BackgroundEmergencies and disasters impact population health. Despite the importance of upstream readiness, a persistent challenge for public health practitioners is defining what it means to be prepared. There is a knowledge gap in that existing frameworks lack consideration for complexity relevant to health systems and the emergency context. The objective of this study is to describe the essential elements of a resilient public health system and how the elements interact as a complex adaptive system.MethodsThis study used a qualitative design employing the Structured Interview Matrix facilitation technique in six focus groups across Canada. Focus group participants were practitioners from public health and related sectors. Data collection generated qualitative data on the essential elements, and interactions between elements, for a resilient public health system. Data analysis employed qualitative content analysis and the lens of complexity theory to account for the complex nature of public health emergency preparedness (PHEP). The unit of study was the local/regional public health agency. Ethics and values were considered in the development of the framework.ResultsA total of 130 participants attended the six focus groups. Urban, urban-rural and rural regions from across Canada participated and focus group size ranged from 15 to 33 across the six sites. Eleven elements emerged from the data; these included one cross-cutting element (Governance and leadership) and 10 distinct but interlinked elements. The essential elements define a conceptual framework for PHEP. The framework was refined to ensure practice and policy relevance for local/regional public health agencies; the framework has ethics and values at its core.ConclusionsThis framework describes the complexity of the system yet moves beyond description to use tenets of complexity to support building resilience. This applied public health framework for local/regional public health agencies is empirically-derived and theoretically-informed and represents a complex adaptive systems approach to upstream readiness for PHEP.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6250-7) contains supplementary material, which is available to authorized users.

Essential service organizations fulfill critical roles in maintaining public health during a disaster; therefore, business continuity planning is paramount to ensure continued functioning of core operations during a disruption. Business continuity planning is typically oriented around a predict and prevent approach. Asset-mapping activities have the potential to balance the predominantly risk-based approach by focusing on strengths and capability already present within organizations. The purpose of this study is to identify a suite of organizational-level assets that support resilience, and to contribute to the empirical evidence base for business continuity planning. Two focus group consultations with essential service organization representatives (n = 22) were held in Ottawa, Canada, in March and April 2014, using the Structured Interview Matrix facilitation format. Inductive analysis was used to identify eight emergent themes that highlight the importance of organizational-level assets and their contribution to adaptive capacity. Leadership and culture in adopting and promoting preparedness strategies were predominant themes, as well as the importance of communication and connectedness across micro, meso, and macro levels. A suite of 25 assets were identified and grouped into seven categories: (a) awareness, (b) human resources, (c) information and communication, (d) leadership and culture, (e) operational infrastructure, (f) physical resources, and (g) social capital. This evidence base can be used as a template to guide asset-mapping activities, and support organizations engaging in business continuity planning.

Objective:Communication is essential during public health emergencies and incidents. This research aimed to understand current uses and challenges for public health agencies using social media during these incidents.Methods:An exploratory, qualitative study was conducted using the structured interview matrix facilitation technique. Focus groups were held with professionals from local public health agencies across Ontario, Canada. Representation from different geographic regions was sought to capture differences in participant experience. An inductive approach to content analysis was used to identify emergent themes.Results:A diverse group of public health professionals (n = 36) participated. Six themes were identified. Social media is identified as a communication tool used to expand reach of messages, to engage in dialogue with the public, and to inform the scope of potential incidents. Barriers to its use include hesitancy to adapt, lack of trust and credibility, and organizational structure and capacity constraints. Key strategies proposed to promote social media use and address barriers resulted from participant discussions and are presented.Conclusion:Social media use is highly variable across public health agencies in Ontario. This study identifies and provides strategies to address barriers and practice gaps related to public health agencies’ use of social media during emergencies.

