrative preparedness activities that occurred, and why those activities occurred.  If critical tasks or activities failed to occur then it is necessary to identify the root cause for this failure.

Process for reaching consensus on identified strengths and areas for improvement associated with core capability gaps.

Corresponds with 2013 HSEEP Chapter 6.


Corrective Actions

Following exercise evaluation, identify corrective actions. Corrective actions are measurable, actionable and address planning gaps. Elected and appointed officials must approve of any corrective actions.

  • Include corrective actions related to administrative preparedness.
  • Include administrative officials (e.g. budget managers, legal counsel) in the review of corrective actions.
  • Ensure that any corrective actions related to administrative preparedness are legal, appropriate, and fall within the organization’s authority. 


After-Action Meeting (AAM)

A meeting for the exercise team to review the draft Improvement Plan, which includes exercise findings and proposed corrective actions. AAM participants are responsible for developing concrete timelines and actions for the implementation of corrective actions.

  • AAM participants should include the leads for relevant administrative activities (e.g. finance, contracts, human resources).


After-Action/Improvement Plan Finalization

Following AAM consensus, the Improvement Plan and related timelines are finalized and distributed to all players.

  • Include areas of improvement for administrative preparedness related tasks.


Corrective Action Tracking and Implementation

Corrective actions should be tracked and reported on through completion. Assign points-of-contact who track and report progress.

  • Track the implementation of corrective actions related to administrative preparedness.
  • Assign (at least) one point-of-contact to be responsible for tracking the implementation of administrative preparedness corrective actions.
  • Incorporate corrective actions into organizational administrative preparedness plans. 


Continuous Improvement

Continue to implement corrective actions. HSEEP guidance identifies several “principles of continuous improvement”: Consistent Approach “across applicable mission areas.”, Support National Preparedness, Effective Issue Resolution and Information Sharing, and Application across Operational Phases (during real-world events, after events, and trends across events over time).

  • Review NACCHO developed resources on administrative preparedness and incorporate guidance into continuous improvement

The following is the summary of a real-world experience where administrative preparedness concepts were integrated into a state-wide exercise and the lessons that were learned from these efforts:

In November 2015, the Georgia Department of Public Health (GDPH) participated in a three-day statewide full-scale exercise. This exercise included the activation of Georgia’s 18 public health district’s Emergency Operation Centers (EOCs) and designated Points of Dispensing (PODs) sites around the state.

Prior to the exercise, the health department spent numerous months creating the exercise scenario, developing injects, and finalizing all details and logistics.  While in this planning phase, GDPH made the decision to evaluate administrative and fiscal processes that had been incorporated into their emergency response plans. To do this, the Exercise Coordinator engaged grants and contracts staff, and together, with support from NACCHO, they developed administrative preparedness objectives and injects to test components of their administrative preparedness plans that were relevant to the exercise scenario. GDPH also identified four local health districts to participate in testing administrative preparedness processes during the exercise.

During the exercise, as administrative preparedness injects were played, a resource request was sent to the Georgia Department of Public Health’s WebEOC and assigned to the administrative and finance section. Once assigned, the resource request was either completed at the state level or sent down to the local level for completion. Administrative preparedness injects over the three-day exercise included activities related to funding, procurement, and contracting. Specifically, the injects allowed the administrative and finance teams to practice expediting a contract with a transportation company to secure additional vehicles, reporting staff time for federal reimbursement, and preparing a purchase requisition for additional printing of emergency screening forms.

Administrative Preparedness Promising Practices

To ensure that fiscal and administrative authorities and practices are used and effectively managed in a public health emergency, the GDPH incorporates administrative preparedness practices into their day-to-day work.  As health departments at both the state and local level work to improve administrative preparedness, they may want to consider the following practices:

1.       Include Administrative Preparedness in All Exercises

Health departments at both the state and local levels need to make sure administrative preparedness is incorporated into all exercise planning. This means that staff members on the administrative and finance teams should be included in all planning meetings and in the development of exercise injects. By including administrative preparedness in exercises, operations staff will familiarize themselves with administrative preparedness procedures and will be better able to execute them during future responses. Additionally, administrative and finance staff will better understand incident command and response systems and be better prepared to support operational activities during an emergency.

2.       Build Relationships

Preparedness staff at health departments need to build relationships with individuals who work within the grants, contracts, and human resources departments. It is important for emergency preparedness staff to cultivate these relationships and get to know these individuals (e.g., finance team members, Chief Financial Officer) so that during an emergency, it is not the first time health departments are interacting with them. Further, leadership at health departments should build relationships with city and county officials that may reside outside of the health department but have authority over health department budgets to educate them on public health responses. By building this rapport, health departments can reduce the time needed to respond and recover from a public health emergency.

3.       Develop Administrative Preparedness Protocols and Procedures

Prior to an emergency, health departments should develop administrative preparedness plans, policies, and procedures highlighting tasks that may need to be expedited during an emergency. For example, the GDPH has developed a plan so they can procure additional funding if needed. In the event of an emergency, Georgia’s health department can utilize their plans and work with the Budget Director to successfully accelerate the process of securing additional funding. Once these processes and plans were implemented, all levels of Georgia’s administrative and finance teams began to incorporate them into their day-to-day activities.

Lessons Learned From the Full-Scale Exercise

While there is always room for growth and improvement, Georgia’s administrative and finance teams felt that the results of the exercise demonstrated that they are prepared to handle expedited procedures during a public health emergency.  In the future, the GDPH would like to have more administrative preparedness injects played during an exercise to further test their capabilities. They would also like to continue to include a local level perspective by having individuals at LHDs engage with them throughout the planning process.  Finally, they would like to develop an administrative preparedness group that can conceptualize administrative preparedness for other staff and support the exercise planners further incorporate it into future exercises.

