“When the Unexpected Happens: logistical and

technical challenges”Carol O’Byrne

Pharmacy Examining Board of Canada

Alison CooperCanadian Alliance of Physiotherapy Regulators

2006 Annual Conference

Alexandria, Virginia

Council on Licensure, Enforcement and Regulation

Expect the Unexpected: Are We Clearly Prepared?

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Anatomy of a Disaster

Presented at the 2006 CLEAR Annual ConferenceSeptember 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...."

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Stage 2 - Nonlinear Event

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Stage 3 - Chaos

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Stage 4 – A Few Survivors

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Distractions and Disturbances

• Candidate or personnel with medical emergency

• Computer theft alarm

• Candidate’s voice resonates thru walls

• Administrative errors and interruptions

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

The S.A.R.S. Saga

ChronologyNov02 – ‘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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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. John’s Ambulance

• Policy to not allow staff to mask or gown• Temporary policy to allow candidates to

defer exam

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

More Potential Threats and Disasters

• Avian flu• Chemicals• Biologicals• Fire• Weather (blizzard)• Angry candidates

or family members

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Lessons Learned

• You can’t 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

More Potential Threats and Disasters

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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”

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

More Potential Threats and Disasters

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Sage Advice from Long Ago

• Don’t 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

More Sage Advice…

• A stitch in time saves nine– Take action quickly and effectively to

minimize later problems– Communicate clearly

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

More Sage Advice…

• It’s always darkest before the dawn– There is a solution, you just haven’t

found it yet– Sleep on it, dream about it, play the

movie in your mind

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

More Sage Advice…

• Every cloud has a silver lining– Learn from each situation

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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

Presented at the 2006 CLEAR Annual ConferenceSeptember 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/leadershipWorking Papers Spring 2006

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Speaker Contact Information

Carol O’Byrne, Examination ManagerPharmacy Examining Board of Canada415 Yonge St., Suite 601, Toronto, ON(w)416.979.2431x226; (f)416.260.5013obyrnec@pebc.cawww.pebc.ca

Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia

Speaker Contact Information

Alison Cooper, Director of ExaminationsCanadian Alliance of Physiotherapy

Regulators1243 Islington Ave, Suite 501, Toronto,

ON(w)416.234.8800x33; (f)416.234.8820acooper@alliancept.orgwww.alliancept.org