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Objective: To identify the key mechanisms, contexts, and outcomes that drive the successful participatory co-design of assistive technologies. Method: A rapid realist review was conducted using a systematic search strategy. After screening, a final set of 28 articles were included. Articles were analyzed for evidence relevant to our initial program theory (IPT), and context-mechanism-outcome configurations were developed, resulting in a revised program theory. Results: All 28 articles included were highly relevant to the IPT, and had sufficient detail regarding the process of participatory co-design. The findings of this review highlight several key context-mechanism-outcome configurations as potential patterns in the data under the two dimensions of the evolving program theory: knowledge integration and the ethico-political dimension. Discussion: This review revealed the key mechanisms of mutual awareness, mutual learning, trust, and reciprocity that need to be taken into account in AT development and assessment. We concluded that participatory co-design requires a restructuring of power relations between end-users and those traditionally in control of technology design. These findings inform the development and assessment of AT for older adults and help guide policy/decision-makers to move forward with the now urgent agenda for scale-up and spread, initiated by the burning platform of the COVID-19 pandemic.

Study/Objective: The aim is to evaluate contemporary Australian disaster practice. Background: The evolution of disaster practice has displayed that the management of disasters extends beyond immediate response needs, and that effective recovery from these events requires a broad, coordinated capacity building perspective, rather than a traditional short term response effort. The concept and practice of reducing disaster risk can be achieved through systematic efforts to analyse and manage the causal factors of disasters, rather than apply current, operational, response designed risk management actions. It is therefore timely to assess the relationship of proposed strategies, and the social determinants of health as a holistic approach to disaster practice. Methods: Contemporary Australian disasters inquiries were to determine what, if any recommendations support action on the causal factors of health and wellbeing as described by the World Health Organization (WHO), using the Social determinants of health as a reference standard. The intent was to examine whether the recommendations undertook action on improving public health, and thus improved community resilience and reduced vulnerability. Results:• Seven post disaster inquiries were reviewed.• Although the scope and Terms of Reference of reports were broad enough to be inclusive of risk, risk factors and resilience, the recommendations focused primarily on emergency management structure and practice, and demonstrated low engagement in health, health equity, and/or health protection as drivers or outputs. Conclusion:The National Strategy for Disaster Resilience has also identified that disasters are increasing in their complexity and frequency. Priorities of prevention and mitigation have been firmly embedded within this strategy, to mitigate the effects of disasters upon the community. There is an opportunity to further engage public health practice with disaster management professions and examine:• what role does disaster health practice play in shaping the social environment in ways conducive to better health and,• how interventions can assume wider responsibility for creating more healthy, resilient societies Prehosp Disaster Med 2017;32(Suppl. 1):s197

Introduction: The Fort McMurray Alberta wildfire was one of Canada's largest natural disasters in history, burning 589,995 hectares of land until being controlled on July 5, 2016. In responding to the fire, Alberta Health Services (AHS) prompted a province-wide coordinated response. Through a combination of pre-emptive strategies and responsive activities, the AHS response has been considered a success. Underlying the successful response is the collective experiences and contextual knowledge of AHS staff members acquired from past events. While the frequency and severity of risks associated with extreme weather and climate change are increasing worldwide, there is a persistent knowledge gap in the evidence-base informing public health emergency preparedness. It is imperative that lessons learned from past events inform future preparedness activities. Learning lessons is a systematic implementation process that can be used to inform future responses and best practices that are transferable to similar situations. Aim: To describe strategies employed and challenges encountered during recovery after the Alberta wildfires. Methods: A single-case study approach was employed to understand the AHS method to "learning lessons," and the process involved in translating lessons into actionable goals. Semistructured interviews with senior leaders (n=11) were conducted and internal documents were obtained. Results: The analysis revealed a strategic learning process, including debriefs, staff surveys, interviews, and member validity checking. The implementation process used to translate the lessons identified included a project management framework, evaluation techniques, and the utilization of tacit and explicit knowledge. Key challenges for implementation involve clarification of processes, leadership commitment, resource and time constraints, staff turn-over, and measuring outcomes. Discussion: Translating the lessons from the Alberta wildfires is crucial for enhancing preparedness, and exploratory research in this area can contribute to building a program of research in evaluation during disaster recovery.

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