Workplace support and disaster preparedness for health professionals and hospital support staff in three Australian hospitals : how can managers best facilitate and support disaster preparedness for the hospital workforce?

Health professionals and hospital support staff have a critical obligation to prepare their response and provide health care, to minimise morbidity and mortality resulting from disasters. Despite an increased focus on disaster preparedness research in the last two decades, there is still much to learn about how health professionals and hospital support staff can best prepare for disasters. Previously published studies focussed on a single convenience sample of nurses or medical practitioners and show that all methods of preparation lead to improved outcomes. However, there is a paucity of research that explores preferences for and the most effective methods of disaster preparedness. Studies that extend to include allied health professionals and hospital support staff participants find that these individuals also benefit from disaster preparedness education. Published research currently demonstrates that many health professionals are not adequately prepared for disasters and indicate a reticence to attend work during disasters. The lack of understanding of the preferred methods of disaster preparedness is particularly relevant to participants other than medical and nursing professionals, because few studies have included allied health professionals or hospital support staff as participants. This research explored how members of the hospital workforce believe they can best be supported by hospital management to prepare for disasters. A critical component of disaster preparation is how to facilitate attendance at work and provision of care or services during disasters. Participants were purposively selected based on their role or experience in disaster preparation or response. The study employed an interpretivist paradigm to explore the participants' perspectives about which methods of disaster preparedness are most effective and preferred. Case study design was used to examine the knowledge gap concerning the most effective method of disaster preparedness. Three case hospitals located in the Greater Sydney area, were selected due to their role in preparing and responding to disasters, their different funding models and geographical locations. The case study design enabled the comparison of differences and similarities across the settings and the impact on workforce perspectives. For each case, six allied health professionals, two medical practitioners and two registered nurses participated in a semi- structured interview; and up to ten support staff participated in focus groups at each case hospital (a total of 55 participants). An interview and focus group question and discussion guide were developed, based on the findings from the literature review and input from local disaster managers. Interview and focus groups data were broadly categorised into four knowledge categories: 1. Methods, content and resources of preparedness, 2. Duration and frequency, 3. Likelihood to participate in disasters, 4. Learnings from actual disasters and other information. These data were then descriptively coded to outline the views of each participant. The Multiple Case Study Analysis framework by Stake (2006) was used to guide the data analysis, including thematic analysis, comparing the data between cases and identification of the findings. The four key findings were: 1. In recognition of their essential roles during disaster responses, allied health professionals and hospital support staff must be included in disaster planning and disaster plans. 2. Factors that increase the decision to be absent from work include: whether the disaster is considered to be dangerous, when there is little understanding of their responsibilities, or when they believe the hospital's preparation is not adequate. Understanding roles and responsibilities is a positive influence likely to support attendance at work, even when a disaster could be perceived as dangerous. 3. The preferred and most effective method of disaster preparedness is practical learning, combined with other methods of preparation. Online learning as the major (or only) mode of disaster preparation was unpopular. 4. Inadequate resources dedicated to disaster preparedness at hospitals, limits the ability of managers to support staff to prepare for and deliver care during disasters. Available resources affect the method, duration and who is included in disaster preparation at the hospital. This study found there is a need for disaster preparedness in hospitals to be reviewed. It is critical to evaluate the extent to which allied health and hospital support staff are included, or feel included in disaster planning, alongside medical practitioners and nurses. Additionally, allied health professionals and hospital support staff should be included as participants in disaster planning and preparation research. These two actions will close the existing gap in disaster preparation knowledge. To maximise attendance at work, measures need to be taken so staff understand their disaster roles. It is important health professionals and hospital support staff comprehend their contribution to a disaster response and know the hospital has an effective plan incorporating their roles for specific disasters. The disaster plan, policies and resources should also promote staff protection and safety. Site or occupation specific differences exist, and disaster planning must include strategies to understand what information and resources are needed by the workforce and how this should be provided. Practical disaster preparation is essential for all staff. This preparation can be supported by other forms of learning, although, online learning in isolation should not be used to deliver most of the learning to staff. Resources are required to ensure all staff can participate in practical and other disaster preparedness, so that this is not substituted by more cost-effective methods, particularly online learning. Staff need to believe the hospital has adequate resources, including educational preparation or training, staff, plans and equipment to safely work during disasters and to provide care, preserving life in the community. The key findings of this research contribute to the evidence that, health professionals and hospital support staff must be supported to undertake effective methods of disaster preparedness, so the hospital workforce are prepared to meet the needs of the community during disasters.