The following list provides examples of administrative preparedness related objectives and injects that may be adapted for use in exercises and other preparedness activities.

Contracting

  • Objective: Demonstrate expedited approval process for entering into a contract for the purchase of services during an emergency
    • Transportation Companies
      • Potential Inject: Local level trucking company quickly backs out of transporting Strategic National Stockpile (SNS) assets to PODs from Receipt, Stage, Store (RSS) sites due to occupational safety concerns from a union representing drivers.
    • Law Enforcement
      • Potential Inject: There are not enough law enforcement staff at the local level to provide security to POD sites within their jurisdiction.  The police department suggests using security agency staff to supplement security needs.
      • Potential Inject: Local law enforcement is providing security to POD sites within their jurisdiction.  Some state law enforcement are supporting federal investigation and evidence collection efforts, so there are not enough state law enforcement personnel available to provide security for the RSS site.  Need to quickly contract with a private security company to provide needed security.

Procurement

  • Objective: Evaluate processes to procure supplies needed to support emergency response
    • Purchasing Cards
      • Potential Inject: State health department staff who deployed at response sites have requested to use their department-issued purchase cards to pay for meals for volunteers who have agreed to assist for at least 8-hours.  Some POD managers have reported that there are no close food options and some volunteers have used public transportation to travel to the POD.
      • Potential Inject: A local hospital is receiving many ill and worried-well individuals at the emergency room.  The local health department would like to set up a triage site outside of the emergency room but large tents are needed in addition to tables, chairs, and other materials due to inclement weather.  The cost is more than the pre-authorized amount for their purchase card. 
    • Purchase Orders
      • Potential Inject: A printing company requires that a purchase order for over $10,000 be approved and submitted for them to begin producing emergency forms, fliers, and screening forms for POD sites.
      • Potential Inject: Department staff identify a medical supply company that has some personal protective equipment available for purchase.  They submit a request through the incident command to purchase the needed supplies.

Receiving/Accepting Emergency Funds

  • Objective: Demonstrate expedited process(es) for accepting emergency preparedness funding.
    • Emergency Funds
      • Potential Inject: Department of Health and Human Services (HHS) has released a public health emergency response (PHER) funding opportunity announcement (FOA) with a period of performance of 18 months that will make funds immediately available to public health emergency preparedness (PHEP) awardees impacted by the terrorist attack.  The FOA language indicates that funding will support public health response efforts at the state and local level, including resource and labor costs.  Retroactive reimbursement is not permitted.
      • Potential Inject: HHS granted a notice of award for public health emergency response (PHER) funds to the health department (for which it previously applied).  The notice of award has a one year period of performance to spend the funds.

Surge Staffing

  • Objective: Demonstrate expedited processes for hiring and/or reassigning staff and volunteers to support surge staffing needs during the incident.
    • Contract Workers
      • Potential Inject: Forty health department staff members who were assigned to roles at PODs are out sick and are unable to work causing a staff shortage.  A contract nursing agency has committed to providing 35 nurses to assist, but their hourly wages are twice that of health department nurses.
    • Hourly Employees
      • Potential Inject: A health department HR policy prohibiting the hiring of new hourly employees, has been in place since 2012.  A jurisdiction that is not impacted by the emergency has 20 health department staff that can be used for the response with the condition that your department pay them at an hourly rate that is equivalent to their current pay.  The Commissioner denies the request of hiring additional hourly employees due to an agency hiring freeze.
    • Volunteers
      • Potential Inject: (Health department jurisdiction) public health staff are insufficient to cover 24/7 POD operations.  As a result, they have submitted a request for volunteer support through (applicable law in jurisdiction).  Ten MRC volunteers show up to support POD operations, an insufficient amount for staffing needs. 
      • Potential Inject: (Health department jurisdiction) reports that spontaneous volunteers have shown up at the health department and POD sites to offer their assistance.  Some of these spontaneous volunteers claim to have a medical background (i.e., nurses, mental health clinicians, emergency medical technicians, etc.) and some have not.  Most are not registered through (applicable volunteer database).  The jurisdiction POD operations are in need to the offered assistance since it is overwhelmed by the demand for services and are understaffed as some personnel have left to check on family members

Usage of Facilities

  • Objective: Test expedited procedures for securing facilities and support services needed to respond to an emergency.
    • Provide Expedited Facilities:
      • Potential Inject: (Health department jurisdiction)’s POD is the gymnasium at a local school.  Due to the limited information on the (applicable communicative disease), one school district commissioner, who has been receiving calls from concerned parents, refuses to allow POD operations to occur because of potential safety concerns for students’ well-being after the school has re-opened.  A new POD facility needs to be identified.
      • Potential Inject: (Health department jurisdiction) has established a drive-through POD; however, after staffing the POD, they realize they need an alternative site for secure storage of SNS assets and for staff members to take a break.  They do not have a pre-established contract with a facility nearby; however, there is an empty office building across the street.

Guide for Incorporation Administrative Preparedness into Exercise 

NACCHO has produced the following reports to assist local health departments in identifying and addressing potential administrative preparedness issues in their jurisdictions.  Each of these documents may be found in NACCHO’s Online Bookstore:

The following are additional resources related to the Homeland Security Exercise and Evaluation Program (HSEEP).

Department of Homeland Security

FEMA Emergency Management Institute Courses

Preparedness Toolkit

Public Health Preparedness Program

Geoffrey Mwaungulu, Jr.

Senior Program Analyst

202-507-4224 / gmwaungulu@naccho.org

Public Health Preparedness Program

Katherine Dwyer

Director, Prep CBA

202-507-4188 / kschemm@naccho.org