1. When the Unexpected Happens: logistical and technical challenges Carol OByrne Pharmacy Examining Board of Canada Alison Cooper Canadian Alliance of Physiotherapy Regulators 2006 Annual ConferenceAlexandria, Virginia Council on Licensure, Enforcement and Regulation Expect the Unexpected: Are We Clearly Prepared?

2. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Anatomy of a Disaster

3. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Stage 1 - Denial This morning we had a full dress rehearsal of an emergency. The alarm bells all rang for ten seconds, then about 50 doors, all steel, gradually slid down into their places, so that water could not escape from any one section into the next. "So you see it would be impossible for the ship to sink in collision with another...."

4. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Stage 2 - Nonlinear Event

5. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Stage 3 - Chaos

6. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Stage 4 – A Few Survivors

7. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia

8. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Threatened and Actual Disasters Threats Fire alarm Picket line around exam venue Bomb threats Pandemics (S.A.R.S., avian flu) Disasters Power failure Hurricane Earthquake

9. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Distractions and Disturbances Candidate or personnel with medical emergency Computer theft alarm Candidates voice resonates thru walls Administrative errors and interruptions

10. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Potential Impact on Exam Venue becomes inaccessible Questions or materials are lost Extra-ordinary measures are imposed Exam climate becomes more stressful Candidates and exam personnel react Candidates appeal, questioning validity of results Exam sitting is cancelled Income declines and costs escalate

11. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia The S.A.R.S. Saga Chronology Nov02 – unusual pneumonia cases in China Feb03 – infected physician at Metropole Hotel in HK Feb03 – tourists in hotel exposed and carry it back home to Canada, Singapore, Vietnam Mar03 – SARS cases diagnosed in Toronto Public health directives Quarantine all exposed parties Isolate patients Strict screening of travellers and hospital visitors Close hospitals to visitors/public

12. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia P.E.B.C.s Response Protocol to protect exam personnel and candidates –Screening questionnaire and referral –Infection control Employ staff for screening and medical consults Extra security and support by St. Johns Ambulance Policy to not allow staff to mask or gown Temporary policy to allow candidates to defer exam

13. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia P.E.B.C.s Response Expand pool of assessors Bring in additional exam personnel and have others on stand-by Rent and equip alternate venue for Toronto site Train standardized patients and staff in private homes Reserve alternate exam venues in all locations

14. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Extra-ordinary Costs Alternate venue rental and equipment ~ $18,000 Personnel and materials ~ $17,000 Total~ $35,000 [6-7 % of exam admin costs, not including extra PEBC office staff time, printing and communications] Candidate withdrawals/refunds and deferred revenue

15. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Lessons Learned Maintain information and referral systems Budget for extraordinary costs/income loss Create disaster/contingency plan –Reserve funds to cover costs of implementation –Extra-ordinary measures policies (part scores, conditional licensure, etc.) –Trained back-up personnel –Trained exam administrative staff Communication plan Enhanced infection control procedures at exam sites

16. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia More Potential Threats and Disasters Avian flu Chemicals Biologicals Fire Weather (blizzard) Angry candidates or family members

17. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia The Parade Rehearsal –Started after 1 hour –Intermittent for about 30 minutes then The pipes are calling –Constant cacophony of multiple bands ongoing for about 45 minutes

18. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Alliance Response – on site Attempts to move the bands were unsuccessful All the other rooms were locked… Paused exam and moved candidates to corridor Continued exam after pause plus allowed an extra 30 minutes of exam time

19. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Alliance Response – follow up Develop a plan, consult, revise and communicate –In consultation with exam experts, Board of Directors, other resources –Communication via email, website No standing, supplemental exam date, free re-write

20. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Costs and Benefits Free re-write for 14 candidates Costs of supplemental exam (preparation and administration) Overall ~$8000.00 No candidates missed the Clinical Component Better relationship with one academic program

21. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Lessons Learned You cant stop a parade Candidates (mostly) are understanding of random events Candidates appreciate prompt communication and a concrete plan Have emergency numbers available to site staff

22. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia More Potential Threats and Disasters

23. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia The Examiner Inappropriate/disruptive examiner behaviour in clinical stations –Falling asleep –Inappropriate comments –Handing out business cards/recruiting staff –Examiner illness

24. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Alliance Response – on site Replace the examiner –Chief Examiner assigned a spare examiner to the station Incident report –Complete documentation from SP, Chief Examiner, site administrator –Flagged tests sheets of impacted candidates

25. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Alliance Response – follow up Investigate, communicate –Talked to SP, Chief Examiner, exam site staff Remove examiner from roster Regulator advised of potential competence to practice issue

26. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Costs and Benefits Unhappy examiner Numerous letters and meetings to resolved ongoing dispute Reliability of exam maintained Appeals minimized Confidence of other examiners and regulators maintained

27. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Lessons Learned Competence is an ongoing issue Practice competence does not ensure exam competence –Training, monitoring and feedback on examiner performance is essential You need a pool of spares

28. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia More Potential Threats and Disasters

29. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Sage Advice from Long Ago Dont put all your eggs in one basket –Store critical information in more than one place –Provide access to information to more than one person –Develop operational teams with overlapping essential skills –Share responsibility for decision-making –Develop contingency plans

30. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia More Sage Advice… Save for a rainy day –Protect sufficient resources to implements (sometimes costly) contingencies –Be prepared for loss of income

31. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia More Sage Advice… A bird in the hand is worth two in the bush –Develop collegial working relationships with others who could help in a pinch –Have ready spare people, equipment

32. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia More Sage Advice… Penny wise is pound foolish –Invest time and resources in contingency and disaster planning –Train back-up personnel

33. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia More Sage Advice… A stitch in time saves nine –Take action quickly and effectively to minimize later problems –Communicate clearly

34. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia More Sage Advice… When the going gets tough, the tough get going –Hire resourceful people who take appropriate initiative, and train them well –Develop and implement a communication system for exam day

35. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia More Sage Advice… Its always darkest before the dawn –There is a solution, you just havent found it yet –Sleep on it, dream about it, play the movie in your mind

36. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia More Sage Advice… Every cloud has a silver lining –Learn from each situation

37. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia

38. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Considerations in Disaster Planning Budget –Staffing, equipment, computers, supplies Work arrangements –Work from home, alternate office –Refusing work Communication –Call lists Emergency response team Early preparation –First aid training, cross training

39. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia P.E.B.C. Disaster Planning System and database back-up stored off site Maintain database of information, contacts and resources Maintain budget reserves Plan for alternate office and exam sites –Identify alternate admin space/facilitate work from home –Identify alternate exam venues (not subject to closure) Train back-up personnel for key roles in office and at exam sites –Train and authorize key decision makers – set parameters Identify contingency policies to be developed in consultation with stakeholders

40. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Beyond Katrina: improving disaster response capabilities Paper by A.M. Howitt, H.B. Leonard of Harvard Center for Public Leadership www.ksg.harvard.edu/leadership Working Papers Spring 2006

41. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Speaker Contact Information Carol OByrne, Examination Manager Pharmacy Examining Board of Canada 415 Yonge St., Suite 601, Toronto, ON (w)416.979.2431x226; (f)416.260.5013 obyrnec@pebc.ca www.pebc.ca

42. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia Speaker Contact Information Alison Cooper, Director of Examinations Canadian Alliance of Physiotherapy Regulators 1243 Islington Ave, Suite 501, Toronto, ON (w)416.234.8800x33; (f)416.234.8820 acooper@alliancept.org www.alliancept.org