ASPR Gets the 2017 HCPR Capabilities Right

ASPR Gets the 2017 HCPR Capabilities Right

The Assistant Secretary for Preparedness and Response (ASPR) got the 2017 Healthcare Preparedness and Response (HCPR) Capabilities right. They've introduced four capabilities that supersede eight that made up the Healthcare Preparedness Capabilities: National Guidelines for Healthcare System Preparedness (HPP Capabilities), published in 2012.

In laying out the purpose of the capabilites, ASPR explains that they "outline the high-level objectives that the nation’s health care delivery system, including HCCs and individual health care organizations, should undertake to prepare for, respond to, and recover from emergencies."

They are not a law or regulation and may only become a contractual obligation for Hospital Preparedness Program (HPP) awardees and sub awardees if strategies within are referenced requirements – partly or in whole – within the cooperative agreement or a sub grant. ASPR advises HPP awardees and sub-awardees that, with the HPP funding opportunity announcement for the five-year project period that begins in July 2017,  they will be presenting "clear expectations and priorities, as well as performance measures for assessing awardees’ progress toward building the capabilities."

HPRC are a Guidance Document Image

Something tells me that the new cooperative agreement will have "clear expectations and priorities" and "performance measures" that look very familier to those who've studied the HCPR Capabilities. Almost like they are meant to be used in tandem.

evolution or revolution

In November, shortly after the HCPR Capabilities were published, I wrote that they appeared to be more evolution than revolution. That is, despite the reduction from eight to four capabilities, they contain much of what was in the deceased HPP Capabilities, albeit repackaged. To a certain extent, that is true.

Yes, much from the past is still in the package, but a closer look exposes a revolution unfolding. Well, maybe just a "micro-revolution." You see, in 2012, along with publication of the HPP Capabilities, a new five-year project period began and, for the first time, the HPP Cooperative Agreement required Awardees to begin developing healthcare coalitions (HCCs). And there was an expectation that sub grants from the states would transition from funding facilities directly to funding regional HCCs.

But the paradigm shift was met by reluctance by many awardees and outright hostility from others. And given the scope of the shift and an understanding that there would be unknowns, challenges, and restarts, ASPR gave a fair amount of latitude throughout the project period. That said, awardees have felt the pressure to get their houses in order as the new project period approaches. It's clear that the ship has turned, and we're not going back. It's time that denial, anger, bargaining, and depression give way to acceptance.

Wouldn't Elisabeth Kübler-Ross be pumped to know that the five stages of grieving can be applied to the evolving preparedness paradigm?

So, if there were an uncertainty whether it is time to accept ASPR's vision, the 2017 HCPR Capabilities should make it – in your face – clear. One of two revolutionary changes is Capability 1: Foundation for Healthcare and Medical Readiness. What's the foundation? Well, Objective 1 is Establish and Operationalize a Health Care Coalition! And Objective 3 is Develop a Health Care Coalition Preparedness Plan, and Objective 5 is Ensure Preparedness is Sustainable.

In the coming weeks, we'll dedicate an article to each of the four capabilities. Stay tuned.

The other revolutionary change in the 2017 HCPR Capabilities is the fact that there is no alignment with the Public Health Preparedness Capabilities: National Standards for State and Local Planning (PHEP Capabilities).

Now, I'm sure many will argue that the departure from alignment with the PHEP Capabilities is a step backward. I'm not quite so sure. Sometimes, it becomes clear that a bad marriage is just a bad marriage. I'm not saying it could not have been worked out; maybe more time and some TLC was in order. Maybe not. It just felt as if the PHEP and HPP capabilities were forced together through an arranged marriage. The love was just not there.

They always seemed more like awkward cousins than newlyweds. Huh… maybe that's why the marriage didn't survive. It was an incestual relationship. I digress.

Let's get back to business.

overarching structure

The capabilities document is structured around capabilities, goals, objectives, and activities. Each capability having a single goal with varying numbers of underlying objectives. And most, but not all objectives have a series of activities within.

HCPR Capabilities: Goals: Objectives: Activities Image

  • Goal: The outcome of developing the capability
  • Objective: Overarching component of the capability that, when completed, helps achieve the goal
  • Activity: A task critical for achieving an objective 

four capabilities

As mentioned earlier, there are four capabilities. ASPR explains that they illustrate the range of preparedness and response activities that, if conducted, represent the ideal state of readiness. They go on to state that they recognize that there is shared authority and accountability for the health care delivery system's readiness that rests with private organizations, government agencies, and Emergency Support Function-8 (ESF-8) lead agencies.

4 HPRC Image

They emphasize that the capabilities may not be achieved solely with the funding provided to HPP awardees and sub-awardees (including HCCs and health care organizations) through the HPP Cooperative Agreement.

Capability 1: foundation for healthcare and medical readiness

Goal of Capability 1: The community’s health care organizations and other stakeholders—coordinated through a sustainable HCC—have strong relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources.

There are five Objectives within Capability 1:HPRC capability 1 objectives Image

And there are a total of 19 Activities within Capability 1's five Objectives. You can cruise them using a sweet mobile friendly, app-like experience on the healthcare capabilities page of the healthcare preparedness center.

Capability 2: healthcare and medical response coordination

Goal of Capability 2: Health care organizations, the HCC, their jurisdiction(s), and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events

There are three Objectives within Capability 2:HPRC capability 2 objectives Image

And there are a total of nine Activities within Capability 2's three Objectives. You can cruise them using a sweet mobile friendly, app-like experience in the healthcare capabilities page of the healthcare preparedness center

Capability 3: continuity of healthcare service delivery

Goal of Capability 3: Health care organizations, with support from the HCC and the ESF-8 lead agency, provide uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, well-educated, and well-equipped to care for patients during emergencies. Simultaneous response and recovery operations result in a return to normal or, ideally, improved operations.

There are seven Objectives within Capability 3:HPRC capability 3 objectives Image

And there are a total of 14 Activities within Capability 3's seven Objectives. You can cruise them using a sweet mobile friendly, app-like experience on the healthcare capabilities page of the healthcare preparedness center.

Capability 4: medical surge

Goal of Capability 4: Health care organizations—including hospitals, EMS, and out-of-hospital providers—deliver timely and efficient care to their patients even when the demand for health care services exceeds available supply. The HCC, in collaboration with the ESF-8 lead agency, coordinates information and available resources for its members to maintain conventional surge response. When an emergency overwhelms the HCC’s collective resources, the HCC supports the health care delivery system’s transition to contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible.

There are two Objectives within Capability 4:HPRC capability 4 objectives Image

And there are a total of 14 Activities within Capability 4's two Objectives. You can cruise them using a sweet mobile friendly, app-like experience on the healthcare capabilities page of the healthcare preparedness center.

In coming weeks, I'll tear each capability apart, exposing the good, bad, and ugly. I'll also relate them to the CMS Emergency Preparedness Rule and the HPP Cooperative Agreement.


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Karl Schmitt, MPA

Karl Schmitt, MPA

Karl is the Passionate Founder & CEO of bParati. He is on a mission to build a national network of effective, sustainable healthcare coalitions. More...

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